Au soûper, on est attaqués par des espèces de fourmis volantes au derrière allongé frétillant qu’on ne voit à nulle autre heure de la journée. Dans ma chambre vit mon araignée familière de 5 cm, toute plate, qui parfois se cache derrière mon coffre, ou sous mon bureau. Heureusement, ma moustiquaire me protège et elle ne m’embête pas la nuit. Depuis le Cameroun, j’ai appris que les araignées sont serviables et mangent les moucherons et les moustiques. Celle-ci ne m’effraie pas malgré mon arachnophobie notable. Au moins ce n’est pas une grosse et poilue tarantule. Il faudrait lui trouver un prénom – auriez-vous des suggestions? “Sam the spider” me semblait bien...
Le mois dernier, la maison a été envahie de petites fourmis qui curieusement produisaient un peu partout des tas de poussière de la dimension d’une tasse en moins d’une demi-journée. J’ai finalement réalisé que c’étaient des termites, et que la poussière en question était... de la fine sciure de bois, résultant de leur digestion des planches de fondation. Horreur! La maison va nous tomber dessus et il va falloir que j’emménage dans un tukul! La solution? Simple et toute congolaise en sa débrouillardise: verser de l’huile de vidange dans les orifices du sol. Ma chambre a senti le garage pendant deux jours; mais le stratagème a fonctionné puisque les envahisseurs ont disparu.
Il y a quelques semaines, après le seul gros orage qu’on a eu, quatre scorpions ont fait leur apparition sur le terrain MSF en moins de vingt-quatre heures. Deux en plein soûper au réfectoire, et un devant l’entrée. Le quatrième a fait sursauter mon collègue congolais lors de sa visite de la tente-maternité. Les gardiens les gèrent avec un clou au bout d’une planche de bois, un tue-scorpions congolais ma foi. Je n’ai pas eu de réponse claire quant à leur venin, mais comme il n’y a pas eu de présentations critiques de piqûres de scorpion à l’hôpital, on va présumer qu’ils ne sont pas mortels...
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L’équipe médicale a changé. C’est un bol d’air. Je m’étais habituée au néo-colonialisme et à l’autorité de l’ancienne équipe en m’en isolant tranquillement et en faisant usage de silences judicieux. Les nouvelles arrivées sont plus expérimentées et bien plus humbles. De par nos origines communes du Nouveau Continent, nous avons le même esprit de collégialité, que ce soit avec les expatriés ou le staff national. La communication est plus fluide. C’est rafraîchissant de ne plus s’engoncer dans la hiérarchie. Au PPD, ils nous avaient prévenus que c’était l’équipe qui marquait le plus une mission, et c’est foncièrement vrai. J’en soupire de soulagement.
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We are visiting the village of Kabala quite a bit lately. Monday, it was my turn to accompany the mobile clinic team there, on one of the Land Cruisers, the T-32. On the road, the “agent focal”, the local MSF community worker, signalled us from his bike. Earlier in the morning, he had tried to bring a woman from Kabala to the Monga clinic after she had spent the night in labour. However, strapping a pregnant woman with active contractions on a bike and riding on Congolese roads is no small feat. He ended up dropping her off in Beela, halfway to Monga. So we stopped there and I investigated the scene. The lady, primiparous, was alone in a hut the size of a queen-size bed, in full-blown labour. She was fully dilated but there was so much cephalhematoma that I couldn’t tell the head position. Membranes had been ruptured for a while. The birth canal felt so small, and with the history of prolonged labour, I could not take a chance. In Africa, my stethoscope’s bell morphs into an excellent fetoscope: good fetal heart. So off we strapped her in the back bench of T-32 and back we headed towards Shamwana, a good forty-five minute ride. The nice, capable national nurse and I sat next to her on the opposite bench, while the Canadian nurse went back to the front seat.
In the car, she was lying silently, asking only “are we there yet?” in Kiluba. I was deeply, deeply sorry for not carrying around my obstetrics textbook at all times. The contractions barely extracted a wince from her face. We had pulled gloves, a dressing tray of three basic surgical instruments, and a few rolls of gauze kling: the only relevant stuff available from the mobile clinic equipment. All of us sweating buckets in the car.
At thirty minutes, I examined her and tried to convince myself that she hadn’t progressed – but she had. Still all caput though: the head felt so tight in that canal, I could not feel the skull. Sweat started pouring down my back. The last delivery I ran was in February up North, and it was an easy one, with expeditious labour – a small baby and a large birth canal. If anything, this was the opposite. But after a few contractions, the head started moving down and the caput was slowly crowning. The nurse went “Euh Docteur, je crois que ça y est!”. He was right. I yelled to the driver to stop the car. Still incredulous, I held the scissors and was contemplating an episiotomy à froid. But then I was too terrified to go through with it. I thought sheepishly: “People who actually know what they’re doing will deal with the tear when we get back to Shamwana. I just can’t do this, I just can’t, it’s been too long. “
Resisting the head so that it would not be pushed out too quickly, I helped it out gently during the next four contractions, praying that the tear would be fixable. The nurse was assisting me by giving constant uterine pressure. The head took forever to come out, an elongated, eggplant-shaped ball of humid black hair. Occiput anterior, face downwards, thank God. No cord around the neck. The baby restituted quickly to my right and was out before I could take the next breath. Loads of baby poo in the amniotic fluid, both the pea soup and the dark green kinds. A few squeaks from a blue baby boy, but not much else. We clamped the cord with the only hemostat from the dressing tray, then tied the rest with torn gauze, then cut it. The kid still wasn’t breathing much... No oxygen, no suction, not even a rubber pear – we’re in the middle of the road in the Congolese bush after all. Sweating buckets. Too bad; it came as a reflex, the old school thing that I’d never done before but had seen on TV: I grabbed the limp baby by the feet, head down, and then administered a few solid slaps on his back. And it worked! He spat out green meconium onto the beige khakis of the Canadian nurse who had come to help from the front seat. Finally, he let out a good scream and pinked up. The newborn scream is a familiar sound to me by now; yet, every time, it still is the best sound ever! I could feel the relief evaporate from my body while I was wrapping the baby in one of the mother’s two pagnes. Off we drove, back to Shamwana. The umbilical cord was still dangling between mommy’s legs, but hey, I’m of the ‘scoop and run’ school and I thought that it was best to bring her back to the appropriate facility as soon as possible.
Fifteen minutes later, on our arrival to Shamwana, the pilot and the FinCo from Lubumbashi happened to be visiting the hospital grounds. Apparently they got quite the scene: the national nurse and I drenched in sweat, hair matted on our foreheads, meconium stains on the expat nurse, all of us with bloody gloves, and a woman barely covered by her pagne being ushered away to the maternity on a stretcher. A delirious smile was plastered on my face while I was holding Baby Conehead like a trophy. The bench and the floor of the Land Cruiser T-32 were stained with a mix of poo, urine, meconium, amniotic fluid and blood. Quite the scene, I must say. Unfortunately we were too rushed to take a picture. But our visitors certainly got quite the glimpse of the true MSF Congolese deep bush experience...
The new, experienced midwife examined the baby and reassured me that it had been a difficult labour, that the baby was occiput posterior (sunny side up) from the position of the cephalhematoma and somehow, he rotated along the way, either on the bike ride or during the car transport. I am incredibly thankful that the outcome was good. There were many opportunities where everything could have gone wrong – we had no equipment at all to deal with any complications. But her delivering in the car was still better than in that dark hut in Beela on a dust floor. We are joking that while we are waiting for the ventouse to arrive, we should simply attach all our ladies in difficult labour on a bike and ride around town for the babies to rotate: it might save a few caesarians... And mommy didn’t tear at all, in the end, except for the very small nick that I inflicted before deciding not to go forward with the episiotomy.
Congolese women are so accustomed to a high neonatal mortality rate that babies born at the hospital do not have a name until they leave. So for now we are referring to this little one as Bébé T-Trente-Deux, referring to the car where he decided to be born. He only weighs 2.5 kg, but then again, Mom is no taller than 4 foot 3.
Now I am afraid to see what else MSF has in store for me... what’s next, a cricoidectomy with my Leatherman on the road?
Bébé T-Trente-Deux aka Conehead, happily breastfeeding, a few moments after arriving in Shamwana. I am still tachycardic on this picture.
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