MUM AND MIDWIFE

How to be a good Mum and still continue to give to the women and babies in my care?
This has been in my thoughts almost permanently during the past few days.
On Saturday Lucas started to feel unwell. Most of the night was spent trying to keep down his fever and encourage him to drink. Living in Malawi means that every fever is possible Malaria. By Sunday he was weak and drowsy, had no appetite and just wanted to sleep. He refused all food and it was difficult to persuade him to take fluids. I was concerned but as the symptoms were very different to when he had Malaria last year I decided to wait and see. I am loath to treat without a pretty definite diagnosis. He continued to fell unwell but was not deteriorating. Monday morning he was not well enough to go to school nor did he want to eat but I felt that he was slightly improved. Instinctively I felt that it was not Malaria but could not find any reason for his persistent fever. I called by to inform his teacher. To be expected she was unable to support my decision to wait and see encouraging me to take him for Malaria testing. I began to doubt myself. The test was done much to Lucas’ disgust who also reassured me that it was not Malaria! I was negative. Leaving him with the nanny I went to work. A busy morning on labour ward then a meeting with Tarek and the project manager of the new maternity units to make some last minute changes to the theatres.
Arriving home at 5pm I found Lucas with fever and still feeling unwell. I had asked his nanny to inform me of any changes but she hadn’t. That night the fever continued and we passed another restless night. Tuesday he still wasn’t fit for school but he was somewhat better than the previous day. I still felt I should wait and not rush into unnecessary treatment which I truly believe would be detrimental in the long run. I left him once again with his nanny. Tuesdays are workshop days. These times together with the Bwaila midwives have become enthusiastically attended. They form an important part of my work here in Malawi. We had undergone a ‘quality control’ assessment during the past week and we now had to hear the outcome and discuss its relevance. It was not a surprise to any of us to find that the results were extremely unfavourable. Much can be attributed to the dreadful environment and facilities in which we are working but of course not all. There are so many areas for improvement. I was encouraged to see how quickly and openly the midwives began to participate in the discussion. It is so important that the solutions or recommendations come from the midwives themselves. I was able to stress the importance of working as a team and try and find small attainable goals on which to start improving. We have actually put some of these into practice already. We are also using these workshops to audit maternal death files of which we have four since the beginning of the year. We look at the details surrounding the death picking up any areas of poor or insufficient care or attention. Lack of staff or materials including laboratory or blood transfusion services. We then decide on actions to be taken and personell to be informed. This is proving to be a strong teaching aid. It confirms my belief that most of the midwives have the knowledge but very often are not converting this into everyday situations. How to achieve this has become my greatest challenge. So I returned home after another busy day. Lucas still had a slightly fever. He was now eating small amounts but as he explained to me “ Mum, I feel strange” Now I was beginning to feel insecure. Was I making a big mistake? Did he need to see a paediatrician? Was I withholding necessary medication? Was I being stubborn? Did I really know what I was doing? I made a decision there and then......If he continued to have fever the next morning we would go hastily to consult a specialist.
We both slept well that night. The best night’s sleep in days. On awaking this morning I could tell that he was better. No fever, hungry for breakfast and willing and keen to go to school. What a relief! I arrived on labour ward soon after 7.30am. The ward was full of women, many waiting for beds. It was going to be another crazy day! Our Norwegian obstetrician was calling for help. The placenta had separated from the uterine wall and the woman was bleeding profusely. The baby was already dead but she feared for the life of the mother. She quickly delivered the child with a vacuum extraction. We were prepared with IV lines, medication and most importantly with a ‘team’ of people. The massive haemorrhage was controlled, blood was available for transfusion, her life was saved. On another bed Stella had pushed out a 24week foetus (abortion) totally unattended. She was lying in a pool of blood, amniotic liquid, urine and faeces. I gave her the appropriate medication to prevent bleeding and began to clean her up. If she decides not to take away the foetus it goes in the bin along with the placentas.....that was the hardest part for me. That was just that was just the start of the day. Then came the usual pre eclampsias, post partum haemorrages, obstructed labours, foetal distress, birth on the bathroom floor ( not to be recommended ..the floor is filthy) I performed 2 vacuum extractions for foetal distress and fortunately just before leaving for home at 4.30pm.one nice straight forward uncomplicated birth. No babies died, though some had to be resuscitated, nor did we loose any mothers. My legs were aching, my throat was dry, I suddenly remembered I hadn’t eaten all day.
The best was arriving home. Lucas came running out to meet me. No shirt, no shoes with his arms open and a big smile. He was obviously better. He stopped when he saw me “I’m not going to hug you with all that blood and stuff on you” The troubles of the day disappeared, the tiredness left me as I took him up in a big hug despite the smelly uniform!