Jannekah, Ezriel, Amariah and Martin Guya

Last month we discovered the incredibly exciting news that we are expecting our third baby!  We were SO excited.  But just a couple weeks later I was showing pretty worrisome signs of a possible miscarriage.  The scariest part was I was an 8-hour drive away from my husband and our home.  I was in a town I knew very little and didn’t know my way around at all.  A dear midwife friend and mentor suggested I try to get an ultrasound to hopefully understand better what was happening.  If it was indeed a miscarriage I wanted to be ready with medicines or herbs that would help me so I wouldn’t hemorrhage and end up with a D&C, which I sadly went through with our first sweet baby – a nightmare I would never want to relive.

When I finally found the courage to pray about it, I spent a lot of time crying out to God, and just crying.  God gave me an irrational peace, as only He can, and the next morning I got up early to begin the search for an ultrasound.  Thankfully I was with my husband’s cousin, Ray, and we asked directions to the hospital at every corner until we finally found it.  Our first try was at a private hospital, where it’s much more expensive, but you receive significantly better care, though still very substandard.  The receptionist informed me that the sonographers didn’t come in on the weekends and would only do so in an “emergency situation”, and that I would be required to pay them double for coming in when they’re on call.  That sounded to me like an all day event that may or may not end in an ultrasound but would definitely end in me spending a large sum of money.  We decided to search out the government hospital – the biggest most “equipped” hospital in town, supposedly.

When we finally found our way there we spent about 45 minutes just trying to find someone to tell us where to start.  We were told the sonographer would be in around 10 am (it was 9:30 am) and that we would need to see a doctor to get a referral for an ultrasound.  After paying the $2 consultation fee at the other end of the hospital, we dodged two stretchers of seriously wounded patients who were being nonchalantly wheeled somewhere.  We stepped over a couple pools of vomit and several pools of blood and managed to find a long row of little closets, only one of which was occupied by a stressed out doctor who clearly was not thrilled with his career choice.

When at last it was my turn I went into his little closet to find him irritatingly cleaning vomit off his desk.  He crossly told me to sit down and asked what I wanted.  I told him I was 8 weeks pregnant and showing signs of a miscarriage.  He softened a little and started scribbling in a book.  He asked me my LMP 4 times, wrote it down wrong 4 times, wrote a referral for the ultrasound, and sent me on my way.  The whole thing took about 2 minutes – by far the shortest stint of the whole ordeal, that unbeknownst to me was only just beginning.

We took the referral back to the ultrasound receptionist who had told us the sonographer would arrive at 10 am.  Knowing Kenyan culture I had already prepared myself that it would probably be more like 2 pm.  But I had not prepared myself to hear her say that actually, they had no sonographer on duty on the weekend, only people on call who only came in for emergencies.  She looked me up and down and informed me that I looked perfectly normal and that there was clearly no emergency.  I told her (a bit emotionally) that I was threatening a miscarriage and asked her if that was normal.  I didn’t wait for her answer before myself declaring it an absolute emergency.  I asked her what she needed.  For the doctor to write that it was an emergency?  I would happily return to the vomit and blood strewn halls to accomplish this.  As I was declaring my readiness for such a mission, she was looking at another piece of paper the doctor had written on.  Sure enough he HAD noted that it was an emergency situation, but he had written it on my patient record, NOT the ultrasound referral, and because the proper procedure was not followed, I was not a candidate for an ultrasound.  She further informed me that no, it did not help that the doctor had written that it was an emergency.  He needed only to write my problem and SHE was the one to determine whether or not it was an emergency.

I sat down, utterly flabbergasted.  I didn’t even know what to say nor did I have the emotional motivation to say it even if I did.  Ray stepped up to give it a try.  Now Ray is a young, single, good-looking man, and when he smiled sweetly and talked to her “pole pole”, as Kenyans would say (meaning slowly and sweetly), she lit up and said she would see what she could do.  She disappeared for about 45 minutes.  I felt pretty sure she wasn’t coming back.  But amazingly enough, she did!  She had gone and found a doctor who was only doing consultations that day, but also knew how to work the ultrasound machine.  She smiled at Ray and told him, “You know, convincing people is hard, but I did it.  He’s agreed to do the ultrasound.”  I was so surprised and thankful I would have done anything for that young woman at that moment.  I felt guilty for all the mean thoughts I had thought about her the whole time she had been gone.  I thanked her over and over again and thanked God over and over again for giving us favor.

Ray went to get me water to fill up my bladder and to pay the $10 for the miracle ultrasound on the other side of the hospital.  I headed down another hall towards the ultrasound closet.  It occurred to me how very much the hospital resembled a prison, with bars on all the doors and windows, the dim lighting, the filth, and the hopelessness.  I thought about how beautiful I want my clinic to be one day.  How warm and welcoming and comfortable I’ll make it in every possible way.  I was jolted out of my lovely daydream when I reached the end of the hall.  I couldn’t believe it.  There was a massive pool of blood and tissue on the floor right outside the ultrasound room and right in front of the bench I was supposed to wait on.  It was probably 4 feet long and 3 feet wide.  A woman had miscarried there.  I started to cry.  It was hard to imagine someone could even survive that much blood loss.  I turned away and stood looking back down the hall, praying for my baby, praying for that woman who had lost her baby right there, and praying for all the other women just like me who were having complications in their pregnancies and would have to see the horrific reality of what is possible.

The sonographer finally appeared and casually told me to go wait somewhere else because that area was too dirty.  He then informed me that the cleaning crew doesn’t come to the hospital on the weekends.  I guess that explained all the puddle hopping I’d been doing and why that pool of blood and tissue was dark and dried.  I walked back and found Ray with the water.  I downed 2 liters as fast as I could, wanting so desperately to get it all over with and get out of there.  But in Kenya they say, “Haraka haraka hyina baraka.”  Which means, “Hurry, hurry has no blessing.”  And surely, no one was hurrying around there.  The sonographer disappeared for about an hour.  In the meantime I watched patients with horrific injuries being wheeled in and out of the x-ray room.

Not long into my wait, another woman came and sat in front of me, writhing in pain stemming from her right side.  She had quite an entourage of at least 7 very concerned family members.  They were going through the same ordeal of trying to convince the receptionist it was an “emergency” and that she needed an ultrasound.  About 4 mama lions were on the job, battling the corruption and ridiculous “procedures”.  This time the receptionist would not give in.  As much as I wished I had a bunch of tough, strong African women with me too, I decided Ray’s charm was surprisingly much more effective as I watched them battle the system to no avail.  The women returned as dumbfounded and frustrated as I had been.  They determined the problem was that the sonographer and receptionist were working together to get bribes.  They asked me how much I had paid in bribes and I said I hadn’t paid anything other than the consultation and ultrasound fee.  This greatly distressed them and they looked utterly hopeless.  I felt so guilty as I looked at that poor woman suffering in so much pain.  It wasn’t fair that I would be given an ultrasound and she would not.  I wondered what would happen if her appendix or an ectopic pregnancy suddenly ruptured.  I decided she would most likely die.

Right about that time I decided to walk back down to the ultrasound area and the pool of blood just incase I had been forgotten.  The writhing woman and her entourage followed me, refusing to give up. Soon the sonographer reappeared and cheerfully asked if I was ready.  I told him I was, but that the other woman was in so much pain I didn’t mind going after her.  He became furious and said, “Oh, ok.” And he stormed off.  The woman’s family chased after him, some of them slowly helping the woman along, all of them begging him for mercy.  I knew immediately I had made a huge mistake.  He was mad at me for sticking up for her when he hadn’t gotten his bribe out of her family yet.  As punishment, he took away my miracle ultrasound.  I stood there in total shock.  I couldn’t believe it!  I had had it! I was SO close!  He asked me if I was ready!  After all those hours of struggling.  All those hours of the emotional trauma of seeing the horrific suffering of others.  All those hours of trying to stay calm and hope for the best in the midst of it all.  And he asked me if I was ready.  If only I had said, “Yes!”  But now it was gone.  My miracle ultrasound was gone.  It slipped right through my fingers and was gone the exact same moment it was offered.  Just like that.

I stood there next to the remains of someone’s precious baby and wept.  I didn’t know what to do.  I wondered how God feels about people who have the power to help others, even at no real loss to themselves, but they don’t, simply because they don’t feel like it.  I thought about the Kenyans who go through this kind of pain and humiliation and helplessness every single day.

After a long time I walked back to the other waiting area where the woman and her family were, looking so desperate and at a total loss.  One of the mama lions noticed I was struggling to control my tears and came to talk to me.  The gentle way she spoke was comforting.  I don’t remember the thought of leaving crossing my mind and I just sat there waiting, not really knowing for what.  I asked God to fight for me.

The sonographer walked by and saw me brushing away tears with a handkerchief.  I certainly didn’t expect any compassion and was irritated that he was seeing he had broken me.  He starred at me and then said, “Come.”  I didn’t say a word.  I followed him back to the pool of the blood and into the ultrasound room.  He started the ultrasound and a long story about why he had refused to help us, all of which I knew was total nonsense, but I didn’t even care anymore.  I was enduring all this for only one reason, and within a couple minutes there it was – a little flashing heartbeat, 150 beats per minute. The joy, excitement, and relief that overcame me is indescribable.  All I could do was pour out my heart of thanks to God.

As I was rushed out of the room I asked if I could go or if I still needed to wait for something, but I was ignored.  I decided to wait.  To my joy the sonographer called the writhing woman in for her ultrasound!  I waited another 45 minutes at the pool of blood as he saw several other patients.  Finally he handed me a piece of paper and the ultrasound print out.  I asked if I could go and when he nodded I walked out of there as fast as I possibly could and didn’t look back.

Though God was so merciful to me and I couldn’t have asked for a better end result, it took me all day to emotionally recover from the experience and my heart is forever so broken for the needless suffering that precious, innocent Kenyans endure every single day.  It was yet another painful reminder of why we as midwives and as followers of Jesus Christ live and work to bring a change.  As horrible as it was, I’m thankful I had to go through all that.  If I would have been cared for at the private hospital, I wouldn’t fully know or understand what MOST Kenyans endure when they are most vulnerable and in need, not only physically, but spiritually and emotionally as well.  May God help us all to fill these kinds of gaps and ease this kind of suffering, all for His glory and the advancement of His Kingdom.

"The human spirit can endure in sickness, but a crushed spirit who can bear?"  Proverbs 18:14