June 18, 2014 (copied from my journal)
Yesterday was antenatal day at the health center. Antenatal, ironically enough, is equivalent to prenatal in America. A woman is supposed to attend four check ups before she has her baby; however, many only attend one or two. At antenatal clinics pregnant women are weighed, given tetanus shots or other immunizations, tested for HIV, checked out by our maternity nurse, and given mosquito nets (without education on how to use them I might add). The women were ready and waiting at eight when I arrived, but the nurse running the clinic had not yet arrived. As we waited for her, all the women stared me. I played with the kids a little; making faces at them and tickling them. I saw a woman bite her child's nail. My counterpart decided it was a great time to play a round of "let's question Emma time" since apparently a lot of the women didn't know me. So I introduced myself and then they interrogated me on where my husband was, how many kids I had, if I would take them back to America with me, if I are nsima, whether I use hot or cold water water to bathe, and why I hadn't learned the language Lomwe (I'm still trying to learn Chichewa I exclaimed!). I was very relieved when the nurse finally arrived and I was out of the hot seat.
The clinic began, and I helped distribute health passports and record weights and tetanus shots. It always amazes me, as someone who is terrified of needles, how nonchalantly these women and receive injections. They line up on the cement benches, pull up their shirt sleeves, and an HSA (health surveillance assistant) pricks them one by one as they stare blankly ahead of them as if it doesn't even phase them. It was actually quite funny when one amayi, who had her 2 year old child strapped to her back with her chitenge, received the shot because her son started screaming when the HSA came near them with the syringe. I had to stand off to the side and force myself to think about other things as all this was happening because I even stand the sight of needles. Pathetic, I know.
As we were going through all of this, my counterpart would pull women aside who looked malnourished and do a MUAC (mid upper arm circumference) test on them. Some of these mothers needed to be put on nutrition supplementation. They would have to come back on Frday to receive the supplements. I couldn't help but question the amount of time that these amayi's must send at the hospital--Monday for family planning (every 3 months), Tuesday once a month for under 5 clinics to monitor their children's growth, Wednesday if they're pregnant (four visits in 9 months), Thursday if they're HIV positive to receive their ARVs, and Friday if they or their children are malnourished and need supplementation. One woman waited all morning for supplements for her child, but the key to the storage room was missing. So, at noon, my counterpart finally sent her home. A whole morning wasted for her. When an amayi who had come for an antenatal appointment (and was pretty pregnant) found out that her child was malnourished, you could see the shame in her face and posture. My counterpart quizzed her on the six good groups; she didn't know them. I saw tiny tears at the corners of her eyes, and she wouldn't look up from the floor. When she bent over to tie her child on her back, teardrops trickled to the ground and she was sniffling slightly when she stood up again. My counterpart pointed out afterward that the women often get upset because they're embarrassed that they have not been able to care for their children properly. How would they know, I thought, they are never effectively taught how!
My counterpart was administering HIV tests, and when he had finished and was waiting for the results to appear, he called me into the HTC (HIV testing and counseling) room to show me how the tests work. Two out of the twelve women who were tested were positive. My mind was blown. Can you imagine being a few months pregnant and then finding out that you're HIV positive? All the more reason to encourage early testing!
A baby was born in the maternity ward. An hour later, a girl was rushed into the out-patient room on a bamboo mat. Ten minutes passed. I heard loud crying and wailing. The patient had died. The family of the girl came rushing out of the room sobbing. I felt a sinking feeling in my gut like I was going to throw up. Everyone knew what had happened. The crying was dramatic and loud. It changed the whole atmosphere of the hospital. It was like a damp blanket. My counterpart turned to me later and said that the funeral would be tomorrow during the time when we were supposed to do a community mapping activity in the village. He asked what I wanted to do. I told him that we should do whatever he thought was proper in this situation. He said, "there's a saying that goes, 'today it's me, tomorrow it's you,' meaning that per Malawian culture, if you don't attend someone's funeral, then the community will not attend yours either. We decided to switch up our schedule to attend the funeral. A few hospital attendants covered themselves with pastic aprons, gloves, and face masks and took a roll of guaze into the room. They wrapped up the body and retuned it to the bamboo mat. The hospital was silent. When the mphasa (mat) was removed from the room by the girl's family, sobs and screams of the mourning family blasted the whole area. The men carried the body all the way back to her house (about half a mile), whilst the women wailed behind them and a crowd of supportive and curious people escorted them. I watched them go; their mourning made my heart hurt, and I felt a wave a sorrow wash over me. My counterpart asked if I wished to escort them as well. No, I replied, as I heard the wails dissipate into the distance.