Sisters of the East End

by Helen Batten

  As it turned out I was right to have been intimidated by our responsibility for the care of the under-fives. Between 800 and 1,000 children had to be seen every year as part of the government’s health and vaccination programme. Generally, about seven in every ten children who arrived at the clinic were malnourished. The most severe cases had to go into the hospital, but for the others we converted a house where they could stay and have supervised feeding. I set the student midwives to work growing vegetables and caring for chickens, so we could offer them some decent food. Meanwhile, Sister Belinda gave their mothers basic lessons in cooking nutritious meals. A great favourite was her rice pudding. Rice was part of the staple Malawian diet, but they never put milk in it. The mothers watched in great amazement as Sister Belinda added milk and sugar to iron-fortified rice, thereby transforming a pretty nutrition-free meal for growing children. As far as I know, milky rice pudding has gone down in the region’s history!

  As our first Christmas approached we wanted to give the student midwives a small gift, but we were rather stuck on what to choose. We didn’t know how they would receive a present, whether they would then feel obliged to give us something back in return, or what the custom was. It seemed quite a delicate issue, but we really did want to give them just a little something each. As we sat at the dinner table one night, Sister Belinda had a brainwave.

  ‘I know, why don’t we give them an umbrella each?’

  ‘Oh yes, well, there’s an idea,’ Sister Marie-Louise said.

  The students hated getting their beloved uniforms wet in the tropical downpours as they rushed from their house to the hospital. I loved the way they took such great care of them, keeping them totally spotless (which was difficult because Malawi was so dusty) and pressed (unlike some of their British counterparts!). So we ordered 20 big, sturdy umbrellas, in a range of the brightest primary colours. On Christmas Eve we wrapped each one and labelled them, and left them on the beds of each of the student midwives.

  That night as the time approached for Midnight Mass, we could hear a rising sound of singing coming from all directions. We looked out of the window and could see tiny pinpricks of swinging lights in the dark night as the people came down from their villages to church, all singing their own carols. It was a beautiful start to Christmas, to be surrounded by such uninhibited, joyful devotion; it was, I think, the most meaningful Midnight Mass I have ever experienced.

  By breakfast time on Christmas Day, however, we still had heard nothing about our umbrellas.

  ‘Gosh, I hope they haven’t taken offence!’ Sister Belinda said.

  ‘I hope they know what they are,’ I added.

  ‘Oh, look!’ Sister Marie-Louise exclaimed, pointing out of the window.

  The students were coming out of their accommodation in a long line, each holding their umbrella and singing as they came up the path. We followed behind them, intrigued and a little anxious as to what they were going to do next.

  They walked into the main quad up to the big tree where we had a crib displayed and made a circle around it. The little student at the front stepped forward to face the crib, bowed and showed her big green umbrella. Then her face broke into a grin and she said, ‘Look, Jesus! Look at my umbrella. It is good. Thank you, Jesus!’

  Then she put it back down and walked back to the circle, and the next student stepped forward and did the same with her big red umbrella, ‘Jesus, this is my umbrella. See how it works. Thank you, Jesus, thank you for my beautiful umbrella!’

  And so it went on until every one of the 20 students had presented their umbrellas to baby Jesus. The umbrellas went on to be treasured by their new owners.

  Gradually the items on the list I had written on my first night were getting crossed off – I had set up the midwifery training school, the Land Rover was increasingly used as a mobile clinic to give antenatal and post-natal services to the remote villages, the hospital facilities were gradually being upgraded (we had addressed the ‘failure to walk’ problem by clearing one of the outbuildings and opening it to heavily pregnant women to come and live in simply, in the one or two weeks before their babies were due), and plans were well underway to build a proper operating theatre.

  Because there was no such thing as a national health service in Malawi, everyone had to pay to use the hospital. Obviously, most people didn’t have any money. To help, we introduced a scheme where every time they came to the antenatal clinic, the money they paid for their visit was offset against the actual delivery. This meant there was a great incentive for mothers to come in for their checks and we avoided quite a few medical problems later, and most people did not have to pay for the birth of their babies.

  But one thing that I felt was still desperately needed was a special baby-care unit for the babies who needed intensive care because they were either born very prematurely or were acutely vulnerable. Our resources were very limited. In the hospitals I’d worked in, back in England, the neonatal units had proper incubators, monitors and breathing and resuscitation equipment. Here, all we could manage was a higher staff-to-baby ratio, hot-water bottles for the night, a fan for the day and specially made tiny clothes. Really, it was about keeping a closer eye on them, their feeding and weight, and guarding them more carefully against infection. However, we felt that this was better than nothing and lives would still be saved, so we got the room set up. We had room for ten babies and it seemed to be helping.

  But in newborn babies, particularly those who have been born prematurely, the greatest threat they face is infection. Of course in Malawi we were surrounded by so many more dangerous diseases than at home. I didn’t really know how we could protect these vulnerable babies except by strictly limiting those who could come into the room to the mothers only, and forbidding anyone who had the slightest cough, sneeze, sore throat or – the biggest threat in Malawi, diarrhoea and vomiting – to come in. So I always had someone on the door with a checklist of questions.

  ‘Which baby are you coming to see?’

  ‘What relation are you to the baby?’

  ‘In the last 24 hours, have you had a sore throat?’

  ‘Have you had a cough?’

  ‘Have you got catarrh?’

  ‘Have you had a temperature?’

  ‘Have you had diarrhoea or vomiting?’

  And lastly, ‘Have you washed your hands?’

  These questions were a constant hum in the background of the special-care unit like a kind of backing track, and I always had an ear open for them, to make sure they were being asked. One day, I was in there and I was vaguely aware of the reassuring sound of the usual checks taking place, when suddenly one of the mothers shouted, ‘She was sick this morning. She lied! I saw her.’

  She was pointing at one of the other mothers, who was stroking her baby lying in her cot. My heart sank.

  I went over.

  ‘Is this true?’

  She nodded.

  ‘You have put your baby in grave danger. You must leave straight away,’ I said.

  She left the unit but it was too late. Within a short time her baby started to get sick and within 48 hours, she was dead. One by one, all the babies started to get ill. We worked so hard. All the nurses and Sister Marie-Louise came in to help, but it was no good. Within a few days many of the babies were dead.

  Soon the hospital was filled with the most terrible wailing. The Malawian people had their ways of expressing grief, which were loud and dramatic. Sister Marie-Louise and I were quiet, in a state of shock. We didn’t know what to do or where to put ourselves. The staff didn’t know what to do with us either. In the end they took our hands and led us out to the big tree in the centre of the quad, where we usually met for prayer. They sat us down and stood facing us, and started to quietly sing hymns for us. They sang until the sun went down and the moon rose. Thoughts of my father and his resilience came into my head. In the end I stood up and said a prayer for the women who had lost their babies, and then said:

  Bless us God, Keep
us safe in your encircling arms, with the bright moon that is above us, and the warm earth beneath our feet. Hold us and protect us through the friends who surround us and in our knowledge of you living in our hearts. Amen.

  And I went into the house and went to bed, exhausted, in the hope of a better day.

  Going to Malawi was the most amazing experience. I grew and I changed; I found an energy and resourcefulness that I didn’t know I had. But it came at a price. By the start of my fourth year I was exhausted and sleepdeprived. The work was relentless; we could only handle a fraction of the mothers who came to us. The sheer scale of the help that was needed was frightening and I began to become overwhelmed with the feeling that whatever we did, we could only scratch the surface. The money, resources and manpower were not there. And most of all, I began to get ill. I had suffered from diarrhoea from the moment I arrived, but I got sicker and sicker, my guts were rotting. I felt I could not stay much longer in Malawi, but I also could not imagine myself back in England, or even back in the Community after being so free. So at the beginning of my fourth year I wrote to Mother Sarah Grace:

  Dear Mother,

  I am writing to tell you I can no longer continue with my work at St Anne’s Hospital. I am exhausted and I am ill. I am also concerned that I am going to find it very difficult to return to life in the Community after four years away, and I am not sure how to go on living the religious life.

  A week later, we received a wire saying that Mother Sarah Grace was on her way over to see us. I felt terribly guilty: it wasn’t a short trip. But when she arrived, a few weeks later, it was not with the reaction I expected. I think she did not know what to say to me or how to handle the situation; I felt as if I had become a stranger to her. For a start she didn’t seem to want to speak to me. Mother Sarah Grace spent most of her time in St John’s House with Sister Belinda. Of course I was terribly busy in the hospital so unless she came down to find me, our paths wouldn’t cross. When I finally did have a meeting with her, it seemed terribly formal. I longed to hear some loving concern and care in her voice. Instead she sat opposite me impassively as I explained that I was exhausted and ill.

  ‘Well, you have just got to get on with it,’ she said.

  ‘I don’t think I can carry on, Mother.’

  ‘In which case you will have to come home.’

  ‘But I’m not sure I want or even can come home now. As I said in my letter to you, I don’t know how I can return to Community life or perhaps even stay in the religious life. Being here has changed me absolutely.’

  ‘Sister Catherine Mary, you made formal vows to God. You cannot seriously consider breaking them. No, I can see, you need to come home straight away.’

  And that was it. Before I knew it, I was packing my bags and Sister Sarah Jane was on her way out from England to replace me. It was heartbreaking. Anton was in tears: ‘Goodbye, Mama,’ he said, bowing and then he broke my heart by bursting into the first verse of one of my favourite hymns,

  Abide with me, fast falls the eventide;

  the darkness deepens; Lord, with me abide:

  when other helpers fail, and comforts flee,

  help of the helpless, O abide with me.

  I’m not sure what I had been looking for from Mother Sarah Grace. Maybe some understanding, some recognition of what I had been through, that I had tried my hardest and yes, maybe some praise. I think I definitely needed to feel someone cared, that I was cherished in some way and concern could be felt for me. Sometimes I had felt these things from our Reverend Mother and indeed the rest of the Community, but on this occasion I didn’t. I was left feeling like I had failed.

  A year later, when we had completed our five years, the Sisters packed up, handed over the hospital to the diocese and national midwives, and came home.

  CHAPTER ELEVEN

  * * *

  WORKING IN A MYSTERIOUS WAY

  I sat in the quiet ward and looked at the clock. I decided to say a prayer.

  Dear God, If I am supposed to take a job at the British Hospital, send the midwife tutor to come and find me. If she doesn’t appear, I will know this is not the path you want me to take. Amen.

  That felt about right, but I couldn’t help glancing at the clock every so often, trying to second-guess when she might finish her talk and appear. I was supposed to go and listen to the senior midwifery tutor from the British Hospital for Mothers and Babies. She had come to give a talk to the midwives at the Lambeth Hospital, where I had a temporary job. But that evening I found myself on the rota to be on call with the ‘bleep’. I was a bit ambivalent about this; I had finished my reorientation to British obstetrics and I was looking for a job as a tutor. I knew that the British Hospital had a position going.

  It was a hospital with a Christian foundation, so in theory it should have been perfect for me. But it was known to be on the evangelical wing of the Church and I was concerned that as a Sister in a religious Community (and therefore likely seen to be more Anglo-Catholic), I might not fit in so I hadn’t made any enquiries.

  Now, sitting in the dark ward, I honestly didn’t know whether I wanted her to appear or not, but I did want an answer either way. Anyway, every time someone went past the door I jumped. Eventually the time came for the end of my shift. ‘Too late now,’ I thought to myself. ‘Oh well, that’s that then.’ So I went off to the nurses’ kitchen, made myself a cup of tea, kicked off my shoes and curled up on the sofa in the sitting room. I felt neither happy nor sad, just like something had been decided. Then the senior midwifery tutor from the British Hospital walked in.

  ‘Sister Catherine Mary?’

  ‘Yes,’ I replied.

  ‘Hello. I’m Anne, the head of midwifery at the British Hospital.’

  ‘Yes’, I stuttered.

  ‘I believe you may be looking for a tutor’s post?’

  ‘Yes’. I was so astonished that I was literally rendered mute but she didn’t seem to notice, or at least it didn’t put her off. She went on to invite me to come and look round the next week. The next thing I knew I’d been for an interview and been offered a job as obstetric nurse tutor. This turned out to be the best thing that ever happened to me.

  When I got back to England from Malawi at the end of 1974, I was in a bad way. Because Mother Sarah Grace had told me I couldn’t do so, I had put any idea of renouncing my vows out of my mind. I did, however, need rest and had to go through extensive medical investigations for my illness. With expert treatment I gradually got better and began to regain a sense of purpose.

  While I recovered, I returned to work at the Lambeth Hospital and because things had moved on a bit in the world of midwifery while I was abroad, I concentrated on updating my midwifery skills. I had spent four intense years working in such a different environment, having to think on my feet, doing things such as tying up pelvises with luggage straps and performing impromptu procedures that would not have been allowed here, that I felt I had to be reorientated (or perhaps reconditioned) to the British system.

  I was struck by how much more medicalised birth had become in the four years I’d been away. Of course it’s on a whole different scale now, but even back in 1974 the world was becoming more litigious. I noticed that midwives were referring up to the doctors’ decisions that ten years before they would have taken responsibility for themselves. This meant doctors were a greater presence in the delivery room. But I’d changed as well. I noticed I was much more confident; I was far more certain in my analysis of what was going on in labour and delivery. I felt I was a much better midwife.

  In 1978 I began work as the obstetrics tutor at the British Hospital. I was on the bottom rung of the teaching ladder, but from the moment I started, I loved it. The hospital was in Woolwich and the people, while not East Enders in the ‘born within the sound of Bow Bells’ sense, had every attribute of the true East Ender – the warmth, gregariousness, humour (let’s call it earthy) and, of course, the fondness for a flutter. They were the East Enders South of the Riv
er, really. Some of the buildings had changed, though. I couldn’t get over the Thamesmead Estate. Long ago, when I was training as a midwife, I had learned to drive, hurtling around doing figures of eight with my instructor shouting at me from the passenger seat, on the derelict land that ran alongside the Thames at Woolwich. When I returned, this land had been turned into the huge Thamesmead Estate. Miles of concrete blocks raised off the marshy ground on columns, connected by high-level walkways, designed to house 60,000 to 100,000 people. It was cut off by large roads, and what should have been a model new modern estate seemed to incubate a whole range of social problems.

  The rest of Woolwich was, by contrast, rather suburban and friendly. The hospital itself was very elegant and welcoming. I loved the way it had a beautiful drive surrounded by immaculately kept gardens and the fact that the chapel was straight in front of you when you entered, right at the very heart. It was all very small, contained and friendly, with a common purpose. We could get out into the gardens easily and when the weather was good, we used to throw open the doors and sit and have our lessons outside underneath a big tree surrounded by flowers.

  I think this common purpose of striving to have God at the centre of our lives and expressing this in our vocation caring for the local people meant we existed happily, with a very good working relationship, with the doctors. My worries about my different religious approach were unfounded, I immediately felt accepted and loved. I became lifelong friends with some of the tutors there, two of whom I still go on holiday with every year, and the small size of the hospital meant I got to know my students well. Because the British Hospital had a Christian foundation, many of the students had either been missionaries or were training to go out and be midwives in the developing world. So I often set aside ten minutes at the end of my lectures to talk about how what we had learned that day could be applied abroad. It felt good to be able to pass on the knowledge I had gained in Malawi.