Monday, November 9, 2009

And Buries Her

I had high hopes this week to do lots of ward rounds and cesareans, but that was thwarted by a new TIA development - the lack of an anesthetist. One anesthetist has been transferred to another site, and the other one is on leave, so there is no option of doing any surgeries whatsoever. The midwives informed of me of the problem this morning.

All patients must be referred to out to St. Anthony's, a private hospital in Tororo (where, of course, they have to pay for services if they are to receive them).

Since no cesars can be done, and the cesarean patients usually take up most of the beds because they stay so long, there are almost no patients on the wards.

Instead, I decided to teach ultrasound to some of the Medical Officers working on my study. As I was teaching one Medical Officer, the midwives asked me to scan a woman who had just been beaten by her husband.

Interviewing her was difficult, because she spoke Japadhola and not a word of English. The nurse kept dashing away to deliver a baby or clean a bed, so I could only get 1 or 2 questions in at a time. I finally managed to establish that she was punched and kicked in the abdomen by her husband, and had no vaginal bleeding.

I did an ultrasound, fearing the worst, but found a healthy, kicking, happy 28-week fetus inside.

At home, we would automatically offer to admit women who had suffered domestic violence - to allow them a safe place to stay, and access to social services. Of course, there is none of that here. I was asked to do the ultrasound so they could send her home. A new midwife arrived who spoke Japadhola, and had more time to translate.

ME: Sister, can you tell her that the baby looks good?

(She does, and the patient smiles, relieved)

ME: I can see the baby moving. Does she feel it now?

(Discussion in Japadhola)

MIDWIFE: She first started feeling the baby move this morning.

ME: Started? I thought it stopped.

(Discussion in Japadhola)

MIDWIFE: Ehhhhh.... (which is a noncommittal yes)

ME: Did it start or stop today?

(Discussion in Japadhola)

MIDWIFE: The baby started moving this morning.

ME: it's moving now?

(Discussion in Japadhola)

MDIWIFE: Ehhhh......We can discharge her?

ME: Where is she going to go?

MIDWIFE: She says to her mother's house.

ME: Why did he hit her?

(Discussion in Japadhola, lasts a long time)

MIDWIFE: She says he is going to kill her.

ME: Kill her?

MIDWIFE: She says this is her first pregnancy, and they are just married, and he has already taken another woman. She says he is going to kill her.

ME: She shouldn't go back to him then.

MIDWIFE: Ehhh....But her is her husband. He probably paid two cows dowry for her. She must go back to him.

ME: Even if he kills her?

MIDWIFE: And buries her.


Lady B said...

Oh Veronica! Awful-ness and hopelessness. Probably there is something that could be said about fatalism, khama and such. But it just seems unfair.

Veronica said...

I know. I had no idea what to say or do. Also, disparaging that custom comes off as cultural intolerance. But how can I feel good about sending a woman home to be killed?

I feel so powerless most of the time here. You do what you can, and you know that back home, it would be horrifyingly insufficient.

Scott Sell said...

How telling is it that the victim was willing to be perfectly honest with you and the nurse about the abuse. What can you do when all these aspects of the culture so absolutely protect the abuser. I think your presence and the sort of thoughtful conversations you have with people might be some of the only effective, if terribly slow, agents for change.