Sisters of the East End

by Helen Batten

  The women sat in a circle with the new mother at the end of her pregnancy, freshly washed, in the middle. Her mother then came and danced for her, wearing a corn on a cob tied around her middle. The corn represented the baby. She sang a song, which she had composed herself, where she went through every stage of childbirth in great detail so the new mother would know exactly what to expect. It was very moving. It was then explained to me that she would be taken back into the hut where she would give birth, surrounded by the mothers of the village. The men would wait outside, and when the baby had been born it would be washed and the mother washed and dressed, and brought out and presented to the village. There would then be great rejoicing, with the traditional noise made with fingers waggling in their mouths. Somehow it seemed to me that the Malawi women were as well prepared by this ritual as British women are by their antenatal classes.

  I was still struggling with the enormity of the responsibility until I had a bit of an epiphany in my second week. One afternoon the local Mothers Union came to sing and dance for us. They stood under the big tree in the centre of the quad, while the patients shuffled or even crawled on to the verandah, and started to sing low gospel songs, swaying, clapping and laughing. Everyone who could joined in. Before I knew it, I found myself shifting my weight from one foot to the other and clapping.

  Sister Marie-Louise stuck her head out of a window and raised her eyebrows at me. I didn’t care – I was the boss now. This was a thought that hadn’t struck me before, and I suddenly felt terribly liberated. Yes, I had huge new responsibilities but with them came a new freedom. My life as a nurse and a midwife, and as a Sister, had been extremely ordered. I had been in institutions for a long time, and I’d had a place in a strict hierarchy (usually somewhere towards the bottom). The standards of procedure, order and cleanliness demanded by both my profession and my calling back in England were very ingrained. They were the canvas and foundation upon which I had worked, and had seemed an absolute prerequisite for any sort of success. Now I realised these standards would have to be left back in England and I would need to learn a new flexibility and resourcefulness.

  After supper I took a long walk outside. The clarity of the sky was overwhelming. The stars were so bright and close I felt like impersonating Henny Penny and running for cover to stop them dropping on my head. Fireflies danced around me. I couldn’t help but fancy them little Tinker Bell fairies – ‘Sprinkle your dust on me and take me to Peter,’ I said – then I remembered myself and said a much more serious prayer: ‘Dear Lord, thank you for bringing me here and letting me witness such a different, amazing piece of Your creation.’

  And as I spoke, in the distance there were flashes of forked lightning, igniting the sky. I wondered where all my resistance to this adventure had gone; I seemed to have left it behind at Southampton docks. I felt terribly liberated and energised. Eloise’s words about getting into Malawi gear came to mind. My head was racing with plans for the hospital. The scale of the task might be overwhelming but if I approached it with the attitude that I could never make it into a mini London Lying-In Hospital, but instead every little improvement I made was a step in the right direction, that would justify my presence here, and I would have done my job.

  I was drawn towards the lake and walked along the shore. I could see the twinkling lanterns of the fishing boats. When David Livingstone had been here he had called it the Lake of Stars because of these twinkling lanterns. A hundred years later, so little had changed. Then I went back and sat on the little bench under the big tree in the middle of the quad as the lightning flashed around me, and the old familiar prayer of St Francis of Assisi came to mind:

  God grant me the serenity to accept the things I cannot change,

  The courage to change the things I can,

  And the wisdom to know the difference.

  Then I got a little notebook out of my pocket and started to make a list of all the things I wanted to do.

  The next day I grabbed Marie-Louise and Anton, and we took a trip into the nearest town. We bought every pot of paint and paintbrush we could lay our hands on and then, with bribes of pennies, we hired some of the local young men and emptied the hospital, room by room. We took out the beds, ward by ward, and laid them out in the sun to air while we swept the floors thoroughly. Our patients lay under the big tree while the children repainted the rooms in cheery colours – red, yellow, green and blue. (And Anton singing ‘Red and yellow and pink and green’, or ‘Dear Lord and Father of mankind, Forgive our Foolish Green, repaint us all in purer mind, in purer lives thy service find’, or ‘Paint then wherever you may be, I am the Lord of the Paint said He’, or any ridiculous variation he could think of.) We then put health charts on the walls. Not that we needed them, but just to give the place the feeling of being professional.

  Right from the start I knew that my most important task was to set up the midwifery school. Once I had installed a proper training programme, there would be a constant stream of qualified professionals who could then go out and spread their expertise across Malawi. First of all we had to build classrooms, a library and accommodation. We were asked to take 20 students on a two-year course. During that time they would have lessons with Marie-Louise, Belinda and me, and have practical experience working with us out on the ward (which was probably the most useful bit).

  For reasons I never quite understood, the Dutch government had given the money for the new buildings before we came, so we were able to start work straight away. For our first six months in Nkhotakota, the quad was a building site. I didn’t know anything about building to begin with, but by the end I thought if ever I was defrocked, I could get a job working on a construction site. Men were forever running into the hospital, asking, ‘Excuse me, Mama, sorry Mama, shall we dig the trench now?’

  I didn’t know, but actually most of the enquiries just seemed to be a matter of common sense, so I guessed the answers and the buildings got built. Of course we did have a Master of Works, but he was often busy off-site. And indeed he had been busy. One day he and a young English lady volunteer walked into the kitchen, hand in hand, and announced their engagement.

  We had a wonderful wedding in the church; I loved being in there. The priest’s vestments and the altar furnishings were ancient and elaborately embroidered. They must have been brought over 100 years ago by the original missionaries, and for me they were a tangible link with our missionary past. The Malawians were so exuberant, the most wonderful uninhibited singers, making up beautiful harmonies as they went along, usually singing our traditional hymns in their own Chichewa language. Especially for the wedding, someone found an old pedal organ and the church was filled with all the locals who crowded in to see what a traditional Western wedding would look like. I did shed a tear – it was a wonderful day. But as I watched them pack up and the young volunteer and her Master of Works disappear up the dirt track to start a new life elsewhere, suddenly I felt a bit left behind.

  However, this didn’t last for long, although it took an unexpected accident to set me back on the path. First, I must point out that food played a very important part in the religious life. When so many avenues are closed to you, a bit like being a prisoner or a patient in hospital, food is eagerly anticipated and relished.

  It’s not difficult to fulfill the Grace, ‘For what we are about to receive, May the Lord make us truly thankful’. We generally were; except in Malawi. My goodness, the food was monotonous! With transport links practically non-existent, we were totally reliant on what the local earth could provide. So, breakfast every day was fruit, often the kind of fruit you can’t get in many supermarkets even today – pawpaws, guavas, passion fruit and granadillas. Lunch would be maize flour with groundnuts and dinner was fish straight from the lake. It sounds appealing but I hated it. Boiled, steamed, baked or fried, cooked every which way, but always fish. I longed for meat.

  Once a month we would take turns to get into the Land Rover with Anton and drive the 75 miles to Lilongwe with a s
hopping list. This meant when we got back there would be a few days of fresh meat for everyone. It was an eagerly anticipated event.

  A couple of months after the wedding I went off with Anton to do the shopping, but on the way back, on a dusty windy road in the searing heat, the car broke down. We spent five hours trying to start it. I began to feel a bit panicky but Anton made me laugh, ‘Don’t worry, Reverend Mama. It’ll be OK – the Lord will save us.’

  Then he started to sing loudly in his rich, low voice,

  She who would valiant be ’gainst all disaster,

  Let her in constancy follow the Master.

  There’s no discouragement shall make her once relent

  Her first avowed intent, to be a pilgrim.

  Now when I find myself in a tricky situation, I start singing Anton’s feminist version of the old crusading hymn.

  Well, as he had predicted, help did eventually come in the form of a lorry. The driver got out a rope and started towing us along the road. But we hadn’t gone very far when there was an almighty explosion. The Land Rover’s tyre burst, sending us spinning off the road and down a slope, saved only by the rope holding us to the lorry. Somehow we managed to get ourselves out and then tow the car back onto the road, change the wheel and get home. But more drama followed when I realised I had left all the food by the side of the road. I was devastated. We did often long for our usual Western food, and that food parcel with its fresh meat was so important to the spirits of the Community, so I felt as if I had let them all down. However, the next day a huge food parcel arrived from home, and then someone left ten eggs on our doorstep, and then someone else gave us the gift of a chicken for the safe delivery of his daughter. Actually, in the end we didn’t lack for anything and I was put in mind of a passage from the scriptures:

  Consider the lilies how they grow; they toil not, they spin not; and yet I say unto you, that Solomon in all his glory was not arrayed like one of these.

  ‘Don’t worry, the Lord will provide,’ I told myself. But I wondered whether He was doing more than that when a few days later we finally got the Land Rover to a garage. The mechanic turned the key in the ignition and the car started straight away. He could find nothing wrong with it.

  ‘Lord be praised!’ Anton said. ‘If the car hadn’t broken down, then we would have been driving when the tyre burst, and we would have spun off the road, down the slope and could have been killed. It’s a miracle. Thank you, gracious Lord.’

  The mechanic nodded and crossed himself. I wasn’t entirely convinced – the car might not have spun completely off the road, we might not have been on the edge of a slope at the time, and we might not have been killed. But then again, here I was alive, and for what purpose? It did feel like a message.

  And this feeling grew as I became more confident in my midwifery work at the hospital. Before we came out, Sisters Belinda and Marie-Louise and I discussed that we would probably have to do procedures that only doctors were allowed to do in England. As soon as I arrived, I realised I would have to perform ventouse deliveries. This is where a vacuum device is placed on the head of the baby to assist birth when the mother is having difficulty pushing the baby out herself. We did sometimes have a doctor visit the hospital but he was more often than not somewhere else. Very soon I was facing a situation when I had to deliver a baby myself with the ventouse. I was nervous but as I told myself, I had witnessed this procedure many times before and I was very clear what had to be done, and if a doctor could do it, then why shouldn’t I be able to do so?

  A young mother was in the hospital with her second baby. I could feel that the birth canal was adequate and the baby was importantly in the correct position, but she had been labouring for a long time and was exhausted, and the baby was not progressing. So I placed the suction cap on the head of the baby and as she had a contraction, I gently pulled. Within several contractions the baby was delivered. It was a wonderful feeling (and a huge relief) that I could do it. After that I regularly used the ventouse. Sometimes it only took a few minutes, sometimes up to half an hour (particularly if it was a first baby), but it usually worked.

  Very occasionally the birth canal was just too small to allow a normal delivery and a small cut had to be made through the back of the symphysis pubis (the joint that unites the public bones), at the front of the pelvis to enlarge the birth canal. Delivery could often then take place with a ventouse. This procedure is never done now in developed countries, you would just perform a Caesarean section. But in developing countries like Malawi, where the option to have a Caesarean isn’t necessarily there, they still sometimes have to be performed. Afterwards the mother’s pelvis would be a bit wobbly, so I had a very useful leather case strap, which I used to place round, her pelvis to hold it up securely while she healed.

  And then I faced a situation that was always going to happen – a mother who had a fully obstructed labour and needed a Caesarean to save her life. We diagnosed that she was obstructed, we knew she needed a Caesarean section and we also knew that the doctor was stuck behind flood water, some 80 miles away. I watched her for hours, labouring in great pain, and it was obvious that unless something was done her uterus was liable to rupture and she would likely die.

  ‘She’s going to die, Dear God, tell me what to do,’ I prayed.

  I watched and prayed in agony as the woman’s contractions grew more desperate and she got weaker. There was nothing I could do – or was there? Unbeknown to me the staff had already started preparing one of the rooms as an operating theatre. Suddenly I knew: this woman was going to die, for sure. But I had a choice – I should try to help her myself and if she died, well at least I had tried; it had got to the point where I felt there was nothing to lose. I asked for a room to be prepared, and then they told they’d already done it.

  I’ve never seen a woman moved into theatre so quickly but even as we got her onto the table, her uterus ruptured. However, it was possible to remove the baby, who had already died, and the placenta then sew her up and repair the rupture. To my utter amazement she did indeed survive. When the doctor eventually arrived he said, ‘I don’t suppose you sterilised her at the same time, did you?’

  ‘No, I jolly well didn’t!’ I said, probably a bit abruptly.

  That night I thanked God for giving me the courage to act. A baby had died, but a woman lived to be able to return to her village and her family. It didn’t take long working in the hospital to feel that I was doing something really important, and I no longer felt left behind by the departure of the Master of Works and the volunteer, but blessed.

  Towards the end of our first year in Malawi, this feeling was reinforced when I hosted the grand opening of the new Midwifery Training School. The Dutch Ambassador was coming especially to see where their government’s money had been spent and I had to make a speech. I was determined to make some of it in Chichewa, as well as in English, so everyone could understand.

  We decided to get the Ambassador to plant a tree to commemorate the occasion. The building work had mainly been done with the help of non-violent prisoners, who came in trucks every day from the local jail. On the morning of the ceremony I asked one of them to dig a hole outside the Midwifery School to plant the tree in. Rather inconveniently, the labour ward suddenly got very busy, so I was otherwise engaged when one of the student midwives came running in: ‘Mama, you come. Man, dig big hole up to shoulders.’

  I went running out to find the prisoner had dug a hole big enough to bury himself in standing up. Seeing as the tree was only a tiny sapling it seemed a bit like overkill.

  The opening ceremony was a joyful occasion. I made a short speech to the accompanying dignitaries in Chichewa. By then we had recruited 20 student midwives. They were mainly qualified nurses who wanted to continue their training to get midwifery skills as well, and I have to say I generally found these nurses the best to work with because they had a basic foundation on which to build. I decided that we should alternate days between working in English and then w
orking in Chichewa, so there was a feeling of equality in the hospital and we all learned from each other.

  Our teaching facilities were terribly basic – a blackboard and a piece of chalk and one textbook – Margaret Myles’ old standard text on midwifery. It helped a bit – it did have pictures – but the level of English was above most of the students’ capabilities and it was too technical. We also didn’t have the equipment that was in the book, so it wasn’t appropriate for the students to rely on. But still, the students were generally very dedicated. We gave them beautiful blue uniforms made by Sister Belinda, which they loved and kept immaculate. They had different coloured belts according to what stage they were at.

  It was a great opportunity for the students: at the end of their course they would sit national exams, which would give them a qualification they could take to other places, and they were proud to be with us. I was particularly fond of Molly, who arrived as a trained nurse and stayed with us after she qualified, working her way up to become a staff midwife. She was a lovely, happy, reliable girl and it gave me great pleasure to see her grow in confidence and rely increasingly on her own judgement.

  During my time in Malawi a phrase of my mother’s kept coming to mind – ‘necessity is the mother of invention’. For example, when a mother died and the baby lived (as unfortunately still occasionally happened), the student midwives would have to look after the child until the baby’s family was located in the surrounding countryside and they had made a decision which of the extended family members would take responsibility for the baby. Sometimes this would take a long time. One little girl stayed with us for six months. Her family seemed in no hurry to come down to the hospital and claim her. It proved no problem, she lived permanently strapped to whichever student midwife was most free on the day, and was a very useful addition in our baby skills classes. She got a lot of nappy changes and baths. Occasionally she slept in my room when she was ill, but as I was usually up each night delivering babies, I didn’t get to know her that well. When she was finally collected, there was much weeping from the students.