One of the things I was most excited about doing in Hargeisa was going to the Camel Market, or Senlaola Hoolaha, and this morning my dreams came true...
It's less than a mile from Edna's hospital, but definitely one of those places where it's better to go with someone who knows the ropes, so I went with Edna and Faisel. In the afternoons, children use it to play, but in the mornings it's one of the bigger livestock markets on the horn of Africa, and has been for centuries, as Hargeisa is built on an oasis. Some of the traders have been walking for weeks to bring their camels to the market, from as far away as Ethiopia.
As you might expect, we quickly stole the attention from the camels, drawing quite the crowd.
Someone tried to sell Edna a "pregnant female camel" for $350 through the car window. A great deal, except that the camel was, well, male. Also, sometimes the traders will give their camels extra water before the market to make them look fatter. You check on a camel's back to know its age and health.
When you're bargaining to buy a camel, negotiations are conducted with a series of hand signals under a cloth so that your negotiations won't affect other negotiations going on around you. You basically grab different parts of the finger specifying a number to signify 1, 10, 100, and 1000 (or whatever number you're using.) The tip is 1, and the whole finger would be 1000. These negotiations can take up to half an hour, but can also be very fast.
You can get a goat for $33 and a sheep for about $50, but these are Ramadan prices: higher, since everybody is buying lots of meat for celebrations.
I absolutely adore goats. They always have this sweet, sort of inquisitive expression on their faces, and you can often see them standing serenely in the most unlikely spots, like on top of low roofs. I offered to buy the hospital a couple so they could always have goat cheese, but Edna said no, they used to have two, but they ate everything, hadn't I seen the remains of that banana tree by where she parks? It's true.
There are cows as well, though they didn't have any of the hump-backed ones I love.
It's not hard to tell who a cow belongs to. This is Dyrdur's cow.
Back at the hospital, it turned into a very busy day. Among other things: five babies were born, including a 34-week 4-pound preemie who went straight into the incubator. A little boy who fell almost 30 feet into a dry concrete well, which no one discovered for an hour and a half, was brought in early afternoon. He seemed okay, but was admitted for observation. 10 minutes later his family left against the staff's protests to go back to their district hospital several hours away, which begs the question, why come to Edna's at all? An expat working for an NGO here showed up with a graphic cut above his eye from a collision during the Ramadan Cup of his football league, which sutured up nicely. He has to come back for a dressing change in the morning, and I'm looking forward to seeing what will surely be a massive black eye by then.
The preemie was doing really poorly this morning and needed CPR with adrenaline at one point in late morning. He stabilized and there wasn't anything else to do, so I went to lunch and to take care of some other things, leaving him in the hands of one of my favorite community midwives. I have to say that I left not really expecting him to be alive when I returned. I know that this probably seems like a terrible thing to say, but as I've mentioned many times here before, there's a pretty limited set of options in dealing with a critically ill or premature infant. You do what you can, and then you watch and wait. Also, there's been a terrible streak of newborn deaths, with almost a baby per day dying. This has been hard to watch, and more than a little demoralizing.
When I got back a couple of hours, I braced myself when I walked into the midwives office, where the incubator is. And I found...his mother holding him and trying to breastfeed! I could have wept I was so happy, partly because he was still alive, but in big part because the mother was there, holding him, trying to breastfeed and the midwife was helping them. This is a big, big deal. In the past, babies in the incubator have not really been held and have not been breastfed or given breast milk. A lot of studies have shown that breast milk is extremely helpful to these babies and can really give them a much-needed boost. Lauren and I have worked really, really hard to teach the midwives that 1) Every mother has breast milk, you just have to show her how to get it out and 2) Every baby benefits from breast milk and 3) It is worth the time and effort to make sure that both of these things are understood by the mother and family. Many of the midwives have been skeptical about the amount of time involved in teaching, and a little foggy on many of the basic concepts of breast physiology, positions you can use, benefits of breastfeeding (especially to infants who aren't doing well) and so on, and we've spent hours and hours working with them on it.
But this midwife recognized that the baby would benefit from his mother's milk even though he's tiny and in the incubator, got the mother out of bed, and taught her how to breastfeed him (and then pump to supplement, since most preemies have a poor suck reflex). Maybe our teaching hasn't been in vain? I love this girl:
As long as I'm posting this now, an update: the premature baby is doing fabulously, made it through the night, is being breastfed every hour, and vital signs look great. A much needed victory on the maternity unit!
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