TIME OUT

Today I'm taking "time out" I can do this. I need to do this

Teaching is going well . My twins and my miracle babies are just fine. But yesterday was just
awful!

Labour ward was as busy as it gets. We were 5 midwives and many students. With 1 midwife in admissions and another nearly all day in theatre we remained just 3 on the ward. The students, with little experience, were attending births with little supervision. I moved from bed to bed trying to keep abreast of each situation, helping out when things were going wrong whilst also trying to care for the more complicated "referred " cases. I had to drag myself away for 2 hours to teach in my workshops, and found on arriving back the situation was no better, it was worse. We only have one operating theatre at Bwaila hospital so please tell me what to do when we have 4 very serious cases waiting for a c/section? Just please tell me which one has priority?
The woman with the cord prolapse who was referred from a health centre. The cord was still pulsating, the baby was still alive ..but for how long? Or maybe the young primigravida who was sent by the TBA (tradition birth attendant) from her village. She had been "pushing "for more than 24 hours, her baby was still alive but severely distressed and she could rupture her uterus at any minute? Or the woman on her 10th pregnancy with 4 live children and severe fetal ditress? or maybe the woman who arrived with ruptured uterus with a dead baby but in risk of loosing her own life?
Someone just tell me, just please tell me who has preference? Who should make this decision? What are the priorities ? Who should live and who should die? Whose life is more important ? What should be our criteria?
Nobody told me how to make such decisions, it wasn't part of my training, yet I found myself there alongside the doctor doing just that.
That woman has already 4 children and her life is not in danger...Yet...That one is her first child and she may rupture. Was that a good enough reason for taking her first?
By 5.30pm. they had all been attended. I had been at work since 7.15am. without taking a break. And even as I tried to leave a student called me to help her with some difficult shoulders and another to suture a perineum. So it was gloves on and "just these 2 more and I must go" We left the ward full of women in labour for the night shift. As I walked away I heard comment. "At least with all that we only lost 1 baby" It was true, but that was someones baby, some mothers child she had loved and carried for 9 months, she had laboured and pushed for two days. Some fathers son, some grandmothers grandchild. It was one loss too many. It was avoidable if the conditions had been right and adequate, if these women really did have the right to decent proper health care if these women and babies really did have just some basic human rights.

TBA's form an important part of Malwian health care. There is such a huge shortage of midwives a least someone is attending the women in the rural areas. These women have no official training but will have learnt their skills from other women in the village. Passed on by the older women as tradition allows. Some will be good wise women who work skilfully and have achieved great knowledge and art. Unfortunately, others will have little or no skills and can be downright dangerous. The ministry of health has a problem. On the one hand they need them as they cannot supply enough trained nurses or midwives so they wish them to have some formal training. On the other hand they would like all women to be attended in health centres or hospitals so don't want to encourage them by giving training. Malawi is not supplying sufficient health care to do without them and does have not the means to do that. It is a problem. I have already made contact with a NGO who are looking at a project to provide these women with basic skills. I find this an exciting and interesting challenge. I will keep you posted.

Grace's baby is back in hospital with another chest infection. She is just 3 months old, weighs 2.800kg. and has been in hospital twice. I still wonder if she does have that underlying congenital heart condition but it seems impossible to get anyone to do any further investigations. Could it be that its just not worth it? There is no pediatric cardiac surgery available in Malawi so why bother making a diagnosis?

Today I had breakfast with some good girl friends and tonight we will go out to supper with other friends. I feel loved and supported. Today I had a good moan to Tarek too. Of course he understands perfectly. Has seen and heard it all before. But he's a good listener and I thank him for that.
Luki is having fun. He's looking forward to being in Spain with his dad and brother and sister next month, though I shall miss him terribly. I manage to talk to my other children regularly and that makes me feel so good. I have started to make plans and bookings for Alasdairs visit in July it will be such fun to visit new parts of this beautiful country. Sometimes its hard to believe the things that are happening behind the walls of Bwaila hospital. We must not close our eyes and pretend they are not there, that they do not exist. That is why I write, so that you too can know the reality of the very poor, the powerless, the defenceless, the women and babies of Malawi. Only then can something be done, can we begin to encourage, to force, someone to take notice, can we begin to make a difference.