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.