This story took place in Uganda while I was working there for a year.   I'm a nurse midwife and went to Uganda to help upgrade the curricula for nurse midwives at Makerere University.  I was a newly remarried widow, whose youngest child was a junior in college and I was ready to share a life of working with mothers and babies with women who rarely had prenatal care and with midwives who worked with the most minimal of resources in countries where women frequently died in childbirth.  Believing that it should not cost a woman her life to have a baby, I had the privilege of meeting some amazing, truly dedicated women.  This story is a tribute to one of them.

The year in Africa began what turned into a 15 year experience working with midwives in developing countries.

“It is the rainy season, Madame, we cannot pass.” Spiro, the project driver, was adamant in his refusal to go.

Despite my pleading, he maintained that driving into the village for any reason did not make sense. Was I really foolish to think of doing this? This wasn’t a pleasure trip. Sara had asked our help in getting to her ancestral village, help in burying the “apple of her heart.”

In the end, compelled by memories of an old grief of my own, I decided to drive Sara myself.

I could not have foreseen my friendship with Sara when she appeared at our gate in Kampala to inquire about work. Her serious face broke into beautiful smiles whenever we talked. She kept her long hair pulled back into a bun and wore western skirts and blouses, not the traditional full-length basutti. I remembered that first conversation with her clearly.

“Madame, I have come to offer my services as your cook.” Sara’s soft voice made me strain to hear. I had learned not to be surprised at such gate visits. The Ugandan grapevine worked well. New American families were easily recognized. The first week Tony and I arrived, Ugandans found their way to our door to offer all manner of services-gardening, water sales, car repair, plumbing- or to sell indigenous drawings, mats, baskets, and batiks.

“Oh, thank you,” I replied, “but I really enjoy cooking and we are just two. I will not need a cook.”

“But, Madame, I must find a way to pay school fees for my children and while you are here, you will need help buying food in the market and finding good meat.” Sara had done her homework. I did indeed have a lot to learn about where to buy the best foods and how much to spend. The food preparation required for safety was also mind- numbing and time-consuming. Trying to figure out how to say no, I searched for conversation that would lead us to my refusal. “How many children do you have, Sara?” I asked.

“Oh, Madame, I have three girls and just last year, God blessed me with a son, Andrew,” she replied. She told me the names and ages of her girls, but her eyes radiated when she described Andrew. “He is the apple of our hearts,” she said, “My husband wanted a boy for so long. God was good.”

She moved the conversation on to the monthly school fees, plus mandatory extras such as navy blue skirts and white blouses, matching socks, lace-up shoes, a sweater, and a raincoat and pair of “wellies” for the rainy season. The British system of elementary school was still alive and well in Africa.

I was wearing down. “We have hired a young man to take care of our place and he has volunteered to do the market shopping and the laundry,” I said.

“Madame, young men in our country know nothing of these things. Really, I am your solution,” Sara insisted. Not totally convinced that I needed a solution, but unable to say no, I relented.

The following Monday afternoon, Sara arrived with two children in arms. Jane, a spirited four year old, and Andrew, a round-cheeked toddler whose smile could break open a glacier. He hid behind Sara’s leg and giggled at Jane, poking his face out to watch her, and glanced at me, then hid again in Sara’s skirt. Jane came right up to me and asked, “How are you? What is your name?”

“My name is Charlotte,” I replied.

Sara quickly interjected “Jane, you will call her Madame” as she gathered Andrew up in her arms. They settled quietly in the kitchen while Sara prepared dinner.

Over the next few weeks, I realized that Sara was developing a “big-sister” relationship with Edmund and the gardener, Francis, a young man in his early twenties. She served them our leftovers and made sweet treats for their tea. I liked hearing their quiet conversations and the way she took care of them. Most of their conversations, except in our presence, were in their native tongue. It sounded to my ears like encouragement, cajoling, and even occasional scolding, as she taught Edmund how to care for our home and foods. I also appreciated that she began to do our laundry. Since Edmund had been destroying shirts and slacks on a regular basis, it was a welcome relief to have our clothes looking the way they should.

Whenever Sara brought Andrew and Jane to work with her, Andrew always became the center of attention, chasing Edmund, begging cookies from Sara, coming into my office to check on me.

Edmund was over six feet tall and very lean. Francis, a Hutu, was built square and rugged and less than five feet tall. They would toss Andrew between them, making him squeal and giggle. Edmund wanted to be a schoolteacher and greatly enjoyed watching over the children. He would scoop Andrew up, saying, “Come on, Mr. Andrew, come find what Edmund has for you.” Andrew would follow him out to his new living space in the rear of the house and look for sweet treats bought just for him that Edmund hid in various nooks and crannies. The two kicked around a deflated futball, and never tired of playing an African version of “peek-a-boo” which involved open hands.

Shortly after the workshop, Edmund came to find me in my office. “Madame,” he said softly, “Sara will not work today.”

“Is she ill,” I asked?

“No, Madame, Andrew has been sick. He is in the hospital.”

Assuming one of the illnesses that African children so often suffer- malaria, dysentery, or respiratory infections- I didn’t think too much about this except to tell Edmund to let Sara know she should tell me if she needed anything. I made a plan to visit Andrew at Mulago Hospital the following day.

The hospital’s pediatric wing consisted of several large, open wards, each with thirty or more cribs and cots. Families were allowed minimal visiting hours. It struck me that these visits worked to the nurses’ benefit. It was virtually impossible for the two or three nurses assigned to each ward to comfort, feed, change, or hold so many crying children. Families brought the only food and drink patients received. They also brought linens and Katanga cloths to wrap and warm them during their chills and fevers. I brought Sara some food for herself, and a stuffed toy for Andrew. Sara had rushed Andrew to the hospital when his fever had resulted in seizures. From there, it was unclear to her what his course of illness or treatment involved. She told me how difficult it was to get information from the doctors.

“But, I am so grateful for Edmund, Madame,” she said. “He is sleeping on a straw mat near Andrew’s crib at night so I can go home to see to the other children. At first, Andrew would hold Edmund’s finger and smile for him, but oh, Madame, now he doesn’t do,” she whispered.

Seeing him now in Sara’s arms, I thought he seemed to be responding to her attempts to make him smile, and though sluggish, he nursed, nestled in the crook of her elbow. Still, a pair of I.V.s trailed from his arm and foot, constant reminders that the doctors were trying to pump a cure into his body.

“Pray for Andrew, Madame. Pray,” she said as I hugged her goodbye.

Sara’s husband, Nehemiah, was buying antibiotics and fluids and bringing them to the hospital for Andrew, the norm for families since the hospital lacked most medicines. Andrew’s body didn’t respond. Edmund was keeping me posted. Daily, he would tell me, “He is not so good, Madame. Sara is very worried.” I made another trip to see them. Now, what I saw alarmed me. Andrew was listless, barely responding to Sara, and had clearly lost a good deal of weight. “Madame, will you help me see if the doctor will tell us when Andrew will be better?” Sara asked.

We spent the next two hours trying to find the doctor responsible for Andrew’s care. I went looking in every office I could find, but either no one was there, or no one knew where Andrew’s doctor had gone. Many of the doctors maintained their own clinics away from the hospital and were very difficult to track down, without phones or beepers. It was also common for very little information to be given to families. All I could manage was to get some lukewarm assurance from the nurses that the doctors were doing everything they could for Andrew.

I left the hospital with terrible feelings of impotence and anxiety. I recalled my own experience of losing a son twenty-five years before. I had watched the nurse try to find my baby’s heartbeat, seeing only a frown on her face. The inability of Andrew’s caregivers to make contact with us reminded me of my nurse’s inability to make eye contact. Something was very wrong.

Then, one morning, some two weeks into Andrew’s illness, Edmund reported that “His eyes are flat, Madame. He does not recognize me or even Sara.”

*****

“Madame, you must come.” It was seven in the morning and Edmund was knocking on my bedroom door.

“What is it, Edmund?”

“It is Andrew, Madame, he has passed and Sara cannot move.” Oh, God, I thought, this can’t be happening. My fingers trembled as I rushed to get dressed, wondering what I could ever say or do to make this loss hurt less for Sara. I was awash with memories of that pain, but I lacked the memory of any words that had helped. What I knew for sure I wouldn’t be saying was, “He’s lucky. He is with God.” Or, “It’s God’s will.” Those words had struck me as so preposterous. How could a son’s death be “God’s will”?

Disheveled, gaunt, eyes wild and red-rimmed, Sara was walking toward the house as I started out the drive. I got out of the jeep and ran to her.

“Oh, Sara, I am so sorry,” I said, holding her close.

Moaning, her thin body trembling, she looked at me and said, “Madame, I must ask you to bring me to my village to bury Andrew. There is no one else I can ask. My family has no vehicle and we can not take a body on the bus.”

The rain had stopped and the sun reflected from the corrugated roof creating steam as I pulled into Sara’s yard. Family and friends stood outside talking quietly. Children ran through brown puddles, shrieking when someone else’s splash caught them. My shirt clung to my back in the muggy-hot air. I stepped into Sara’s home, darkened now by closed shutters. Andrew’s once-chubby body lay on white starched pillowslips in the corner of the open room, elevated on boxes to keep him from the mud that formed their floor in rainy season. Three women, friends and a sister-in-law, dressed in the traditional basuttis, usually riotous in color, but muted today for this occasion, huddled close to Sara, holding her. It was the first time I had seen Sara in a basutti. Sara saw me and keened an African grief lament, acknowledging what she had been able to deny until my arrival. It was time to take Andrew for burial.

Ugandan custom requires the burial of children take place in the village of their grandparents. Custom also decreed that the grandparents name the children. The grandfather to whose home he journeyed for the last time had named Andrew.

Sara’s husband, Nehemiah, approached me and thanked me repeatedly for taking Sara. He would not be coming with us. Nehemiah worked for the US Embassy and could not afford to take the time away. Andrew’s illness had cost them dearly in time and dollars and he had a realism I first found difficult to understand. There was nothing else to be done for Andrew. Supported by her women friends, Sara reached over and scooped Andrew to her, wrapping him in her best shawl. Cradling his head, she covered his face only after planting several kisses on his eyes, mouth and chin. Nehemiah took him from her and placed him gently in a small pine box lined with one of the starched white pillowslips. The miniature coffin, narrow at the foot, had a rose carved into the cover. At the closing of the box, all the women in the room wailed out their last goodbyes. I heard my own voice catching in my throat.

Sara wanted to hold Andrew all the way to the village, so she climbed in to the narrow back seat of the Suzuki and reached out her arms for his coffin. With Sara settled in an improbable position -- a mother cuddling a too-big child—the coffin squeezed Sara into the rear seat, where she draped her arm over the top, determined to hold it steady. Carefully, we left the yard, headed for the village southwest of Kawempe. I reminded Sara that she needed to give me directions as we went, since at my best I am not a pathfinder. Nor was I completely used to driving on the left side of the road, even after several months in Uganda.

We hadn’t been on the road for 15 minutes when the downpour began in earnest. Adjusting the wipers to accommodate heavy rain, I struggled to find the balance between heat and air that would keep the windows somewhat free of fog. The roads in Uganda were terrible, destroyed in the civil wars. With the rain crashing on the jeep’s roof, it took all my concentration to see and avoid potholes, so deep and wide they were a challenge even in the dry season with clear windshields. Every time we hit a hole, I was jerked against the seat belt and Sara held on to her precious load with all her strength. I was terrified that I would land us in a major hole, break an axle, tip the jeep, or worse. Watching for oncoming drivers added to the tension, since Ugandans drove without lights. For some reason, they believed that this saved battery power. They used the horn almost continually. Hand signals were confusing or non-existent. When we had first arrived in Uganda, a friend had told us, “The only thing you know for sure when you see a hand signal in Uganda is that the window is open.”

Just when I was convinced we had been at it so long I must have overshot our turn- off, Sara pointed to a secondary road. “There, that is the way.” Here, there was no longer even a semblance of road, more like a mud pit.

“There?” I asked, checking over my shoulder.

“Yes, Madame, that is the road.”

I turned right and tried desperately to maneuver around toward the rim of the giant puddle. Bumping and sliding, we progressed at an infinitesimally slow pace, aided somewhat now by the cover of the banana leaves and the absence of tooting horns. I was grateful for my experience with New England mud seasons past. I knew when to give it more or less gas and not to trust the innocent-looking ruts. The Suzuki shook us to the bone whenever we hit a deep pocket. Slowly, I drove along the path.

My eyes were frequently diverted to the rear view mirror, where I could watch Sara balance the small coffin on her lap like an oversized treasure. Unbidden, thoughts of my first husband, Bob, burying our son came to mind. What had it been like to drive to the cemetery that beautiful October day? What did that coffin look like?

Suddenly, she shouted out, “Madame, please stop here for a moment.”

On the left side of the path was a small market. “Sara, what do you need? Is anyone there?” I glanced over at the small shop, its corrugated roof pouring water straight down over the front door. The windows were boarded u against the rain and I could see no sign of life at all.

“Oh, yes, Madame, they are there. They will send a message to my family we are coming with Andrew and to prepare a grave.”

“But there is no electricity or phone here.”

“Oh, they will tell with drums.”

Of course. She would have had no other way to pass the notice of her loss. As a grandmother, I could no more imagine getting the word of the death of my grandchild by distant drum than I could imagine my daughter in this circumstance of driving her baby home to be buried. I pulled as close to the shop as I could and watched as Sara lifted Andrew enough to scoot out from under, placing him gently on the seat before she ran into the shop.

I could barely make out her form disappearing into the shop. Waiting, my hand found Andrew’s coffin and rubbed the carving, awed again that women ever survive this kind of loss. A few minutes later, Sara returned to the jeep, slipping into the back seat to reclaim her beloved bundle.

We continued on our way, but with the rain beating down on the car and the path, we could hear only muted drum sounds. Shortly, Sara directed me to another right-hand turn.

“But Sara, there is no road here.”

“It will be, Madame, just pass here.”

Narrower than a bicycle path, the vague outline of a footpath appeared ahead. Terrified now that I would get the vehicle stuck between the matoke trees, I inched forward, stalling and starting up again, visibility often blocked completely by the large matoke leaves. Sara was totally pre-occupied with a soft lullaby she crooned over Andrew. After forty-five minutes of this driving I was struggling for the courage to suggest that we leave the car and walk the rest of the way, when Sara pointed to a small clearing. “There. They are waiting.”

Oblivious to the rain and the slapping matoke leaves, a group of people stood at the clearing watching our approach. I pulled the car as near as I dared and turned to help Sara but she was already opening the front passenger door, negotiating the casket on her hip. Many hands reached out for her and her baby and again, she collapsed in the arms of women who loved her, all now keening the now-familiar lament. I was grateful for the rains that camouflaged my own tears. I stayed in the car, leaving them some privacy in their grief, caught up in my own remembering.

Years before, before I knew this kind of pain existed, I had been a young mother eagerly awaiting the birth of my third child. I could see it being played out again, the agony as fresh and harsh as the rain beating down on the jeep.

Going up in the hospital elevator, I leaned against Bob to catch my breath between contractions. “This baby has stopped his acrobatics for his grand entrance,” I whispered, aware again that I hadn’t felt the baby move in quite a while.

“He’s saving his energy for his big brothers,” Bob answered, pulling me close.

The nurse who greeted me quickly moved through the paper work, acknowledging an imminent birth. She got me settled in the labor room. She leaned over me on the bed, checking my distended belly and moving the heavy fetoscope over every inch until I pushed it away with my hand, overcome by the next contraction.

I was encouraged by the fact that I was eight centimeters dilated and worked to focus my energy. The nurse urged me to take whiffs of cloying gas from a hand-held mask, but I was determined not to. “I want to have my baby naturally, like my other two,” I told her. I began to have an ominous sense that something wasn’t’ right. Why isn’t she listening for the heartbeat with these contractions? Overwhelmed by the next contraction, I concentrated on my breathing, “pant, pant, blow,” my mantra, my arm pushing away the mask. Several more contractions and the urge to push took over completely. As I leaned forward to grab my knees for better traction, the nurse suddenly place the Trilene mask over my nose and the next thing I remembered, I was awake and the room was still. Dr. Caron was sitting between my elevated legs, finishing up with the afterbirth.

“Where’s my baby?” The room was too quiet. “I can’t hear my baby. What did I have?” I glanced over to the bassinette but could only see a blanket-wrapped bundle. No one was attending my baby. The nurse had never really found that heartbeat, had she? I couldn’t see the baby’s face. “What’s wrong?” I asked. “Let me see my baby. I want to hold my baby.”

“I’m so sorry, Charlotte. Your baby was a big boy, but he had his cord tight around his neck three times. He never had a chance.”

“Please, please let me see him,” I cried, all the while thinking, this can’t be happening.

I tried to stand, to yank my legs out of the stirrups. Dr. Caron’s hands held my knees firmly. “I know, I know. I’m so sorry,” he murmured. He cradled my head while the nurses cleaned and covered me, moving me to the stretcher and back to my room.

I kept struggling to get up. I couldn’t breathe. “Where’s Bob, I have to see Bob,” I cried.

As they wheeled me into my room I could see Bob holding the doorjamb into the bathroom, retching.

Bob and I begged them to let us see Stephen, but in the ‘60’s, mothers weren’t allowed to see or hold their stillborn infants. The nurse told us he’d been sent to the morgue. “Oh, no. Please, please don’t send my baby there,” I begged.

No one answered, and soon we were left alone, desperately trying to figure out what had gone wrong. How could this be happening? My arms ached to hold my baby, my breasts to nurse him. Who did he look like? When had his cord wrapped around him? What could I have done to prevent it? We held each other, lost in our pain.

The next day, the chaplain came to see me and told me, “This is God’s will.” I wanted to slap him when he started telling me Stephen wouldn’t go to heaven since he wasn’t baptized. He’d spend eternity in limbo. My father came to see me on his lunch hour and held me against him, unable to speak. In the four days of my hospital stay no one mentioned the baby again.

Bob was sent to bury the baby by himself, before I left the hospital. He didn’t tell me until later, afraid I’d leave the hospital and force open the casket. I spent years furious at this betrayal. I had assumed the hospital sent the undertaker to bury our son. I couldn’t believe Bob was sent and hadn’t told me. I was convinced he had seen Stephen, that he looked into the coffin. I couldn’t believe he was the last one to hold our baby and had left me out of that moment.

It was a sparkling fall but I saw it with blurred vision. I took the boys for endless walks, crying all the while. I avoided the streets that took me past the homes of relatives and friends. They all thought talking about Stephen would delay my recovery. Even to his death, Bob and I had never talked about what that time was like for him.

Sitting in the jeep and crying openly, I thought of Bob with more sympathy now as this African family gathered to bury Andrew. Oh, Bob, I thought, how lonely that must have been for you. Where did you even get a casket? I wondered now. And who dug the cemetery hole? I cried, too, for that young mother who lost her beloved son without the arms and tears of her own extended family to soother her.

None of Sara’s relatives spoke English, but they beckoned me with their hands and led me into the house. I was offered tea and the only chair in the crowded, stuffy living space of a one-room mud hut. The thatched roof kept most of the rain out, but the mud floor was slippery and scuffed, and the bare feet coming and going had difficulty gaining ground. A man who appeared to be their minister was intoning over Andrew, while Sara, held close by the women, cried softly.

Eventually, the rain eased and the family moved to the hastily-dug grave where they gently laid Andrew. The three-foot hole wasn’t much deeper than the coffin itself, and the rain caused the rusty mud to slide and fill it as fast as the men could shovel. His family opened the coffin for one last viewing of Andrew. He looked waxy now, and stiff, his pudginess gone. Sara gently lowered the shawl she had wrapped him in, and his small-boy hands fell loosely on his chest. Mementos from his grandparents, aunts and uncles-a colored ball, a small rag doll, a hand-stitched pillow for his head-and a piece of Sara’s hair had been placed along his body to accompany him on this last journey.

Later, as we prepared to leave the village, I struggled to figure out how to get the jeep turned around and headed back along a path marked now by our own earlier passing. To my great embarrassment, I slid into a huge mud hole and could not maneuver the vehicle in any direction. Within seconds, men and young boys surrounded the car; without leaving the car, we were easily lifted from the hole and turned the right way.

The return trip, like many return trips magically seem to be, was shorter. The Suzuki was covered with such a thick layer of iron-colored mud, its original white now obliterated. We talked quietly about the day, and about Andrew, and I told Sara the story of losing my own son, Stephen. She quietly placed her hand on my arm where it stayed while she navigated our way out of the bush.

Mother of six adults, grandmother of ten, I worked as a nurse midwife and Chair at Yale University School of Nursing; practiced midwifery in New Haven CT, them moved to northern NH and developed the nurse midwifery program at Dartmouth Hitchcock Medical Center.  I spent 15 years working with midwives in developing countries and subsequent to that, worked with Centering Pregnancy as a consultant.  Most recently served two terms in the NH Legislature, during the last term introduced and saw passed a bill to study maternal deaths from childbearing causes in NH.  I have recently moved with my husband into an independent living retirement community.
 
 

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