IT NEVER RAINS BUT IT POURS

Its rainy season here in Malawi. It rains nearly everyday and pours nearly every night. The beautiful tropical trees, plants and flowers are thriving , the mountains look glorious, the river is full, has even burst its banks rushing frantically through the old centre of Lilongwe.No one can remember seeing the river quite like this. Everywhere is muddy, unbelievably muddy. It is almost better to go without shoes and just wash your feet.Well at least that's what Lucas thinks!

There is water everywhere. Huge muddy puddles . Suprisingly deep potholes in the road that appear in the most unexpected places..I'm sure that wasn't there yesterday? (Unfortunately I don't have a large 4 wheel drive car) Slippery slidey paths and umbrellas by the score.Have you ever seen a town full of people riding their bicycles protecting themselves from the rain with vast and highly coloured umbrellas?



But at Bwaila hospital we have now been 36hours without a drop of water. Now that really is hard to imagine, especially for those of you who work in the hospital service.

No water for drinking.. most of our women will not be able to afford to buy bottled water.No water for washing. After having a baby there is no way to clean the mother nor in the postnatal period. No water for staff hygiene. How to protect oneself? How to protect the women?

We have been cleaning our hands as best we can with white spirit or meths. No water for washing floors .No water for washing beds between patients. Birthing a baby can be a pretty messy business without suitable materiales ..blood, faeces, urine, amniotic liquid, all manner of bodily fluids and no means of clearing it up. The few sheets that are provided by the hospital are all used up and of course no clothes washing can be done. This is smelly and uncomfortable. But this afternoon our operating theatre closed indefinitly. This is desperate.There are no clean or sterilised drapes or theatre clothes, instruments cannot be washed for sterilising, it cannot function. This means that all c.sections, haemorrages or any other emergencies will be transferred to the nearest hospital which is 4km away with just one ambulance if it works, if its available and weather and traffic permitting. Women will die today, tonight and untill normal water services can be resumed.We have not been told when that will be.



This morning I arrived at Bwaila as usual at 7.15am. I enter the labour ward with the usual feeling of dread as to what will await me this morning after the long and busy night shift. What needs to be attended to first, to be sorted out when day staff arrive? What and who? for these are women and babies.

Oh no! not another fetal death! Alive on admission at 3.30am... no fetal heart heard at 6.30 am.

Whatever happened in that time? Why has this baby died?

I look at her labour chart and once again it springs to my mind what they say in our favourite film..Pirates of the Carribean... THESE ARE NOT RULES THEY ARE GUIDELINES

Guidelines means thought and assesment.

Guidelines means each women is different and individual and should be treated that way

Guidelines means taking responsibility

Guidelines means being interested in outcome

Guidelines means caring

RULES are easy to follow...blindly, religiously, without thought, with no sense nor common sense, no ability to see the wider picture, just obey the rules and if it goes wrong its not my fault!

So the rules were obeyed and the baby died.

I cried, I cry now as I write this .

Such a sensless loss.That was a mothers baby, a fathers child , a grannies grandchild, that child was loved. That child is no more and all because of rules... OK the rules aren't to blame. So some one please help these poor overworked, underpaid, exhausted , well meaning" carers " to use them as guidelines...........

I PROMISE I WILL TRY..................



Her first baby had beeen born by c.section. I found her fully dilated and ready to push. "Please let her birth this dead baby without more surgery" She had little or no contractions, without help it would not work. The rules are.. no drugs for labour enhancement with a uterine scar, (this can be potencially dangerous but is widely used in western hospitals under close supervision.) I approached the senior obstetrician. I asked her under what circumstances would she be prepared to use this drug on a previous c.section? She replied that if I was to take care and responsibilty for this woman, at no time passing her care to anyone else she would permit this. YES ! Now we were working with guidelines!
This poor, lovely woman went on to birth her stillborn infant with Oxytocin and without surgery. I recieved her little girl onto the bed , dried her off and wrapped her in her brand new 'chitenge'(This is the colourful material that the women use for everything.Skirts, dresses, wraps for babies and children, for carrying them on thier backs and many other uses.) Even the poorest manage to buy or be given a special new one for their new baby. She cried and I cried as she held the little one in her arms and said goodbye.

Last night I couldn't sleep.
I was wondering if water services had been resumed ? How had they managed during the rest of the afternoon ? Had there been any disasters ? When I left we were running out of clean instruments in labour ward.The last birth I attended before going off duty had been with one plastic cord clamp, one piece of wide cotton thread and a razor blade.

Today is my day off. I needed to call in this morning to find out if the water supply was back on. I was not sure what I could do or how I could help if not, but was unable to go off for the day knowing how terrible the situation could be. The water supply had been resumed sometime during the night.
Thankyou, thankyou, thankyou.
But it had not been without incidence. As they were getting three women ready to transfer to another hospital for c.sections,for various reasons, all with some degree of urgency, the breech baby started coming.There was no stopping things, no time for the ambulance. The head got stuck, as they had rightly diagnosed it would and with a snap of the neck the baby died.
Just one more casuality at Bwaila.
Why ? Because they are poor, very, very poor and they are women.They have no voice.
WE MUST BE THEIR VOICE.