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Doing pre-natal care cross-culturally

Living cross-culturally leaves you vulnerable. You don’t know how to do all the ‘normal’ things or what the everyday procedures are. People laugh at you. They think you are stupid. Each new life experience brings this home in new ways. So doing the already vulnerable state of pregnancy cross-culturally is a wicked combination.

I’ve done almost half of this pregnancy in Tanzania, and it’s something of a relief to think of doing the rest in Australia. The Australian system is far from perfect; there are even things I prefer about the way Tanzanians do things. But at least I know what to expect in the Australian system. For example, I understand what’s happening in interactions with a receptionist.

When we went for a dating scan in Dodoma, at what turned out to be 8 weeks, we just turned up, no appointment, to a clinic recommended by a friend of a friend. No instructions were given to us so it wasn’t until after our perfunctory meeting with the doctor that they told me to drink a litre of water. Then we waited. After a while, the receptionist said to me, ‘Not yet.’ I figured she was telling me to keep waiting, that the doctor wasn’t there yet. The orderly smirked when I said, ‘OK, I’ve finished my water’. Actually, the receptionist was asking me a question, ‘Not yet?’, as in, ‘Are you ready?’ My expectation was of a set time between drinking and the ultrasound; she was asking me how my body was – did I feel ready?

At our 12 week ultrasound, I was prepared and drank beforehand. The reception laughed at me when I told her that. The radiographer was surprised at how high my uterus was, no doubt because every other woman who comes in doesn’t actually have a full bladder, though his explanation was, ‘Perhaps because you’re an mzungu so you have a big uterus’!

Both times when we went in for the ultrasound, no instructions were given to me. It was clear I was to lie on the table. The technician didn’t ask me to re-arrange my clothing, there no commentary as he tucked in the wipes, no warning that the gel might be a bit cold. The wipes were paper serviettes, like you’d use at a sausage sizzle. The little details of an ultrasound do seem a bit superfluous when I think about it, but I’m guessing they’re aimed at the mother’s comfort rather than functionality.

At the first (8 week) scan, the technician showed us the baby on the screen very briefly, but we didn’t get to see or hear the heartbeat. We were told ‘Your baby is alive.’ What more assurance did we need other than the technician’s statement?

Then he said, ‘There’s a problem’. He pointed to the unusual part on the screen. ‘This shouldn’t be here,’ he said. I asked, ‘Is this a big problem?’ ‘No, not a big problem,’ he said and left it at that. No more information. I tried to remain calm. And I remembered the 12 week scan with Elliot in Australia, when the technician was fussing around and looking worried but refused to say whether there was a problem because she wasn’t authorised to give us any information; we had to wait for the doctor to tell us if there was a problem. (There’s wasn’t.) Back in Tanzania, the doctor clarified the technician’s statement; not to worry, the issue was very minor.

It’s not that reassurance doesn’t matter in Tanzania, but the phrasing’s not set up that way. At our 12 week scan, the radiographer said, ‘The baby’s heartbeat is weak, but that is normal for this age.’ I checked when I got home – the beats per minute were bang on average. In Australia, no doubt it would have been phrased something like, ‘A very healthy heartbeat for this age’.

As we left, both times we were given a full report, with all kinds of medical jargon that we didn’t understand. I remembered then that in Australia if I want to get the medical records of Elliot’s birth, it will cost me at least $50. The ultrasound at this private clinic cost TSH20,000 by the way (AU12), not the $200 you might pay in Australia.

Everything about this seems backward to me. There aren’t procedures when I expect them to be. I’m given more authority over my own body at some points, and less at others. There’s more freedom with certain types of information, but less with others. I had to ask in order to receive any reassurance.

It’s topsy turvy, not in a bad way; just in the sense that I have to unlearn my expectations. That, after all, is the bread and butter of living cross-culturally, whether or not you’re pregnant. But I do feel that pregnancy adds an extra vulnerability to all this, and I start to think, for all the things I disagree with about pre-natal care in Australia, at least I know what they are.

Categories: Tanzania Woman Written by Tamie

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Tamie Davis

Tamie Davis is an Aussie living in Tanzania, writing at meetjesusatuni.com.

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