Newsletter: April 2010

Samke’s new baby Siyamthanda (we love you)

She was born the afternoon of Saturday 6th March at Edendale Hospital to Samke Shange and Nkulu Mhlongo.

Samke greeting her new baby and the midwife showing Nkulu all the intact body parts!

This newsletter is not for the faint hearted; I’ll be sharing all the facts and the reality of state sponsored medicine here in South Africa as we experienced at Edendale Hospital.

Samke & Nkulu are two youngsters who were caught in the heat of the moment and now they have Siyamthanda. This cost Samke her grade 12 certificate; and she will rewrite next year.

The only reason I can write about this is because Mags (visiting from Canada) and I gate crashed; it was visiting hours and Samke was in labour ward screaming. Casually and firmly I mentioned that we are both RNs and would be staying for the delivery given that Samke is an orphan and we would support her; a total no, no became an okay! No one attends deliveries apparently.

Edendale is a poverty stricken hospital in the township that serves the masses. It is in such poor shape, only seeing is believing.

Labouring women sit in the passage on hard wooden benches leaning against the wall in their flimsy hospital gowns that may have no buttons, strings or be the right size. They are given no food or fluids; eat and drink something decent when family and friends come with supplies. They sit and sleep on the bench or the hard cold floor; no sheet, blanket or pillow.

They get called every 4 hours to be assessed.

There are no prenatal classes and first time moms have no clue of what to expect.

Membranes can be ruptured; they sit on the bench. Strong labour, on the bench….and they are told to walk up and down the passage.

Samke sat on that bench for 2 days and nights. When we first visited her with Sena, her older sister, I was totally and utterly stunned; my shock made Sena cry.

When a woman is fully dilated she goes to labour ward; or some women deliver in the passage because the assessment either didn’t take place or was inaccurate.

There are intrauterine deaths while women sit on the bench; and they sit there waiting to deliver a still born baby. No one cares no counseling, zero support.

Samke had an Oxytocin IV in place, unmonitored, either not running or running fast; she was clearly in agony and exhausted. Whilst enduring hard contractions she had an (I’m sure) outdated foetal heart monitor strapped around her belly causing her even more discomfort.

In attendance were about 6 medical students, most about to witness their second delivery. Samke had inexperienced fingers examining her and it was hard to find someone who knew what was going on. Her nether regions were the only parts that mattered; she was lucky if sterile gloves were used especially seeing that her membranes were ruptured.

She was bearing down and everything that goes with that process; being told not to push (no stopping her) and no one qualified in attendance. It was awfully distressing.

Needless to say I was interfering; we were there as advocates and I was concerned for the baby’s well being to say nothing of Samke’s struggle. I asked for them to find someone who knew what was going on to examine her and assess the situation.

A midwife appeared, to examine her, declared ‘head on perineum’ and the delivery trays were hastily set up and Samke’s feet set to rest in uncovered hard cold stirrups. The foetal heart monitor was removed, the last of the monitoring thereafter; who knew what was happening with the baby!

The medical students were hastily kitting themselves with outfits that appeared for an outer space trip….even though Samke is HIV negative….and they were not even in splash range!

With many gawking people, Oxytocin was flowing; no coaching & lying flat on her back to the chorus of PUSH, laboured brave young Samke. She was vomiting and when I asked for cloths to clean her, a dish came and when the request was repeated, dry paper towel arrived.

The baby’s head descended and receded, repeatedly; Samke was exhausted and in agony; it never quite crowned. This seemed to go on forever; I didn’t keep track of the time as Mags and I were at the head of the bed trying to comfort and support Samke (and each other). I was holding my breath hoping the baby was okay. Mags and I were staring at each other speaking volumes non-verbally…..

The midwife injected local anaesthetic into the perineum and proceeded to cut an episiotomy with blunt scissors, very obviously before the local took effect. Another very knowledgeable midwife appeared (must have been the screaming) and took charge thank goodness.

She elevated the head of the bed, barked instructions to Samke, told her to be quiet and PUSH. She also barked at the students to get out of the way.

(It was ’hysterical’ to see the students in gear from outer space (that I realize is essential in many circumstances) and the midwives with only gloves on).

She gave more local, extended the episiotomy with those same scissors and proceeded to be really helpful; obviously experienced and skilled. As she encouraged the head to descend it became obvious that the cord was around the neck; which she clamped and cut speedily. The delivery of a live baby girl proceeded fast as did the aspiration of fluids given that no suction existed at the bedside nor was the baby’s face cleaned before she took her first breath.

Siyamthanda was whisked to the resuscitation unit after a brief pause on her mom’s belly and she responded well to suction and a little oxygen.

Sena meeting her niece for the first time! She’d been waiting in the passage listening to the commotion & cried with relief.

The placenta was delivered and the process of suturing her perineum commenced.

The medical students had all disappeared; Samke still an item.

It was stunning and shocking to bear witness to such a lack of humanity, compassion, respect and dignity.

A student midwife, supervised by a midwife, sutured the perineum; a lengthy process.

We waited.

Suturing complete, a pad was placed between her legs, Samke rose to walk, IV in situ, to the section behind the delivery room (divided by half a wall, the women freshly delivered lying and listening to fellow women labouring and delivering).

She wasn’t washed nor cleaned.

Her new bed had 2 sheets, no pillow nor blanket. The baby was wrapped in a flimsy cotton sheet. Nkulu and Samke meet their daughter together and name her; Siyamthanda (we love you). Samke was amazed and seemed delighted that he was there. Nkulu was clearly shaken and moved by the whole process of meeting his daughter and having a slight inkling of what had taken place (I certainly shared with him how hard she had worked and suffered).

The babies lie with their mothers and these two were discharged on day two.

Samke and her daughter are doing very well. Siyamthanda doubled her birth weight by her 6 week check up and is sitting nicely on the 50th percentile. Breast feeding is going very well and the little lass are calm and happy and obviously well loved; she has 4 aunts in the house!

Nkulu and his family are good to Samke, provided all the necessary for a new born and are paying attention; which is most often not the case sad to say.

Samke has fallen in love and although the timing was not ideal, Siyamthanda has brought a deep meaning to her life and filled a gap created by the loss of her own mother. Samke is being an excellent mother and intends devoting a year to her daughter before pursuing her studies.

Isn’t a picture worth a thousand words!!