Through the U.S. Peace Corps and SEED Global Health Service Partnership, our mission and goals for volunteer placement surround medical education. A majority of our volunteers are placed at medical or nursing universities and aid in the theoretical and practical training of nursing and medical students. As many of you may already know, Sengerema did not receive its first group of medical students until March 2016 (3 months prior to my expected end of service date). Thus, the first year of my service was primarily direct-patient care.

My typical day starts with a hospital-wide morning report at 0730. The clinical officer on duty presents patients that were admitted during the night shift. The nurse in charge reports on the ICU, and any pertinent events or serious patients in each of the wards: Labor and Delivery, Maternity, Female and Male medical, Female and Male surgical, and Pediatrics. However, unlike many sign-outs that I am accustomed to, there are no details given in regards to patients currently in labor or antenatal patients.

At the end, we discuss the deaths that occurred in the last 24h. One Monday morning, we reviewed 12 deaths that had occurred over the weekend. This is the reality. If I had to guess, more than 50% of the cases are due to severe malaria. Many deaths are of children under 5 years and within 12h of admission to the hospital. Usually there are about 2 – 4 cases to review each day. Needless to say, my first morning report was quite shocking.

Around September/October 2015, the hospital opened a Neonatal Intensive Care Unit or rather an advanced care neonatal ward. Doctors and nurses were trained in basic neonatal resuscitation and advanced care. Soon, I wasn’t the only person initiating bag/mask ventilation to a newborn slow to take that first breath. The most terrifying and emotional moments that enveloped me on arrival were the moments I found myself leaving a mother before completion of the third stage of labor to begin resuscitation on a blue, limp, breathless neonate. Coupled with the fact that when I called for pediatrics at a delivery or a “NICU alert” back home, they would rush in with 2-3 people and a giant bag full of … I actually have no idea what, but it was very large. Of course I took certificate trainings on neonatal resuscitation as an Obstetrician, but I only ever lead one on a rubber model. The terrifying part was that in most cases I was alone in the acts of simulation, drying, visually searching for something to suction fluids, finding a small feeding tube and twisting it onto the tubing of the suction machine, stimulation, stimulation, time to find an Ambu Bag, ventilation, ventilation, stimulation, ventilation, ventilation, ventilation… how long do I continue ventilation breaths? Is intubation possible? The answer I found was No. Certify death on a newborn, then rush back to the mother’s bedside hoping for an uneventful third stage of labor.

Terrifying and emotionally charged.

Then the NICU came and I exhaled.

Until my counterpart, and the doctor assigned to the labor ward was switched to solely care for the NICU. Inadvertently, I fell into taking charge of our antenatal ward and labor & delivery. The nurses started asking me if I had eaten and I was quickly reminded of residency. As I was living in a dark, depressing déjà vu, I met Josephina.

It was typical for me to spend the day responding to various emergency calls and not have time to round on my antenatal patients until evening. I was always exhausted and hungry. I often debated going home and seeing them tomorrow, but I would push through.

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Josephina always had the brightest smile. She was the mayor of the antenatal ward. Through our Swanglish (Swahili-English) we made it through addressing the needs of every patient. She would laugh with so much energy that it was infectious. I had discharged her twice, and she didn’t have a true medical indication to be in the ward, but after she came back a third time, I decided to let her stay until her delivery, which at that time was 4 weeks away. She told me we had one month to teach each other our native languages. And I learned much from her.

I would constantly counsel my patients on exercise, and with Josephina’s help, we played music and encouraged the mamas to dance. As a spin on centering pregnancy (where you give antenatal care in a group), I taught them how to use the blood pressure cuff and fetoscope. With Josephina’s help, the mamas would take each other’s blood pressure and listen to each other’s fetal heart rate. She made rounding fun, enjoyable, and less stressful.

I delivered her by repeat scheduled cesarean section on February 29, 2016. She birthed a vigorous, healthy baby girl. And with a heavy heart she was soon discharged home. She continues to call me to say hi and give me updates on her baby girl that she affectionately calls Siobhan ndogo (Little Siobhan).

I am forever thankful to Josephina for her support and friendship during a time that was difficult for me as a health care provider learning a new system, a new language, and a new culture. She is a strong, compassionate woman and everyday I strive to embody the joy of her smile, the exhilaration of her laughter, and the kindness of her spirit towards others.