a couple of hours before heading out for my first night shift, i was sitting on the veranda with some other girls from the house. they were in their pajama pants, eating chocolate, and talking about their days. i was drinking strong tea, getting ready to stay up all night and (again) asking myself: why am i doing this?

i was looking forward to the night shift at Maramba clinic, but nervous because i had no idea what to expect. i wasn’t sure what security would be like and whether previously unnoticed creatures of the night (ie: rats, cockroaches, weird people) would give me a miserable time. as it went, only one of those three figured prominently into my evening. i have since found out that there is indeed a (rather dozy) security guard on duty because there is a loud bar just around the corner from the clinic. drunken patrons on their way home have tossed rocks through the window in the past.

i arrived at the clinic around 8pm and met the two nurses on duty in the labour ward. Tina is a tiny solid mother of two with gray lightly touching her frizzy hair. she has a dry, sarcastic sense of humour and it’s easy to make the mistake of taking her seriously when she is teasing you. you would recognize her tenacity from the “It’s a boy! (x2)” entry because she was the midwife on duty that day. Theresa is an equally solid, but much more stout, mother of two with five grandkids and an open round face. she will be retiring in 2 years when she reaches the pension age of 55.

in the labour ward, there was one woman impatient to deliver and another not quite ready. within two hours we would have a third mother-to-be checked in. the young impatient woman would have to wait another 4 hours to be rid of the burden in her belly.

the rest of the clinic was closed, but a small room at the front was open for emergencies. mothers with small babies and tightly-knit families trickled in slowly, apparitions taking shape from the dark night outside. each waited their turn to talk to the nurse and paid 5,000 kwachas for the off-hours consultation.

there was also a team of clinical-officers-in-training from Lusaka with us. two men and two women, they crowded the small consultation office and later trailed into the labour ward. they seemed to move as a coherent whole — white lab coats and dark pants blobbing them together in my brain. one man was named Jeffrey and i remember him mostly because i said “ah, my brother’s name is Jeffrey” and he said, always smiling, “oh! i am your brother, yes!” later we traded stories on med school from our respective countries: years involved, cost, difficulty to get in, etc.

the first initiation of my very first night shift occurred shortly after Theresa showed me the staff lounge (which she called “lodge”) with oh-so important heater(!) and told me that there isn’t much to do in the evenings if no one is giving birth. then she walked from the “lodge” into the main waiting area and plunked down in a chair in front of a TV blaring WWE wrestling! she motioned for me to sit on a nearby bench and told me she loved wrestling because “it’s so entertaining.” i could hardly believe my eyes. the whole experience felt totally surreal as Triple H and Shawn Michaels, the Heartbreak Kid, yelled at us about “Degeneration X” while the nurses laughed and exclaimed at their antics. i don’t watch wrestling at home (well, duh) so the contrast between the TV and the clinic with its’ aged posters instructing us to get tested for HIV and sleep under a malaria net may have been even more pronounced.

we sat there watching wrestling for at least an hour. i got up to stretch my legs a few times and wandered down empty hallways that i have only ever seen overflowing with people. at 930pm, it was time to do a follow-up exam on the woman who seemed to be so impatient to have that baby out of her. the nurses do a pelvic exam, check dilation, temperature, blood pressure, and fetal heart rate every four hours after a soon-to-be mother first presents at the clinic. it didn’t seem this young woman was going to give birth as quickly as she had hoped.

Tina, Theresa, and i retired to the staff lounge, along with the cleaning woman, Rhoda and the nurse handling the emergency walk-ins, Lucy. water was boiled in a big pot and distributed among five mugs, as a huge round loaf of bread appeared from somewhere. margarine, tea leaves, instant coffee, sugar, and a bag of boiled sweet potatoes followed soon after. the sugar was in a small plastic bottle labeled: Folic Acid. the tea leaves came from a black bottle with the words Acetylsalicylic Acid on the front. there weren’t enough mugs to go around, so Tina drank her hot water (squeezed with half of a fresh lime) in a large white bottle that used to hold yet another sort of drug.

it was truly a pleasure and an honor to “break bread” with these women. they offered me hot drink, bread, butter, and — at their insistent encouraging (“what? you don’t like sweet potato??”) — i even helped myself to cool slimy sweet potatoes from a plastic bag. i had brought a small packed lunch with me, but not enough to share, so i didn’t even bother opening my tiny pack of chips or meagre sandwich. i promised myself i would bring chocolate and fruit and maybe even real tea bags to the feast the next night.

while i sat and sipped my watery instant coffee, i took the time to digest my surroundings. more huge pieces of paper with crooked handwritten instructions, similar to in the labour ward, shouted down from the walls the instructions for handling an emergency, when to wash your hands, and which staff meetings were coming up when. there was a large deep freezer used as a fridge along one wall. two other walls had low oversized chairs and a small couch. in the corner rotated a very bright space heater, blinding me every time it shone in my direction. i wasn’t cold until later in the evening, but realized it was a precious commodity to these night nurses.

it was also in this visual sweep of the room that i occasionally noticed small beetles and cockroaches the size of quarters scuttling in and out of the seams of the oversized chair Theresa was sitting in. one even ran right across the top of the back and down the other side. i shuddered as i realized i was sitting in an identical chair that must be filled with identical bugs. it was certainly this thought that prevented me from resting well later.

as quickly as the night lunch had been spread out, it was packed away. not a crumb remained as Lucy washed out the mugs and Rhoda swept the floor efficiently. Theresa snored a bit as her head lolled back on the cockroach chair. Tina pointed at her and giggled. i couldn’t understand a word of what sounded like gossip between the two women and my eyes grew drowsy as i listened to the rhythmic cadence of Tina and Lucy’s conversation.

around midnight, the impatient mother finally delivered after being in the labour ward since 530pm. it was a baby boy, but there was no squealing, no crying. “it’s flat,” Theresa pronounced. she held him upside-down by his feet and slapped his back hard several times. when that didn’t produce much more than a gurgle, she scooped the baby over to the table and proceeded to attempt resuscitation with a small hand pump. i found myself chanting in my head: “come on, cry. come on, cry… come on! cry!”

he cried. his face squinted up into a prune of dissatisfaction and he let go a wide wail. Theresa swaddled the baby and laid him on a table near the mother. i rocked him gently while the clinical-officer-in-training delivered a shot of oxytocin to the mother’s thigh and Theresa encouraged the placenta to come out. i remembered learning from the doctor at Fort St. John that if you hurry the placenta along too quickly or forcefully, you can actually tear it away from the uterine wall. i’m pretty sure this is what happened with impatient mother and impatient Theresa. there was a lot of bright red blood even after the placenta was safely in a metal dish.

Theresa called for a spotlight and a bare bulb hanging precariously from a tall rusty lamp with exposed wires was wheeled over to the bed. the cord barely reached the plug on the wall, but it was enough to see something wasn’t quite right. i have no idea how the problem was fixed because i spent most of that time rocking the ignored baby and moving the swaddling from his puckered mouth cries. eventually the mother stopped bleeding and was moved back into the bedded area of the labour ward. i turned over the tiny boy to his mom, but she didn’t seem terribly relieved to see him.

after that, not much of anything happened. one woman seemed precariously close to delivering all night and violently vomited around 4am, but didn’t deliver before i left at 615am. i spent the rest of the night with my too-long legs curled in an uncomfortable position and dozing on the cockroach chair in the lounge, ever-terrified that something would crawl across my neck or ankle. every time i opened my eyes, i saw a small cockroach crawling across some surface in my field of vision: the table, the wall, the chair next to me. around 330am, i had had enough and got up to stretch my legs. it was on that journey i realized there wasn’t really a working toilet on the premises for me to use.

the clinical-officers-in-training were in the waiting room watching some strange African sitcom about a rich African man going to London and marrying a white woman and bringing her back to his village. the acting was bad and the jokes were horrible, but i could see the potential for comedy in such a situation. we all continued to wander in and out of the labour ward, checking on the vomiting woman. i’m not sure if it was the time of day or if the nurses were just too tired to enforce anything else, but the women vocalized their pain more at night than they were allowed to in the day.

Jeffrey and his comrades left at 5am and i was abandoned to watch “Mr. & Mrs. Smith” (with extremely bizarre English subtitles) on my own. well, the night security guard was there too. i exchanged a few text messages with Jonathan — since it was a decent hour in Vancouver — and played Scrabble on my phone. Jane came to fetch me at 615am and i went straight to bed as soon as i got in.

i have only slept for about 3 hours, but i know i’ll have another nap this afternoon before my next night shift. yep, i’ve signed on for night duty until Thursday. some of the girls from the house are interested in coming in the next couple of nights because most want to see a birth. the company will be nice. i’m going to be sure to bring a blanket to at least muffle the cockroach chair. and a book might be a smart idea!

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