The Travelling Midwife: The Garden Route

The Garden route is one of the most beautiful areas in South Africa. Once you get past Mossel Bay, the oil depot on the coast, the air begins to moisten a bit, the grass shows a tinge of green. Sadly the area is in the grip of a severe drought and ‘water restriction’ signposts introduce the entrance to each successive town. The town of George has the largest provincial hospital in the area and I was surprised to learn that there are no midwife obstetric units such as we have in the Western Cape. It seems as is there is a drought on the midwifery front too! There is only one independent midwife ‘in training’ and that is Mandy Busson, who spent six months with me in Cape Town as part of her apprenticeship.

Unfortunately I missed seeing Mandy on this trip, and spent the night instead with Gauri, in a village called Hoekwil with the most pristine views. Gauri is now qualified as a medical doctor and doing her internship at the public hospital in George. Gauri and Patrick had a homebirth in Cape Town 6 years ago and I was lucky enough to be the midwife attending, and witnessed the birth of Locan first hand!

I was delighted to see him and how he is developing. He is into the “Why ?” questioning phase. Where do you live? In Cape Town. Why? ‘Cause my house is there. Why? ‘Cause that’s where I work. Why? Lets play with the dogs. Why? Where you a dog in your past life? MMmmm, not sure about that one. Is that one a boy? Yes. Why? Let me say no more about how we dealt with this pertinent subject.

Needless to say, it was rich. Locan loved playing with the dogs once he overcame his initial fear, and has a very busy mind, constantly asking questions to gather information which I could almost watch being processed into neat data packages.

George hospital serves the general public of the whole Garden Route area. There is also a private hospital for those who can afford to pay the exhorbitant fees. The caesarian section is the most performed operation in the area, and the rate in the private hospital is more than 70% of all women who give birth at the private hospital. What I would really like to hear are stories and birth experiences from women on the ground throughout South Africa, so I stopped to interview women from the area.

Elsie Joemat, from a settlement near Hoekwil shared her story. Elsie had her first born son 18 years ago at Oudtshoorn hospital. She was please to report that the father of her son was with her for the whole experience. She was however quite nervous and when she presented at the hospital in labour, she said she was handled roughly by the midwives. The midwives berated her for being “nog dom” (“still stupid” – implied because she fell pregnant) and asked her why she had fallen pregnant. They made her lie on her back to give birth and told her to push. She said at this point she just wanted the birth to be over. When the baby was born, he was cleaned and placed in a bassinet. The staff then commanded her to get up saying “Get up now, its not time to play with dolls, you have to get up and feed your baby now”. Eighteen years later and Elsie remembers every word that was spoken to her. Her second baby, a girl, was born 9 years ago at Uniondale hospital and the experience was satisfying she said, as the father of her daughter was also present at the birth. Elsie said that most of the women in the area go to George hospital to give birth. Her sister, Marie Joemats, said she was fortunate enough to live close to her mother who was a lay-midwife in Uniondale, and all her 5 children were born at home. Marie said that she did not want to go to the hospital, because her mother was a midwife and she preferred to stay in the comfort of her home!

The next person I interviewed was Elizabeth, living in a devastatingly poor community called “Nekkies” in Knysna, overlooking the bay mansions. Elizabeth gave birth nine years ago to her son in Fort Beaufort hospital and said she slept after the birth from exhaustion and did not breastfeed her son, but have him a bottle. She said she had very little milk. I was saddened to hear that her son does not attend school as they do not have money for transport costs to the school neither for school fees. He was playing somewhere in the township she said.

I left Kysna elated by the beauty of the mountains, forests and rivers, yet muted by the apparent lack of respect and care in hospital midwifery care. The large disparities between the rich and poor living conditions, particularly in built up densely populated areas, is always a thorn in the side! I stopped at the Storms River bridge, the border between the Western and Eastern Cape, to walk the dogs and again, the beauty of the scenery astounded. My next stop will be with karen Clark in Hamburg, where she is pioneering “Busfare Babies”, a rural midwifery service.