Saturday, September 30, 2006

My first birth

Sydney Opera House, Sydney, Australia.
March 28, 2004

On Thursday I witnessed a birth for my first time. Our visiting medical student, soon-to-be Doctor Charlie has done Caesarian Sections (emergency and scheduled) and assisted with natural births but had yet to deliver a baby naturally herself. (Charlie is specializing in obstetrics and gynecology.) When her chance suddenly arose I rushed along with her to the Liberian Government Hospital to witness the miracle of birth for myself.

When we arrived the 17-year-old prima gravida* mother was 8cm dilated and incredibly noisy. Whenever she wasn't emitting a pure piercing yell she was demanding an operation (she meant a Caesarian) and for someone called 'Jasmine' to 'come to my rescue'.

Charlie quickly took charge but was expecting to learn from the midwives. They were marvelous - guiding but respecting Charlie as she learned the routine procedures. From time to time Charlie or the midwives would refer to the clock or to hand-drawn circles of different diameters on the wall. (It was all too technical for me.) Their style with the Mom was a bit rougher than I expect we have in the west - slapping her when she didn't hold her ankles properly or for any other infringement.

(The Liberian Government Hospital's obstetrics ward has about 12 beds which often have to hold two women and one or two babies each, a nursery with five cots and two incubators - awaiting proper wiring - and a room with two delivery beds. We deliver an average of about twenty babies a month. A large proportion of those are complicated cases because ordinary births can be done at our nearby 'Well Baby' clinic - or, very frequently - at home.)

The midwives tickled the woman's (huge) belly to provoke contractions - which in turn provoked the intense screams, which made me wonder whether Merlin should install sound absorption materials. I tried to pretend to be useful by stroking the mother's head - she didn't pay me the slightest bit of attention. Finally the baby's tiny head emerged. Charlie seemed to yank it around terribly roughly but she knows what she's doing. The head took about a minute of manipulation and then Charlie pulled the rest out easily. It was a baby girl - incredibly tiny but way way more beautiful than I'd ever imagined. (I thought babies were just slimy little animals until this. Maybe that stage starts after a day or two.)

She was a kind of grey-blue colour. I've learned that African babies turn black only a bit later on. The first thing Charlie did once the baby was out was to suction goop out of it's mouth and nose. I was incredibly nervous until it started crying. Then she clamped the cord in two places and snipped it off - leaving about 10cm on the baby. Then I think they washed it and weighed it and stuff like that - I was watching the mom who'd gone catatonic and therefore thankfully quiet.

They wrapped up the baby and showed it to the Mom who just stared without expression. (Later my sister Ruphine told me that when that happens you refer to the history and form certain suspicions. but maybe the Mom was just in shock.) Anyway when we went out into the main OB ward and told the family they started to dance with joy and then I realized that I'd really seen the growth of a family.

I think I'd like to see another birth but I'll never forget this one. I was honoured that I witnessed Doctor Charlie's first complete personal delivery. And I was pleased that the Mom finally stopped her ghastly screaming. It is truly the miracle of birth but I'm so glad I had a vasectomy.

Tuesday, September 19, 2006

Olga's Cat

Sydney Aquarium, Sydney, Australia.
March 29, 2004

Several years ago I vowed to try writing some short stories. Several years later I've only the following to show for myself. (It also sits, horribly formatted, here.)

Olga's Cat
©2001, Tom Haythornthwaite

In January, 1958, Olga Khmelnytsky had been an energetic journalist for Pravda. She normally worked the East Berlin beat but suddenly she was dispatched far to the east of her native Ukraine, to the Baikonur Cosmodrome in central Kazakhstan. She noted as she rode the frozen Moscow - Tashkent line that the special train was heading hundreds of kilometres from the actual town of Baikonur. This she put to Soviet secrecy, and gave it little further attention. She knew not to refer to the fact in her stories.

Andrei led Frank up the stairs to Valentina's apartment in the eastern suburbs of Kiev. Valentina worked for Andrei but was away and had allowed Frank to crash there. Valentina shared her apartment with Olga, an elderly woman. Frank would be living with Olga for two weeks. This was in 1996, and Olga now spent her days washing and cooking for Valentina in return for reduced rent, reading the poetry of Taras Shevchenko, and trying to share vodka with her cat. The cat kept sniffing and withdrawing from the chipped 'Brandenburg Gate' coffee mug she offered, so Olga would drink the vodka herself. Frank had come to visit Andrei because when business had brought them together the year before, Andrei had said that Ottawa was pretty but Kiev was more beautiful.

If things had occurred differently in that Cold War winter, Frank would never have met old Olga, so many lonely years later, because she would have become quite famous. But this was the way it was and over the next few days Frank observed that she drank more vodka than he would ever have believed possible. Each day, when he returned from photographing Kiev, she would greet him with her handful of English words - 'Darling', 'Vodka', 'Poetry'. He would sip vodka with her and she would urge him to read her Shevchenko from an English translation she treasured. Sometimes she would also read along in Ukrainian, and once he was fairly sure (he found he could recognize a lot of spoken Ukrainian vocabulary because of its similarity to French) that they weren't on the same poem.

Frank's Ukrainian was worse than Olga's English. And even worse than he thought, because although he had learned a few polite words which he would use around Andrei and his friends, after a few days Andrei took him aside and said "Words you use - you are very kind to try to learn - but these are Russian words. Ukrainians now proud of Ukrainian history, Ukrainian literature, Ukrainian language." When he was a schoolboy in Kiev, Ukrainian had been banned. Schools only taught Russian, and Andrei and his twin brother were teased by their mother about not being able to speak good Ukrainian until they were twenty. Now Kiev was bilingual. Pairs of Cyrillic signs on the Metro doors looked almost the same to Frank, but Andrei pointed out which characters were not shared in the two languages.

Olga had grown up before Stalin's suppression of Ukrainian culture. She was fluent in Ukrainian, Russian, and German. Part of the reason she was sent to Baikonur in 1958 had been so she could immediately report the lift-off in those languages. But the Politburo had another motive in mind - out of a mixture of kindness and propaganda, they pulled her from Berlin because of the identity of the cosmonaut on top of the Vostok rocket: Sergey Shaborin, her husband.

A week after Frank arrived in Kiev, Valentina returned unexpectedly. She had been on vacation, buying canned goods in Moldavia to sell outside the Kiev Metro stations. Through some urgent telephone translations via Andrei, she told Frank he must still stay in her apartment, and would sleep on a folding camp bed. Now the apartment was even more crowded. Olga and her cat occupied one tiny room, Valentina and Frank the other, and when they were peeling potatoes in the kitchen there was hardly room for the cat to spin itself around. But they would play the radio and laugh at the difficulties Frank had with the language. There were many phone calls to Andrei but they managed quite well with sign language.

Valentina did not return straight to work. The next day she took Frank to the hydropark on an island in the Dnepr River. Along with hundreds of others, they swam in one of the world's most polluted rivers - scarcely a hundred kilometres downstream from Chornobyl. Andrei had explained that Valentina would love Frank to photograph her. She posed on the beach, hooking her sunglasses through the string of her thong. Then she lead him across the island, past the bodybuilders working machines made from tank parts, to a quieter beach. They met a boy with a tethered hawk, and she posed for more photographs. Andrei had said that it was Valantina's dream to be a model instead of a programmer.

That night, after some vodka, Frank signed that he wanted to sleep with Valentina. Olga grinned and nodded vigorously. Valentina looked doubtful and opened up the camp bed, but before she turned out the light she beckoned him into her single bed. She would jerk away from even the gentlest touch of his tongue, but then grab his hair and pull his head back into her. The next day she prepared him and Andrei a feast of lobster.

Olga had arrived at the Cosmodrome and met the other journalists. She would only have one hour with Sergey before he went into isolation; and they hadn't been together for three months. They held each other tightly, but could not say what they really felt because of the others around them. They spoke only in Russian. She wished her Comrade good luck. The rest isn't history, because she never reported from Baikonur. Sergey's rocket blasted off four days later, reached an altitude of about seven hundred metres, and then fell back to earth. Smoke still rose from the wreckage in the snow when the journalists were told that there would be no reports of the fate, crew or existence of the mission. In April, after she and the world learned of Gagarin's success, she tried to meet Valentina Goryacheva, his wife, but it was not approved.

Olga lives on her pension from Pravda. She had donated Sergey's pension to an orphanage. She let her party membership lapse but had kept reporting from Berlin. Eventually, when she retired back to Kiev she was put at the top of the waiting list for a two-bedroom apartment, where she lived in relative luxury for 25 more years until a friend asked if she would share with Valentina. She found the cat at the food distribution centre where she bought her vodka. She found solace in Shevchenko.

Sunday, September 17, 2006

More on the execution

Indian Pacific Railway, New South Wales, Australia.
March 27, 2004

We have learned the following about the troublesome death penalty case from a valuable source at the United Nations:

1. The guilty man is one Emmanuel Kpah, found guilty of murder. He has been in pretrial detention since January 2005.

2. On September 7, 2006 Mr. Kpah was sentenced to the death penalty, by public hanging, scheduled for September 29, 2006.

3. Liberia DOES still have the death sentence in the Constitution. However, on September 16, 2005 Liberia signed an "International Covenant of Civil and political Rights aiming at the Abolition of the death penalty."

4. An appeal is in progress and the supreme court will most likely be changing the ruling to life in prison.

5. A death warrant would have to be signed by the president to be carried out.

6. 1978 was the last time the death sentence was carried out in liberia.

Thanks very much to the friends who have written in with advice and encouragement.

Wednesday, September 13, 2006

Liberian execution?

Child at Well Baby Clinic, Buchanan, Liberia.
September 13, 2006

There's great confusion about this possible public execution penalty issue - Liberia supposedly abolished the death penalty in August 2005 but then, in December, passed a rape law that prescribed the death penalty. This was then altered to life imprisonment but the lack of commitment to the abolition is very disconcerting.

Various sources are giving various 'facts' so first of all we have to find out if there really is a plan to execute.

We (MSF-Holland) and I have contacted our HQ with varying levels of success. We've communicated with Amnesty International but have had no response yet.

Thanks to those readers who have sent in advice.

I hope to post good news here soon.

Sunday, September 10, 2006

Capital punishment

Danielle, Richland WA, 2002

A little while ago I began an atomically small bit of activism when I complained to the Mayor of London about a street performer I thought could be dangerously influencing children. Not much became of that but now I have a much bigger thing to worry about: we learned yesterday that the Liberian Government intends to perform a public execution of a convicted murderer here in Buchanan on September 29. Here's a brief media reference about it.

Capital punishment is more objectionable to me than the crimes of the murderers being executed. I'm not as eloquent about it as many more important and heroic people but I think I might be about to get vocal. I won't be quiet on this but I don't know what I can do while representing Merlin. Or will working for Merlin give me a useful voice?

We're also wondering security issues - will there be any social unrest that could mean 'business' for the hospital? - or conversely, might there be risks that would require us to get out of Grand Bassa County? Part of me wants to be far away when it happens and another part wants to fight it.

I'm seeking advice and direction from Merlin but I'd also like to hear from anyone reading this.

Tuesday, September 5, 2006

Kidney Stones are no fun at all

May, Thailand, March 2005

SO MUCH has happened since my last entry. The gist of it is - I had three episodes of absolutely agonizing pains in early August (following a day of bloody urine) and on August 12th it turned even nastier. Dr. Simon was away in Monrovia and very helpful by phone but I also called in my friends from Medecins sans frontieres. Before long I was on a (wonderful) morphine derivative and feeling a little bit better. I am very very lucky to have had such concerned, caring and skillful help, particularly from Emmanuel, Dr. Jochan, Dr. Brown, Brian, Anna, and Anna.

Dr. Jochan from MSF took really marvelous care of me. The initial diagnoses were appendicitis or kidney stones but my symptoms were not classic for either. There was a LOT of consultation between Dr. Jochan, Dr. Brown (of the Liberian Government Hospital) and Merlin Doctors Simon and Julius (and my boss Jen) in Monrovia - and even our London office. Dr. Brown brought an ultrasound viewer and although we learned a bit I kept needing that (wonderful) morphine and it was soon decided that I had to be evacuated to Monrovia as quickly as possible.

Anna (left) and Anna (right) from MSF-Holland took great care of me, as did Dr. Jochan (in the car, adjusting my (wonderful) morphine IV).

'Quickly' meant a UN helicopter so to get that approved I was taken to the UNMIL (UN Mission in Liberia) hospital where I was examined by my third and fourth doctors of the day. They quickly approved the chopper flight - and I'm very grateful for that - but the typical Liberian rain was reducing visibility too much. Instead I was placed on a mattress on the floor of a Merlin LandCruiser and after a few false starts (due to the on-off-on-off possibility of a chopper flight after all) Dr. Jochan and I rode to Monrovia.

On the way I was looking up out the windows and sometimes could only see blue sky... Liberian weather is very changeable. On the way we stopped to meet MSF's Dr. Aileen on her way to the airport and a new life - so she became my fifth doctor of the day although basically she only teased me. I was taken straight to the St. Joseph Catholic Hospital in Monrovia where Merlin Doctors Simon, Julius and even Alex (who is normally based far away in Harper) examined me, along with a Liberian doctor. (This brought my doctor count to nine for the day.)

My colleagues described the Liberian as a 'Journeyman' doctor - I think because he wanted to scoop out my appendix first and ask questions later. Dr. Julius was his normal diplomatic self and kept me from going under the knife. I had more pain that night and still needed very strong analgesics.

I was admitted into hospital for the first time in my life. From the next morning on I didn't need any more pain killers - only boredom killers. Thank goodness my friends and colleagues visited but I didn't really need the hospital counselor who told me so many times not to worry that I began to worry quite seriously. I stayed two nights, hardly seeing any hospital staff except nurses who would visit with their successors at shift changes, who I would then not see until their shift ended...

When I was finally released - feeling as fit as a fiddle - I had another night in Monrovia and then was told I had to go to London for further investigation! The doctors (by now I'd had another Liberian, making ten in all) could not confirm that I'd had kidney stones and Merlin's insurance company preferred to fly me to London for tests and treatment than perhaps to have to fly me out urgently in their private jet later on.

At this point I'll emphasize that I've had no discomfort since my first night in the hospital but I've just come back from ten rather fun, rather relaxing, rather stimulating and very very very expensive (but for the insurance company, not me) days of consultations and investigations and treatments. I met friends and ate out and saw four movies and the hardest part was not feeling guilty about a) not working and b) 3.5 million Liberians who could certainly not have had any of the care I received. (If they'd had what I felt, but out in the jungle, they'd probably be pleading for death the way I would have if MSF hadn't been there to help me.)

To finish up the story a (£1000+) CT scan revealed a 2mm kidney stone in my LEFT site (my pain had been on my right). If I understand the medicine correctly, this gave strength to the unconfirmed theory that my pain had in fact been due to the passing of a kidney stone. Stones up to 4mm are supposed to be able to pass without help - but not painlessly. I had (£2,600) lythotripsy treatment to pulverize it and I'm now trying to drink lots of water every day to prevent this ever happening again. (But I'd accept being flown back for a check-up...)

One very last thing: I'm planning a dinner to thank as many of the people as possible who helped me. And - oh - I haven't been running in a month...