SO MUCH TO LEARN... SO MUCH TO TEACH

Exciting news this week. Its seems that I will officially be able to start teaching. A project has already been funded to set up an ongoing teaching program for the midwives (and I hope others) at the hospital. I have been asked to take part.
Details are still uncertain but those who attend will probably be given a meal or some sort of incentive. This is always attractive to the highly underpaid health professionals.

This week has had its slightly quieter times on the labour ward. I took advantage of one of these moments taking aside any students who wished and I talked about pain. What was their perception of pain and particularly pain in child birth ? How did they percieve the women's pain in labour and did they think they could or should do anything about it ? I soon found I had 10 people gathered round me, mainly male clinical officer students, willing and eager to listen. It was a good moment, I shall try to do this as often as possible along with the clinical teaching each day as they work alongside me. Their training is really quite inadequate and they find themselves in positions of responsibilty with very little preparation, experience or knowledge.This leads to the strict following of rules, as I mentioned in my last blog, with decisions being made too late with disastrous consequences. Recently a fetal monitor was given to the hospital. The foriegn midwives are using this for cases of suspected fetal distress. It was sad, but understandable, to find that many clinical officers did not know how to use this or how to interpret the findings on the graph.

Other big news is that I finally took my birthing stool into the labour ward last week. I had already approached the idea of vertical birth with posters and photos from Spain and had assisted a few births with the women in crouching position, though rather precariously on the bed. One of these had been particularly sucessful as it had been to aid the birth of a 2nd twin. The Malawian midwife was getting concerned. The first baby had been born easily but the second didn't seem to want to come down. I confidently suggested she be told to get up on her feet and crouch.With 3 pushes the baby was born. It did wonders for my credibility !
A few women have now used it for pushing in 2nd stage and 3 women have given birth sitting on the stool. The midwife on the rather dirty floor to the amazement of our malawian colleagues and me sitting behind to support the woman. At the moment it is just interesting and maybe a bit crazy but its early days. I hope time and experience will show the huge advantages of vertical birth. It is not only the midwives we have to convince, the women too are highly reluctant to get off the bed. We have to be careful not to create insecurity and distrust.

I have so much to learn about the people, the women of Malawi.
I was told by a fellow midwife " you have to treat them with aggression, that is what they are used to. If you are too soft and kind they will not co operate." I find this difficult to believe and more difficult to do. I can be firm but kind, but to be aggressive to a woman giving birth ? I think not. Sometimes communication is difficult.
Many babies are unwanted. A result of rape, incest or agression. It is easy to distinguish these women who often have their babies pulled out of them with the same agression as which they entered. These cases are particularly difficult. She may be just 13 years old , very often young girls under 18. There will be no counselling or emocional support for her just rejection and scorn. Many babies will be " just another mouth to feed " All this is reflected in the way she births and the way she receives her newborn. Of course this happens all over the world but here in Malawi it happens a lot ...too much.

I have been fortunate to be able to visit 2 mission hospitals in the Lilongwe area. Both primarily supported by the catholic church. What a difference! Much cleaner, more materiales, more space, sheets and blankets, but more importantly a feeling of caring, of love and concern.This is generally missing at Bwaila. Lucas has been with me on these visits and loves to visit the pediatric wards to see if he can make the children laugh.This is often difficult but when we achieve a smile and a giggle then he is happy. Two cases in particular have stayed in his mind. The small child with severe malnutrition, literally "dying of hunger" and the children with burns. "
" But mummy, when their skin is taken off they are pink just like me !"

EXACTLY !