BEAUTY AND FRUSTRATIONS

This morning I decided I should finish my obligatory "orientation program" for my official registration with the Malawi nurses council. This means spending 3 days in the Ante natal clinic. Up to 100 mothers are seen between 8am. and 12am. As you can imagine they are passed through at great speed. It seems that the basic checks are done but there isn't much time for midwife/mum chit-chat! In the same building is the underfive vaccination clinic, family planning and a special HIV follow up clinic.This means lots of mums and babies milling around. I am amazed to see how well everyone knows where to go and in which line to queue. On asking for an explanation for this very organized chaos I was told that there is excellent communication and support between the mothers. It was evident, the next mother in the line would look after the young baby or child while she was being seen. I think we could all take example from these women in this way and also find some of their endless patience as they wait their turn happily chatting away to each other without that feeling of anxiety, impatience and stress that is so palpable in European waiting rooms.



Before I tell you all about our weekend on the Lake, I should first let you know how Pilirani and her twins are getting on.

OnWednesday morning we (Doreen and I) set out early to do our visits. Lucas was at school and would be picked up at lunch time by a friend.

First I called in to the nursery to fetch the portable scales for weighing the babies. We then passed by the market and bought fruit, vegetables and bread. I had already prepared a tray of hard boiled eggs as I worry about the lack of protein in the average diet which mainly consists of a maize flour porridge. This serves to fill their stomachs but instead of being used as part of a balanced diet it is often the only thing they eat.

I had been in contact almost daily with Grace and her tiny, prem baby. She had left nursery weighing only 1.500kg. and with a possible heart problem. We would first go to see her.

I wrote the above last Wednesday and have tried unsucessfully to complete and post 5 times since then! It has been so frustrating! I am daily learning the lesson of how little control I really have over so many things. I am told that all the internet conections in Malawi were either down or slow and could only access some sites.. obviously my blog wasn't one of them! So, for those of you who began to worry that you hadn't heard, I thank you for your concern and for those who are eagerly awaiting my next installment...here goes!!

Grace met us on the "main" road, a muddy potholed track leading to who knows where! She was thrilled to see me and gave me a big hug. She climbed in the car and off we went onto the minor tracks. I still havn't managed to acquire a more suitable vehicle so was particularly challenged by a narrow wooden plank bridge and a steep muddy grooved incline. I even stopped to take pictures as I thought no one would believe it possible to pass! I have now realized why both Doreen and Grace are so confident that we will get through...Neither of them has ever driven a car!! Still their encouragement definitely helped! Grace is living temporarily with an aunt and uncle whilst the baby is so tiny. It was obvious that they have a little more money as the house is built of bricks and there is a small amount of furniture. I was shown into the main room and we sat on the sofa and talked for a while. Grace speaks some english but it was good to have Doreen there to make sure that we fully understood each other . The baby had not gained weight in the 2 weeks since discharge from the nursery. This is typical of babys with heart problems. I also felt that she was not giving enough feeds so advised her on 2-3 hourly feeds day and night. The little one, weighing just 1.5kg looked strong and active so I hope that when I next visit I will see some weight gain. I left her with the milk, sugar and fruit I had brought promising to return in 2 weeks time. Before leaving I was desperate for a bathroom so I was shown to the toilet facilities. I have still to improve my aim when peeing down a small hole in the ground but am working on it! I was touched when they brought me a bowl of HOT water to wash my hands. Its these little things that bring me such pleasure.

Precariously we took the road back, I was glad to reach the main road and drove the 30 minutes to reach Piliranis village. The welcome was tremendous we were greeted this time by the great grand parents. On enquiring their age nobody could remember ! The twins looked great and had regained the weight they had lost. I do hope this continues. I am concerned about Piliranis diet untill the new harvest begins. It is a great strain on an already hungry body to be feeding 2 hungry babies. I shall take what I can but I can't feed the whole village, I never feel I have taken enough.

Easter weekend was spent on the southern shore of Lake Malawi. It was an oasis of calm and peace. The incredible richness and beauty of this country made it hard to believe the reality of its poverty.
We were generously entertained by some friends we had met at the airport on arrival.
Time was spent relaxing, eating, swimming, canoeing, snorkeling and daily trips in the speed boat to visit small islands and coves. Luki was able to show off his already acquired fishing skills (endless hours fishing with his father in Spain) catching 3 or4 fish each day. These were later prepared and served for our supper. One of the highlites had to be "feeding the fish eagles" Fish were caught in the evening, then on an early morning trip to a nearby island they were thrown to the eagles who swooped down to retrieve them as they touched the water.It was truely amazing! After 5 days of sheer bliss we returned to Lilongwe.As you can imagine Luki wanted to stay for ever. I wouldn't have minded either!

Back at the hospital and after 3 days in Antenatal clinic I returned to labour ward. They were obviously pleased to see me. It is good now to feel part of the team. I am accepted and welcomed in all departments. Yesterday I was attending a young unmarried girl, first baby.( Its difficult in Malawi to have a baby outside marriage, culturally not acceptable) It was a long tiring labour and equally long 'pushing' stage. We went over the official time limit both for first and second stage. The senior midwives began to ask questions. Although I explain clearly that both mother and baby are fine, that women are all different, that we must be capable of adapting to the individual needs of each woman and each birth, they find this concept almost impossible. I was not following the rules and that made them feel insecure. At last a healthy baby boy was born with minimum intervention and a lot of hard work on my part. Not to mention that young mother. The senior midwife commented that I must be very tired. They do watch! they are noticing! at the moment that is enough for me. I managed to catch 2 other babies during the same shift and although labour ward was not busy, women laboured alone and even one popped out unattended.
Where were the other midwives? Why weren't they alongside caring and encouraging? I still can't answer this.

Next week I start teaching... officially! I prefer to think of it as group leadership of midwives who will regularly get together to talk, share, discuss and learn. It will be a time to explore our own feelings and motivation. We will be realistic within the environment in which we work but we will be willing to change, to improve. From these groups we will go out with a new/renewed vision to experiment new techniques with the sole aim to improve our care to women and babies.
Well at least I hope so!!!