CARING FOR THE CARERS

What a privilege it is to be here! To be working in a place where amongst all the pain and suffering the appalling conditions, the dirt and poverty, miracles happen! How many of you can say that? Not a week goes by when I cannot say “ I HAVE SEEN A MIRACLE” Could it be that in the affluent world everything is so controlled, so much technology and knowledge , so many answers and logical explanation for everything that you wouldn’t recognize a miracle even if it slapped you in the face?
I believe in miracles more than ever before in my life. Why is that? Because I see them!
Let me share them with you........
Having been attended at a Health Centre several kilometres away from the hospital this mother was referred to us at Bwaila with a prolapsed cord. Those of you who have read my other blogs will understand that this is an emergency situation. It means that the baby’s umbilical cord, its life line, is coming first and is in danger of being compressed by the presenting part either the head or the breech( bum!)This will cause its death before being born. Apparently no ambulance was to be found so she was brought to us on the back of a bicycle! It is a common form of transport as most people will not have a car and the minibus may be too expensive or not available. When she arrived she was examined and taken straight to theatre for a c/section. The operation was performed and the baby was extracted alive and well! The baby was badly positioned in the uterus, meaning that as there was no presenting part in the pelvis there was no cord compression! Mother and baby are doing fine!
Yesterday another cord prolapsed. Yes, it is not uncommon to see this and many prove fatal for the baby. On examination she was found to have a foot and head presenting plus a long loop of umbilical cord. The doctor and midwife rushed to attend. The cord was still pulsating! What should she do? The head would compress the cord but was still high up. Quickly she made her decision and caught hold of the foot. Then with the help of abdominal palpation she was able to catch the other foot. It wasn’t easy but it was worth a try. It took some time, the baby was delivered, they feared it was dead, it looked dead. But no.... there was just a small sign of life. The midwife rushed the baby to the resuscitaire and began work. It took a while, but 30 minutes later it was sucking contentedly at its mother’s breast. Today it’s doing fine!
Now do you believe in miracles?
It’s not uncommon to hear the recently delivered mothers praising God for a safe birth. Mother and baby alive, hallelujah! “ Thankyou Jesus “ they say. I have to agree, but thanks to US, just a little, I say!
These last few days there have been more than 25 births overnight with just 4 midwives. The night shift starts at 5pm and finishes at 8am. This is of course much too long for any person to work continually. This means that they have to take turns to sleep for a while thus leaving the ward covered by 2 or three midwives only. There is one clinician on duty who may be operating or attending patients on the ante natal or post natal ward. It is not difficult to see how some women or babies will be missed and tragedies occur.
Arriving on labour ward early in the mornings is still a difficult time for me. Having greeted the night staff I always ask if they have any particular problem cases, prolonged labours or any referred patients. These I attend first. However very often the problems have not been recognized and a quick assessment shows women exhausted from labouring too long and babies struggling to resist. Although these situations continue to frustrate me it is also rewarding to solve the problems, perform the appropriate interventions and give the correct care. My knowledge and experience is increasing as each day presents a new challenge.
The work on the two new maternity wings is progressing well. Some of the buildings are already finished. It’s an exciting time but also full of worries and concerns as to how the change over will take place and particularly as to staffing matters. Malawi has a huge deficit of health workers especially nurses and midwives. We will be opening two units simultaneously with just one skeleton staff. This is our biggest concern. Malawi is not training sufficient nurse/midwives to cover its needs. Many of the more highly trained are being taken up by the private hospitals or NGO organizations and others are leaving the country for greener pastures. How to make working in Bwaila hospital attractive to the nurses and midwives is proving to be a huge challenge. The new buildings and working conditions will of course be tremendous but will that be enough and for how long?
Last week I attended the launch of an iniciative to lobby politicians to commit to reducing the enormously high maternal and neonatal death rate here in Malawi. It was well attended and an appeal was made to government , in light of the impending presidential elections, to increase funding and resources to this end. A young mother told her story of how she nearly died in childbirth. This woman had been attended at Bwaila hospital. According to her story she was badly treated and neglected. The blame once again was aimed at the midwives. It is true we must be accountable, it is also true that women and babies don’t always receive adequate care but it is also true that the midwives are working under great pressures and stress. Appalling conditions, huge lack of staff in all areas, miserable wages not to mention the vast personal problems and loads that many of the midwives carry .Many are responsible not only for their own family and children but also that of their extended family after the death of a sister, cousin or family member. Life expectancy is still less than 40 years. HIV AIDS, malnutrition, hunger, TB and many other illnesses are killing off the poor people of Malawi and leaving vast numbers of orphans to be cared for by others. These sort of public attacks do nothing to raise the moral or encourage the nurse/midwives. CARING FOR THE CARERS is the motto of the National Organization of Nurses and Midwives of Malawi.
I will be an advocate for the midwives of Malawi. We must find ways to support and encourage them not to criticise and demoralize. This is our only way forward.