I have never spent as much time in the care of medical professionals as during my pregnancy.  It is incredible for me to think of the vast number of professionals who cared for both baby and I, during the months leading up to his birth, during labour & delivery, and in the weeks that followed.

I remember the first time that the amazing medical care available here in Ontario really struck me.  Jon and I were driving to the Queensway Carleton Hospital.  I was having the worst pain I had ever experienced, and it was concentrated in my lower back.  We had just left my parents' house, where my mom had calmly cautioned me that I may be in labour.  I was 16 weeks pregnant.

As Jon drove to the hospital and I clutched onto the door with all my might to ease the pain, it occurred to me that no matter what was happening, there were doctors and nurses and hosts of other medical professionals who would immediately care for my little baby and I and determine the best way to proceed.  There was no mystery or fear; I knew that they would do all they could.  (In the end, they weren't actually able to determine what was wrong at this first visit, but a few weeks later I was back in hospital and it turned out that I had kidney stones).

During this drive to the hospital, and at numerous points throughout this first visit to the hospital - which lasted several days and would not be my last - I had a vivid picture in my mind of travelling to the hospital nearest one of the villages I stayed in briefly in Zambia in 2006.  A friend of the family I was staying with wanted to bring me to the hospital to show me what it was like, particularly since one of the family members had just returned home from a stay there.

As we cycled to the hospital, we passed many people who were walking along the same road, seeking the same destination.  I remember passing a man who was balancing his ill family member on a bicycle as he walked alongside, pushing the bike by the handlebars.  It was a long ride for us, going at a good rate.  My companion told me that many people would walk for more than a day to get to the hospital, a long journey even in the best of health.

When we arrived, we were faced with dozens of people who had set up camp, as it were, outside of the hospital.  My companion noted that these were family members of those who were in hospital.  The journey was so long that people would simply stay and wait until their ill family member was released rather than returning home and coming back a second time to retrieve them.  There was an entire market set up solely to sell food & necessities to these individuals waiting for those in hospital.  The people were under makeshift roofs, on whatever blankets or mats they had brought along with them.

We toured a bit in the hospital.  I noticed that many of the women didn't have bed nets (for prevention of malaria through mosquito bites) or even beds.  My companion explained that there were only so many bed nets, so the men were given priority.  We went by the birthing ward, an open room with multiple beds and not a bed net in sight.  The hospital often didn't have power, I was also informed.  They were short staffed and short supplied.

And me, here in Canada?  Each time I was in the hospital, I was given heated blankets.  Fresh, clean blankets, kept in what was basically an oversized oven, to give to patients for comfort & warmth.  I had 3 square meals a day, each with the nutrients needed to help me recover and a cup of strong tea to cap it off.  I had access to juice & water at any time, along with a selection of food vendors within the hospital that I could easily afford to visit,  if the provided food wasn’t to my liking. 

Before my precious baby was even born, I received more medical care than I'd like to relive:

How much did I pay for this care?  Not a single cent.  Sure, it is included in my taxes, but really?  I paid not a single penny for this care, aside from a few parking vouchers.  I didn't earn this care; I am not of any more importance than any other pregnant woman.  My baby, while of immeasurable importance to Jon and I, is of no more importance than any sweet baby born anywhere else in the world.  Which brings me to another memory from my time in Zambia oft replayed during my pregnancy, a memory of my host sister in Choma, the main town I stayed in.

My host sister, Elle*, was pregnant when I arrived in Zambia.  She had been impregnated by her teacher.  She was 14.

You can't say no, she told me.

We grew close during the months I was there.  Elle's mother had demanded that the teacher pay for a maid to come to the house and do the duties this daughter was unable to do while pregnant - cooking, cleaning, etc.  Elle was strong, but scared.  She would quietly confide her fears of what would happen to her body, what she would do with her baby, how she would learn to be a mother.  Her own mother was desperately tired, running an NGO that had been somewhat co-opted by a European foreign aid agency.

Elle had the baby while I was away for a few days.  Not much was shared around the delivery, but I had also visited the hospital in town where she delivered.  There were a few large ward rooms, with not much in terms of supplies.  To be honest, you wouldn't really know it was even a hospital aside from the familiar, metal-framed beds so often depicted in old Hollywood films.  During my last few days in Zambia, I got to hold Elle's dear little baby and hear of her uncertainty on what to name him and how weird it was to be nursing him.

Elle was lucky, in a way, in that she received care at the small hospital in Choma. Statistics weren't on her side.  Unicef reports that only 47% of births in Zambia are attended by a skilled health worker and more than half of the women do not receive postnatal care. There were three (incredible) midwives present at my son's birth, two caring for me and one caring for the baby.  The birth took place in a large private room in a hospital, full of doctors and nurses who were just a page away if anything happened that was outside of the scope of midwifery care.  I had options to give birth at home, at a birthing centre, or at a hospital.  

I had two midwives come to my home every day following the baby’s birth for the first week because he had lost 17% of his body weight by day 3.  He regained 5 ounces in a day and had passed his birth weight before he was 10 days old.  In Zambia, 45% of children under 5 are chronically malnourished.

Throughout this time of transition in my life, I have been oft reminded of another unique time.  A time where I got to live and work amongst people who had an abundance of ingenuity, fortitude, and will, but were severely lacking in opportunity and social services.

When I think of that ride to the hospital in Ottawa and the deep sense of peace I felt knowing that I'd be cared for, I think of the uncertainty and unrest that mothers around the world must feel as they carry their developing babies.  I remember sitting in the hospital bed in the labour & delivery ward during my first hospital stay and hearing parents leave with their brand new babies.  I quietly wondered whether I would get to hold my own baby.  Whether he'd make it, whether we'd make it.  Those fears were so short lived and I had all the support you could ask for to bring my baby to the world, and yet they were real fears, of a nature I haven't experienced before.  The medical team couldn't diagnose the cause of the pain during that first stay at the hospital, but they could assure me that my baby was doing just fine.  They did ultrasounds and all kinds of tests and assured me that the little guy was growing well and there was nothing to worry about.

I don't know what it would be like to experience the pain of passing a kidney stone at home, without the support of a knowledgeable medical team.  I don't know what it is like to have those same fears about the health of your baby with no one to assure you that everything is ok.  Or to support you if everything is not, in fact, ok.  I don't know what it would feel like to know from the moment of becoming pregnant that my child has a 10% chance of dying before the age of 5.  I actually cannot comprehend the depth of emotion that mothers must feel across this globe.  All I know, is that it isn't ok.  It is an injustice.

I still haven't quite figured out what to do with these thoughts and reflections.  What I do know, is that all of these memories have flooded back with a purpose and I still need to sort out what that is.  Poverty and the lack of opportunity are complex.  It isn't just a matter of money or of politics or of infrastructure or of good governance. Elle’s situation alone shows that there is more to the story than a better hospital and more doctors.  The situation also isn't something that I can simply ignore, retreating to the comfort of my day-to-day here with my gorgeous little boy. 

There are three principles that serve as a guide for me in situations like this:

1. Recognize the terrific blessing of living in Canada and the privilege I hold.  Be thankful and grateful.  Don't take this land of opportunity for granted but use it for the betterment of the world.
2. Do something.
3. Good intentions aren't good enough, so be thoughtful and wise when taking action.

Beyond these principles, I also remind myself that God is good and this is not the end of the story. That might not resonate with you if you don’t know God personally. But as someone with an growing relationship with God, let me just say that God is good. And that these realities break His heart even more than my own and I’m thankful to find hope in Him.

There are some organizations doing great work in Zambia to improve maternal health and as a practical first step, my husband and I have chosen to support their efforts.  In particular, MSF has assisted over 2,000 births in Zambia and recently handed over a maternal health programme to the local ministry of health after 3 years of building the programme base.  Their work can be supported here.  (MSF is also doing some amazing work in areas that are vastly underreported in the media at the moment, for example in South Sudan and the Central African Republic)

Engineers Without Borders continues to support ventures in Zambia that address barriers facing farmers and build into local businesses.  It was EWB that first brought me to Zambia and the organization continues to strive to combine passion and pragmatism to bring about systemic change.  You can learn more about EWB and support them here.

My experience has also brought back thoughts of my friend, Shauna, who worked with the local community in Penyem, the Gambia, to open a birthing house in 2011.  Over 75 babies have been born in the birthing house since it first opened, providing a safe and culturally significant environment for labour, delivery, and post natal care & rest. The birthing house is a neat example of an effective approach to improving maternal health. You can read about the birthing house here.

* Not her real name

© Courtney Edwards 2014