HOW LUCKY WE ARE

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