St. Mary's Clinic

Mary Bari was the revered midwife in the village for 40 years. She safely delivered hundreds, if not thousands of little Irigwe babies during her lifetime, and I am keenly aware of the truth that I can never fill her gaping shoes. Nevertheless, since March 2005, I have been trying. Mary’s daughter, Abi, is one of my dearest Nigerian friends, as well as my partner at the clinic. Although she is not a trained nurse, she assisted her mother in the clinic for many years, and is generally considered an expert midwife now. Together we treat approximately 100 women per year, and regardless of the fact that I have been at the clinic every week for over 3 years, I am constantly learning new things about the women.
The Irigwe language is quite different than the common trade language called Hausa spoken in this part of the country. Irigwe has a sing-songy Asian sound, and uses muscles in the tongue that I do not believe I possess. I try, and am able to say quite a few words, but the women usually laugh or look at me with a blank stare, wondering what language I am speaking. Inevitably, Abi will repeat EXACTLY what I have just said, with the same intonation, and the women will give that knowing expression of comprehension and repeat the phrase again to me, to try to clarify to my unwilling mouth how to form the strange words.
The women come one by one into the exam room, whose water damaged ceiling is clinging to the cross beams by a thread. The walls, painted 3 years ago, are home to more than a few spider webs, with which I gave up my fight sometime in 2006. I must constantly resist my prior-life addiction to Clorox wipes. In the absence of running water, I have resorted to bathing my hands in Germ-X until the stickiness drives me crazy and I dip them in rain water to wash away the gunk.
Most of the women are dressed in a very similar manner, as though there were a dress code for the pre-natal clinic. The uniform is a V-neck white, lacy blouse with puffed short sleeves atop the familiar “wrapper.” Every Nigerian woman owns several wrappers, 6 yards of brightly designed fabric cut in half – three yards serve as a shawl with the remaining three yards wrapped around the waist “sarong-style.” There are no strings to ensure that the wrapper stays in place, but the ladies have learned to tuck them in such a way that their money is stored safely in a knot at the end of the fabric held closest to the stomach. Even the heaviest of Irigwe women will only weigh 140 lbs at full term, so they do not have to wear a special white lacey blouse near the end of their pregnancies. They also cover their heads with a chiffon scarf or a head tie made from the same fabric as their wrappers. One of the classic signs of beauty among this tribe is “de open teeth,” a condition that forces many Americans to the orthodontist every year. Here, however, this is considered such a sign of beauty that some women will force their upper and lower front teeth to separate with a twig. If someone was to have the luck to lose one of their front teeth, all the better!
If a woman is bringing an infant for vaccines, the baby will be strapped to her back with two more wrappers. No matter the temperature outside, the child will be bundled in at least 5 layers of clothing with no fewer than 3 blankets, booties, and caps on its head. Even the newborns are painted with charcoal eyeliner and eyebrows, many with a tiny black dot between the baby’s eyes. Often as I peal away the many layers, I discover the boils of heat rash, and try in vain to plead with the well-intentioned moms to use fewer layers. This week, I watched as Abi bathed the tiny Baby Mary, whom I have affectionately named “Kadunk kadunk” (Small small), as she was 4 lbs at birth. After a soak in a bucket of scalding hot water, the screaming infant was slathered in Vaseline, then oil, then powder, then charcoal, then 50 layers of clothing.
I learned early on that I am a visitor, appreciated for my knowledgeable contribution, but dismissed if my advice contradicts common Irigwe practice. If my treatment regime is not enforced by Abi, it is invalid. This is a very difficult time of year my patients. The men of the village prepared the fields for planting several months ago, but the remainder of the labor is women’s work. This farming community does not use any modern equipment. Rather, the women bend over the ancient hoe as they till, weed, and transplant their crops. It is back-breaking work and many times the women will begin premature labor as a result. The rule is that if a woman will not work in the family field, she will not eat the food that she is responsible for planting, growing, and harvesting. One of the most common cures for preterm contractions is rest and hydration. So if I ask a woman to rest from her work while she is hurting, she leaves the clinic laughing. Last week Abi had a visit from a husband whose wife was instructed to rest. Abi, of very slight build but extremely fiery temperment, informed the reluctant father, “Okay, I did not know dat you had too much money. Fine. If you have so much money to pay fo de hospital bills, go ahead and allow your wife to go to de fields.” The man, knowing that he could not afford a hospital admission, allowed his wife to stay home and rest.
One of the most confounding scenarios follows the initial greeting and assessment phase of an exam visit. I smile and say “Na quway, rayray weray, chweray?” (Morning greetings) Then invite the patient to sit down, “srabay, njeeya.” After blood pressure, the patient lies down, “Nyebay” for a listen to “nufanchin yaro,” or baby’s heartbeat. After the exam is complete, the patient sits on the bed, obviously with something to say. However, she is too shy to say anything, so we all sit in silence. Finally, Abi takes a deep yawn, which to her is a sign of interest, and claps her hands together, as if to say, “What is wrong?” The lady diverts her eyes, as maintaining eye contact is a strong sign of disrespect. After a few more seconds, the woman will whisper in a tiny voice what her true concerns are. She and Abi may never actually look at each other during this conversation of hushed whispers, but eventually she will leave, and I am left to wonder what just happened, a reminder that I am a visitor and Abi is the boss.