Today I joined 15 other Eden Reforestation and Sarobidy Maternity Center employees to walk across the road to the Eden test nursery. I have been there many times before- to meet the ladies as they pack bags with soil ready to be planted, to watch the trees grow, to see the trees be loaded on trucks for planting, and to bring the kids to fish in the little pond. On the property is a home where a long-time Eden employee lives with his family. He is the caretaker of the property. I visited his home once before to do a routine follow-up house call on one of his daughters and her baby. She was the first mama to give birth at our maternity center.
Today I visited for a much different reason. I came with the group to formally express my condolences and to present a gift of money to the family. This money will help with the funeral costs of burying one his daughters and his grandchild. His daughter was a mother of 4 children. Her fifth child never took a breath. They died in childbirth. This daughter lived on the outskirts of town and because of the distance she did not attend the Sarobidy Maternity Center for her care. As is almost always the case here in Madagascar, the family was never told exactly what happened and why their loved one died and therefore the reason for her death is speculation only.
While the eldest in our group was giving the presentation to the family, as is the custom here, my mind was racing. In this country moms die all the time in childbirth. I know the statistics and she has contributed to the incomprehensible and inexcusable maternal mortality rates in Madagascar. But knowing the statistics and seeing the devastation with your own eyes is a whole different ball game. I KNOW this family. They are NOT statistics.
This past month I have been discouraged and frustrated at times with the clinic staff. I have realized that we have to teach them so much more than just medicine. We need to teach them how to think critically. It is one thing to gather information- vital signs, a history, physical findings, lab tests- but if you don’t understand WHY you are doing these things and WHAT to do if things aren’t normal, there is no point in doing any of it. How do you teach people to THINK and not just memorize a list of things to do and boxes to fill in? Having a perfectly filled out chart will not prevent a death, it’s what you do with the information that you have gathered that will change the outcome for the mother and baby. This has been such a difficult concept to teach and is absolutely foundational to providing effective medical care. At times I have literally beat my head against the wall and thought is it even worth it? And then I walk across the dirt road and stand in the home of a grieving family and I am no longer dealing with statistics. Instead, I see the faces of the real people who are affected by the lack of quality maternity care in Madagascar. This is a problem that absolutely must be solved. The alternative is ongoing suffering of women, children and families who are REAL ACTUAL PEOPLE. This just cannot keep happening.
So as I left his home I had new resolution and determination. This is not an easy thing, to provide compassionate and safe maternity care for all moms in Mahajunga. But this is something that absolutely must happen. In my life time. In your life time.
We are preparing to leave next month and I am wrestling with the massively difficult question of what next? What is my role? Where do I go from here? While the future is still unknown what I can tell you for certain is that these deaths just can’t keep happening. We need to have many more Sarobidy maternity centers around the city so that more moms can be seen and cared for. We need to keep mentoring midwives and training them how to not just gather data but how to then use the information to help their patients.
I am so incredibly grateful for Alissa Shattenberg and Danielle Carlstrom, two brave women who have committed to living here and serving these woman long term. I am also so honoured to work with Rota, our Malagasy midwife leader and champion. She understands and has really started to gain confidence in teaching our new midwives and mentoring them in how to critically think. Shortly after I leave a very experienced midwife from Belgium will also be joining the team here long term. I see this excellent team forming and developing, a team of woman who can make safe maternity care a reality for all woman in Mahajunga. I am so honoured that I have been able to be a part of this and hope to be for many years to come.