Warning. This one is sad, and the photos aren't in the right order. sorry.
I first heard mention of Mary when I had just arrived here
at FreMO. She had attended for antenatal care, but when the time came to birth,
she either couldn’t make it to FreMo, or she decided that she couldn’t afford
our fee of 4800KSH and went somewhere closer, and cheaper.
Now here’s the thing. They were talking about her because it
turned out that Mary was carrying twins. She went to this other medical centre
where she was put in a room, and promptly left alone. This isn’t her first
labour, she has a 4 year old ‘senior child’, so it didn’t take long for a baby
to be born. She didn’t get any help from the staff at this centre. When the
first baby came, she called out for help, and everyone was surprised to find
that another one was on the way!!! Twins, now that certainly complicated things
for Mary.
Welcome to Angela and Cecile! Hold onto your hats, because
here is the clanger. The other medical centre charged Mary DOUBLE fees because
there were two babies. Never mind that they didn’t do anything for the first
one! But wait, there is more. They sent her home within the hour. Can you
imagine? Both of the girls weighed around 3000gms so I guess they figured
everything would be alright.
Mary and the girls the first time I met her. |
Well it wasn’t. Vicki was still here at the time so they
went to Mary’s place to do a postnatal check when they heard that Mary had
delivered. Bless Mary but the twins weren’t doing so well and Vicki had
concerns about their weight, justly so. Mary came back to FreMo for a postnatal
check after Vicki left, but for some reason, the twins weren’t weighed.
This is where I come in. Vicki left me a parting message
that she was concerned about the twins and thought that they needed further
follow up. It wasn’t until a Friday afternoon that we managed to visit Mary to
check on everyone. One look at the girls and I was concerned. They were pale
with dark circles around their eyes. Their fontanelles were sunken. Their lips
and mouths were dry. They were drowsy and didn’t really move much when I
undressed them to weigh them naked. I asked how often they were being fed, and
mum said she woke them twice a day. I don’t know how long it had been since
they had a decent feed. We weighed them and they were 2800gms and 2900gms. I
thought that was ok, but later I found out that there is a known discrepancy
with the scale of around 300gms. I didn’t know that at the time, being the new
kid on the block. And I didn’t want to be the one to walk into a new work
environment and be all bossy. I was still learning how things worked.
Your's truly weighing the girls. |
The postnatal check was performed partly in English and
partly in Swahili and I wasn’t party to all the information. We tried to get
the girls onto the breast. One was better than the other, and Mary confessed
she didn’t know how to feed them simultaneously. As she fed one, I weighed the
other, and while it was vaguely awake, we put it to the other breast. I took a
photo of Mary, in her house, breastfeeding both her twins together for the
first time. She looks happy! We took our leave but there was no real plan in
place to do anything further apart from telling mum to wake them and feed them
more often!
The scales on the floor to have it even. |
Once we were around the corner I spoke up. I voiced my
concerns for those two babies, and so did magdalen. I think she was waiting for
me to take the lead, but I’m not sure why that was? We decided to leave Mary
with a bottle of clean water that I had in my pack and instruct her to give
each baby a capful every half hour, hoping that we could slowly rehydrate them
to the point they might wake up and get hungry!
The sleep over night when we intensively fed the girls |
On our return to FreMo we spoke to the boss. We voiced our
concerns about the twins. I knew their condition was extremely poor. I still
hadn’t figured out the true weight loss. Moffat, who is not a clinician but an
administrator with a lot of experience and knowledge, put it back onto us. He
asked us what we wanted to do. I thought about it and said that in a hospital
situation, the babies would be admitted for observation and rehydration, either
IV or NG tube or both. He just said do it. Bless you Moff.
Syringe feeding |
We called Mary and explained what we wanted to do and
invited her to come in. She did. She was there by the end of the afternoon and
we settled her into our postnatal room. We started with oral 10% glucose and I
syringe fed them small amounts as they could tolerate to give them an initial
boost. We syringe fed, because we couldn’t find an NG tube. Plus, they were in
such poor shape that we didn’t want to traumatise their oesophagus at all. Then
we started to express mums milk so that they could have that too.
Mary was a trooper. She let me express her, but the milk
just started to flow. Then the other breast started of it’s own accord and she
just sat their holding specimen pots under her breasts catching the liquid
gold. We kept syringe feeding for a while, but then when the girls got their
energy back we started to cup feed. Cecille was bigger and better than Angela
but they were both going OK. Soon Cecille decided she didn’t want to bother
with the cup and was back at the breast. Angela was a little more of a concern.
The first time Mary twin fed. This is at her house the first time we went there. |
We had started with half hourly small amounts, then hourly
and I gradually lengthened the space between feeds as they had more and more.
They were cold and their temperatures were down. I wanted to put the electric
heater on but there was no power point in the postnatal room, and no extension
cord available. Needless to say there is a power point there now. We continued
in this way over night with me popping back in at 3 hourly intervals. By
morning the girls were doing much better. We wanted to keep Mary in all
weekend, at our own expense, but Mary had problems at home. There was no one to
care for the senior child at home. So by morning tea time she was ready to up
and off.
Weighing the girls the last time I saw them before they went up country |
Change of plans. I gave Mary the feed charts that I had made
up for the twins, and showed her how to continue filling it in. We made
arrangements to visit her on Sunday to check and weigh the babies. She was
agreeable to this.
Same day, both together. Mary's hand for perspective |
Sunday came and we went off to visit Mary in the afternoon.
It was later in the day because of a labouring mumma we had been looking after.
Mary had continued with the feed chart up until 9pm the night before. I asked
why she had stopped. Her simple answer was that the next door neighbour who had
a clock had gone to sleep and couldn’t tell her the time anymore. To find out
the time, they called out to each other through the corrugated iron walls. That
made me stop and think about the things we take for granted.
We weighed the babies. They were the same. BUT, they were
hydrated, they were peeing and pooing and they were waking for feeds. They were
moving their skinny little arms and legs and I was happy with all of these
things. We made arrangements to come back in two days. But Mary had a problem.
Her father was very ill in a remote area of Kenya, and had
been calling her back to see him before he dies. What do you do? It’s a 12 hour
or more, depending on what’s happening on the roads, bus trip. She would have
to keep the two babies on her lap and possibly not have a seat for the senior
child either. How do you breastfed twins on an African bus, that would
typically be shoved full of people, animals and stuff to the very limits? We
advised her for the interests of the babies not to go. She asked us to call her
father and explain the situation. We did. But it was only a temporary reprieve.
We came back in two days. The babies could have been the
same weight, but the scale isn’t that accurate. It measures in 100gm
increments. They could have even lost a little weight; from where tho I had no
idea. There were already skin and bone. Why weren’t they gaining weight? Mary
had milk, she was feeding them regularly. It was time to feed the mumma. We
bought greens and bananas and avocadoes. Well I did. When we returned the
husband had turned up. Mercy advised him that Mary needed more nourishment and
described a bone marrow soup that he was to procure the ingredients for and
to make. He agreed and left straight away to do it.
I asked Mary if there was anything else that she needed. She
said yes, that she needed Pampers (any disposable nappy here is a Pamper). Now
what to do? I am here to support FreMo, not to sponsor any single family. I
graciously declined and pointed out that the traditional cloth (flannel) nappy
that she had been using was sufficient. She said that their skin was suffering
from the urine. I pointed out that their skin had looked fine when I undressed
them. I gently suggested that a little barrier cream like Vaseline (which she
already had) would be perfect, and to not let them sit in a wet nappy for an
extended length of time. I didn’t want to start Mary using Pampers because they
often leave them on for very extended time frames, and then dry them out and
reuse them if they aren’t ‘dirty’. Plus who will then buy them when I leave. I
thought that changing to Pampers would be worse than her current system. She
accepted this, what else could she do? Then she came out with it.
Her neighbours were giving her a hard time. They thought
that she had a sponsor. Why else would Mzungu’s be visiting her in her home so
often? They were putting pressure on Mary to ask for Pampers, and probably lots
of other things. What a predicament for her to be in. And to think that I was
responsible for it. I was simply doing what I had come to Kawangware to do. I
explained it to Mary in this way, and suggested that she could use the same
explanation to her neighbours. I am not rich in money where I come from but I
have lots of knowledge, skills and the time to share it with others. I have
come to Africa to support FreMo, so that they can continue to support their
community in ways that are needed. Like helping Mary free of charge when we are
essentially a private organisation. She said something in Swahili that I didn’t
catch. Mercy said she was embarrassed because we were helping her even after
she went somewhere else to birth because it was cheaper. We arranged the next
meeting to be at the clinic, so that I wouldn’t cause Mary any more trouble
than necessary.
We wanted to see her a few days later in an effort to give
the twins time to gain weight. Mary didn’t come. We called her and she said she
had no one to help her carry the second twin. We waited. We called. I worried. Finally a week later she came in. We went
through the usual process assessing the girls, but they still weren’t gaining
weight. They were still under their birth weight and they were nearly a month
old. They were certainly in better condition than before, but I think that they
were using all their energy to actually feed. I spent some time with Mary and
her friends talking about the first milk and the behind milk. We spoke about
patterns of feeding and allocating one breast to one baby for each feed. If
that was too hard to remember, then maybe one breast per baby per day. Either
way, they both needed to have the first milk and the behind milk. It seemed
that Angela was still the one that was struggling, so I suggested that every
time Cecille fed she needed to wake Angela and feed her. Since Mary had done
such a good job of syringe feeding and expressing before, I also suggested that
she express milk for Angela during the day and cup feed every second feed to
give her a rest. We talked about hygiene so that the girls wouldn’t get food
poisoning.
I had been dwelling on Mary’s inability to move around
easily. You see traditionally, mothers of twins stay at home until the babies
are big enough to be slung onto her back. She will then have one on her back
and one on her front. When babies are small, they are bundled up into great big
loose cocoons of blankets and carried in the arms of the mother. Once they can
tolerate it, they are then strapped to their mummas backs. But when there are
two babies, it’s hard to carry them. There are no pram, they can’t afford them
and the paths are well, not paths! I had been trying to figure out how to tie
the lessu’s around Mary so that she could carry them both. That way she would
be a little more independent. I suggested we try to find a way. Mercy was
doubtful. Mary was tolerant. I tried a couple of different ways in an attempt
to mimic a sling, but it didn’t work. Peninah laughed. I guess if there was a
way, someone would have figured it out by now!
Mary being very tolerant of my attempts to tie her up in knots |
That was the last time I saw Mary. I don’t know if I will
see her again. We rang when she didn’t come to the next appointment, but she
had gone up country to her family. I’m happy with that idea as I think some
nurturing by the women of her family and village is exactly what she needs. We
rang her last night. She said that she was fine, and the babies were fat. Let’s
hope so.
PS. Mary turned up
today. She came to weight the babies. I also asked if she needed immunizations
but she said that she had them done that morning. I did think it was odd as the
babies would have been weighed at that point, but we were all so excited to see
the girls that I didn’t think more about it. As you can see, the girls a
gaining weight, plump and ‘bonnie’. Mary is also very happy. When I was left
alone with them, Mary asked me for some money for her friend who was ‘helping’
her. It seems that this is why they came to FreMo, to see me, to ask for money.
It’s a difficult position to be in. Mary’s husband has a job, and I am here to
support FreMo. I’m very happy that the babies are doing well.
One is still bigger than the other but at 3600gms and 3400gms we are happy. |
No they don't look happy but they are fatter! |
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