Zimbabwe is a sad place to be at this time. That was my feeling after spending 4 days there. I did not feel threatened or afraid but there was a noticeable tension and fear in the eyes and the behaviour of its people. There was little chatting in the bare, half empty shops as we queued to pay for our kilo of carrots costing billions of Zim.dollars. Yes, I became a billionaire overnight, though when I paid 5 billion dollars for a postcard and stamp I realized it wasn't worth much!
Life in Harare continues as best it can, the city people going about their business and everyone wondering what will happen next. There was a definite state of insecurity and those that would talk with their conjectures of what may happen but not really knowing what tomorrow would bring.We heard many distressing stories of torture and violence and many rumours which all led to a sense of the fear and the unknown.The people feel intimidated and controlled but by what and by whom? Who might be listening who could be trusted? The people are tired of living this way. They just want a normal life but they dont know how it can be nor who will find the way to create this change. They are looking for help .From where? from whom? They are praying to God, they are asking for help, to the rest of Africa, to the rest of the world, they dont know when this will end but they still have hope. I too hope and pray that the world and its powers will not desert them, that a way will be found to ease their pain and their fear and change this totally unacceptable situation that is life in Zimbabwe.
The long road to Harare was a wonderful experience for me. As I was not driving I was able to really take in the beautiful changing scenery as we passed over the Malawian border through Mozambique and down to Zimbabwe. We were able to break our journey with an overnight stay in Tete boths ways. We were wonderfully entertained by friends and I was able to enjoy a truly Mozambique experience as we climbed up high in the evening to watch sunset over the Zambezi river. It was interesting to see and feel the differences between the 3 countries their dress, their villages and their cultures. I was suprised to find the city of Harare so much more of a developed city than Lilongwe with its tall buildings, good roads, lighting etc. The infrastucture is still there, very obviously still present and that is what the people rely on to bring it back to prosperity, as and when this dire situation resolves.
My visit to Zim.was made possible by my good friend Sandy who invited me to accompany her on this trip. She was able to take food and provisions to her family and staff whom without this trip would have been sadly lacking in basic food stuffs and as in the case of the staff become very hungry. They were the lucky ones. As we crossed the border on our return journey we realized that we were the lucky ones. There are many Zimbabweans in the surrounding countries who have not given up hope of things coming right and are just waiting to go home. I hope that will be soon for them.
My best story from my visit is as follows...
When asked "How are you?" doesn't everyone answer "Fine thankyou"
Well it was the same in Zim.
Untill one day I asked the Zimbabwean housemaid at a families' residence.
"I'm not good " she replied.
Full of concern I asked as to what was her ailment.
" My body is fine thankyou" she said, " but my country is not fine, my country is sick and I pray for it to become well"
On Friday I was back on labour ward. My first task was to assist at the birth of triplets. It was a great experience for me and more so as I was able to team up with a young Norweigian obstetrician and work together to achieve a positive outcome for both mother and babies. Just 32 weeks pregnant so the babies would be small and premature. After a quick scan we confirmed they were all presenting breech. (or more acurately feet first) This shouldn't be a problem as it was her 3rd pegnancy and they would be small. As I got to work to deliver the three babies the doctor was scanning and checking heartbeats and positions. We soon had a audience of young Malawian clinical officers and interns looking on. It was great to show, by our example, how to actively manage safely this type of siuation. First a girl weighing 1.400kgs. Then 2 boys both weighing 1.500kgs. I checked up on them yesterday in nursery and they seemed to be doing ok. Its early days yet so I am not being too optimistic but at least they have a chance of surviving. I will continue to follow their progress and offer to help out with clothing, blankets and formula milk, if it becomes necessary.
Due to lack of medical staff and experienced clinical officers I have now learnt and am becoming capable of performing assisted birth with vacuum extraction. I have spent many years assessing the conditions and safety of performing this intervention so have now moved on to take this extra responsibility.
I was particularly pleased with yesterday's events. When taking the decision for an urgent vacuum extraction for fetal distress and finding that the only clinical officer available was involved with an eclamptic mother, I was able to
to perform quickly and safely this procedure and save the baby's life. Alongside me was a young Noweign midwife who had been caring for the mother and recognized the problem. We both felt good after that!
When things are difficult and black we can pull on these moments to keep our spirits up and know that what we are doing is worthwhile.
I have been feeling rather sad and lonely these days.( though my friends are great) I am missing all my children and my family. Its been 6 months now since I last saw them. I know it feels more exaggerated by not having Lucas around but I can't help wondering if I'm doing the right thing being so far away?
How difficult it is at times to see clearly where we should be and what we should be doing. How torn between our responsibilities and our needs. Responsable to who? Needing who and what? I feel I have so much to give so much love to share. Whose needs are more important? I have gifts, we all have gifts, I am enjoying using those gifts but its confusing ......I look for clarity, I pray for guidance. I am thankful for what I have and for where I am, so many people needing help, needing care, needing love..........
Sunday, 29 June 2008
Tuesday, 17 June 2008
LUCAS LEAVES
I didn't write about Grace's baby last time. There are always so many things to tell. During her stay in the pediatric ward at the central hospital here in Lilongwe her condition seemed to deteriorate daily. It was impossible to make a diagnosis as neither the technology nor the experienced operators can be found here in Malawi. As her breathing became more and more difficult and laboured they could only treat with antibiotics, just in case she had a chest infection diuretics for her pulmonary and cardiac congestion and oxygen to help her breath, to try and keep her more comfortable. It didn't work and although I visited daily and she received more medical care and attention than any other baby on the ward Grace's baby Angela died last week. She was just 4 months old. Maybe her little lungs were too immature? or maybe she did have that congenital heart defect? Whatever.... the necessary neonatal care and attention were not available and another Malawian baby dies. Born too soon and in the wrong place.
I was invited to attend the funeral and visit her house the following day. It was a sad day, I could only give Grace a hug and tell her how well she had loved and cared well for her beautiful baby. That she had been a good mummy. Baby Angela would remain forever in her heart...and in mine.
I am challenged daily and that is exciting and stimulating. Labour ward continues to be busy and many bad things happen that are avoidable but I think that now after nearly 6 months I am finding my way to work, to care and to live with the reality of the situation that faces me daily.
I dont like it, I will never like it. Its not acceptable, it will never be acceptable but I am happy in my work and enjoy great pleasure when it goes right. I do everything I can to make it go right and with the support of my friends and a few colleagues, I cope when it goes wrong.
There are always many students to teach and many inexperienced young clinical officers. They now come looking for me as they know I will always be kean and eager to share as much of my knowledge as I can. Today I arrived just in time to find one midwife attending a breech birth very obviously without even the most basic knowledge of how to assist. I was able to instruct her as to the different manouvers necessary and them take over when it became difficult. It was satisfying to achieve a healthy baby and a better informed midwife.
Last Sunday I said goodbye to my little Lucas for a month. He left on his own to go to spend some time in England with my family and then on to Spain to be with his Dad, with Alasdair and with Fiona. Just 7 years old but with so much confidence as he bade me goodbye and went off to board the plane for the long flight to London. I had given him a small wooden crocodile necklace. Everytime he touched it he was to think of me. We spoke on the phone whilst he was waiting in Nairobi for his connection. " I've touched the necklace twice he told me!" He will have a wonderful time but I will miss him.
On the way back from the airport I went to visit Pilirani and her twins, Edward and Alex. I am always a little nervous as I never know if I will find them healthy and well. They were doing incredibly well but are still very vunerable. As usual the children from the village came running to greet me and carry my bags. 20mk ( 200mk/1 euro) for looking after my car...thats normally at least 4 of them and 20mk for carring the bag! The boys were fit and well. Both weighing well over 4kgs. now with chubby cheeks and more chins than me! Pilirani is still supplementing her breast feeding with 2 formula feeds a day so she needs me to continue taking the milk. At nearly 1.000mk a tin she could definitely not afford it. As I got up to say goodbye the Aunt came out of the house carring the twins elder sister,age 4 years. She was obviously sick. I examined her as best I could and asked many questions. It seems she had been sick for 3 weeks. She was covered in a rash that she had been scratching and was bleeding. Her skin was dry, she refused food and took little water. I'm a midwife and a nurse but not a doctor. I could not diagnose her condition but I knew she needed help. I gave them money for transport and made them promise to take her to the hospital the following day. I am anxious to know how she is. Talking to medical friends it may well be a vitamin deficiency ...this would not suprise me. The diet for the majority of the village people is maize flour made into dumplings and little else. Not dying of hunger but of malnutrition.
I have been invited to accompany a good friend and her family to Zimbabwe for 5 days this weekend. My family are very concerned for my safety due to the political situation at this time in that country. My Zimbabwian friends are in constant contact with their families living in Harare and feel it will be OK for the trip to go ahead. I will tell you all about it when I return. We will drive through Mozambique and onto Zimbabwe. I am looking forward to seeing more of Africa. It is a beautiful and fascinating continent its places and its people. I feel very lucky to be here.
I was invited to attend the funeral and visit her house the following day. It was a sad day, I could only give Grace a hug and tell her how well she had loved and cared well for her beautiful baby. That she had been a good mummy. Baby Angela would remain forever in her heart...and in mine.
I am challenged daily and that is exciting and stimulating. Labour ward continues to be busy and many bad things happen that are avoidable but I think that now after nearly 6 months I am finding my way to work, to care and to live with the reality of the situation that faces me daily.
I dont like it, I will never like it. Its not acceptable, it will never be acceptable but I am happy in my work and enjoy great pleasure when it goes right. I do everything I can to make it go right and with the support of my friends and a few colleagues, I cope when it goes wrong.
There are always many students to teach and many inexperienced young clinical officers. They now come looking for me as they know I will always be kean and eager to share as much of my knowledge as I can. Today I arrived just in time to find one midwife attending a breech birth very obviously without even the most basic knowledge of how to assist. I was able to instruct her as to the different manouvers necessary and them take over when it became difficult. It was satisfying to achieve a healthy baby and a better informed midwife.
Last Sunday I said goodbye to my little Lucas for a month. He left on his own to go to spend some time in England with my family and then on to Spain to be with his Dad, with Alasdair and with Fiona. Just 7 years old but with so much confidence as he bade me goodbye and went off to board the plane for the long flight to London. I had given him a small wooden crocodile necklace. Everytime he touched it he was to think of me. We spoke on the phone whilst he was waiting in Nairobi for his connection. " I've touched the necklace twice he told me!" He will have a wonderful time but I will miss him.
On the way back from the airport I went to visit Pilirani and her twins, Edward and Alex. I am always a little nervous as I never know if I will find them healthy and well. They were doing incredibly well but are still very vunerable. As usual the children from the village came running to greet me and carry my bags. 20mk ( 200mk/1 euro) for looking after my car...thats normally at least 4 of them and 20mk for carring the bag! The boys were fit and well. Both weighing well over 4kgs. now with chubby cheeks and more chins than me! Pilirani is still supplementing her breast feeding with 2 formula feeds a day so she needs me to continue taking the milk. At nearly 1.000mk a tin she could definitely not afford it. As I got up to say goodbye the Aunt came out of the house carring the twins elder sister,age 4 years. She was obviously sick. I examined her as best I could and asked many questions. It seems she had been sick for 3 weeks. She was covered in a rash that she had been scratching and was bleeding. Her skin was dry, she refused food and took little water. I'm a midwife and a nurse but not a doctor. I could not diagnose her condition but I knew she needed help. I gave them money for transport and made them promise to take her to the hospital the following day. I am anxious to know how she is. Talking to medical friends it may well be a vitamin deficiency ...this would not suprise me. The diet for the majority of the village people is maize flour made into dumplings and little else. Not dying of hunger but of malnutrition.
I have been invited to accompany a good friend and her family to Zimbabwe for 5 days this weekend. My family are very concerned for my safety due to the political situation at this time in that country. My Zimbabwian friends are in constant contact with their families living in Harare and feel it will be OK for the trip to go ahead. I will tell you all about it when I return. We will drive through Mozambique and onto Zimbabwe. I am looking forward to seeing more of Africa. It is a beautiful and fascinating continent its places and its people. I feel very lucky to be here.
Monday, 2 June 2008
BEING ACCOUNTABLE
I'm begining to think Thursday is my unlucky day, or more correctly unlucky for those little babies and mums on labour ward.
That's why I didn't write last week. You see I felt just too responsable and responsabilty weighs heavy at times.
It was a busy morning, starting at 7.15am. yet another 2nd twin born over 2 hours after the first. I found him on the resussitaire barely alive just a small heart beat and nothing else. Oh no not again! Each and every time it happens I try to find the person responsable but no one feels responsable. I try to explain how we should have cared for that mother and her babies, what was the correct procedure for a better outcome but I am obviously not being heard or I'm not speaking loud enough.
I did report the case loudly and clearly on the ward round. The clinical officer who attended told me he didn't want to do a c/section because the baby was well presented. Well presented and almost dead! He died at 4pm. that afternoon...thankfully....as the level of brain damage would have been huge.
Two rather complicated referred cases both with prolonged labour needed my attention. They had been fully dilated and pushing for how long? Together with the students I started sorting out how to deal with these women. Their was no immediate urgency as both babies were fine, but neither could they be left without constant care and observation. Unfortunately I have to leave the ward on Tuesday and Thursday to lead our workshops. At 10.30am. I handed over to a senior midwife and to the clinician on duty. I explained everything to the young student who had been working with me and reluctantly left their side. My instructions were clear. One woman could be encouraged with the help of a drip for just 30 minutes more, before assisting with a vacuum extraction, and the other should birth within the hour or be seriously considered for a c/section.
It was not untill I returned two and a half hours later that I realized my mistake.
Both babies had been born vaginally. Both had been born 1-2 hours after I left. Both in poor condition needing intensive resusitation. Both had been admitted to nursery. Both these outcomes could have been avoided.
So what had been my big mistake?
I suddenly realized that 3 midwives from labour ward had been present in the workshop, plus myself. This had left just one midwife on the ward with all the students and a very inexperienced clinical officer.
What was the point of teaching them in the workshop when there were distressed babies and birthing women unattended just 20 metres away?
It still lays heavily on my shoulders, I still don't understand how this can have happened. Of course its not really my responsability, I was not in charge of labour ward. There was a clinician on duty. But that's what I am hearing just too often. Of course I take responsability, we must all be responsable, we must be accountable. Accountable to such a degree that we realize that what we do, that how we act, does and will always make a difference.
This morning I arrived in labour ward and was greeted with the usual " bed 6 is pushing'
I hurriedly ( I think I'm the only person in Malawi who hurrys) collected what I needed and came to her bedside. How long had she been pushing? A referred case with prolonged 2nd stage. She had arrived on labour ward at least 20 minutes ago. Why hadn't anyone done anything? Listening to the fetal heart I knew that this baby needed to be born quickly. I encouraged her to push, performed a good size episiotomy ( incision to facilitate a greater vaginal opening and therefore a quicker birth) and with 3 pushes the baby was out. Floopy baby..not breathing, slow heart rate....not again! I quickly resuscitated the little one and slowly but surely he came round. When I took him to nursery later for a 24 hour observation period he had already had a good breast feed with his happy mum.
Ok so where do I go next? " There's a twin in bed 10...fully dilated...we know you like twins" the night staff called out to me, glad to be able to hand over after a long and busy night.
Twin one came out head first with no problem. Twin two was a breech and needed more care and attention but with active help on my part was born just 10 minutes later.
Before the night staff left they had all become aware that twins can and should be managed actively and safely. I said nothing, but hope that this would be an example to them.
" Good work, thankyou " commented the midwife in charge at night.
I felt positive and pleased. It was enough to keep me going for what turned out to be a long and difficult morning.
Lucas ' ran for his life ' on Saturday! Well actually he ' Ran for Wildlife' but he got the name wrong !! It was a sponsored run in aid of preserving the Malawian wildlife and endangered species. He had to run round the athletics track for one hour and would be sponsored according to the number of laps completed. I was very proud to see how he never stopped however tired and managed to complete 10 laps. This was an excellent run and more than most who were much older than him. He too was proud of himself, especially when he went round collecting money. I might find it more worthwhile to collect for health related projects but Lucas definitely finds it a worthy cause and as we are hoping to enjoy a safari with Alasdair and then Katy and Fiona when they come to see us I guess we should pay attention to other issues too.
That's why I didn't write last week. You see I felt just too responsable and responsabilty weighs heavy at times.
It was a busy morning, starting at 7.15am. yet another 2nd twin born over 2 hours after the first. I found him on the resussitaire barely alive just a small heart beat and nothing else. Oh no not again! Each and every time it happens I try to find the person responsable but no one feels responsable. I try to explain how we should have cared for that mother and her babies, what was the correct procedure for a better outcome but I am obviously not being heard or I'm not speaking loud enough.
I did report the case loudly and clearly on the ward round. The clinical officer who attended told me he didn't want to do a c/section because the baby was well presented. Well presented and almost dead! He died at 4pm. that afternoon...thankfully....as the level of brain damage would have been huge.
Two rather complicated referred cases both with prolonged labour needed my attention. They had been fully dilated and pushing for how long? Together with the students I started sorting out how to deal with these women. Their was no immediate urgency as both babies were fine, but neither could they be left without constant care and observation. Unfortunately I have to leave the ward on Tuesday and Thursday to lead our workshops. At 10.30am. I handed over to a senior midwife and to the clinician on duty. I explained everything to the young student who had been working with me and reluctantly left their side. My instructions were clear. One woman could be encouraged with the help of a drip for just 30 minutes more, before assisting with a vacuum extraction, and the other should birth within the hour or be seriously considered for a c/section.
It was not untill I returned two and a half hours later that I realized my mistake.
Both babies had been born vaginally. Both had been born 1-2 hours after I left. Both in poor condition needing intensive resusitation. Both had been admitted to nursery. Both these outcomes could have been avoided.
So what had been my big mistake?
I suddenly realized that 3 midwives from labour ward had been present in the workshop, plus myself. This had left just one midwife on the ward with all the students and a very inexperienced clinical officer.
What was the point of teaching them in the workshop when there were distressed babies and birthing women unattended just 20 metres away?
It still lays heavily on my shoulders, I still don't understand how this can have happened. Of course its not really my responsability, I was not in charge of labour ward. There was a clinician on duty. But that's what I am hearing just too often. Of course I take responsability, we must all be responsable, we must be accountable. Accountable to such a degree that we realize that what we do, that how we act, does and will always make a difference.
This morning I arrived in labour ward and was greeted with the usual " bed 6 is pushing'
I hurriedly ( I think I'm the only person in Malawi who hurrys) collected what I needed and came to her bedside. How long had she been pushing? A referred case with prolonged 2nd stage. She had arrived on labour ward at least 20 minutes ago. Why hadn't anyone done anything? Listening to the fetal heart I knew that this baby needed to be born quickly. I encouraged her to push, performed a good size episiotomy ( incision to facilitate a greater vaginal opening and therefore a quicker birth) and with 3 pushes the baby was out. Floopy baby..not breathing, slow heart rate....not again! I quickly resuscitated the little one and slowly but surely he came round. When I took him to nursery later for a 24 hour observation period he had already had a good breast feed with his happy mum.
Ok so where do I go next? " There's a twin in bed 10...fully dilated...we know you like twins" the night staff called out to me, glad to be able to hand over after a long and busy night.
Twin one came out head first with no problem. Twin two was a breech and needed more care and attention but with active help on my part was born just 10 minutes later.
Before the night staff left they had all become aware that twins can and should be managed actively and safely. I said nothing, but hope that this would be an example to them.
" Good work, thankyou " commented the midwife in charge at night.
I felt positive and pleased. It was enough to keep me going for what turned out to be a long and difficult morning.
Lucas ' ran for his life ' on Saturday! Well actually he ' Ran for Wildlife' but he got the name wrong !! It was a sponsored run in aid of preserving the Malawian wildlife and endangered species. He had to run round the athletics track for one hour and would be sponsored according to the number of laps completed. I was very proud to see how he never stopped however tired and managed to complete 10 laps. This was an excellent run and more than most who were much older than him. He too was proud of himself, especially when he went round collecting money. I might find it more worthwhile to collect for health related projects but Lucas definitely finds it a worthy cause and as we are hoping to enjoy a safari with Alasdair and then Katy and Fiona when they come to see us I guess we should pay attention to other issues too.
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