January 4, 2010

Moments earlier I had been sleeping soundly, but the night took a sudden turn and I was sprinting down the dusty roads of Ouelesebougou with only my headlamp lighting the path to the hospital keeping me from running into the donkeys and goats scattered along my route. A pregnant woman had been in labor for hours– she was fully dilated but the baby would not descend, so the local doctors called our group to do an emergency cesarean. Despite the urgency in this foreign, minimally supplied operating room I was impressed by how calmly and quickly the physicians and nurses moved into action. By the time I could wrap my mind around the night’s rapid acceleration of events the doctors were already deep in the tissue of this woman’s abdomen.

This week I have experienced a lot of “firsts”. I placed by first spinal block, I bag ventilated a patient, I scrubbed in on hysterectomies and colpocleisis, embarrassingly I also passed out in an operating room for the first- and hopefully last- time; I placed and removed my first IV lines. And for the first time I saw a stillborn baby; I witnessed fruitless rounds of chest compressions and epinephrine injections– she had tiny, perfectly formed fingers, chest and nose but they never moved on their own­– and I noticed when the doctors and nurses began glancing at their watches all waiting for someone to say it was enough. And for the first time I watched doctors tell a parent her baby didn’t survive.

Sadly, while this falls in my list of firsts, this is regular event in Mali, a country with one of the highest infant mortality rates in the world. While taking histories in clinic no woman I saw had an equal number of pregnancies and living children.

In Mali and Lesotho (the small country in southern Africa where I traveled this past summer) death is unfairly common– both countries are near the top of the list for infant mortality and shortest expected lifespan. As a result of this widespread suffering and death, I realize I have unconsciously convinced myself– or perhaps consoled myself– that it must be easier to handle death here. That it is somehow less painful and easier to recover, and resume your daily activities, after the death of a child, parent or sibling since everyone experiences this type of loss.

What a foolish idea. Watching this young mother’s anguish upon learning her child died, it became clear how mistaken this reasoning is. It is not less painful to lose a child simply because everyone else has too. The stoic women who fill the post-op ward with only a couple ibuprofen to comfort them after major surgery do not inherently hurt less than their American counterparts receiving strong narcotics. Being surrounded by suffering doesn’t minimize the individual’s pain.

Mariam, I’m sorry we weren’t able to do more to help you. I’m sorry your daughter died. And I’m sorry that I have selfishly diminished the reality and suffering of those I “compassionately serve” to make it easier for me to empathize.

As I ran down that dusty path to the hospital I thought this story would end differently– with us walking home exhausted, but content, leaving a happy new mother with her child.

But it didn’t.

Erin Greenberg, MS2. Ouelessebougou, Mali