Hatching Babies...

-From Joanne in Masaka

I've been reminded of how few resources it can take to save lives. A year ago this nursery for premature babies did not exist. Now premature, sick, or struggling babies are brought to this nursery to be watched over, largely by one of our amazing midwife mentors here –Sister Prossy. She frequently gets called in the middle of the night to advise staff of how to care for a newborn in distress. She has now trained some of the other nurses and midwives in the art of infant IV’s to ensure babies get proper fluids and medications. Reading lamps create makeshift baby warmers. My first time into the nursery I glanced around at the stacks of blankets and assumed most babies were being carried around by their mothers, with just their blankets left behind. But as I slowly made my way around the room, peaking under corners of blankets, I found a baby under each stack! (You can always spot the babies the mazungus have brought in after resuscitation –swaddled and with their face exposed!) I can’t help imagining a flock of chicks hatching everytime I enter the warm room –the only room heated in the hospital. Being that warmth is so critical to newborns, particularly preemies, these few lamps and stacks of blankets, along with the TLC of Prossy and other staff, are literally saving babies’ lives.

 When I first met Amina she was sobbing quietly in the corner of the nursery. She spoke English quite well, and explained that her tiny daughter, born at approximately 6 months, was deteriorating. Her feeding tube had been removed, she didn’t know why. Desperate to ensure her baby was nourished, the infant’s tiny body seemed limp and weak as Amina attempted to get the miniature mouth to latch onto her breast. The babe was too small and exhausted to nurse. Fortunately there was a lull in the usual whirlwind of deliveries across the hall and I was able to sit with Amina and try to console her. I found a syringe and helped her express breastmilk and finger feed her baby slowly drop by drop. She only swallowed a few drops before she was quickly exhausted and fell asleep.

A school teacher from a rural community, Amina explained that her baby had been born two weeks earlier. When I asked her daughter’s name, her eyes welled up with tears again and she looked down to the cold cement floor. I just nodded, put my arm around her, and sat quietly. In a place where the survival of unwell babies, let alone a very premature infant, was so tentative I could sense how a mother might hesitate to believe that this little person would survive.

When I returned later in the afternoon, the baby was worse off. Her breathing was labored, she had poor colour, and her heart was beating slowly. Another nurse came in and we began resuscitating the baby with the smallest mask there was –still far too large. Even as we were doing it I was unsure that it would be helpful. It felt like a very temporary solution for this wee baby that, by Canadian standards, actually needed a ventilator, an incubator, a heart rate monitor... and even in Canada this baby would have tough odds. The baby responded, the heart rate came back up, and she was given a new feeding tube and IV fluids. I assured Amina that the midwives were doing everything they could. I left the hospital that evening considering that her baby may not be there when I returned in the morning.

Amina and her baby holding on.

A week later I walked into the post-natal room to check on a mother who had delivered the previous night. A dozen foam mattresses were spread across the floor in between the token three cots. Each makeshift bed was filled with mothers and babies, bright fabrics, visiting family members, water jugs and food dishes. “Hello Joanne!” I was shocked to hear both English and my name! Amina was smiling at me from one of the few beds. She had now been staying at the hospital for just over three weeks. Her baby had improved and continued to get breast milk through a feeding tube. She went on to ask me advice for some of the other moms in the room. One mom had had a preterm c-section and didn’t have enough milk yet to breastfeed. I suggested she eat meat and vegetables, drink chai and lots of water, and hold the baby skin to skin. Amina translated this into Luganda for the other mother. The next day she reported that the mother’s milk had come in and her baby was feeding well. One of the cherished moments where my most foundational midwifery skills had been helpful!

Based on a doctor’s estimate, Amina tells me she expects to be at the hospital for another month. She has relatives that bring each of her meals throughout the days. She will continue to float between the postnatal room and the nursery - where she expresses breast milk and holds her wee baby.

Before I leave her bedside, she grins and proudly tells me that she has named her daughter Sarah.