While working in the South Sudan, OB-GYN Africa Stewart must wait for an elder's permission before treating a pregnant woman gored by a bull.

Dr. Africa Stewart graduated with honors from Johns Hopkins University in 1995 with a BA in psychology and mathematical science. She then attended Drexel University Medical School in Philadelphia. In 1999 she completed a Masters of Business Administration with a concentration in Strategic Planning from the University of Pittsburgh's Katz School of Business. She then returned to Philadelphia to finish her medical training at Drexel. In 2000 she received a Doctorate in Medicine and began Obstetrics and Gynecology residency at Hahnemann University Hospital. Her career with MSF began in Sudan in June 2011. Dr. Stewart has completed 4 surgical field missions and served as a guide for the Forced From Home exhibit in 2016. She continues to support women's health care locally and abroad with an emphasis on education and prevention.

This story originally aired on September 7, 2018 in an episode titled “Expectations: Stories about surprising discoveries.”

Story Transcript

So I have a story.  It’s full of love and loss and magic and blood and guts and all of those things but I can’t tell it at you.  I need to tell it to you.  So if you would please, an imaginary cup full of your favorite thing, if you would have a sip.  Now, I can tell you a story.

The beginning.  Okay.  We heard the commotion; we heard it before they called.  It’s a radio system so it’s, “Maternity to OT, Maternity to OT, please send doctor to Maternity.  Repeat.  Please send a doctor to Maternity.” 

I knew it wasn’t going to be good.  So I go out of the OR and I see her blood on the ground and I know it’s not good.  But I was taught to run at it, so I run.  I follow it.  I hadn’t been there long, but I got the feeling it’s time to run. 

Mind you, I’m an obstetrician so blood on the ground, wailing in the distance, it’s part of the job.  But this wasn’t a day at the office.  This was my first mission with Doctors Without Borders.  I left my private practice when my baby girl and my oldest… my baby girl was born.  My oldest was adopted.  And the world was on fire.  I had a teenager all of a sudden and a newborn and a beautiful baby boy stuck in the middle. 

And I went.  They called and I went.  A houseful of kids, a couple gallons of breast milk left in the freezer, I went to Sudan.  This was the spring of 2011, so it’s right before south was scheduled to secede from the north.  So South Sudan wasn’t a country yet. 

I went because they didn’t know what was going to happen.  Nobody did.  A new international border changes everything.  We thought there would drama and killings, but it turned out to be mommies and their kids.  Because now they had to figure out which side of the line they were going to live on and the hospital is on the other side. 

So this is a little village east of Darfur.  They called on Friday.  I texted my husband, “Babe, MSF called.  Can I go to Sudan?” 

He texts me back, “Yo.  Autocorrect is bugging.  What’s up?” 

“No, no, no.  I want to go to Sudan.”  And that was Friday, I left on Thursday. 

The village, if you're familiar with the area, Aweil is halfway between Wau and Nyala.  If you're not familiar, it’s the middle of ever-loving nowhere.  It’s the middle of nowhere.  There's not another surgeon for a thousand miles in a circle.  There's nobody.  So I went because there was nobody. 

It’s first mission so everything is new and scary and exciting and wonderful, but now I have a job to do because women walk for days to get to the hospital so a delay in timing is crucial.  It changes everything. 

So I am out of breath, heart racing when I get to maternity.  There's a patient on the cot, there's a bunch of people around her, I don't know who’s who but there's a lot happening.  There's anxiety and urgency. 

But I don't speak the language.  I only know three people in the whole country, and I just met them.  I've only been here a week.  But I see one of the translators that I worked with before and I’m trying to figure out what’s going on.  She's bloody, she's got a bloody thing and her face is so swollen.

But this language has clicks in it.  I mean, I can make my way.  I can say push, don’t push, mommy, sorry, congratulations in a lot of languages, in a lot of dialects.  It’s part of the job.  But this language has clicks in it. 

So the translator, “The bulla strucka.” 

And I say, “Oh, I don't know what that is.”  I know a lot of things.  That ain’t one of them. 

“The bulla strucka!” 

So I look at the patient, because that’s my natural reaction.  I’m used to being able to talk to my patient.  Okay.  I’m going to work with him, I'll work with you. 

He says, “You know this one.”  And he does like a milking motion with his hands. 

I say, “Yes!” 

He says, “No.  Not this one.  I speak now of the man-cow.”  And he does the devil horns over his head.  “He has struck her.” 

I’m like, “Is he trying to tell me that she’d been gored by a damn bull?”  And that’s exactly what I said aloud, like no dignified Dr. Stewart filter. 

“Are you trying to tell me she got gored by a damn bull?” 

Gored.  That’s the word.  So he turns to the family and he says something to them.  He does the devil horns again and he lunges at them.  And they all click.  It’s a chorus of clicks.  That’s the word that we were missing.  That’s the word that he never learned on television when he was learning English.  Gored by the man-cow. 

All right.  Okay.  Now, as you can imagine, for me this is all hands on deck, man your battle stations, batten down the hatches.  Goddamn, we’re going to the OR.  It’s about to get serious. 

“She… are you…,” and the patient just quietly sort of moves her garments up.  She has a twenty-week baby bump and a hole in her.  A big bleeding hole in her. 

So in my mind I've just turned into Captain Dr. Africa Stewart.  Dammit.  I've got on a sparkly onesie, there's a little fan gently blowing my hair like Beyonce, a cape unfurls.  “We’re going to the OR!” 

That’s how it is in my mind.  Everyone has dreams.  So me and my Beyonce fan, we’re going to the OR. 

OR for me is home.  It’s where I grew up.  My mom was a surgical tech almost forty-five years so when our sitter failed, when school was closed, those administrative days that don’t make any sense, I went to the OR.  This was some time ago.  This was before you had to fill out a waiver to take your kid to work.  It wasn’t like that. 

The Doctors’ Lounge was for men, the Nurses’ Lounge was for women, and both lounges had ashtrays.  Nobody thought it was weird for a little girl to be sitting in a cloud of secondhand smoke for hours.  Nobody.  School’s out.  It’s okay. 

So this is where I feel most comfortable.  This is where I feel like me.  We’re going to the OR. 

Except nobody is moving.  Nobody is running around.  There's nothing STAT, you know.  Nothing is happening. 

I’m like, “Oh, the translator is not good at what he's supposed to be doing,” because I’m expecting when you step on an anthill, like we should be running around.  But they’re not because they know something that I don't know. 

And I’m asking the translator, I’m making sure that he understands what I’m trying to say because nobody is doing nothing.  But they can’t because they know that, here, families are in multi-generational homes.  The decision maker is the oldest person in your family and that’s just the way it is. 

Culture is weird that way.  It’s hard to tell when you're in but it’s obvious when you're out.  I was raised on Women’s Rights.  Come get it.  Patient says it’s her body and we can get down if we want to, but that’s not how it works here. 

She understands that she's got a hole in her and I can fix it whenever she is ready and I can’t vouch for either of you while we wait.  And I hate telling people that because I feel like that’s the biggest card I got.  If she don’t bite, I have to do the things that OBs have to do sometimes. 

But she understands completely.  I’m the one who doesn’t understand.  She would rather lose her baby and her own life than disrespect the thing that she built her whole self on, that love and the support that you can’t get in the middle of a civil war.  This is how it is here.  That’s why nobody understands that I’m wearing a sparkly damn onesie and I’m trying to get to the OR.  So we wait. 

I'll admit, I asked every translator in that building just to make sure that she understands what I understand.  And she was as pleasant as pie each and every time.  She said, “No, we wait.”  And we did. 

And then comes The One, the one that we’re waiting for, the one that can make the decision and do the thing.  Mind you, this part of the world has a group of people that are very, very tall and very, very dark skinned.  So when I tell you and I've been black all my life and I have never, ever seen that shade of black.  I've seen it with like a blue undertone and I've seen it with like a purply undertone, but I shit you not.  Her undertone is magic.  I don't know what that is. 

White hair and you know the duck that tall people do in order to enter a room?  So the hospital was built by westerners.  They call them Khawaja, people who aren’t from here.  It’s comical to them that the doors are so short and wide.  Everyone else is not built that way.  So The One has to duck in order to come into Labor and Delivery. 

I've never seen anybody that old duck to enter a room.  I'd gotten used to my staff.  They're young, they're agile, but everybody is at least six-feet tall.  So getting used to a 6’4” pregnant lady just waddling by, just handling it it’s like this is like giraffes giving birth everywhere.  It’s beautiful and entirely foreign to me. 

But the thing, I've never seen this shade of black.  I've never seen hair, never seen wrinkles so beautiful.  Like the assemblages, it’s just packages I've never seen.  And it had never occurred to me that the one we were waiting on was a woman.  Dammit, I’m ashamed to tell you but it never crossed my mind until she ducked into Labor and Delivery. 

Regal would be… and it had purple that you wouldn’t believe.  But it was regal-ish, fragile, and proud, if that word isn’t offensive to her. 

Anywho, she looked at me, she looked at my staff, she says something to the translator and the translator asks me, “She wants to know if you will do the cutting.” 

And I sort of nodded and bowed.  I wasn’t really sure what I was supposed to do.  She clicked.  Just once.  And then my emergency started.  One click.  [clicks]

Translator gets out an ink pad because, for the most part, Sudanese are subsistence farmers, cattleperson.  The surgical consent form is in French or English.  So what we do is we fingerprint her.  So this regal creature signed my surgical consent form with her fingerprint and then we went to the OR. 

Mom and baby did okay.  The horn got through her abdominal wall but kind of grazed the top of her womb.  The baby was fine.  Major organs and whatnot were manageable, nothing a kid who was raised in the smoky OR couldn’t handle, right? 

But as I’m getting of a certain season, getting closer to being one of The Ones, I look back.  I only saw her once more and this was the wee hours of the next day.  She was in the bed with my patient, spooning her.  The staff said that she stayed up until the patient fell asleep.  She hummed to her.  And by the time I finished the rest of my morning rounds, The One was gone.  The patient did well.  I never saw The One again. 

But as I look forward to being a grandmother, of being the oldest one in my clan, I’m not sure if I’m ready.  I’m not sure if I’m made of magic yet.  But I had this richness, this fullness of experience. 

When we go past like a pasture, my kids moo.  They moo at the cows every time, but I look for the man-cow.  For no other reason than I’m curious to set eyes on ‘the beast that strucka’.  And it makes me know the contrast and the reflection that comes with it. 

Every time I tell this story to someone, there's always the man-cow, there's always the patient, there's always me in some form or another with a fan.  Wait a second.  It won’t be uncomfortable.  See?  But I think about myself as a grandmother.  I think of my grandmothers who are long passed.  And I look back and I remember neither one of them ever wore makeup.  And I’m pretty sure because it’s impossible.  You cannot find a lightweight foundation if your undertone is magic.  You know what I mean?  [clicks]