Its been two weeks since I was last able to have access to my mails and to my blog. Its been one week since I was able to work on labour ward. I have felt frustrated, out of touch and very low.
As can be seen by all my writing over the past months Malawi is not the place to be in need of health care. I am strong I am healthy. I have a natural capacity to look for and find the positive side of even the most difficult situation but during the past week I have been severely tried and tested. I have entered a Malawi operating theatre, as a patient, only minor surgery but how much better it feels to be wearing the nurses uniform and not the patients gown. As a nurse and midwife for so many years the familarity of the hospital feels like home, the ward my bedroom, the operating theatre my kitchen. Its not strange, not worrying, its known, its familiar at least untill I became a patient. What a lesson it has been to me to have this insight into how these uneducated village women must feel as they confront the unknown sights and sounds of the labour ward and especially, of the operating theatre. I think I am mending though the process will be slow and I will need a great deal of patience... this will be another lesson for me. With the help, support and love of my family and of my good friends I will achieve this..
Alasdair arrives with Lucas on Tuesday.... at last! Just what I need at this time. I had already decided to take some time off work and had planned a small trip so it will be a wonderful convalescent period for me. I need to be fit and well, I need my health restored my strength so that I may continue to give of myself, to love and to care for the women and babies at Bwaila.
I have recently informed my employers in Acuario (Spain) that I will be staying here untill the end of the year. My work here is still not done, I feel I have more to do/to share, it is too soon to return, I search and pray for guidance. In the same way that it became so totally clear when I made my decision to come to Malawi I am confident I will know when it is time to leave.
Today I will share with you the experience of my Norwegian midwife colleague.
We are continually receiving referred cases from the outlying health centres, it is the first place the woman will be taken when things go wrong with the attention of the TBA ( traditional birth attendant) in the villages. Nina decided to spend a day in one of these places. We know they are extremely understaffed very often without a doctor or medical cover. There have few materiales and only the minimum of emergency supplies.
The mother was carried into the centre by her husband accompanied by the TBA who was attending the birth of her twins. Twin pregnancy is considered high risk and therefore one of the reasons that they are advised to have a hospital birth. She was stiff and unconscious. She was having and eclamptic fit. The two nurse/midwives on duty began life saving tasks with the limited equipment and drugs available. They phoned for an ambulance for immediate transfer to Bwaila. This would take a minimum of one hour. On examining the woman they realized that the child had already been born, though the placenta was still in place. When? Yesterday.....and... the 2nd twin was still inside the uterus! More than 24 hours had passed! Why hadnt she bought her before? Because she will not be paid if she doesnt deliver the child!
Eclampsia demands the immediate delivery of the baby as it is the only way to save the mother. In these cases mothers life is always considered before the child. But it was not possible to deliver the 2nd twin . At last the ambulance arrived, the mothers condition had not improved, No one even thought to listen for a fetal heart beat ..what was the point? Did she live or die?
We dont know, as she was taken to a mission hospital that was closer. We shall try to find out. But no one else will. The mission hospitals are paying hospitals so many women cannot afford to go.They do attend emergency cases without payment. Nina came to see me that evening at home. She was noteably distressed. She said she will not go back again to the health centres as although she knew Bwaila hospital was not always adequate she could not cope with feeling so utterly alone and unsupported with not even the basic necessities for life saving tasks. We talked, we hugged, I was able to support her and give her the assurance she needed that she had done all that she could. Yes we are doing all that we can...not enough..never enough ... but all that we can.