THERES NO HIDING THE TRUTH

"Megan's mummy died at Christmas so she could have her presents in heaven"
This was Lucas' news after his first day back at school. How easy how simple it was for a child to accept the unacceptable, to rationalize the unrationable, to fathom the unfathomable.
Is this why we hide the truth from our children? To protect them from reality, from the pain of knowing too much?
"But she died at the wrong time" he continued.
Now I was confused... I thought he had it sorted out? What did he mean now?
"Well you're supposed to die when you are old and she was just forty or fifty!"
That night he found it hard to get to sleep, we talked and we cuddled. He demanded I stay with him. I held him tight and he slept.
Being in Europe during our Christmas vacation was a bit like that... it made me realize how easy it is to hide from the truth, from the reality of Africa. Most people didn't want to know, didn't ask. They didn't want to hear of the poverty, the appalling conditions in the hospital, the critical shortage of nurses and doctors, the preventable deaths.... No, that would upset their comfortable world, so better not to ask. But not all ...some like Lucas knew there was more, that they wouldn't and shouldn't be protected from the pain. Here I found great generosity of spirit and of love. I found both financial and emotional support and for that I am grateful. You know who you are.. I don't need to put names but I do thankyou from the depth of my heart.
Christmas in Spain was all I expected and more. Being together with all my four children is such a priviledge and a joy. I am such a proud mum! How I miss them...but how lucky I am! Lucas spent many happy hours with his Dad which was just what he needed. He was pleased to find that he hadn't forgoten how to speak Spanish and even communicated with his Spanish family in Valenciano with ease.
We then spent time in UK visiting my family and a few old friends. I was so pleased to find my Mum in good health and spirits despite her recent operation. Its so much easier to be working here, however difficult it might be at times, knowing that these people love and care for me/us.

And so we arrived back in Malawi after a long and tiring flight through Nairobi and Lusaka. It felt good to be met at the airport by our good friend Mina, she and her family have adopted us since the day we arrived.
Going back to labour ward felt good. I was received with such warmth. Cries of how much I had been missed and lots of hugs. It's strange how one feels after being away, that things should have changed, but then you find they havn't and that makes you feel comfortable. Of course there is so much room for change at Bwaila I should have been happy to find some signs of improvement but no things were just the same.
Thursday was a public holiday. I knew we would be short staffed so decided to start work early.
It was probably one of the busiest days ever with just a skeleton nursing staff and one clinician. From 7am untill I left, exhausted at 2.30pm women were delivering their babies anywhere and everywhere, On the floor, between the beds, on unwashed matresses finding space whereever they could. I spent my time caring for mostly high risk mothers although couldn't help but catch two or three as they popped out unaided and unaccompanied on the next door bed. During these times its all about prioritising, I can't attend you all so who needs me most? Sometimes its the one who shouts loudest but thats not always the right one. How difficult it is to ignore their cries of "nursey, nursey, pain, pain!" but they are often ignored. She was just 17 years old and already HIV positive having her first baby, what were her chances of surviving to see her child grow. ?
Another 20 years old also HIV positive with chronic anaemia aborting her first pregnancy at 24 weeks. Luckily we managed to find blood to transfuse ,the following day she was still alive. Then there was the woman carrying her 10th child but with no living child. Now 2 weeks past her due dates and with a dead child. And so it went on and on that day. When I left the beds were stll full but I could do no more.I was phisically and mentally exhausted. The hardest thing is to walk away. I dont think I will ever learn how to do that well.
Then I came down with a rotten chesty cough and cold. I remember thinking as I listened to that man on the plane coughing loudly I wonder how many of us will catch that? Well I did!
Friday no labour ward. I left my cosy bed to attend our weekly 'Quality Improvement' meeting.Tarek and I arrived both arrived on time at 2pm. By 2.40pm we were still waiting. When the first attendants started to arrive 45minutes late we were so discouraged by the lack of interest we postponed the meeting until next week. Saturday morning I was to meet with other nurses to audit the maternal death files. This is supposed to take place regularly with the aim of critically reviewing the circumstances around the death focusing on where the problems are and taking the appropiate actions. Once more no one arrived. I set about organizing the files and taking a brief look at some of them. I was eventually joined by one of the senior nurses. We only audited one file. For me that was enough. This maternal death was purely and simply due to absence of blood for transfusion from the central blood bank and delay in organizing family donation which may have saved her life. This must be difficult for you to believe but it is the continuing reality of Malawi.
Tomorrow is another day. I will do what I can...that is all.......

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