SOMETIMES ITS ALL TOO MUCH

I didn't write last week, I couldn't write last week.

What could I tell you?

Of the mother that should have been taken to operating theatre at four in the morning, who failed to be assessed and examined by the clinical officer on duty. The c/section was done at 8am. the baby was dead, the mother hemorraged so severely she needed a hysterectomy and later died in the ambulance on the way to intensive care in the central hospital. No blood was available at either hospital .

OK.. so she was HIV positive which was probably the cause of her poor general state, would further complicate her chances of responding to the hemmorage and lead to her death ...BUT ... here in Malawi there are more NGO', charity organizations and do-gooders spending huge sums of money on AIDS projects then any other cause, so I am afraid I can only ask why? why?

Or should I tell you of the morning that on arriving at labour ward I was asked to attend bed two where the 2nd twin was waiting to be born. I listened for the fetal heart and found nothing. I examined her and felt the umbilical cord presenting and not pulsating.The baby was in an impossible position for a vaginal delivery. So when had the 1st twin been born? At 4.20 am. more than 3 hours ago! The clinical officer had visited at 5.10 am. the fetal heart was heard, he told the midwife to wait! She waited. Too long for that baby. ( one midwife's comment was " well she does have one" )
But she had two babies! two healthy babies! untill she came into the hospital!

Or maybe I should tell you of the 2 prem babies. Just 28 weeks gestation, weighing around 1kg. Both breech presentations both difficult to deliver the head. The first was determined to live but lasted just 5 days the second was just too prem. too small.

Or I could tell you of the mother that transferred in after delivering the first twin in a local health centre. It took 3 hours for the ambulance to arrive. The second twin was dead and the mother needed a c/ section for bad presentation.This was confirmed by an ultrasound scan done by one of our clinical officers. Whilst waiting to be taken to theatre she pushed out a live healthy 2nd twin head first!!!



I can talk about it now but I couldn't write it all down last week.

I went to see Tarek, I just needed to talk, to get it all out of me. As usual, he listened and he talked and I felt better. He also gave me something to read, things he had written about human rights.. what are they..what do they really mean to us, to you, to the developed world, the politicians and how relevant are they to the mothers and babies in our care. It started with a quote which I would like to share (actually I'd like to share it all, but its not mine to share.
"It is possible to adapt to a given situation precisely because you have got to live it and you have got to live it everyday. But adapting does not mean that you forget.You go to the mill everyday-it is always unaceptable to you, it has always been unaceptable to you and it remains so for life-but you adapt in the sense that you cannot continue to live in a state 0f conflict with yourself"





My second visit to Pilirani was less eventful as we managed to take all the right turns.

She looks well and the c/section scar is totally healed. When I asked if she felt strong her mother replied that she can now carry a full bucket of water on her head. I guess that means she is very strong! I certainly couldn't!

Unfortunately the twins Edward and Alex weren't doing as well as I expected.They both looked lively and active but underfed and not gaining weight. In fact Edward who had been doing so well had lost weight. We talked about breast feeding, she said "they are very hungry babies" I could see that! She seemed to have plenty of milk but I did suggest that maybe she should supplement. I asked about her diet. She was eating just beans and potatoes.

Last year Malawi produced a bumper crop of maize..the staple diet. More than enough to see them through till the next harvest. Unfortunately someone sold off a large amount to neighbouring Zimbabwe and S.Africa leaving insufficient for the people of Malawi! No one seems to know how or why it happened but poor Malawians are now dying of hunger and severly under nourished due to some high-up political "mistake"

I took bread and bananas, it was not enough. This week I shall take eggs (hard boiled) and rice.

As I got up to leave, Pilirani went to her mud hut and came out with a plate of dried beans for me. She had so little but still gave me of the little she had. It was so difficult to take but I knew I should. I got in the car and cried. This is just one family that I have the priviledge to be part of, but how many more are there like that? It was all too much for me last week.

I must just tell you a last detail..... As we walked through the fields of maize that leads to her house we met a very small child walking towards us. I recognized her as one of Piliranis elder children.She is just 4 years old. On her back she carried what I thought was a doll (silly of me.. little girls in Malawi don't have dolls) I could not believe it when I realized she was carrying Alex the smallest of the twins, now weighing 1.550kg.!



Friday was my day off. I dyed my hair and painted my toenails with my friend Filly. The choice was dark or light brown. I now have a very youthful dark head of hair and bright pink nails. It felt good to do that!

On Saturday evening I had my first real "night out" since arriving. It was a charity dinner dance in one of Lilongwe's nicest hotels. It was a great night. The food only reasonable but the music and company fabulous. It was totally therapeutic. I danced nearly all night to the golden oldies.. of my era, lots of Rolling Stones, Meat loaf, Rod Stewart and Michael Jackson. I was exhausted but happy and felt this was a good way to recharge and prepare myself for what I might find this week.



Easter is close and school holidays.We will be going to spend a few days by the Lake with some kind friends. We are very much looking forward to the break. I am looking forward to the rest and Luki to the snakes!

On Tuesday I shall go to visit Pilirani again and also Grace, who has been phoning me everyday just to make sure that I havn't forgotten her. Well actually she gives me a missed call and I phone her back, but its always to say the same " dont worry I will come to visit and I havn't forgotten you"





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