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E-book Documenting Death : Maternal Mortality and the Ethics of Care in Tanzania

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Penilaian

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After two long days on the bus, I arrived in Sumbawanga in the beginning of February 2014, the rainy season well underway. The next day, I reported to the Mawingu Regional Hospital and stood up in front of the morning clinical meeting, with nearly one hundred hospital staff members staring back at me, to introduce myself and explain why I was there. I was proposing to research mater-nal death, a subject often accompanied by resonances of blame and failure on the part of individuals, institutions, and the state. I explained the goals of my research in a way that emphasized the need for the voices and perspectives of health care providers, those who were working hard to provide pregnant women with life-saving care during emergencies, despite many challenges, and who are so often overlooked as whole people, or are taken for granted, in the reams of protocols and technical guidelines that policy makers and public health practitioners continue to turn out.In less than three weeks after my arrival, we saw five maternal deaths on the maternity ward, one of whom was Paulina, the woman whose story opens this book. Over the course of the following fifteen months at the hospital, I began to unravel the complex intersections of history, geography, regional identity, state policies, political economics, biomedicine, and institutional and individual goals for providing and receiving care as these factors all influenced maternal health and death in the Rukwa region. Life on the maternity ward of a regional referral hos-pital is fast-paced and high pressure. Not only are these wards often understaffed and lacking material resources for lifesaving obstetric and neonatal care, but the nurses and doctors must respond to, and implement, a seemingly endless parade of new protocols and procedures, evidence based and Ministry of Health sup-ported. All the while, women’s and babies’ lives rest in the balance, caught between the moment of what might be—an uncomplicated birth—and what sometimes occurs—a quick, often silent, turn of events that leaves one or both dying. A flurry of other activity constituted the background to Paulina’s care on the day of her death. As she and Dr. Deo were in the operating theater fighting for her life, another woman came to the ward with a retained placenta. Even after a physi-cian surgically removed the placenta, she continued to bleed heavily, still under the effects of the earlier general anesthesia and unable to call for help as blood pooled under her. Not twenty minutes later, another woman, Pascalia, started hemorrhaging after she gave birth. Nurse Rukia improvised a pair of elbow-length gynecology gloves (because the real ones were out of stock) and delved into Pascalia’s uterus to manually remove the clots that were leading to the hemorrhag-ing. After she finished, Nurse Rukia had blood well up her arm, as well as where her makeshift elbow-length protection had given way; she was desperately calling for antiseptic to disinfect herself because of this blood contamination. Later that morning, relatives came to pick up a baby whose mother had died on the ward after giving birth the day before. In the afternoon, an eighteen-year-old woman arrived as a referral case from an outlying health center. She had started having seizures due to eclampsia from pregnancy-induced high blood pressure. Shortly thereafter, Nurse Lucy came back to the ward to deliver the news of Paulina’s death in the operating theater.

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Ketersediaan

Informasi Detail

Judul Seri

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No. Panggil

304.646781 STR d

Penerbit

USA : University of California Press., 2020

Deskripsi Fisik

271 hlm

Bahasa

English

ISBN/ISSN

9780520973916

Klasifikasi

304.646781

Tipe Isi

text

Tipe Media

computer

Tipe Pembawa

online resource

Edisi

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Subjek

Mortality in Tanzania

Info Detail Spesifik

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Pernyataan Tanggungjawab

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Versi lain/terkait

Lampiran Berkas

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