Wise Woman - Midwifery in Congo

The Wise Woman

I can't remember the saying exactly. Is it "With age comes wisdom"? My 47th birthday was today and I spent it getting wiser.
When we refer patients who live in Mungele to the hospital in Lubutu, we give them a ride. When they are done with their hospital care, we take them home. I enjoy seeing the same people go both ways—sick towards Lubutu, healthy going home. The vehicles can carry a maximum of eight passengers, other than myself and the driver.
This morning was normal. It was a Mungele day. I went to the waiting area and announced that the car for Mungele was leaving. Carrying huge tied-up bundles of their belongings, fourteen patients and parents made a mad dash for the truck. The person in charge of giving out the tickets for the rides home had miscounted.
Fourteen officially signed and stamped white slips were waved at the unhappy driver. How could he choose? Some of these people had been in the hospital for a long time and wanted to get home. After a few minutes in crisis mode, we discovered that another truck was headed the same direction. They had plenty of room. Crisis averted.
The trip was uneventful- rolling hills, jungle, little villages, waving screaming kids, goats and chickens and pigs in the road. Normal.
I decided for a change I would work with the midwife today. She was doing prenatal care. Before we introduce her, we need some background.
Four weeks before departing the US, I met with David, a physician who had done lots of overseas work. We talked about his experiences and what I might expect. I asked him what I should pack. On his list was the book "Obstetrics in Situations of Isolation." David said that this subject terrified him more than any other. I thought there was no way I'd be doing obstetrics in Lubutu, so I didn't buy the book. Guess what I was doing on my birthday? Obstetrics in a situation of isolation.
The majority of pregnancies in Congo are delivered at home of by midwives in the Centres de Santé. Kenimbe (photo) is the sage femme (pronounced "sahj fuhm, literally "wise woman") at Mungele. She does prenatal and postnatal visits, delivers babies at all hours, and immunizes mothers and newborns. She is intelligent, works hard, wears elegant clothing, and speaks beautiful slow, enunciated French. Today she was doing prenatal checks. I joined her in the mud-walled, banana-leaf-roofed maternity department.
Women get pregnant younger and more often in Congo than in the US or Europe. Kenimbe told me she rarely sees a first pregnancy later than age 19. Four to six children are average. Some women start prenatal visits very late. Two of the five new patients today were nearing term.
At their first visit, Kenimbe takes a long history of the women's previous pregnancies and medical conditions. All the usual vital signs are taken- temperature, blood pressure, weight. Urine is checked for protein. Even if asymptomatic, each woman has a blood test for malaria and syphilis. If positive, they are treated. If the malaria test negative, the women receive oral malaria prophylaxis. Everyone gets folic acid for the baby and albendazole for mama's intestinal worms. Each new patient carries home a mosquito net for malaria prevention.
Kenimbe then examined each woman in the room next door. To estimate delivery date, she measured uterine fundal height. She feet the baby's position to make sure the head is pointed down. Next out came a cornet acoustique ("kor-nay ah-koo-steek"), a tubular metal instrument with rounded ends. One end was placed on the mother's abdomen, the other on Kenimbe's ear. She gently pushed with the weight of her head until she hears the infant's heartbeat. That done, the mother received a tetanus shot and appointment slip for her next visit.
The place ran like a factory. The ladies waited outside in a small covered area. For 2 to 3 hours they were verbally given information about maternal and childhood health topics. Kenimbe called the patients in turn, having to only slightly raise her voice as there is no glass in the windows.
After clinic, we chatted. Kenimbe is a strong advocate for women's reproductive rights. She knows all about contraception and family planning. She called the current situation in Congo "catastrophique."
I had a great birthday with this very wise woman. But what about my Mungele birthday present? As I was leaving to return to Lubutu, I walked through the area where patients wait to see the Consultants.
A small boy had been brought in for vomiting and diarrhea. He was sitting on his mother's lap. I was four feet away when the poor child vomited again. As the mother took the child to the wash basin to clean him, I noticed movement in the wet spot on the ground. A fifteen centimetre white roundworm wiggled. Ascaris. Happy Birthday!