Sitting on the floor by the fireplace with Wawerũ, her legs outstretched and crossed at the ankles, we have to keep ourselves from laughing too loudly. It’s 10pm at Flying Kites, a school in rural Kenya, and a handful of orphaned students who don’t have homes to go to are sleeping in the bedroom just behind where we’re sitting.
Wawerũ has taken a long pause in her story. She smoothes the wrinkles on her skirt and rubs her shins, which are covered in thick purple scars – some slashes are so raised they look like slugs warming themselves by the fire. “What do you mean you had to cut the umbilical cord yourself?” I ask, and we’re both laughing again, like two women recounting a crazy night out. Except we’re not. We’re talking about Wawerũ giving birth to her first child alone on a dirt floor in Njabini, a small village in the foothills of Kenya’s Aberdare mountains. And I probably shouldn’t be laughing, but Wawerũ is an incredible storyteller and very funny. “And then I nursed the baby and made chai. You just do what you have to!” she says, leaning back against the wall, and I am in awe.
Ten years ago, I started working in Njabini – and for the past decade I’ve split my time between there and Boston. The older I get, the harder it is to adjust to the back and forth. I find myself stumbling into the disorientating gap of privilege and poverty with increased clumsiness.
I messed up. When I found out I was pregnant, I thought about Wawerũ and all the women I knew in rural Kenya who had similar stories to her and I idolised them in a way that romanticised their poverty and nearly cost me my life. After years of working in development, it still surprises me how naive I was.
We were back in Boston, and planned to stay there for the pregnancy, which, to begin with, proceeded as normal. My husband, Mike, quickly bought into America’s tendency to scare every pregnant woman into buying all the things. It seemed like he had downloaded every app and ordered every book. Small bottles of thick red juice called Prenatal Revive suddenly showed up in our fridge (revolting) and a tub of something from Burt’s Bees called Belly Butter appeared on my bathroom sink.
But I vehemently rejected what I felt was the commodification of the pregnant woman’s body and I made reference to all of my friends in rural Kenya who had done fine without it. Whenever he asked me what my plan for something was, I wanted to answer truthfully: “Mike. My plan is just to hold on for dear life while my body does what it was made to do, just as all women have done, since the beginning of time.”
Women give birth all the time without making a big deal of it. I saw no reason that it wouldn’t be exactly the same for me.
Our first doctor’s appointment was with a sweet nurse. She advised me not to travel to rural Kenya and I rolled my eyes. She asked me how I’d been feeling and I said I’d been feeling sick and that the week prior, I’d experienced an episode of pains. She smiled reassuringly. I didn’t make demands for second opinions. I didn’t scour WedMD. I reminded myself: “Leila, this is older than you. Much older than you. There is nothing for you to control or achieve here.”
On the way to our second prenatal appointment, I felt a sharp pain. The closer we drove to the doctor’s office, the worse it got. I rolled down the window, peeled off my sweater and began to breathe intensely. I don’t remember much after telling Mike that I was going to pass out, but I turned white and slumped over. He screamed my name and drove at full speed to the emergency room, one hand on my inert body, straight through a red light, arriving at the doors of the ER screaming for help. Within minutes, I had IVs in both arms, bags of blood being pumped into me so quickly that some spilled on to the white floor, and a doctor saying, “Leila, stay with me. Leila.” I heard him command someone across the room to arrange a helicopter for us.
“I don’t want a helicopter,” I whimpered through the oxygen mask to a woman standing over me. “Why? It will be fun,” she said unconvincingly, her gaze not moving from the screen above my head, “Are you afraid of flying?”
“No, I’m afraid of dying,” I thought, as I caught a glimpse of Mike’s expression in the corner of the room.
Boston Medflight sent a critical care team to airlift me from a big hospital in the suburbs to a bigger hospital in the centre of the city. It took 14 minutes. Within seconds of the wheels of my stretcher hitting the floor, I was greeted by a team of scrubbed-up surgeons. I thought about rural Kenya for a brief moment. I now had more doctors around me than most of our neighbours there will have access to in their lifetime.
Hours after surgery, I woke in a dark hospital room; my shoulders were throbbing. Mike was in the chair next to me. “Your fallopian tube ruptured, he said. “Your vitals plummeted and you lost litres of blood. The ER team saved your life.” I drifted back to sleep, nurses and doctors coming in through the night to check on me, machines beeping and muted conversations in the hallway, a deep feeling of fortune washing over me. Not fortune in the sense that I had truly grasped social inequalities or was humbled by my winning birth lottery ticket – in the much less profound, much more selfish sense: I could have easily been in Kenya and I would have certainly died.
The next morning, my surgeon came to see me. She told me ruptured ectopic pregnancies were a life-threatening medical emergency, and a leading cause of maternal mortality in the first trimester.
She explained why I wasn’t staying on the maternity ward. “They don’t put you there, in case, well… it might be hard to hear a baby crying.” I know I am supposed to feel sad, but I somehow can’t get past this stark advantage glaring down at me like the fluorescent hospital lights. I’m alive. I get to live because of where I live.
A woman in a developing country who doesn’t have access to prenatal care and gives birth alone is brave. And she is oppressed. Pregnancy is often lethal. For every Wawerũ, there are millions of courageous women who don’t live to make chai, to tell their story. Approximately every two minutes a woman dies from (overwhelmingly preventable) complications during pregnancy and childbirth and – while the US certainly has a long way to go in terms of maternal mortality – 99% of these deaths take place in the developing world, where a woman will leaves behind an average of four orphaned children. I’ve worked with orphaned children for years, but today, it’s their mothers who take root in my heart. The profound access I have to medicine isn’t something to take or leave, it’s a basic human right that should be afforded to all expectant mothers and isn’t.
For sure there are lots of variables that would have changed my outcome. If I had been a poor woman in a rich country, or a rich person in a poor country, or if Mike had tried to bring me to the clinic instead of the emergency room, or if we hadn’t had a car. It’s less about geography and more about disparity – and this is the most glaring difference between my life in Boston and my work in Kenya.
When the nurse brought in the paperwork for me to leave the hospital, I lifted my arm and held out my hospital ID bracelet for her to see. It read, Diana Critical, DOB 1.3.1930. “That’s not my name or my birthday,” I said. “I know,” she sympathised, “there wasn’t really time for any of that.”
Driving home, I was struck by a sense of panic by every mile I was putting between myself and the hospital. Looking in the rearview mirror and realising: “I don’t want to be five miles from the hospital. I don’t want to be six miles from the hospital”. Three days before I had been so fearless, somehow so sure of my right to go wherever I wanted and get whatever I needed – which is embarrassing to admit, as someone who spends so much time in the poorest parts of the world. I suppose this is the subtle difference between having healthcare, and needing healthcare. The difference between me, and Diana Critical.
To support maternal health, everymothercounts.org or pih.org.
Leila de Bruyne is founder and executive director of Flying Kites.
