“This man is like a rebel for the women” Christine says, reminding me of a line in a poem I once wrote about my rebels back home, who weren't rebels at all but simply men who rape in times of peace.The man she is referring to has beaten Lalam so badly she reaches us eight months pregnant and unconscious. We quickly transfer her to the hospital. “Last year he kicked another one of his wives in the stomach causing her to lose her baby and her ruptured womb. Can you imagine he even accused us of preforming an abortion on her? So that the police would go after us instead of him?”
“That happened to my aunt” - we turn to look at the nurse midwife we have been struggling to train in the ways of gentle, physiological birth. "She lost her pregnancy when she took a beating in the stomach. Luckily the man’s mother told her mother to take her home, even without paying back bridal fees. He had a second wife who stayed with him and ended up dead by his violence”.
But as it turns out, in the hospital Lalam receives little to no care at all. Ten days later she arrives again at the birth center saying the doctors would not see her without a letter from the police. The police would not open a file because she didn't have twenty thousand shillings to pay up. In the hospital they did confirm the beating has caused her to be blind in one eye and to lose hearing in one ear. When she went home he would not give her any food or any money. He took away her phone so she hasn't been able to call her mother. Lalam shows us where it hurts. I can clearly palpate fractured ribs, and swelling in the head and side of her body.
״I was just serving him food at the co-wife's house and the next thing I know he was beating me”. We do what we can for her injuries and at her insistence we accompany her to the police. They send us back to the doctors to fill out a medical report. No one is willing to cooperate. Even offering money does not seem to make a difference. The medical and legal establishments are so perfectly coordinated against Lalam it is a wonder where she finds the courage to turn to them at all, to stand her ground and tell her story. Thinking of my experience back home, I wonder if there is even a difference. Days go by and when the police finally bother to attempt an arrest one of the officers who is related to the husband informs him so that he escapes.
There is no safe home to be found for victims of GBV. According to Acholli customs, a pregnant woman cannot return home to her parents: if something happens to the baby they would be blamed. “Even if I want to take her, my husband will not allow it”, Lalam’s mother tells me on the phone. To make things just a bit more complicated one of the other co-wives just had her baby with us. I am told she is probably safe for the moment since she produced a boy.
The clinic does not stop or wait for us to find non-existent solutions. Every night seems somehow busier than the night before. We safely deliver a footling breech, then two sets of twins. The first set are premature girls. The second are cephalic and breech, sister and brother. With twins it is especially important for the placenta to be buried on ancestral land.
“This is not a preemie kindergarten!” I announce when at some point all our birth rooms are filled with tiny humans, not yet ready for this strange world, if any of us ever are. Where are all the healthy, wanted term babies? One could say these pregnancies are being interrupted by malaria, urinary tract infections and dehydration, but the true meaning of so many premature births and miscarriages is that women are being over-worked with insufficient access to food, water, rest and medical attention.
I receive into my hands a breech fetus at twenty two weeks. The mother says she started feeling pains a week ago and each day since had wanted to reach the clinic, but her husband insisted she keep working in the garden, harvesting the Simsim (sesame) before it spoils. Now she wants to hurry home for fear that the husband and co-wife are already saying things about her, accusing her of causing this by witchcraft. She must be there to defend herself. We convince her to stay at least until the bleeding slows.
Three nights in a row we have emergency transfers to the hospital in Gulu. A premature baby who needs more than we can provide, a woman in septic shock from intrauterine infection and then a woman with eclampsia or possible HELP syndrome (a life-threatening liver disorder). Still the sight of an overcrowded African maternity ward is hard to take in. Laboring mothers crowd the floors in the hall as far as the eye can see. The parking lot is full of sick, sleeping and dying patients. Meds, power, gloves, safe blood for transfusion and staff can all be hard to come by, but perhaps the resource most lacking is compassion.
Back at the birth center we finally welcome a healthy term beautiful baby boy. Stepping out of the delivery room I am told, “That baby has to be given away. His mother is 14 years old and the baby's father is her 18 year old brother.” We are now looking for a safe home for a battered wife and an orphanage that will accept this sweet innocent newborn. The girl's father comes to ask for our help with the adoption. He says when he found out what happened he gathered a meeting of the family elders. They first thought to terminate the pregnancy. But he didn't want to risk his daughter's life. Abortions are strictly illegal in Uganda and illegal abortions mean many women lose their wombs if not their lives to unsafe procedures, in unsanitary conditions and in such secrecy that it is nearly impossible to seek medical care once something goes wrong. So it was decided to let her carry the baby to term and then give him up for adoption. Even though the young mother does not want to be separated from her baby, the father says there is no way this baby can come home. Once it becomes clear that this separation is unavoidable, and since the father is asking me directly for help, I make him promise me that if I do my best to find a good home for the baby he will do his best for his daughter. She must be separated from her brother and he must make sure she stays in school. He shakes my hand and swears and I wonder how well either of us will be able to be true to our word.
The next day we call the police officer again to see if there is any progress with the arrest of Lalam’s husband. Instead he asks for our help with two new cases. In the afternoon after a busy morning of prenatals the officer brings us an eight year old girl who had been raped by a grown man, and a woman with epilepsy who had lost consciousness after a seizure and was gang raped. She came back to her senses when one of the men was still on top of her. The officer had taken both victims to the health center but they refused to provide them with complete care. The girl, escorted by her mother, told us her story. The worst of her tears came when she mentioned how roughly she had been examined at the health center. We took the woman back to the health center to try and get her on medication which would prevent her from contracting HIV. Getting any help from them was like pulling teeth out of an infant who was not yet teething. For the longest time they refused us with different reasons until finally they looked at the clock and said they were off duty.
The woman already had a child she could not care for because of her condition. Somehow we managed for a plan B pill to be shipped from the pharmacy in the city. But by the time she took it it's efficacy was significantly reduced… The woman said her stomach and lower back were hurting, her skin was crawling and itching. She let herself receive a massage , I could feel how the sacral bone had been shifted by the repeated blows. She allowed me to rinse her skin with a washcloth soaked in oatmeal, which seemed to help the itching; a vaginal steam appeared to relieve some of her internal pelvic pain. Then she chose to go back to the police and lead them to the scene. As I write this she is lying on the birth center floor staring into space, unable to make eye contact.
The eight year old girl weighs less than twenty kilos. We had to calculate the dose of prophylactic antibiotics she would need for being exposed to STDs and vaginal infections, then found ourselves slicing and breaking pills so they would match her size. We ask her, Where does it hurt? She points to her heart. We apply some homeopathic cream on her chest and then she said “here too” pointing at her womb. A selfie of us together on my phone is still enough to make her laugh.