Saturday, March 21, 2015

Kasha Hulu mama!!


This week Natalie and I (Courtney) were placed on the maternity ward at Lewanika General Hospital here in Mongu! We were both ecstatic to be starting our time here in Africa on the Labour and Delivery Ward!

Courtney, Natalie and a midwifery student.

It's nearly impossible to capture our experience on the labor ward with words, and no matter what, I know we won't be able to fully describe what we saw and felt this past week.

Initially on the ward we felt very out of place. We didn't know the routine, the traditions, or the language. To cope Natalie and I just threw ourselves in to the thick of it, falling back on our knowledge base and critical thinking skills. We found that there were just as many parallels, as there are differences, between how we practice in Canada and how they practice here in Zambia. 

One of the differences that I'm having a hard time with is how mothers in Zambia, when facing pregnancy and childbirth, are mostly alone. Most of these mothers were between 15-18, and were single. Babies having babies. Moreover, family members are not permitted on the Labour and Delivery ward due to infection risk and limited space. I found this very different from my experience in Kelowna, as Canadians consider pregnancy to be one of the happiest moments in a women's life. Expecting a newborn and preparing for its arrival is such a celebrated journey, and in my experience these women are supported greatly by their partners and family. 

Delivery beds. Mamas cover them with plastic and their chintenges before delivering. (Chintenge is an African fabric worn by women and wrapped around the chest or waist, or as a baby sling.)

Medical equipment for babe in the delivery room.

Instead, very rarely have I seen women together with their partners here in Zambia. Women generally arrive at the hospital alone, they labour alone, and generally go home alone with the newborn. 

The women being alone during labor and delivery was one of the only things that really got under my skin this week. I found myself critically questioning my western views and ideals surrounding childbirth, and trying to decide if my western attitude was getting in the way. You really can't compare the two health care settings, as everything is so dramatically different. The way they do things here is how it works for them, and many times is all they can do with the resources they have. There is a reason they don't nurse the way that we do, and It's important that we check our opinions of what is right and wrong at the door. 

So when working with these women, we shifted our focus from thinking about the different conditions, lack of resources, or the different medical skills we could do, to doing what we as Canadian nurses do best, relational practice and providing holistic care! 

Natalie and a babe we helped deliver.

Natalie's highlight: 

I never got to fully deliver a baby, but by the end of the week I didn't care anymore about delivering a baby, I had truly made an impact in someone's experience. It was the best gift of all. This is my story: 

Thursday morning, I was visiting the moms when I realized this particular mom looked quite dehydrated. We grabbed a blood pressure cuff and ran to grab her a cup of our own water. Resources here are limited and the moms are responsible for their own food and water. Shortly after this mom was in the delivery room, and this was my babe, I was going to deliver this baby! 

I was very nervous, I kept running through emergency resuscitation in my mind, but I was also thrilled. In Canada, you would never get to deliver a baby as a student. I stood beside this mom and kept saying "Kasha Hulu", this means push hard. If there was anything I felt sure about, I knew how to encourage her. 

She was giving up and was extremely exhausted. We were blowing cool air on her face and fanning her with a sheet. I can't even imagine trying to push out a baby in 34 degree weather in a congested room with another mom labouring beside you.  I was going to do whatever I could to comfort this mama. After many interventions and no baby, we later found out she went for a cesarean section. 

On Friday morning, I went to the post natal ward and I was frantically looking for this mama. I couldn't wait to see the babe. She smiled a smile I will never forget. I can't even describe the emotions I was feeling, but I knew I had made an impact. I held this baby so tight, and I felt one of the greatest moments I have ever felt. I gave her soap, baby blankets, jumpers and the mom said "how much?".  I said "it's from us mama". I could see the appreciation in her eyes, and it truly touched me, I have never seen someone so appreciative. The moms here are so strong and even in the hardest moments they will never express their pain or sadness. I had tears in my eyes.  I went from being so excited over the skills I could do in Africa that I couldn't do in Canada, to walking away from this week feeling like I made a difference in someone's experience. I feel so content! There truly are no words to describe how this week has made an impact on my life. It's the people! This mom reminded me of why I love nursing. I think back home people become unappreciative about the small things. In Africa it's the small gestures that make such a difference in someone's experience.

Natalie and the mama she bonded with. 

Natalie carrying a baby back to the ward after a Caesar. 

Natalie, Dr. Njwenka and Courtney after a Caesar (c-section).

Courtney's highlight: 

My highlight of the week was working with a mother who was on her fifth pregnancy, for the purpose of this blog I'll call her Mwangata. She came into the ward in active labor, and was quite ill.

As a nurse I am constantly putting eyes on the patients and asking myself who is the most acute. Constantly prioritizing patient needs over the past four years really helped Natalie and I this week. We chose the two mamas who were the closest to delivery, and also the most ill, and spent a lot of our time monitoring them and their baby's condition. 

Mwangata was vomiting, and as Natalie and I were cleaning her up we noticed her water had broke. She didn't speak any English so it was difficult to communicate with her. We took her back into the labor room and asked the midwife to come assess her. After 10 minutes in the labor room she was back on the ward in her bed, space is limited and she was not progressing fast enough. In the meantime, Natalie's mama was moved into the labor room and we assessed her as being 10 cm dilated, she was ready! 

While we were in the labor room we heard the most urgent SISTER! SISTER! Coming from the back bathrooms down at the end of the ward. When I got there I saw Mwangata squatted down in the doorway of the bathroom with her baby crowning. I got down in front of her and put my hand on the baby's head, just in time to 'catch' as she delivered her baby boy into the world. I stimulated him and wiped the mucous out of his nose and mouth with a gloved finger, and he took his first breath and began to wail. Thank goodness! The midwife came and clamped and cut the cord, and Natalie and I took the baby to clean him off, warm him and do an assessment. As we assessed the baby I had a little cry, and pulled myself back together. 

Courtney and the babe she delivered.

The next day I visited this mama and her babe in postnatal. She was so happy to see us which really made the experience that much better. She let me hold her sweet baby and I sat with them for awhile. Even though there was a language barrier we really bonded over the experience and her baby boy. 

Sweet baby boy.

We really fell in love with the resilient mamas, their babes, and the wonderful, knowledgable staff on the maternity ward this week. Natalie and I really felt at home and are sad to leave! 

We took Polaroid pictures of the moms and the babes after they delivered to give to them. Many of these women do not have cameras, or even mirrors so they don't see themselves often. It was quite the event with lots of laughter and smiles! 

- Courtney and Natalie!


  1. Oh my goodness! I LOVE this! you must have had the most amazing week with the babies and loving those Mamas! Wish I could be there with you! Linda Linda Linda (Drew)

  2. I have goosebumps reading this - even a little tear. What a great idea to bring a Polaroid camera. Amazing work girls. <3

  3. Some amazing moments indeed. I just love the idea of taking a Polaroid to give the Moms! (somebody was thinking ahead) We are so used to having so many pictures that the thought of not even owning a camera doesn't even cross our minds. What a thoughtful touch, great job girls!

  4. Dear Natalie & Courtney,

    You stories about mamas and birth are ones that every nurse could relate to in any country, anywhere - especially how in the end, what every woman needs is to be accompanied. In the villages, childbirth may be more accompanied, but a,so more dangerous due to the lack of emergency medical services if there are complications. In the hospital with its crowding and restricted resources, it may be safer for needs like emergency C-sections - but it is also lonelier. It makes me dream about a birthing center beside the hospital - with enough room for at least one family member to stay with each woman - but close enough to the hospital should emergency medical help be needed.....that kind of dream gives me goosebumps, just like your stories. Thanks for sharing them with us,

    Tricia Marck

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