SUNDAY ON EMBANGWENI STATION,
GOING FROM CHURCH TO MAKING ROUNDS
AND
FINDING MYSELF AGAIN IN HIGH-RISK OBSTETRICIAN STATUS WITH A 16-YEAR-OLD PRIMIP
BREACH
GIVEN NATIVE HERBS BY THE NGONGO—
FOR YET ANOTHER C-SECTION
Mar. 3, 2002
Moon over Malawi! The very full moon is hanging over us here at 13* below the Equator in what is coming up upon Eater time over there and getting toward the fall dry season here. The mosquitoes, which I had expected to be nasty have not been bad, perhaps because I ma late in the rainy season. But, I am happy to be under treated mosquito netting by night, since the funny-looking mosquitoes that come out around ten o’clock by the time I am sleeping, also stand on their heads when they bite and cause a nasty injection of a plasmodium I would like to avoid.
But, that is not the only thing visible in the nighttime sky. With no light pollution from the ground the overhead sky is brilliant. The constellations are of the Southern hemisphere, and we can see the Southern Cross with a little effort. Also Orion and a few other unusual stellar attractions are seen, with a fair number of passing satellites and space junk is seen in the clear sky.
These stars are mostly gone at the time I am up at dawn to do my consistent morning run. So, what I see is mostly on the ground rather than up in the heavens, which is where I have to be looking to avoid tripping over the deep eroded ruts, or stomping through columns of army ants. I always see something photogenic, and today it was a man leading (from behind) a pair of goats hose back legs were tethered in a tangle of rope he had used to have them precede him to market. They would shortly be the quarters I would see hung up in the flies and the sun, and hacked apart according to know known meat with any name. From the dinner we had had at the Matron Kathryn’s house, however, I will have to admit that the goat was quite tasty, no matter what cut was produced that brought it to the pot.
SUNDAY: A DAY FOR ME TO FOCUS ON THE HISTORY OF LOUDON STATION CHURCH AND ITS PIECES, EITHER BRICKED UP OR DETACHED
I was ready with tape recorder, cameras and notepads when I went to church at the eight o’clock service, the time being announced by the ringing of a bell, that sounded like a hand-hammered bit of cookware, even thought there is what should be a perfectly serviceable belfry now freestanding in the field adjacent to the church. That is part of the story for the day. The other I may have mentioned in my return for the run the other day when I posed in front of the “Leper Door: of the church. It was a door of the front, whereas the rest of the parishioners of this presbytery entered from the back of the church and filled up the pews from the front. Those were the choice seats for the church leders, since they had backs on the benches, and tghat is where the hymnbooks were distributed. The hymnals ran out about the same rows back as the bench backs. So, if you were later than ten minutes after the start of the service, as almost all of the attendees were, such tardy worshippers got neither book nor backrest. But, they also got about forty-five minutes less service to attend, also, since no matter when it got started to the one-quarter or fewer of the eventual audience, the service would be over by nine thirty. In that time there would have to be greetings of the visitors, and for the first time visitors, such as I was with my group last week, we must be presented at the front of the church and respond to their greetings to us personally. For those from another presbytery of the CCAP, they are encouraged to bring with them their “papers”—their “certificate of dysjunction,” it is called, which announces that they are members in good standing of some other congregation, and they can affiliate here while they are at school, for example, at the Robert Laws Secondary School (named after the missionary sent out to consolidate the explorations after Livingstone and to establish the big church at Blantyre, around which he named the town after Livingstone’s Scotland birthplace.
My purposes of the morning included taping the various choirs, and soloists, with special attention to the special number I had heard the Deaf School rehearse for the first time just before they broke out into one of their more well-known renditions for my entertainment—“Twinkle Twinkle Little Star” when I had visited just before returning to the theatre where a sick patient was awaiting operation postponed by my brief “school call” to encourage their bell-ringing choir. They were good in their new rendition, and I photographed them as they played their bells, and waved my hands in the air wiggling all the fingers in the deal equivalent of applause when they had completed their number.
THE LEPER DOOR:
OPEN FROM THE FOUNDING IN 1902—
A CENTENNIAL TO BE CELEBRATED IN OCTOBER—
AND BRICKED UP IN 1958, AS THE LEPER COLONY WAS MOVED TO ANOTHR SITE
NOT NEAR THE MAIN CHURCH
I was fascinated by the “Leper Door” and went back to photograph it several times with various people around it. One of the first people to be photographed at the Leper Door was I, coming back from my run, since I figured no one nearby qualified as much as I at that particular time as being “Unclean.” I had originally thought that the church had come to terms with the Biblical injunctions toward treating any person as unclean because of the plague they bore, but it was not as clean as that in the researching of the story. The lepers actually were moved away to another site so that the church did not have to confront their own attitudes toward the plague and the less than pretty people who bore it. So, the isolation of the plague bearers made it easier for the church members to continue a bit more comfortable in their Sunday best in the pews, neatly aligned with the men on the right side of the aisle and the women on the left. The only exceptions to this rule are the choir members on the women’s side, and we, the visitors, who can be said to have culpable ignorance for having both genders sit side by side on the left, since the color of our skins probably makes us different enough to trump the male/female thing.
Now, of course, there is a new plague to be brought in to church along with the poor people who bear it, and there is as much stigma with this one as the leper’s saddle nose or missing digits. People with advanced Kaposi’s Sarcoma are as unsightly and as clearly to be proclaimed in advance of their coming as “Unclean!” When a conference was assembled only two years ago to see what the church’s position should be toward the victims of AIDS, there was a uniform affirmation that the victims should be treated with compassionate care, without moral judgments—easier in Africa where the disease is heterosexual in its acquisition or MTCT, in which it is surely blameless. When the discussion was brought forth about the three ways of preventing the disease, the church could resoundingly endorse the first two, but let it be said that after swallowing hard and stifling their reservations they came through with all three recommendations: 1) Abstinence, 2) Single partner monogamy and fidelity, and 3) Condoms. Even those with reservations about the whole list were peer pressured into endorsing the whole program of recommendations by telling the congregation to come forward and pick up the red ribbons at the front, and every member present did so.
The Leper Door was bricked in 1958, but there are still reasons each of us would like to isolate some sinners away from us, since we cannot be that bad, or at least not so much a threat to the whole of the more wholesome among us. Leprosy from Biblical time to the earlier part of this century has had a very long period of social evolution in mainstreaming. AIDS may have to do the same on a very much accelerated fast track, especially since a quarter of the flock are infected already, whether or not known to be.
The church had been built in a very large and imposing central location in a very impressive structure. The roof was made of burnt clay tiles and crowning it all was a tall steeple with a belfry and a heavenward pointing spire. In the belfry, of course, there had to be bats living, since there would not be a completion of any other metaphors if I could not close the first. But, that is not the point of the story. The people were concerned about the very arrogant erection by man of this finger in the sky, and were not at all sure that this was the right thing to do. The original church of St. Michael and all Saints built tin the 1860’s when Robert Laws came to the area along the Shire River at the outlet of the big lake Malawi was even bigger, when he founded Blantyre, and remains a very large building by all African scale. The only other building here as tall for several hundred kilometers around is the two story Manse behind our guest house, built two years after the church by Loudon in developing the station.
There was a very severe thunderstorm once, which seemed to cluster all its fury of darkened sky around the steeple, and the fears of the somewhat spooky Africans were justified. The church, its roof and its steeple stood up well through the storm, but they were not at all certain that the steeple did not cause the storm, scraping those clouds as it did. It was not hit by lightning, and not damaged by wind or rain, but they were taking no chances with any further heavenly offenses. They took down the steeple and parked in a grassy field a respectful distance away from the church, where its belfry still harbors both bells and bats, but it is on a level that does not reach even as high as the roofline of the church, so it has been cut down to size. This audacious erection by over confidant man, rather like the insolence of the World Trade Center towers, has been brought low. And there have been no more big storms to threaten to take down what man has put together, and God might rend asunder.
I have these, and about ten more essays to develop more fully when I have the fact-checking book on the history of the Loudon Station and its CCAP church to confirm the details against.
I watched a s the MacLean girls, recently arrived in their gangly pre-adolescence, from Scotland and a decision to be sent out from the Free Church of Scotland, before that was quite understood what that would mean for a GP from urban Scotland and his fecund family in the wilds of Malawi, and they are still a bit overwhelmed, and there is another baby on the way to join the three girls and a boy. This is the Price family of Barbara Kingsolver’s Poisonwood Bible. I would give them the book, since it is: Little Women In Africa, which might be important reading for them in a few more years.
Calvinism did well for and through David Livingstone, but may not be exactly the au courant model for rural Africa in crisis just now. The 100 year history of the Loudon Station and the 150 year history of the Synod of Livingstonia are long heritages by any interior African standards, and the timeless humanitarian aspects of liberation from the oppression of slavery and the exploration of the world around us are the solid pieces I would emulate, but the rest of the burdens may make for a fit that like the steepled parish church transplanted from the home village of Blantyre to a largely unknown Africa may need a bit of further reconstruction.
The historic revisionism is not alone that of white missionaries coming to tell what has been the truth, since the sermon today reflected a bit of revisionism in the glories of Malawi’s own recent past—a building almost entirely within my lifetime. The elder pastor reflected the great reverence for the founding fathers, and created special myths about a couple of them, chief among them all being the good Dr. Kumuzu Banda. This “Presidents’ Day “ sermon I would be able to understand, since we have had to create a number of myths about founders of our own—like cherry trees, and tossing a dollar, and crossing the Delaware, and kneeling in Valley Forge in Prayer, and Wooden Teeth, and Cannot Tell A Lie, etc. But, we may be a bit to close to the more recent Doctor Banda to see him as other than a self-serving neo-colonialist, who came from London, even if he was an indigenous black. Repression by an indigenous black hand is the “All-African Success Story.” This has been the pattern from time immemorial. It was the way of Shaka Zulu, who had such execrable habits as cutting open all pregnant females to satisfy his curiosity as how life started, or twisting his soldiers heads around until the stared forward 369* from the start when they fell over. Name a single African nation that censured Idi Amin, or Jean Bidel Bokassa, or Sergeant Doe. Only European Imperialists are anathema, and condemned by all.
So, we had a little admixture of church and state in honor of Martyrs’ Day. It is not a lot different in the conservatizing influence of a study of history, and the steps by which we have developed to the point in which we are at the time we commemorate. It sis probably necessary also to make the devolution of Africa, since it did not happen all at once but in a series of not inevitable downhill steps, since there was more promise here in the first blush of revolution for improved human condition than there is at present, and the Martyrdom may actually be continuing in a larger number suffering a greater panetic burden.
Little things mean a lot. I have been running in the dawn in short pants and running shoes. These things would be illegal during the era of the beloved Kumuzu, but so also would the wearing of pants by women. There is one schoolgirl here who actually owns a set of slacks, not only one set of khakis but a second blue set. We have seen here twice dressed in pants of different colors. Before she left, Elizabeth was going to try to meet her for making such a revolutionary statement. We saw a woman wearing a red pajama style pants but underneath a chitenge, so it was only evident when she was hiked over the frame as a bicycle passenger riding sidesaddle. So, little by little the restrictions of the era of the forefather Martyrs of 1958 Independence Movement may be making their own independence known, continuing the revolution in personal terms despite oppressive destitution.
THE MATERNITY SERVICE GETS ADMISSIONS TO BE WATCHED
We made quick rounds on the problem cases, and then went to Maternity. Several women were coming in to sit quietly on the cement floor without raising their voices or calling for any attention until the midwife on call got around to examining them. One woman looked like she might be a problem for us to come back to re-examine, but by the time we came back to see her she had quietly delivered spontaneously. We were concentrating on a 16 year-old girl who was a primip with a breach presentation and she herself gave dates that she would only be 6 months along. So, without that helpful information we had to go aro0und to get a determination of our own. If she were at 6 months why would she be in active, if not very productive labor? We wheeled her over to Ultrasound, and tried to line up on the head and freeze the frame to get a fix on the “biparietal diameter.” Then it is a simple task to read off the chart posted on the wall, that she should be at gestational age 32 weeks. That would make for a viable fetus, but still why should she be in labor?
Mercy, who had had no action for the morning was abruptly juggling several active laboring patients, and would handle them all except for the 16 year old in labor. When I asked “Why?” She responded simply, “Because she has been given herbal native medicine by the mother,” the potential Gogo who has acted on the advice of some native practitioner, who had determined that now, is the time that the baby should be born. The young girl had no choice but to take the native medicine, so her induced labor was being “managed” by someone outside her own control.
“How do you know that?” I asked Mercy. “Because the contractions are not normal, but are prolonged and continuous clonic contractions.”
A primip breach with a labor, especially an induced labor, is an indication for a C-section, even in the “developed world.” So, off I went to “do it again.”
So, I delivered 16-year-old Tmonfula Zimba of a live 1.76 kg squalling female infant in a very easy C-section, since the small baby was breech, lying high with the head way up in the fundus. The C-section was easy, but I figured that the resuscitation of a premature infant would not be. After sucking the infant’s upper airway, and bag breathing with the AMBU for three minutes, Mercy pronounced the Apgar was 3, but now 8, so we had another “save” of an otherwise nonviable infant and perhaps mother as well.
I may be accredited (if that is the term to best used instead of “blamed”) for a one man and many-women “population explosion since my appearance here at Embangweni!
As is true for nearly all other women here, but especially for a teenage girl, her reproductive potential is not a personal property, but a community resource, and treated as a public commodity. She had no choice probably in whether she would become pregnant, nor did she even have any choice when it was determined for her that she would have the baby this weekend, whatever dates were accepted—her own estimate of 6 months or the US measurement of 32 weeks, and the final product of a 1.76 kg infant, which in any other setting would be whisked off to the NICU in an incubator. Here the baby was bundled into a cloth and tucked under the barely conscious girl’s crooked arm on the narrow gurney and wheeled back to the smiles of the all-knowing Gogo—“See, I told you so!”
During the Banda era, Martyrs’ Day, celebrated tomorrow on the 4th although it is really today on the 3rd of March, was a solemn holiday in which one should stay indoors and quietly contemplate earlier sacrifices. On penalty of being arrested, one could not go out of the hut, nor turn on a light or a radio. Now, it has been moved to a Monday celebration, and we are going to witness a dance and a drama to be held on the martyrs’ Day tomorrow—and who can say this is not a mark of great progress! I might be under arrest for my excess activities today, like the Pharisees’ trying to rescue an ox from out of the pit on the Sabbath. And, here I will be kicking up my heels in a high time with (are you ready for some of my favorite names?) Mzukuzuku and Bwekawaka!