Tuesday, 28 October 2008


The workshops that I started up several months ago for the midwives at Bwaila and Kamuzu Central Hospital continue to be enthusiastically attended. Sometimes I wonder how much of what we share and learn is ever taken back into the clinical situation but that is on my more negative days. As requested by the midwives, in the evaluations, we have been covering topics that are directly linked to their everyday practise. Skills and knowledge that I inicially took for granted would not be necessary have been well received. Many of these topics have covered actuation in emergency obstetric situations. I was priviledged to have attended an excellent course last year before coming to Malawi on these same subjects which has helped me to prepare a more structured presentation. Todal we were looking at post partum haemorrage. This is profuse bleeding after delivery.This is one of the main causes of maternal death in our hospital. Prompt and acurate dignosis and attention really does save lives. After learning the basic theory I set up a clinical situation in which they could practice. As I lay on the conference table pushing out my baby and then fainting from blood loss the midwives practised how to call for help, organize the team and methodically go through the process of attending to this simulated emergency situation. As you can imagine much fun was had by all and amoungst shouting a laughter I hope we all learnt something. I did, however, draw the line at having medication inserted in my rectum!! I have also been using case histories as a means of looking crictically at our work. We were not suprised but were concerned by what we discovered.
After I had finished teaching I returned to the labour ward positive and encouraged. Unfortunately I was met by an alarming situation. The woman was 34 weeks pregnant with here 4th child. She had been suffering from severe anaemia during most of her pregnancy this is not uncommom due to extremely poor diet and hunger. She had been regularly attended in the antenatal clinic as well as being an in-patient for some time. Her membranes had ruptured spontaneously several days ago with no other signs of labour. It was decided to incuce labour. The procedure is to insert medication in the vagina to ripen the cervix. This was done earlier this morning. At 1pm when she was being assessed it was noticed that the baby had an irregular, slow heartbeat. A monitorization showed severe fetal distress. She would need and immediate c/section to try and save the baby's life. We prepared her for theatre and called the clinician. It was noted that her anaemia was still severe ( her Hb was now 5 having been increased from 3.9 with blood transfusion, a normal healthy Hb is around 12 to 14) Blood samples had been taken during the morning to prepare blood for her to be given as soon as possible. We contacted the laboratory who told us that there was no blood available. They would be processing blood at 2pm but it would not be ready untill later in the afternoon. It was not that there was no blood for her, she has a very common blood group, the situation was that in the biggest hospital in Lilongwe, the capital of Malawi, there was NO BLOOD AVAILABLE. I went to theatre to talk to the anaesthetist who confirmed that it would be too risky to operate without blood, that she would have to wait. I walked slowly back to labour ward to give the news my heart was so heavy. The young Irish midwife, who had been looking after her, cried out" This cannot be happening! " But it was true. I told her to remove the fetal monitor, there was nothing more we could do and listening to the baby's slow heart beat was not going to help. She cried. I tried to console her and felt resigned. I did notweep as I would have done a few months ago. Am I starting to harden to these situations? am I accepting them? I hope not.
The lights have just gone off, there is a powercut in this place that I come to talk to you all. How strange that the computer still works! Here I share my highs and my lows, my laughter and my tears. I let you into my life and my work, into the lives of the poor women of Malawi. Why? Just so you know how lucky you are! Just so you realize how much you take for granted! Just so you think again when you complain of the health care you receive! Just so you appreciate every day and moment of your comfortable lives! Just so you love and care!
My midwife friend Joanne sent me this ( she was working at Bwaila before me) I thank her for her insight and her continued concern for Bwaila.
"If we are lucky, we will suffer a taste of powerlessness in our own private lives. Because then things change. Then we begin to see with a gentler, broader vision and talk with a kinder tongue and feel with deeper feelings for those for whom powerlessness is a way of life." Joan Chittister

Friday, 17 October 2008


I really can't believe that nearly three weeks have passed since I last wrote to you all of my life here in Lilongwe Malawi. Time passes so quickly and I am already starting to make plans for our return to Europe in time for Lucas' birthday and for Christmas. These are special times for us as a family and it will be good to be together again. My mum has be operated on recently and although she seems to be recovering it has not been without its difficulties. I am grateful to have my brothers and especially my sister available for her as I am really not much use to her being so far away. I sometimes question my dedication and availability to the poor, the women and babies of Malawi when I am not even able to care for my own mother. Still ....I guess life is full of confusing and conflictive thoughts ....nowhere more so than here in Malawi, one of the poorest countries in the world. It is evident that huge amounts of donor money is being poured into this country. Many projects covering a huge multitude of different areas of health, education, agriculture, etc.etc. Conferences and congresses. Training programs and education to improve knowledge and skills. But yesterday we found ourselves with no gloves. Just for 15 minutes whilst someone went off to find the matron and replenish supplies, but during these 15 minutes nothing could be done! Well not quite true... I managed to deliver a baby and resuscitate another without gloves... much to the horror and disgust of all my colleagues. On our busy labour ward many things can happen in 15 minutes it is not acceptable to be without gloves. Proper suture material has been absent during most of this week. Yes, women are being sutured but not as well as they could. But this is normal at Bwaila hospital this has become acceptable ...at least to some. So all this money pouring into the country and we have no gloves and no suture material. Not to mention scissors, forceps, curtains, vacuum extractor, beds, sheets, lights, soap, syringes, needles, washing facilities, showers, hot water...........do you want me to continue? But I'm not saying that the answer is to keep donating these necessities. I just want to emphasize that these are necessities for dignant care.
I have heard that large sums of money are being spent on courses and training on how to deal with a major crisis or disaster. Earthquake, floods, tsunami or the likes. I'm sure it is very relevant and important but hunger, poverty, lack of decent health care and education are here with us now. Crisis and disaster are here with us now and we are not managing to deal with it effectively.
The twins that I wrote of in my last blog were able to go home after just 5 days in the nursery. They returned one week later for a check-up and were looking fine and healthy both having gained weight. Before discharge their mother had asked me to give names to the two little girls. This is a great honour and one becomes as if a god-mother. I shall have to be careful not to take on too many of these adopted children! I decided to call them Ruth and Rachel ( My elder sister and I) When she came to show me the girls they were dressed in the clothes I had given them and wrapped in the little blue Ikea blankets that Katy had brought out. She proudly told me in broken English that Ruth and Rachel were doing well and would like me to visit them. I shall put aside a day next week to do just that.
Some days are more chaotic than others. Very often labour ward is full of staff. Students of all types mill around with what seems like as a total lack of direction. Many times that is so. I continue to try and teach as much as possible. I move from bed to bed trying to keep aware of what is happening ask questions and discuss care plans. I am always particularly vigilant to make sure that the referred cases are assesed promptly. This is still a problem. This past 2 weeks my in-service training sessions have been looking at case studies to try and pick up any mistakes made and learn from them. I was suprised to find that most of the midwives were quick to spot the delays in giving the appropiate care and could easily present the case and make the corrections. They also could appreciate the evident lack of record keeping. They found the sessions stimulating and helpful...or so they said... I was dissappointed to find that the following days showed that this knowledge was not being put into practice. They were not able to perform the care that they knew was correct. Or they were too busy or tired or complacent. This ended in two particularly sad cases where the result was two dead babies. If they had acted quicker or made a more responsable decision instead of waiting these babies would not have died. Much of the delay is in getting to the hospital but we need to confront the obvious delays that are occuring in our own labour ward.
I will try not to leave it so long before writing again.
Many times I just don't feel like writing it all down as its too upsetting or just too repetative.
My moods change and swing each day and sometimes many times in a day. Today I am not so positive and just a little tired and angry. I am sure it reflects in my writing.
Lucas has been on half term holiday this week. We were so lucky to be invited to spend a long weekend at a cottage on the lake shore. It was a fun and peaceful few days. We feel very fortunate to have such good generous friends.
I remain with the image of the sun rising over the lake. A huge fiery red, orange and pink circle changing the colours of the sky as each minute passed and a new day began. I crept out of bed quietly and wandered down to the lake for a morning swim in its calm sweet waters. I have so much to be grateful for. Sometimes the contrast from that to my work with the women is too much to bear.