If I knew then...

As we discussed some of the extreme challenges associated with reproductive health in rural communities, a colleague commented that if she knew then what she knows now, she would never have had any children.  Her first delivery was in a rural health center, similar to the some of the facilities I visit.  She shared a cot in the labor ward with two other women and had to walk 7 miles back home the day after the baby was born.  Her second child was born in the ‘private’ health facility and even though the doctor did not make it in time for the delivery, he didn’t miss the chance to still make her pay high out of pocket fees.  The third delivery was prolonged, and without proper medical care, she suffered irreversible damage and was seconds away from a fistula. 

It is no wonder then that when we raced into the health center to warn the staff that an extremely ill woman was being carried by her appendages (no such thing as a stretcher) from the backseat of the truck, that they would assume it was pregnancy related.  However, the woman from the oxcart was more likely a victim of malaria. 

It was as we were making our way to the final clinic visit in Masaiti, that we first passed by the oxcart. It careened off the road to make way for our Land Rover.  I glanced in their direction to see what they were carrying.  It was then that I thought I noticed a woman lying in the middle, most likely surrounded by her daughters and sisters.  Maximo hadn’t noticed and swiftly passed the cart, leaving a trail of dust behind us. I yelled that he needed to go back.  I wasn’t sure what I saw, but I definitely wasn’t going to continue without checking.  (While the oxcart is able to transport people who are unable to sit or stand, it is by far the slowest form of transportation on the bumpy dirt roads).

While waiting for the woman to stabilize, I spent some time chatting with her daughter, the mother of William.  She was 25 and William was her third child.  She actually had left the village and was living in Lusaka, but was called when her mother became ill.  She had to arrange for her own transport from Lusaka to the village and then she needed to organize the money (15,000 kwacha or $3) for the oxcart to get her mother to the rural facility, all the while the woman’s health was deteriorating because of the delay.  “You see, everyone gives money for the funeral, but will do nothing to prevent death in the first place”, the daughter explained to me.    

As we continued talking, another young woman joined us.  At first I thought she was child, but she was introduced as the wife of a man working at the clinic.  I inquired about her age and was told she was 13…a child after all.  In the afternoon, I heard of another young woman who was 11 and with child.  I would rather not think about this than to comment.  Later, as we drove on the dirt road away from the village, I noticed a painted sign on a school that read, “If you educate a girl, you educate a nation”…