'every little thing' (part 2) *upsetting*

The ride to the hospital wasn't as jovial as it had been the day before. Beverley and I felt very anxious about the outcome of the little girl we'd met the day before.
We arrived, got changed and the sister greeted us. Tense on the events from the day before we immediately clocked there was a new resident in one of the incubators. Beverley glanced in reluctantly and said by the face this baby looked ill too. As it happened the doctor was already writing a care plan. The mother was lying in the bed adjacent to this incubator receiving a blood transfusion. It had been a home birth and the mother had a retained placenta followed by a hemorrhage.
The doctor asked Valerie to take the baby to NCU and that it was to have a 40ml blood transfusion, IV antibiotics, have it's Hb checked and be warmed. At this moment I felt relieved that everything that had happened the day before wasn't "normal" or a regular occurrence. There was a plan for an ill baby.
While the doctor had been discussing this Beverley had gone to the baby, then called the midwife. The midwife unwrapped the blankets and appeared to nudge the baby. Beverley caught my eye and immediately I felt deflated. The midwife called 'Daktari? Daktari?' The doctor appeared, they peered into the incubator, nudged the baby again while talking in Swahili. The mother began to stir and turned over to see. From where I was stood I could see a limp limb...the midwife spoke to the mother and while I couldn't understand what was being said, her tone was 'matter-of-fact' rather than sympathetic. The woman slumped down and began sobbing. The doctor went to her, patting her head as he spoke. Beverley checked for a heartbeat. While it appeared lifeless we were stunned that they had broken the news to this woman that her baby had died without certainty. The infant was wrapped back up, face covered, only the care plan the doctor had just written laid on top as identification. The mother was left with her bereavement.

After we'd asked, we were given the history of this mother and child. The baby was born 5pm the night before, then mother and child were transferred in due to the obstetric emergency. We were told that the baby had lost blood from the cord; that the string hadn't been tied tight enough. I asked why, if the baby had been born the night before, hadn't it been reviewed before now, or even gone straight to the NCU when they arrived? I was told they were busy looking after the mother. I continued to ask, while the midwives and obstetric team had been attending to the mother, why hadn't someone taken the baby to NCU to receive treatment at the same time? Why was this doctor writing a plan when he'd not even reviewed the infant? The midwife looked blank and couldn't give any reason. Nobody had been caring for the baby despite the baby needing attention too. Beverley went to the woman to try and give her some comfort. I couldn't hold it together, I went outside and wept. A poor baby that could still be alive if adequate care had been available. A poor mother who was lying in a bed, oblivious that her child was slipping away next to her. I was so angry that this child had been allowed to die. Angry that this was allowed to happen. And I couldn't be angry at anyone specific, it wasn't that the staff here just weren't bothered, just such huge demands on their time that they really have to prioritise their time. The mother had taken initial priority when they arrived and I don't know what other events happened through the night to keep them away from that particular baby. I was angry that the midwife and doctor seemed so unaffected by finding this lifeless infant. Again, I didn't perceive that they were two uncaring individuals, I got the impressions that it was more that these events were normal to them and they had no emotion left for situations like this. This was their normal working environment. I was angry that this was allowed to be normal - anywhere! That the staff had no other choice than to become passive - for their own emotional grounding. 
While I was sat outside the wind turned, the smell and smoke from the nearby incinerator hit me. I felt I might throw up. I went back in and busied myself with some cleaning, I couldn't handle anyone face to face. I was now dreading going to NCU to see how the little girl from the day before was, if she was still with us. Beverley appeared, we gave each other a hug and agreed to go to NCU. We told the sister where we were heading and I shook as we walked over.
We couldn't initially find a member of staff on the pediatric unit so went to the tinted glass door of NCU. In a bedroom before we spotted the mother, she looked relaxed which relieved me slightly. We went in, donned our hair nets and shoes and went to see the little girl. She looked better than the day before, was still having oxygen, but now had some tone to her muscles, occasionally moving her her hands or feet and responding to stimulus and her chest sounded much clearer and heart stronger. A nurse appeared and told us they'd been continuing with the antibiotics and NG feeds of the EBM. Things, thankfully, were looking up. We went to see the mother and I can't remember the exact details but we found that she'd not seen her daughter since I took her the previous day, so again we led her into NCU. It seemed unfair that all the other women came and tended to and nursed their babies as they pleased in the warm room, but this mother hadn't had that opportunity. I'd remembered to take my phrase book so with broken Swahili I introduced myself and told her that her daughter was beautiful. She told us that she'd named her daughter Mercy. I told her Mercy and I had become friends. She still kept her distance so again we both encouraged her to have some contact with her daughter. She started whispering to Mercy. We left them to get to know one another better.

When we returned to the labour ward, the woman from the morning was still receiving a blood transfusion and there was a labourer in the bed next to her progressing through second stage. We pulled the curtain around the bereaved mother so she didn't have to face a new mother and live baby. Although, we couldn't stop her from hearing the baby crying or the new mother praising and thanking God for the safe arrival of her child. 

After this new mother had moved into the postnatal ward I told the sister how at home in the UK, when there is a neonatal death we give the woman and family the opportunity to see and hold the baby, to say goodbye and how, for some people, it is a way of acknowledging there was a life, no matter how short and how this can help with their grieving. The midwives looked at me as though I had three heads, so the three of us mzungu tried explaining how some women appreciate this and find peace in at least having time with the child they nurtured and grew. The sister nodded towards the woman and said, 'she knows it's gone. It's dead.' They simply kept saying 'No' as if what we were telling them was not an option. Ever. The midwives could not understand why anyone would want to hold a dead body, one even told us that women there would be too scared to see a dead child. In a way, by not offering this closure, they're protecting women from having to face death. It was one of the cultural differences I least expected but one I found easier to understand and accept. 

I knew it was inevitable that I'd encounter death while here in Tanzania. But I didn't expect to feel such anger and frustration about it. It seems so unfair that lives are being lost just because of the lottery of where they are born and the resources and facilities available there. I knew before travelling that in Tanzania the neonatal mortality rate was 25 per 1,000 live births and even though I'd mentally prepared myself to encounter neonatal deaths I wasn't prepared for the circumstances surrounding the deaths. Unfair, unjust and tragic.

The day continued and a relative came to collect the body of the infant. On the way home we asked Tom to stop at the local supermarket; we needed a strong drink that evening, Konyagi was our poison of choice-the local gin! As the drive continued the sun was shining and the sky was the clearest it had been since I arrived. Instead of getting a glimpse of Mount Meru, we saw her in all her glory. Tom pulled over for us to admire, while we took some photos some locals working in a field were shouting and waving to the east...I think they thought we were crazy mzungu and were in awe of the wrong mountain-KIlimanjaro was to the east, but not at all visible. We got home and all had a little time to ourselves to digest the events of the day, Beverley went for a lie down, I did some washing in a bucket on the porch with the help  and guidance of some of the local children while Valerie read in the living room. Then we gathered on the porch, soaking up the evening sun, reflecting on our thoughts and indulging in our Konyagi. I was glad to be off the following day.