TOTALLY CRAZY

My health has forced me to take time off from my work at the hospital. This beautifully coincided with the return of Lucas to Malwai after his trip to Europe. He was able to have time with my family in UK and catch up with his dad in Spain. He was accompanied...I'm not sure who accompanied who?... by my eldest son, Alasdair, who stayed with us for nearly three weeks. The timing was perfect. I was in great need of family love and care which is exactly what he's good at and which he did to perfection...thanks Alasdair. We had already organized to explore some of the Southern part of Malawi together and were away for 9 days. Alasdair got thrown into Malawi life straight away as he took over all the driving. Our trip included time at the lake..warm sunny and swimming. 2 days in the mountains... chilly, log fires and pine forests, followed by a 2 day safari. This was an amazing experience for us all. Unrepeatable episodes with elephants were the highlights of our trip as we managed to get the car into the middle of the herd.. this is not recommended and was a cause of a huge adrenalin rush and much fear for a while! We also had a huge bull elephant grazing outside our cottage just 1 metre from the window! I should also mention the tyre that punctured on the road to the lake. We thought we were in a pretty remote spot untill we found ourselves rapidly surrounded by a dozen locals all offering there services. I must admit the pit stop was unbelievably quick. Alasdair was quite willing and able to change the tyre but didnt get a look in, he just handed out wet wipes for hand washing afterwards much to the amazement and amusement of all!
We have many lovely stories and incidents from our trip too many to write down now but sufficient to say it really was just what I needed. I feel strong, I feel positive and refreshed I am ready to continue with all that I believe I still have to do here. I am looking forward to being back with the women and the babies at Bwaila.

Last Thursday we said a sad farewell to Alasdair and on Friday morning, bright a early, I was back on labour ward.

I was very warmly welcomed back. My fellow midwives kept telling me how much they had missed me. ( I expect they have to work harder when I'm not there!) I too had missed them, the work, the mums and the babies.

I have worked every day since then. I shall tell you that when I left this afternoon we had recorded 340 births during the month of August. Today is the 6th ( tomorrow is my birthday!) that means more than 50 births a day!
This is unbelievable, this unimaginable, this is totally crazy! If you could just see the size and condition of labour ward. The women who dont have a bed and birth on the floor. The lack of clean ..not to mention sterilized instruments, of gauze swabs or cottonwool, of gloves, but more importantly of midwives. Today I apologized to the woman in the bed opposite..."pepani, pepani... sorry, sorry". No one should birth alone. I was attending a post partum hemorrage an emergency situation. She screamed and she pushed "nursey, nursey" but I could not go to her so her little one slithered out alone. They were alone. I called to her to encourage her I could do nothing more. My priority was to attend the other woman. So there were no caring hands to catch him, no one to scoop him up and clean him off, no one to stimulate his first breath he /they were alone. It was lunch time. The student midwives and clinicians had gone for lunch, one midwife was in the admission room and the other was in theatre with a c/section. I looked up, I looked around, I was alone. I attended 5 births in the next 2 hours. At last I saw a clinician attending at the other end of the ward. I called for help. When he arrived it was to ask me to help him perform a vacuum extraction for fetal distress. I quickly left the woman that I was suturing..that could wait till later..the intervention was quick and simple the baby was fine, I left him and returned to another woman pushing. She had been on labour ward for more than 1 hour but nobody had examined her or listened to the baby's heartbeat. I could see the baby's head. I tried to explain to the lady I was suturing that I would be back, that I had not forgotten her as I rushed to find some instruments, some basic materiales to attend this birth. Three pushes and the child was born but its condition was not good. I hurriedly took him to the resuscitation area. As I worked on the baby, who responded well, I was thinking of the woman lying there on her own. Was she bleeding? Was the placenta out? did she need me? Where should I be? with the mother or the baby? There was no one to help me, I was on my own too.
All these mothers and babies are now fine and well. When I had finished and left them all clean and dry with their babies suckling at the breast I had to fill in the labour files and charts and found I could not remember most of the details of each one, no times of birth, boys or girls? it wasn't important so I didnt know! 2 hours had passed as if it had been 5 minutes!
Dont think this is a strange situation, that this happens every now and then. No.. this is happening nearly every day and most nights. Where are the other staff? how is it possible for them all to disappear at once? These are the very questions I continually ask. And I do ask, but I get no answers. Now can you understand why the busiest maternity unit in Malawi and one of the busiest in the whole of the South African continent has such a high maternal and neonatal mortality rate? Why oh why is it like this? why do these women not deserve better? They do deserve better. I am trying oh how I am trying, but it sometimes feels impossible. However hard I work, however quick I run I just can't reach them all. I suppose this is normality for the Malawian staff, but I have seen better, I know better, I know what should be, but how?

I was so angry yesterday. I was told that on " bed one" the baby had died in the first hour of life. On examining her file I found that she had been pushing for 5 hours. The clinician had been called but arrived 3 hours later, meanwhile no one had checked nor the maternal nor the fetal condition, nor had they used any interventions to aid the birth. This happens with referral cases that have to journey fron outlying districts, or have been attended by poorly qualified attendants. But this woman was on our labour ward in our hospital! I informed as many people as possible. I was not prepared to keep letting these incidents happen without any accountability without any responsibility. On talking to one midwife she informed me that some midwives believe that if the woman pushes and the baby doesn't come it is her fault for not doing it properly for not putting in enough effort. The mother is responsible! This is the attitude I knew existed in the villages but we are a hospital with trained midwives! Could it possibly be that some of our midwives share these beliefs? I despair.....but I am strong and I can carry on.

There is so much I could write today. I am feeling good and positive and confident despite all that I face daily. If I can save just one baby or one mother If just one baby or one mother is better cared for because of me it is enough. At least for today...I wonder how I will feel tomorrow?