Even with all I had heard about the conditions of Ugandan clinics, I was immediately appalled and shocked by the state of this one. We were in a very small room, two dirty and torn brown vinyl tables sat next to each other separated by only a filthy sheet hung from the ceiling. Weak, Miriam could barely walk, and the nurses hardly looked at her, let alone helped. I saw them exchange amused glances with each other, and I knew they found it absurd that we should be attending to this young girl the way we were. Managing her as carefully as we could, we lifted Miriam onto the table after first placing down the black garbage bag underneath her. I could hear the woman in the other bed moaning softly, and I watched as the doctors rolled up the garbage bag she was lying on, blood pouring out onto the floor. They had just performed an abortion on her, which is illegal in Uganda. There are no modern vacuums used, just a sickle shaped instrument that scrapes the uterus. I felt horrible and invasive watching her while she stared vacantly at the ceiling listening to Miriam sob and choke doubled over in labor. Finally someone led her out and as she passed we made eye contact. I smiled weakly in support, but she just looked away. I couldn't help but wonder if terminating her pregnancy made her feel heartbroken or relieved.
The doctor finally came in to examine Miriam, and she held back a scream as the doctor pressed firmly on her belly and probed her cervix with his other hand. "She is fully dilated, but the head has not dropped yet," he said. "She must continue walking." Miriam began to whimper, and with this the midwife made Miriam get up by firmly nudging her off the side of the table. Miriam, fully naked, blood and fluid running down her legs, was wobbly on her feet, but managed with our help to walk the small room in circles. Suddenly she was seized by a violent contraction and slid to the floor onto her back. We insisted she get up because the floor was coated with filth, including smears of blood from the abortion. As her genitals touched the filthy floor, I got anxious that she might get an infection, so we managed to get her to another part of the room. Putting her soiled wrap on the floor beneath her, we encouraged her to squat and push. With each exhale we would all let out long moans and encouraged her to make sounds as well. She would mostly make small, covert little wails, but every once in a while she would strongly vocalize her pain and I could tell it was a relief. Our routine was to keep getting her up and holding her steady while she did squats up and down until the contractions came. Then she'd fall back into our arms and we'd help guide her onto the floor where she would push. This cycle continued for over an hour. By then we all smelled and were sweating, but completely present to this raw and primal experience in front of us.
At one point, I was on the floor rubbing her feet trying to ground her, while Suzanne was singing quietly near her face. Miriam's eyes were closed, tears running down her cheeks, when a fierce contraction ripped through her. Her body arched and one hand gripped tight onto Suzanne. She looked at me frantically, her other hand pushing down near the top of her vagina and pleaded, "Has it come?" Looking between her legs, her vagina dark, bloody and swollen, I could see a slick mass beginning to push its way through the opening. Miriam smiled with anticipation and relief when I told her, "Yes, beautiful, your baby is coming."