14. An ebb tide

14. An Ebb Tide

10th November 2013

“A rising tide lifts all the boats”. A cheerily positive proverb, with something of an undiscerning optimism. Unseen and unintended benefits accrue when a big enough boost is given to the system.

I had been glibly thinking that my visit to Berega might have been something of a rising tide. Plenty of improvements occurred, many unlooked for. I had never expected, for instance, to see a charter of standards emerge; nor a 30-minute maximum delay for caesareans; nor a plan for collaborative community development; nor a wonderful hat-knitting frenzy causing fleeces to be topping the Futures Market in Wall Street. Besides the unexpected benefits, there were the expected ones: the AMOs got better at caesareans; the midwives got better at resuscitating babies; and the Tim Henman of the culinary arts got better at soaking stony-hard yellow things mixed with grit overnight before creating intestins douloureux des ragoût de haricots jaunes – best served with anything edible.

The ‘rising tide’ axiom has something of a disquieting history, however. It was first used by a Republican politician to reassure the Senate that the vast sum he was suggesting that they sink into a water project, on land coincidentally owned by his family's associates, would produce ripples of benefit spreading out across the country. Maggie Thatcher, the Iron Lady, later made the philosophy her own, (and I may have misunderstood this slightly, coming, as I do, from a somewhat biased and antipathetic position towards the greedier of the multinationals); anyway she believed that if you made extremely rich people inexpressibly more wealthy, then they would spend some of the extra money on buying more peasants. (Please let me know if I haven’t quite captured the soul of monetarism there.)

What none of us realised as Maggie lifted our boats above the muddy banks of inflation, was that tides turn. A rising tide is followed by an ebb tide. (The moon, it turns out, is the culprit. It bestows its silver seemingly unstintingly, but all the time has been trying to steal our water.  Hats off to Isaac Newton, by the way. What sort of brain do you have to have, which when awoken abruptly from a summer slumber by an apple on the head, unleashes the following train of thought:

-          What attracted that apple to my head?

-          It was surely my head itself?

-          What if my head attracts all things, not just solids, but liquids too?

-          Let me check it out with this glass of beer…

-          Gadzooks! It is true!

-          But the man in the moon’s head is immeasurably bigger than mine…

-          What if he is trying to drink our seas? … etc)

 A rising tide does indeed lift all the boats, and gives each a few precious hours of possibility. Each newly envigorated boat needs a crew, and a purpose, and a sea-worthiness, if it is not to be found later floundering on the rocks. Choose which of the boats are most important to you, and when the tide goes out, let them be ready. Unfortunately for five women of Berega and its surrounding villages, if my visit was a rising tide, then its ebb has left their families and children mourning the loss of a mother, a wife, a daughter. Five mothers have died in childbirth since I came back nearly three months ago, and it is difficult to know which of their stories was the most harrowing. I think probably Mpendwa’s story troubled me most, and it has left the hospital in shock. Mpendwa lived in a village forty kilometres from the hospital, and with the November rains on the way, she chose to come and stay in the ‘waiting mothers’ house, rather than risk being left in obstructed labour on the wrong side of a torrent. And so she waited with the other mothers and the relatives – plaiting hair in the afternoon sun after finishing the fetching and fire-lighting and carrying and washing and cooking and cleaning. Giggles and girlish gossip, whilst trying not to think too much about the family left at home to fend for themselves until she returns with the new baby.

Obstructed labour was what indeed happened. After a month of patient waiting, Mpendwa went into labour, made no progress, and was taken for the caesarean that should have saved her life. The baby came out and cried lustily. Then suddenly, a rare complication of the anaesthetic, and the team, with their primeval equipment and under-developed responsiveness to crises, did too little, too late. Her heart stopped beating. She never saw her baby.

The reason that this was the most heart-rending of the five deaths was the effect that such a death has on the other mothers. No-one will look on Mpendwa’s death as being what anyway would have happened had she stayed at home. She would indeed have died at home, just as one or two do every week in Berega’s territory. But she came, for a month, to the place, the haven, where we all hope that women might expect life and health. Despite the fact that every successful caesarean at Berega means two lives saved, and that the huge majority of women do indeed survive the caesarean, the death of Mpendwa sent out the message: “Here be danger! Stay at home!”

And stay at home is exactly what one other young mother did. She could see the hospital perimeter fence from the hut in which the Traditional Birth Attendant struggled to stop the bleeding after her childbirth. By degrees, she gradually realised that her life was ebbing away, and that she must say goodbye to the child that would never know her. By the time she arrived at the hospital gates she was minutes from death, and heroic effort could not save her.

Three other deaths; three other tragic tales.

By contrast, when another rising tide washed up Berega’s inlets, many lives were saved. Grace Parr, a Canadian resident, was perplexed on her first day of a volunteer stint in Africa, to find a relatively empty maternity ward. She needn’t have worried. Each of the next seven days brought a new eclamptic patient – having seizures due to high blood pressure. Untreated, the condition is fatal for mother and baby. Grace stayed by many a bed that week, nurturing and nursing, and all seven mothers and five of their babies went home healthy.

Meanwhile, Sion Williams has now worked tirelessly for six months with barely a day off, for no pay, and countless families have had their loved ones returned to them intact. His love sends out an even more powerful message than his medicine. David Curnock, a retired paediatrician from England goes out annually for two months with his wife Anne, and each visit finds a few more boats afloat.

What can we learn, then? Berega, and the quarter of a million population in its remote mountain villages, need a rising tide.  Not just a trickle, but a tide, and one which to last long enough to train the crew, to clarify the purpose, to make the boats seaworthy.

Then the ebb tide becomes just another opportunity.