August 2009

Endulen Diary
Vol. 24, #8
August, 2009

This edition of Endulen Diary and other issues of the Diary with pictures are on the web at:

Florian Schneider, a medical student and close colaborator of the Spiritans both in Ethiopia and Tanzania shares his thoughts with us.

After I have been writing about revisiting Nengai’s family last year – Nengai, the girl suffering from upper cleft pallet – I’m going to tell you this year some stories of my work with the traditional birth attendants.

Being a male medical student from Germany won’t make it easy – I thought before returning to Endulen Hospital this year again for nearly five weeks. During my stay last year I was interviewing many hospital workers, many people living around the hospital and many elders in the villages, what they think of Endulen Hospital and what they think shall be improved. One of the first things everybody mentioned was the protection of pregnant mothers and newborn children, since all of them had the feeling there is hardly anything done for them. So our small non-profit organization in Germany set the aim to support them in the future as best as we can. Dr. Yadira, a Dutch doctor, who is working at the hospital since nearly two years now, started a small working group called “Safe Motherhood”, which started already a small progress to set more attention to pregnant mothers and newborn children. In my last four weeks here at Endulen Hospital we were working closely together to really push that project. We are renovating the second labour room, in case that there are two emergency deliveries. We are buying new furniture for a maternity room, which is only for pregnant mothers and newborn children. We establish plans and look for sponsors to start building a new maternity ward next year. And we interview a lot of Traditional Birth Attendants to get a slight idea, which traditional practices they use at home and what they think a new maternity ward should look like.

It is seen as a great problem in the Maasai community that pregnant mothers are not coming for regular check-up examinations or even for delivery to the hospital. As they deliver in an unsterile environment without medical support, complications can easily occur during delivery. As staying without medicine, which could help the mother or the babies, early intervention of some of the great diseases fails. They usually do deliver their babies at home in their familiar environment with the help of local midwives, the Traditional Birth Attendants. At least one of them is living in each Boma to support the pregnant mothers during pregnancy and during the delivery. They have a great responsibility since the future of their tribe lies in their hands.

This week I was very excited to go with a translator/social worker of the hospital by motorbike for two days to three different villages to interview some of the Traditional Birth Attendants in their homes. After asking the elders for permission, we sat down under a tree on the soil and started talking about anything concerning birth. I can prove anyone wrong, who might think, that there are issues they would never dare to talk about. I asked about the situation of the women in their societies nowadays, about the state of pregnancy, about the delivery and about the years after the delivery – and of course about sex and family planning, since there are so many rumours about it. It has been an amazing experience, just to be received as a complete stranger and to be able to ask question about such intimate details about them and about their culture.

On Thursday Dr. Yadira and I invited them to come to the hospital for a knowledge-sharing workshop. I wasn’t sure at all, if anybody would follow that invitation. You can imagine how surprised I was, when around 45 Traditional Birth Attendants came to talk about their life and their job in the Bomas. It started of with some Maasai prayers and songs. Maasai patients waiting outside the conference hall and workers of Endulen Hospital were startled to hear such tunes here, since it’s not common. Looking at their faces, listening to their voices, hearing the prayers and seeing the number of traditional birth attendants really moved me.

We talked about their rituals during delivery to get a slight impression: One TBA is usually standing behind the pregnant woman during delivery in order to hold her tight. Another TBA is lying on the feet of the pregnant woman to catch the baby. If the delivery was successful the TBA holds the baby in her hand and returns it to the mother. The mother pretends to cut the umbilical cord three times with a knife while saying “Go with your heart, leave me mine!” before returning the baby to the TBA. After the TBA separates the connection between the mother and the baby with a small thread, she cuts it with a razor blade with a cow skin as underlay. The TBA puts some saliva and ashes on a piece of cloth and covers the umbilical cord. The baby is hit four times with a leather belt and is lift around the main pole four times. The placenta is kept during daytime under the delivery bed and buried at night in the cow enclosure. After that ashes and water are put into black clothes held in the right hand of the mother she spits this mixture in four directions while pushing the roof of her house with her back and calling all the women. After that the baby is breastfed by the mother. Both of them are washed and creamed with fat. Sometimes they make a necklace for the baby, putting sugar, salt and ashes in separate compartments of a black cloth. The following day there will be a big feast honoring the occasion. The traditional birth attendant receives the fat of a sheep and the tail of a sheep as a present.

We were agreeing on working together in the hospital and to include the traditional birth attendants in the hospital delivery procedure. Since the meeting was so open, we are additionally quite optimistic to include some of their traditional rituals in the deliveries to be able to have safe deliveries at the hospital, to be able to have healthy mothers and babies and to be able to fulfill our part for the future of the Maasai.

Till next month,

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