Birth in Central Africa

We were up early to check in at the airport and had enough time left over for a cup of coffee before we needed to board. But the representative from Kenya air couldn’t give us boarding passes for the Amsterdam leg of our journey, and the Java House was out of coffee. We sat quietly wondering how we would negotiate less than an hour lay-over having to get new boarding passes.

The flight from Nairobi was uneventful, thankfully.  This time we were seated near a window and marveled as we slowly crossed the Sahara desert. Huge does not even begin to describe it. Hours of nothing but sand as far as the eye could see. I knew we were reaching something important when I could see a road and a few houses. Then suddenly the desert stopped right at the Mediterranean Sea.  I wondered about the view from the other side of the plane–were they able to see the Nile river delta?  Soon we began passing beautiful islands and finally we arrived at the European continent as we flew over Greece –a country that is as green and hilly as the Sahara is flat and sandy.

We arrived to thunderstorms in Amsterdam, which meant the guidance system was shut down and we sat about 100 yards from the gate waiting for the lightening to pass. By the time we stepped off the plane we knew about 40 others were transferring to the Atlanta flight, but we would need to hurry. Through security and up to the counter only to find out that we had never actually been checked in for this leg of the flight and our seats (which we had selected a week ago) were reassigned. I was dumbfounded. We produced our tickets from Nairobi as proof that we had checked in for the entire flight, our bags were checked through to Atlanta, this had not been our error. The efficient and sympathetic KLM representatives got us the only seats left on the plane.  We could not sit together, but we would be in first class. The flight was fantastic.

Aside from being very annoyed that TSA agents made us throw out unopened water bottles given to us on the plane by KLM to go through a carry on security check to LEAVE the airport, the rest of the trip home was great. Tammy is flying back to Iowa this morning. I will see my children as soon as they wake up –in about two hours.  It seems my body will take a day or two to readjust this time

We are counting the hours until a taxi comes to collect us.  Our bags are packed, and Tammy’s looks to be OK even as it bulges at the seams. I’m sure all my clothing will smell like the coffee beans packed under my dirty clothes when I return home Good thing I like that smell.

At the end of the training, each doula made a wish for the women of Nairobi while placing a glass heart on a tray.  As we left, we each took one of the wish hearts to keep safe until next year.  I shared my wish, that no woman in Nairobi will have to give birth alone, with a tear in my eye.  And as Kenyan tradition requires, the women gave us gifts and sent us off “showered with flowers.”

Life will continue for the doulas of Nairobi. We are hoping that the easier access to communication will allow us to have more frequent updates from this group, and are looking forward to sharing their successes, and challenges, with you.  Tammy is already planning a return trip to train even more doulas to ensure no woman in Nairobi gives birth alone.

We were reminded today that to say most international residents of Nairobi have epidurals is unfair. Which made us realize how little we really shared about the hospital system of Nairobi. This gets confusing, but I’ll do my best.

First – there really is no set price for hospitals. Public hospitals are subsidized so much more standard in price (I think, that is the impression I got), but private hospitals set a fee based on the level of service. So to be in a private room in a hospital (for example Aga Kahn where we visited) is significantly more expensive than to be in a semi-private room. Additionally, Aga Kahn has a different cost for a maternity stay than Nairobi hospital (another private hospital) even when they are offering the exact same service.

Second – there really is no set price for physicians. The range of fee for a private physician is wide, one midwife guessed the costs could be anywhere from $30,000 Ksh to $100,000 Ksh (roughly US $300 – $1,000).  I get the impression you are paying for prestige, which is not necessarily the same as skill or quality.

Third – there really is no set price for cesarean surgery.  As one midwife estimated, the hospital fees alone can range from $20,000 Ksh at the “cheap” hospital to $120,000 Ksh at the top hospital.

Fourth – Nairobi is huge, with very busy roads and many hospitals. We are guessing the “nicer” hospitals are in the “nicer” regions of Nairobi. Some women have the funds to travel to differing districts for care. But other women are limited to what is in their region, not only in hospital but also in physician. It looks like the antenatal clinics are associated with a specific hospital, rather than one physician having admitting privileges at several hospitals as is done in the US.

So you put this all together and what you see in midwifery practice is that what is “normal” of the patients at one hospital is not the “normal” at another hospital. This made for a very interesting training as we tried to gauge what maternity care in Nairobi was like. Apparently, there is no consistency. So, while a midwife at one hospital may see all her international patients receiving epidurals, that may have more to do with the opinions of the referring physician at that hospital than the choices of the women.

We began our last morning by visiting a local baby fair to see what is available for Nairobi families. We met one of the women from our training at the fair, she had already booked the booth and was advertising herself as a doula (and childbirth educator from her Lamaze training last year).

We then stopped at a local book store to see what pregnancy and childbirth books were available to the women of Nairobi. Nearly everything we found was out of the UK. We took note of a few titles and will offer suggestions for suitable substitutes for the DONA reading list if necessary.  I am happy to say I found a cookbook put together by a Kenyan woman with a local cooking show.  I now have the recipe for Mandazi!

We toured the walking safari at the national park, which was similar to a zoo with fewer animals and larger habitats. At the edge of the safari is a stream that separates the walking safari from the rest of the park. One of the workers was explaining that all the animals of the park are free to roam there, and sometimes guests are able to see lions stopping by for a drink. But on our visit we were only able to watch a crocodile sunbathe. It does turn out that crocodiles are native to Nairobi, although I would never have imagined they were this far south.

After lunch we visited another tourist sight to view the various dances and national costumes of the people of Kenya.  Some were more lively than others, and if you get a chance ask Tammy to do what we now refer to as the “Mine is Bigger than Yours” Dance.

We ended our day with a short walk to purchase some kangas because we were unlucky at finding them at any of the tourist shops. I am leaving Nairobi without soccer jerseys for the boys. What a strange world we live in that it is easier for me to order a Kenyan national team jersey from the United States than it is to actually find one in Nairobi.