The labor, delivery and post partum section of the Kafountine clinic is a small building, badly in need of every kind of repair that sits at the end of the clinic compound. It consists of 5 rooms: 1.) The large post partum room which is known as “Le Grand Salon.” It has 10 twin sized beds for the post partum moms. A post partum mom normally stays for 2 days or longer if she had a medical complication;
2.) The small laboring room which is just big enough for 1 twin bed and a foam mattress for a family member;
3.) A small delivery room which has 2 delivery tables and a place for 3 people to stand. Family members, not even the women, attend the birth;
4.) A large office with a twin bed for a laboring mom or a post partum mom if the post partum;
5.) A small room with 2 twin beds which can be used as another spare post partum room or a sleeping room for the visiting midwives;
6.) And an outhouse with no shower; and
7.) A water faucet for washing clothes or getting water to bathe or drink.
The building is in critical need of renovation and repair. The cement floor has pits and holes, the windows and doors have no screens; the rooms are poorly lit—with one 60 watt light bulb per room, even in Le Grand Salon. Each bed has a mosquito net hanging over it (USAID makes these available for about $3.00 for pregnant women and children under 5 years old). There are only 12 fitted twin sheets and no top sheets for 14 beds; many of the foam mattresses have sheets with big holes in them. The walls have not be cleaned or painted in years and cob webs and spider webs adorn the ceilings and corners of almost every room. There is evidence of mice in the visiting midwives room. The floor of Le Grand Salon is swept and mopped only twice a week. The outhouse is horrendous and there are no showers or bathing facility.
When we arrive, the midwives are out of exam and sterile gloves and vitamin K and almost out of erythromycin and methergine. Thank goodness for the supplies I collected and Jessica bought with her!
We meet with the staff and get our first taste of midwifery care in Senegal. Awa, the lead sage femme, has been stationed here for over 4 years. After a few days of working with her we have the utmost respect for her professionalism, grace and caring. Rose, the second sage femme has been here for 1 year. The sage femmes are assigned by the government to a clinic site and are paid by the government. The midwives do prenatals and other OB care, work 12-hour shifts and are on call for emergencies that are beyond the skill or resources of the matrones.
The 2 matrones, Mom and CheCha, are the backbone and foundation of this clinic. They deliver twins, breeches and other births that are not commonly managed by non-nurse midwives in the U.S. They also teach a once-a-week class to the young women on family health and women’s health issues.
What is a matrone? She is a woman who leaves her village and family for a term of 1-2 years to study midwifery; she is not a nurse. She then returns to her village and works full time doing labor and delivery in tandem with the sage femme or by herself. She has a room at the clinic in which she lives for her 2-days-on, 1-day-off schedule.
Her salary is paid from the proceeds from the women’s prenatal visits; the matrones and pharmacy staff (6 people) share 25% of the proceeds of the prenatal visits. The Senegal $1,250 birthing fee is given to the village—the village decides how that money is to be spent, but it is not used to pay the salaries of the matrones. The matrones have 2 gardens on the clinic premises and the money from the gardens’ produce provides them with money for themselves and their family.
For the last few months the clinic is averaging about 60 births a month. By the time we had arrived they had had over 30 births so far in January. There is a high incidence (over 20%) of fraternal twins in Senegal as elsewhere in western Africa. The common belief that this high incidence is a result of the consumption of African yams and sweet potatoes.
During my first day I assist with prenatal visits. The prenatal clinic building is in a separate wonderfully kept building. It is bright, clean, tiled, and the walls are covered in wonderful information posters. There is a lab for blood work and exam rooms.
The visit is much the same as in the U.S. except that there is a vaginal exam at each visit and there is practically no lab work done.
A routine prenatal schedule consist of 4 visits; one during each trimester. These visits focus on prevention issues–typing blood, testing for HIV, and vaccinations. Clients are routinely given iron pills for anemia. There is no free medical care here so the clients are responsible for paying for these visits. Because the clients do not know the date of their last menstrual period, the estimated due date is simply indicated by a month, not a specific date.
Tomorrow I will begin working in the labor and delivery section of the clinic!