Musings on what this research is really all about.

One of the most difficult aspects of working here at the Komfo Anokye Teaching Hospital is witnessing the horrible conditions under which the doctors and nurses must work to ensure the health of laboring women and their infants, and the squalid conditions under which women give birth. It is not seeing a woman give birth on the floor of the ward, or the lack of sanitary instruments, or even hearing of the woman who died the previous night after she delivered a still born baby. Rather, what makes bearing witness to such events so trying for me is learning to deal with seeing such daily happenings, without becoming numb to their significance in the broader global context of countries that have versus countries that desperately need. As my directer of this research Dr. Anderson pointedly remarked before he headed back to the States this past weekend, "Don't forget the significance and implications of what you see here. When you see two women to a bed, or hold the maternal death registry in your hands and feel its weight, don't ever forget that it should not be this way - that this is unacceptable." And yet, how does one allow oneself to feel so indignant at what one sees, when day after day one witnesses it and it becomes "normal." It is an intense exercise in emotional and intellectual compatibility.

Today was a glimpse for me of what lies in store for me as I work here. This week we are piloting our research, practicing collecting data and interviewing patients before we officially begin next Monday. When we made our way down the stairs from the 5th floor labor ward for the "VIP" women to the first floor where the delivery ward and "dark room" (the room housing all post-delivery complications) are, we were greeted with a loud, rather chaotic scene. On the tiny landing between the stairs, the elevator and the entrance to the delivery ward were about 20 men and women milling about. The elevator door was open - but there was no elevator. Men were shouting loudly up and down the shaft, below the elevator was stuck due to power failure with a laboring patient inside. Meanwhile, just inside the doors to the delivery room, people were peering through the windows to the floor. Inside is a very small waiting room where women who have begun labor but are not yet fully enough dilated to be brought to the delivery table wait. And as we arrived and walked up to see what they were looking at, I saw a woman lying, slumped against the doors, giving birth on the cement floor. It was over in seconds, there were two nurses there, one of which quickly cut the umbilical cord and carried the baby to the delivery room. The other one attended the new mother, and pulled her to her feet about 2 minutes later to walk to the recovery room. The woman was naked, covered in blood, and watched by over ten pairs of eyes through the door. We waited around a few minutes to see if we'd be able to get inside the doors to find our data books, but upon seeing the large amount of blood on the floor left to be cleaned up, we decided it was time for lunch.

Later today I told one of my medical resident friends what we had seen, and he laughed gravely and said that it was very common for women to give birth on that floor, and that the elevator ride was never a sure thing.

Last night, a woman died after giving birth. Two students here from University of Michigan to observe the wards saw three infants pass away today, all from asphyxiation - a cause of death that would never happen in the States where every newborn has access to assisted breathing machines.

As I left the hospital this afternoon, I noted the 30+ women sitting and lying under the tree in front of the main hospital entrance. these are the women who have no friends or relatives in Kumasi with who to stay with as they wait for their family members to be seen for their various illnesses.

Witnessing today's events and knowing that they are in no way unusual makes me evermore sure that my research matters. The death of these women and newborns will not be forgotten - through our careful recordings of their delivery, determination, and sometimes death, our research will contribute to the reduction of obstetric complications in this and other hospitals in Ghana.