Mamas and Babies and Physiotherapists, oh my!

Today was my first day “observing” at the antenatal clinic at the Savusavu Hospital. It took me a while to get there. First, I talked with the (only) private doctor in town, Dr. Joeli. I asked him if he sees pregnant women, and he said yes, but he doesn’t provide routine prenatal care or do deliveries. He told me if I want to be involved with birth, he would talk to the head doctor at the hospital about me possibly observing or volunteering. He was true to his word, and told me I should go up there and talk with him myself. So I went up the hill to speak with Dr. Ishaq. Dr. Ishaq is a very busy man. He sees a normal case load of patients in addition to running the hospital. He told me that if I wanted to observe in the prenatal clinic, I should go talk to Kini. So over I went. Kini is a nurse midwife, and is in charge of the antenatal (prenatal) and family planning clinic. She was very nice and said it would be fine if I wanted to observe. She said she thought the best place for me to be of use, if I wanted to actively participate, would be to help out with the physiotherapist. Apparently, (and I saw this today), women are sent to the dental clinic after their “booking” or first appointment, and to the physiotherapist after their second appointment. The physiotherapist, Kini told me, goes over exercises for pregnancy and birth, and talks about posture, etc. He does a good job, she said, but since he’s a man, she thought it would be good to have a woman there teaching exercises because the mamas would be more comfortable with that. Well, I certainly think she is right. The physiotherapist was super nice, but it was clear that the situation was less than ideal. He was an Indian man speaking English to a group of mainly Fijian woman from rural villages- not the best English speakers. Basically all of the factors are working against this situation- gender, race, and language. And I could definitely see it on the women’s faces. Then there was the content. It was, well, mostly correct, and very well meaning, but seriously lacking in a number of ways. There were no visual aids- no model pelvis, no poster or flip chart with pregnancy anatomy, nothing. At one point, the physiotherapist used a picture of a (non-pregnant) female urogenital system from an anatomy textbook (ok, so there was one visual), but he was somewhat uncomfortably trying to explain how the baby comes out without using the words “cervix” or “vagina” and he was pointing to the bladder the whole time he was talking about the “baby bag” and “baby passage”. Sigh. Clearly, a lot of work can be done here. I think I’m going to start by making him a cardboard pelvis.

After observing the physiotherapist, I went back to the clinic and observed the intake, which was just a nurse retrieving charts, taking weights and blood pressures. Then the women go to Kini and get counseling regarding both breastfeeding and birth control. Then they see the doctor (for Wednesday clinic) or Kini (on Monday clinic). Monday is “low risk” clinic and Wednesday is “high risk” clinic. Today was Wednesday, so next I went in with the doctor and spent the rest of the clinic doing exams with her. It was awesome, in so many ways. I not only got to observe, but completely participate, doing everything that the doctor did (and she was super nice)- chart review, measuring and palpating the uterus/baby, determining the position and station, listening to fetal heart tones, etc. It was awesome to get more hands on experience, but also really cool, was that the doctor told me at the end of the clinic that she had learned a lot from me (!). We talked between mamas about maternity/midwifery care in the US, and I asked her questions about standard maternity care in Fiji. The clinic was a lot like a standard medical model in the US, where the mamas only spend about 10 minutes with the OB. I told Ana (the doc) about how we (meaning midwives) spend a lot of time with the mamas in the states, and how we give them a lot of information, and encourage them to make their own choices. She was surprised when I told her that we give the mothers the choice of whether they want an ultrasound or not, and she was highly impressed when I told her about my home birth, how I exclusively breastfeed my son for seven months, and that I’m still breastfeeding him once a day at two years old. She was surprised that I didn’t have an episiotomy as a first time mama. After I had done a few exams, she asked me about why I talked to the mamas about their baby’s position (while I was palpating, I was asking the mamas about what fetal movement they were feeling, where they felt kicks, etc, and explaining to them what they were feeling and what position the baby was in, etc.). I told her (well, in a nutshell), that I was able to have such an easy birth because I was prepared and relaxed, because I had a lot of knowledge about birth, and that I had this because of how much my midwife talked to me. I said that we talk to the women a lot to give them information, because then they are better prepared for their birth. She nodded, and I noticed that she started doing this during her exams too. I asked her about procedures for postdates (sweep membranes, then send them to Labasa for induction), and then if she recommended any natural induction methods. She said she heard about intercourse helping to start labor about a month ago, but she didn’t know why. So I explained about the prostaglandins in semen, and also told her about nipple stimulation and castor oil. I also talked with her about exercises for turning breech babies and for posterior babies, which she had never heard of either. I was so excited to be there, and she was super excited to hear about these things from me.

The doctors rotate duty at the prenatal clinic, so Ana won’t be doing another clinic for about a month. Next week, there will be a new doctor for me to meet. Hopefully the next one is as nice as Ana. One of the strange things (to me), is that the nurse midwife who works in the labor ward does not have any part in the prenatal clinic. She’s the only midwife in the ward (which has one room), so she’s on call 24/7 for a population of maybe 35- or 45,000 people (with a high birthrate). She’s one busy lady, and the mamas don’t meet her before they go into labor.

New Neighbors

After getting used to living outside of town, with only two quiet neighbors (and those are separated from us by a steep hillside), practically in the “bush”, it’s suddenly very different around here. After a long saga involving lawyers and property lines, the house directly next to us (we share a covered breezeway) is being torn down. The folks who have taken on this project, who are friends of the owner of the computer store, are living there while they take it down. Since our house is more window louvers than walls, and the house next door is now missing several walls, there is not much privacy.

It feels like we are living next door to a miniature replica of a Fijian village. There are four men and two women staying there, but several other people come and go as well. The men work on the house, carefully taking it apart and numbering and stacking the materials so they can be used to re-build the house on another piece of land, and the women (as far as I can see) cook for them. They cook with two big pots over a fire they have built on a workbench under the carport. They all get up around (usually before) dawn—no problem for me since that’s when Jasper wakes up too—and stay up late drinking grog (a.k.a. kava or Piper methysticum), which is a bit more problematic. They take a break to rest during the middle and hottest part of the day. We don’t do that at the computer shop, naturally, and so I am really building up a sleep deficit since I’m such a light sleeper and can’t fall asleep while they are laughing and listening to music and drinking grog.

Despite the annoyances of sleep disturbance and constant construction noise, things are very pleasant. The people are very friendly and they LOVE Jasper (everyone here does). They bring him food whenever we are home, and although they say it’s for Jasper, there’s always a ton for me and Miles to eat too. So we are basically being fed traditional Fijian food every day: “pancakes” for breakfast (which are like un-sweetened donuts), and cassava and soup for lunch (made with lentils, noodles, and whatever else is around- prawns from the creek, tinned meat, wild greens, etc). Sunday, a group of people came over for dinner and there was a bunch of traditional food, and of course we were invited. We had cassava, taro (the staple root crops served with everything), fish and some plant related to sugar cane cooked in coconut milk, curried fish, stew and rice, and of course lots of grog. These people, like all Fijians, are so generous. If they have something, it is shared. This is especially true with food. I don’t think it’s possible for them to make food and not offer us some when we are right there. Every time I go outside with Jasper, they offer us something to eat. That happens a lot, since Jasper loves playing with them.

It’s nice to be invited to eat and drink grog with people, but it’s hard too. They speak very little English, and Miles and I speak very little Fijian, so most of the time we just sit there and smile while everyone is talking in Fijian around us. Often I can get the gist of what they are saying, but since I can’t really participate by saying much, they assume we don’t know what they are saying. This is kind of annoying, because they are frequently making jokes about us. Now, I know we are weird kaivalagis (“Europeans”), and there’s plenty to make fun of from their perspective, but it is rather uncomfortable to understand enough to know that people are laughing at you but not be able to say anything, and the whole time, they think that you have no clue. They do try to teach us new Fijian words, which I really appreciate, because I am always trying to add to my vocabulary, but even this can be frustrating. Sometimes it feels like they think we’re really dumb, like when they were telling us the words for “hello” and “thank you” after I had already been using full sentences and asking how to say “he’s in the house” (prepositions are hard in every language!). It’s been fun learning more about the culture and food, and their generosity is amazing, but I’m also really missing our privacy and am getting tired of being laughed at.

Luckily, we are getting a short break. They worked on the house for a week and a half, and they are now spending a week in Labasa for a conference for Jehovah’s Witnesses. If current progress on the house is an indicator, we can expect them to stay for three or four more weeks when they come back.