Cassoumay Birth Center and a note on Dirty Laundry

Trip Start Jan 15, 2014
Trip End Mar 15, 2014

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Flag of Senegal  , Ziguinchor,
Sunday, February 2, 2014

I was pleasantly suprised by a call from Oumina that there was a woman birthing at the center, and me and Safi should come on over. Oumina is the matron (also known as a TBA- traditional birth attendant by the international birth community) in charge at the new birth center in Kabar where I am hoping to spend some time. She is a newly trained matron herself, and along with another, more experienced matron named Sally, she serves the women of her community. She was trained by midwives at the hospital in Kafountine, and also works some shifts there doing prenatals and taking call for births. Safi is an english speaking nurse from Gambia that was originally hired by Mother Health International to work at the clinic and engage the local matrons and mothers in classes and skill shares. She has worked several years as a nurse in labor and delivery in Gambia, and is great to have around for her english skills. She also lives at Mame Diarra's house and with communication at home as well. Unfortunately, as Mother Health International does not seem to have the funds to support this birth center, she will not be working here for much longer. The local health official has also ordered that all classes be stopped until proper paperwork has been completed. I do not have a good understanding of why, but perhaps classes will eventually resume provided there is someone here to give them in Safi's absence. Anyway, on to the birth. Safi and I caught rides on the motorbike taxis, and made it to the clinic in good time (10 minutes or so). We arrived to a healthy mom and baby in the postpartum room. Apparently the birth was very quick, and everyone did great. We hung out there for a while as members of the community visited. It was a very social event, and I couldn't help feeling sorry for the mom who wasn't getting much rest, and the baby who was dealing with all the commotion. Mom was encouraged to nurse baby, and orders were made to bring her food and hot tea. A woman arrived with a big cup of super strong coffee. This was received with some eye rolls, but hot coffee is better than hot nothing so she drank it. I guess she is used to it since she drank it all and didn't seem to be affected. Meanwhile Sally was preparing tea from a tree that helps with afterbirth pains, and bringing the milk in. They seemed to feel that her milk/colostrum would not flow until she had hot fluids. This is a common theme in cultures around the world, that women should only have hot foods and drinks and never cold, after birth. We stayed for a couple hours. Oumina, who lives next door, went home and made us lunch. We share a typical meal of a large platter of rice topped with fish, onions, and some optional palm oil. Palm oil is saffron colored and has a strong flavor. I don't really like it but can see how one could develop a taste for it. People here eat really well. Because it is a fishing village, fish is cheap, and everyone gets plenty of high quality protein. White rice is calorie rich, and fruit is always in season. There is not a lot of trouble with anemia, parasites, and low birth weight babies that other areas in Africa are dealing with. Birth goes well here, the trouble comes when there is a more rare complication, as there is no access to emergency type care, or surgical delivery. After lunch we said our goodbyes to return in the morning to discharge the mother in baby. All women stay the night at the clinic with one or two matrons. This woman had delivered early in the day and was doing well but would stay the night. When I questioned this policy the answer was that Oumina had previously released a woman on the same day as the birth and everyone complained that she either should have stayed, or they themselves had been made to spend a night so why didn't she. It was essentially, a social issue, not a medical one. When we returned in the morning, we did more sitting, talking, and visiting with women stopping by. Life is very social here, and there is a lot of time for hanging out. Though I couldn't understand anything that was being said, conversations were very intense, lively, and full of laughter. The mother and baby were discharged with a mere taking of the temperature. I'm sure the process would have been more involved if there had been any concerns, but I never saw a newborn exam, or the mothers fundus or bleeding checked. I was happy to hear that a new mother is pretty much exempt from all work for at least six months. If there is ample help around the house then she may not cook for a whole year. Life is set up for this as most homes have several women living there, and some men have more than one wife. I am told by Sally that there are several women due soon, so hopefully I make the next birth!  Though I would like to observe more before making contributions, I can tell that I could make suggestions on protocols and demonstrate a different style of midwifery. I look forward to working in the hospital as well, observing at first, and potentially spending the night there on call if I wish. We'll see, I'll keep you posted! 

A note on Dirty Laundry-
I have had a lot of feedback from my posts here and on Instagram that it looks so "amazing" here and we are in true "paradise". Just wanted to drop a bit of reality, as things are not always so easy. When we arrived, we all but Chris got pretty sick. This involved the typical gastrointestinal upset and vomiting. I definitely underestimated the difficulty of traveling with Samson, who is dealing with incontinence. When the runs came along, the poor kid did not stand a chance. So for a solid week I was doing a lot of laundry, and doing it by hand. Poppy laundry by hand is not very much fun. Every night there were very messy accidents and every morning sheets had to be washed, plus the towel we rolled him up in. Then there was underwear and pants all day long. This was all on top of Franklin's normal diaper load, which is pretty modest. Things have settled down, we were able to find some big sized disposable diapers for overnight, and have had some on and off success with bowel control. I find myself questioning the surgery, and wonder if life would be easier for him if we hadn't done it. There is not hot water so in the night I have to wash him with cold water and he doesn't like it. He is getting used to it though, and does not complain much anymore or ask for wipes. Hirschsprung's disease is a tricky one. Because he is normal and healthy in every other way, I often feel worried that others think I simply didn't bother to potty train him, or that he is pooping in his pants for behavioral reasons. Anyway, things have gotten a little better, and I have gotten help with laundry! 
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Mom on

Now things are getting interesting. Wonder if the hospital births use a little more of our routine with checks for fundus, bleeding, baby apparently etc.....not that this is the only way :-). Sorry to hear about your laundry problems etc. Hopefully as Samson gets older he can control a little better. Don't second guess the surgery, I don't think his condition gave you a choice. Maybe a follow up with the doctors after you return. Keep writing, I love reading your posts.

Sam Rotondi on

Sounds like you getting closer to the purpose of your visit. Too bad about the clinic closing. How far is the Hospital? I think Samson is better off with the surgery since his prior condition was much worse, though I thought surgery would solve all problems. Love, Dad

avrotondi on

The clinic is not closing! Just getting going, it's just the Safi will not be there. The hospital is right in Kafountine, a few blocks from our house.

Jim Vandegrift on

Hey Annie...really enjoying reading your blog and seeing the photos of where you are. I was sorry that when I was traveling that I went north up through the Sahara when I hit souther Sahara, rather than heading south toward Dakar, but feel I am getting a great peek at that area of Africa through your travels. Keep it up and good luck with everything.

KerriHolden on

Beautiful birthing center... so happy you get to be involved...
so sorry about all the extra work and hardship for you all and especially Sampson ...Must be frustrating for him..
Take care

Lauren on

So very proud of my sister!!!!!

Theresa on

Oh Annie,
You are so very sweet to not let us believe its all beautiful sunsets and beaches as we sit here in the frozen cold.
You are an amazing, adventurous, and adorable little family.
Thanks for the stories and pictures, you are an incredible mom.
I need to remind myself of washing poopie babies with cold water at night when my baby wakes me up to nurse three times tonight!

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