Phyllis Wanja Kariuki
Age: Early 30s
In her own words:
I lost my first pregnancy at 15 weeks. I had begun bleeding, and doctor in Mandera, where I worked as a Logistics officer with Save the Children, Kenya, recommended two weeks bed-rest. I came back home to Nairobi and all went well. The day before my scheduled return to Mandera, my friend and I went shopping. I started feeling funny, like cramps and remembered that the doctor had permitted me to take regular painkillers for this, so I took a Panadol. I did not expect that there would be any adverse effects, and it helped. At night however, I woke up to the same cramps, intense pain. When I went to the toilet, some water came out. I did not understand what to make of this, as it was my first pregnancy. I was rushed to Nairobi hospital, and on getting there, they discovered that the amniotic fluid had leaked out. Their prognosis was not good. They suggested a termination of the pregnancy as it had only a 90% chance of being viable. I resisted this and sought a second opinion. I went to Aga Khan hospital. I was given the same story. The doctors there meet and make sure that by the time they are giving you your report, they have tested you, they have discussed it together and allow you to make the final decision based on their thorough analysis of the your case. I had stayed for so many hours, and since this was my second stop, I felt I had no other choice but concede.
It was a horrible experience. They started with the treatment, and I was discharged and moved on with my life. After six months I conceived again, and I still had issues. I started bleeding at 8 weeks. This time I was more cautious, and able to see the warning signs. I went to the nearest clinic, St. Bakita in Utawala, and was injected with Buscopan. They suggested I go for a scan. I went home and the next morning went to Agakhan for the scan. I was frightened of loosing my child. During the scan, the doctors were discussing the point of bleeding around a certain spot. But there was another spot and when I asked what that was, I was told it was another baby. I understood them the magnitude of what I was carrying and how careful I needed to be. After the scan at the ER, I was referred to Dr. Obura, a Gynaecologist. He looked at the results and gave me hope. He gave me medication to strengthen the wall of my uterus, and advised me to avoid strain.
At around 18 weeks I started spotting again, but this was not serious. Both at home and in the field in Mandera, I took very good care of myself. Mandera was less strenuous for me as I only had short distances to walk, and we are basically taken care of. I did not have to cook or do anything for myself. I stayed there for six weeks and then came back for R&R. At the airstrip, the flight attendant asked me how far along I was. She alerted me to the fact that I could not travel in a small aircraft beyond that point, and I understood that to mean that I would now be working from Nairobi. I worked for one more month before I started swelling. One of my colleagues, Eric Muthiani adviced me to have my blood pressure checked to rule it out as a cause for the swelling. My pressure was normally but now my feet begun to swell as well. It was during clinic test. I was to do a HCG test to determine my glucose level. It takes time, but they advised I change the clinic date as it was too late in the day. But I wanted to understand what was causing the swelling. The doctor insisted on a urine test. I had to do it twice for them to determine what the problem was. The doctor told me that my urine had a lot of protein in it, and suggested for additional tests to determine the functionality of my kidneys. This came out normal. They connected me to someone closer to home who would monitor my blood pressure daily, as they had noticed that it was fluctuating. I was to call the hospital daily to give them the readings.
This was on a Friday, but on Saturday, I was planning on going shopping for baby clothes so I did not go to check my pressure. I went in on Sunday, it turned out high. It read 170/100mmhg. The doctor recommended I go home and rest. I rested, and went back for another reading in the evening, this was even higher after then rest. I know High Blood Pressure is serious, but had no reference for people having it around me, and therefore did not see it endangering the pregnancies. The doctor recommended that I go into hospital immediately. I went home, got ready and then went to hospital. I was alarmed to find a team waiting for me on my arrival at the hospital. I was feeling fine, and wondered why they found this reception necessary. The scan showed that the blood was not flowing into the second baby as it should. I was admitted, but even then I thought it would just be for a night. At around 1am the doctor came to check on me and informed me that they would have to do an emergency Caesarian Section if my blood pressure did not go down. I had no idea that HBP could lead to one giving birth to pre-terms.
In the morning, a group of four doctors, took me to radiology for a scan. They sat around me and studied me. They told me they needed to do the emergency CS, in order to save my life and try save the lives of my babies. I therefore signed the consent and the CS was done at 3pm that day. This was on February 2, 2015. Everything went well. They did a spinal epidural, where I can see what is going on. They did a good job, they engaged me a lot. I heard my babies cry and I was excited. I was not able to see them immediately as they needed to be taken into the ICU, as they were a bit small. My daughter was 790grams and my son was 970grams. My son was a bit bigger. Everything was completed and I was taken to the ward. I wanted to go see my babies but I was not allowed then. It was too early, I was still numb. I saw my babies the following day.
It’s quite bad when you are in the ward, can hear other babies crying and you don’t have yours. You deal with a lot at that point, even the bills. I went to see the babies on February 3rd, around mid-day. I remember the nurses telling me that I needed breast milk, even if it was just two drops. Imagine there is no way I can be able to stimulate…you need the baby to stimulate it to produce milk. The nurse told me to be strong, calm down, focus on the babies, and try to express. There are other liquids they give the babies for feeding. I tried to express and nothing was coming out. By evening I had two drops and the staff was quite encouraging. The biggest trauma was when I saw the babies and how tiny they were, and wondered when they would ever grow to the size of the other newborns in the ward. I remember my daughter was the size of the 300mm soda bottle, she could be held in a hand. A nurse advised me to be strong and to take every single day at it comes. Her words remained with me through my darkest times.
The reality of the bills started hitting me. My insurance had been exhausted and my family began counselling me towards moving to a cheaper hospital. I was spending about Kshs 50,000 per baby per day in the ICU. On the 4th the doctor attending to the babies came to the ward. I sensed that something was wrong. The previous night, my son Jaden had been transfused. She started with the positive, telling me that my daughter Winnie was doing well, but the boy was struggling. I did not want to hear anymore. I told her to take me to them. She got somebody to take me to them in the ICU. I found them trying to resuscitate him. They did this while I watched. I told them to do all they could, within their power to make sure he was well. A male doctor assured me that they were. They kept encouraging me that girl was doing well. Unfortunately Jaden passed him while we were looking at each other. I felt like he was telling me ‘mum do something’ or ‘you are going to be okay just take care of my sister.’ Everything was done. I cried a lot. But I turned to the girl, and prayed to God ‘God I am going to walk out of this hospital with this one, and I know you can make it happen.’ I kept telling my close friend and colleague Jane the same. She was there for me through it all. I told her I was sure God would answer my prayer to the affirmative.
I did not want to mourn a lot because I needed to be strong for the girl. I had no choice. I remember the nurses counselling me and telling me, “this one was not yours, let go.” I could not let go the first day. It could hit me and I could cry, and then remember that this one was not mine but I had one surviving. I also remembered that the first time I came to this hospital, I had left without a baby, this time I had a chance to leave with one. I gave it all my energy, I did everything possible to get enough milk. I did not want stress to be a reason for not having milk for my baby. We paid a fee for the hospital to take care of my son’s remains as I did not have the energy to handle it. The hospital recommended some counselling, but most times I cannot and help me move on during dark times. I stayed for a while as they needed to monitor my pressure, but I was doing well. I was discharged on the 6th of February.
The bills were also increasing but my colleague encouraged me to focus on the baby as the money would somehow come. Miraculously everyday passed. When I was told to give a deposit of Kshs 600,000. I borrowed this. I did not care where it came from as long as I could save a life. The credit office kept calling me and one day I went there and just told them “you are ladies like me, and am sure some of you are even mothers. You call me every time. I know you are doing your job, but at some point try and engage someone. My baby is in these wards, meaning I have not running away. Meaning I cannot run away. At this time my baby was in ICU. She stayed there for two weeks, and luckily she was doing well. She had the oxygen tubes from the 2nd to the 7th then they removed them because she was able to breath on her own and her oxygen saturation was normal. We moved out of ICU to the normal HDU ward. She had a oxygen desaturation, so she was put back on oxygen. I remembered the nurses words about living a moment at a time. She had also told me about how much pre-term babies were affected by movement. Moving mine from 1st to 2nd floor had had this effect.
Proffesor Aketch, told me that they would put the baby on medication to strengthen the lungs, and this caused the sugars to rise up to 21 and its supposed to be between 6 and 8. It really stressed me. I tried to get information for myself, from Google. The pain of seeing my child on injections, tubes and the thought of them having to put down her sugars. I cried a lot, it was very painful to watch.
I started doing Kangaroo at 800grams while she was still at the ICU. She was very tiny. I remember the feeling of putting her against my chest, how nice it felt. It was the first time I was touching my baby and she was calm. Every time I was doing Kangaroo I was happy and not tense. I could sense how happy she was as she could pray. Whenever I arrived in the hospital in the morning, she would play as though she sense I was there. I would do at least two hours daily. I would split this between morning and evening. I sometimes extended depending on how available the baby was in between procedures. The nurses used to encourage us and I used to Google the importance of Kangaroo MotherCare. It improves oxygen saturation, helps in weight gain which was very important for me since I needed my baby to gain weight, and also the bonding thing. These three are the three things that made me keep at it. It really motivated me.
There is this powder they normally mix with the milk call suffactor that helps them to gain weight. Winnie’s body rejected this, so they needed to lower the quantity they put. She got an infection after getting it. Imagine this was her chance for boosting weight gain. I could look at other babies, and though we were told not to compare our babies. I was jealous. They had their own problems but not those challenging weight gain like mine. I never lost hope. I even encouraged others. We had a group and I was considered the experienced. We had a room and we would chat and I discovered that others had problems that made mine. For instance one lady told us how her cousin had triplets and stayed in hospital three weeks and then they suddenly died, one by one. This really challenged me, as I still had a baby. Every time I remember that situation I remember her. I realised how blessed I was. There were others who were crying, and I needed to motivate myself to care for my baby. These helped me get stronger daily.
It was my job to wake up in the morning like I was going to work, get to the hospital, express milk as I could not kangaroo with the milk as it would leak, and then kangaroo. The fact that our babies could not breast feed by themselves, they were too tiny for it. For Aga Khan, until the baby is 1800grams they are still kept in an incubator. After that they are put in a cot. The first time when I saw my baby in cloths it was really happy, it was exciting. I would tell the other mothers “am nearing the door”. In her first two months Winnie went through several lung treatments and two blood transfusions. I did Kangaroo for two months and increased the hours. I could do several 1 and a half hours sessions. I used to cry a lot when I had to leave her especially when she was under treatment. She went through two transfusions. These were the worst since I connected the death of my son with the transfusion he had undergone the night before he developed breathing complications that led to his death. From Google I learnt that transfusions sometimes cause complications in pre-terms.
Some of effects of Kangaroo on Winnie Wakanyi is that she is very close to me, she is also friendly and independent. She is still small bodywise though she weighs 8.3kilos, but this does not discourage me. I knew this would happen. The nurses taught us that when we went to the clinic and were asked the age of my baby…even now when I tell them that she is 1 year 5 months, I see the shock in their faces. I don’t explain unless I feel it’s necessary. One time a nurse responded by asking me if my child was picky about food. She is doing very well, I make sure that I don’t miss clinic. She has never been put on a special diet on her hope. She is now walking on her own and is really fast. I remember the nurses telling us to never compare our children’s milestones with another child’s. The pace does not really matter as long as they get there. As long as everything else is normal, they are good. For pre-terms, don’t mix yourself with pressures from outsides, its her time. If its kangaroo, her time is her time.
Photography: Nash of NaMeD Afrika Studios and from Family Files
First published on the Sunday Magazine, Sunday Standard, August 21, 2016 (shorter version)