She came into my office alone, without a family member as a guardian, and she didn’t want a student to sit in on our meeting; her issue was a private matter. It only took a few questions for me to understand her concerns. She had abdominal cramping, nausea, and her period was one week late. She and I both knew that she was concerned about a pregnancy. She had been pregnant before, I inferred that things did not go well, maybe she lost that child. She was not planning for a baby any time soon but feared that her contraceptive methods had failed her.
I remember the last time I cared for a woman like her, the first time I discussed an unexpected pregnancy. Many years ago, that woman sat stunned for a while and cried and then left my office, and I never heard from her again. I’ve been a doctor twice as long now, have been in Malawi four more years. I want to provide more support for today’s patient than the woman from years before.
So even before ordering the test, I ask her what she will do if it is positive – who can support her through this unexpected time. She mentions a friend who can support her, but she’s not sure how she can get through. If I was working in California, I would be required by law to connect a woman to pregnancy-ending resources if she asked. Here in Malawi, there are no legal abortions. That removes some stress away from my counseling options, but puts a lot more pressure on her struggle. If she seeks illegal means of ending this pregnancy herself, it could easily cost her life.
I know that a urine pregnancy test might not show a pregnancy yet, but she can’t really afford the $20 blood test. I ask her to think about what options she has, and what she might want to do as she waits for the test to come back. I pray that the test will show the truth about her condition one way or another. Then I send her to the lab and then the waiting room and together we wait. Is there new life growing in her womb? Will her life be forever changed based on this one test result?
I peek into the lab thirty minutes later. The test is positive. I take a deep breath. At this point, at least it is better than not knowing. I grab her from the waiting room and sit her back in my office. I tell her that she is pregnant. She takes a deep breath this time. “I thought so” she says. At least now we know. So now we return to discussions. What are her plans? She says that she wants to keep this baby. I tell her that I admire her courage and that I know it won’t be easy. She can’t tell her family, she says, they won’t understand. I probe a little bit. Will her boyfriend be supportive of her? Will he be a good father? She nods and says that they were going to get married at some point, that he brought her to the clinic and has been sitting in the car this past hour waiting for her.
I ask if I can bring her fiancée into the room. I don’t usually feel compelled to pry like this, but I can just imagine what it would be like if this woman had to tell him alone. Better to have this discussion in an official room with an authority figure in a white coat encouraging and affirming them both. She thinks about calling him, and decides it would be better if I go bring him from the parking lot. She gives me his name and license plate – “he’s in a silver car,” she says.
I’ve never done something like this before, walking out to a carpark, coming up to a car, greeting a guy I’ve never seen before, asking him if he was the one I was looking for. He takes it incredibly well, says that he is the fiancé, and readily follows me into the clinic, down the hall, into my room. We sit in a triangle, all facing each other. I count to 5 and since my patient doesn’t start I begin by telling the results of the test. She is pregnant, and she wants to keep it. I share about how proud I am that she can make this decision, how I would like to offer any support possible. I ask him what he thinks about the situation. “We expected it.” He says. “We weren’t planning for it, but we were going to get married. I will support her, I will help raise this child.” That’s saying a lot in Malawi where men often come and go, leaving women to care for babies and children themselves. I tell him how much I admire him, that I know times will be difficult but that I am impressed by their decision and want to support them. We talk a bit more, about timing or prenatal tests, abut supporting each other, about planning ahead for when times get stressful or difficult. I give them my e-mail. They can contact me at any time. I’m not the best at delivering babies myself, but I can connect them with a lot of resources about staying healthy during pregnancy.
I pray for this young couple as they check out and pick up their antenatal vitamins. I’m going to be praying for them every morning this week, I decide. It was an unusual visit, I reflect. I had time and flexibility I never would have had in America. But this setting brings with it unique challenges. For once, I am happy for my white coat, for the authority foisted upon me in this context. Maybe hearing that I believe in them and that I’m supporting them will help them through the difficult times to come.