A twenty-year old walks to the County referral hospital with the dignity of a married woman, tummy protruding before her, she is walking with her legs slightly apart, thanks to her protruding belly. She is in the company of three women; her mother in law, her own sister and an elderly neighbor. Every twenty or so minutes, she pauses, puts her hands on her waist and takes long purifying breaths as a strong contraction starts at the fundus of her uterus and radiates down, causing indescribable pain. The long, slow breathing, she has realized helps. She is hopeful that everything will be fine, she is not worried about anything. The most important thing to her is that she is married. This child is not a bastard. He (she hopes it will be a son) has a father and hence a future.
At the entrance to the wards, she is allowed in without delay. The security people don’t keep women with protruding bellies and dancing feet waiting. She is ushered into the maternity ward. The admitting doctor gets her details. She is a first time mother. She doesn’t remember when she got her last period, like ninety percent of all the women admitted into maternity. Currently she has low abdominal pain, that begun about sixteen hours before she presented to the hospital. Her baby is kicking just fine but her water hasn’t broken. The admitting doctor notes that. She asks for the antenatal clinic book. She is handed a purple booklet which, except for the name, is essentially blank. ”Mama ulienda clinic?” She asks. The patient answers in the affirmative. How many times? Once. The reason why no test was ever done is because she was unable to go back a second, third and fourth time. The county health care workers were all on strike over unpaid salaries. She couldn’t afford the private hospitals because she has no insurance cover. And she couldn’t go to the next county hospital either because she had no bus fare.
The doctor performs her examination and realizes she is carrying twins. Her cervix is five centimeters dilated. She hastily draws blood, to check her hemoglobin level and do other basic tests like HIV testing, blood grouping, et cetera. Her HIV sero-status comes out positive, her hemoglobin level a mere seven. The doctor summarizes the patient’s condition; “a first time mother, who is anemic and HIV positive, carrying twins, never been on ARVs.” This is definitely a recipe for post-partum hemorrhage and other chaos.
She decides to look for blood for her just in case she develops post-partum hemorrhage. When she goes to the lab, the fridge is opened so that she can see for herself that there is no blood. Because seeing is believing. So the doctor goes back to the ward just to consider her options; take out her prayer beads and say a continuous prayer for the poor clue-less woman. Pray that she delivers safely. Pray that she doesn’t bleed excessively after delivery, or refer her to the next county hospital. Her cervix is now nine centimeters dilated. The first baby will be born about one hour from now. The next county hospital is one hour thirty minutes away. So referral is clearly out of question. but she still calls the hospital for the sake of it. But the person on the other end is so sorry they also don’t have blood. So the doctor goes back and sits in the maternity ward and waits for a miracle, the miracle of safe delivery, good health to the mother and the babies. Because she can’t have a maternal mortality. Mothers shouldn’t die when bringing a new life to earth. And also mothers shouldn’t die because maternity care is “free” paid for by the government. Our dear government!