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.