As the floral henna design fades from my feet, thoughts of Tamesna and Niger sneak into my consciousness. It is cool here on the east coast which I have been enjoying as a pleasant change. The heat of the desert can at times seems all enveloping, annoyingly, relentlessly, hot. It is difficult for me not to say over and over to anyone who will listen, usually Becky—it is soooo hot. There are small reprieves—cold drinking water, chilly towels aroound the neck. Ahhh. The beautiful dark patterns across my arches and toes, heels and body of my foot are gentle reminders of how colorful the matrones are and what each brings to our birth attendant program.
Leslie had assured us that we would have a large group of trainees, but I certainly did not expect 20 women. They arrived a few at a time, throughout the day, over a number of days until we were filled to the brim. The heat does not seem to bother them. They shroud themsleves in layer upon layer of color-rich gauzy fabrics. Some women drape scarves over the tops of their heads and fling them across a shoulder, while others perch deep indigo turbans atop their heads that can leave them with blue stained hands and faces. Just as each matrone brings her own personal style, she also brings along her personal approach to learning. The women arrive at each session, slip rainbow hued flipflops at the door, come into the class, move to greet each of us with a little phrase, then settle into a comfy position on the floor mats.
This year we reviewed basic content from last year and introduced the use of new drugs and additional management skills. We always hope to build on what we present the year before as a review then offer the new concepts. This allows untrained students to catch up and former students to offer up questions they may have about specific practices. Generally, we review the importance of prenatal visits which allows for instruction and distribution of medications—for malaria and internal parasites along with vitamins. These practices should help improve the overall health of a pregnant women and reduce the risk of complications at birth. The process of labor and birth is discussed and includes what is normal and typical complications and interventions. Initial newborn care was added to our curriculum this year which we hope will help get newborns off to a good start.
Like last year, the women were eager to participate in the simulations and role playing situations we created for them. In the process, we learned more about their common practices, while we shared what are considered best practices for today. This is a slow process, of course, given the amount of translation that is required to share information. But everyone is patient, and at the end of the day, learning happens. Somehow we manage not to talk over each other too often. With the variety of languagues flying around the room it is funny to listen to—different tones, varied inflections. Sometimes it is very noisy in our classroom.
One of the most serious complications for the population of nomad women is preeclampsia/eclampsia. This condition can be identified by a number of physical symptoms, but the most common is elevated blood pressure. The sooner the condition is identified the more opportunity there can be for a good outcome. Here in the US this can be a challenging condition to manage, and women do die from it. Teaching more matrones how to take an accurate blood pressure was something we incorporated into the program each day so they could practice. This was just one area where more experienced matrones were able to assist newcomers to develop accuracy in a skill that is not easy to learn.
As a nurse midwife who assisted women in homebirth after completing my education, I confess it is one of my very favorite places to attend birth. It offers freedom of movement during labor in a familiar place for the parturient surrounded by a supportive group of people who can include anyone the woman wants. One of the most challenging things about out of hospital birth occurs when the process does not go perfectly well. I worked with an enormous safety net when I practiced. My homebirth bag contained drugs, IV solutions, oxygen, resuscitation equipment for both moms and babies among other things. I was seldom more than a couple of miles from a hospital where I had priveleges and could transport the woman and assemble a team with an obstetrician, multiple skilled nurses, an OR and various interventions quickly if I needed to. These matrones have only what we are able to supply them. This year with an increase in the number of deliveries performed, the adequacy of their supplies seemed questionable. I served an essentially healthy population of women untouched by malaria, typhoid, or malnutrition and limited clean water. It is almost unimaginable what these matrones are accomplishing. They bravely go forth and do the very best job they can with the supplies we give them. They are not paid. They truly should be celebrated. At times their work must be anguishingly difficult.
So, as I think about the heat in the Sahara I am reminded of what these women are doing. They are on endless call—24/7. They meet all birthing obstacles head on and try to learn everything they can to make birth as safe as it can be for the women in their community. I could not be more proud to count them amongst my colleagues—probably the very hardest workers in the most dire conditions that I know. They are wonderful, and I am honored to be able to go to their country and teach them things I know that may make a difference in their communities. We could not do what we are doing without the very generous supporters of the foundation. I left Niger feeling uplifted from all that we accomplished this year but sensing that we need a bit more of everything.