Monday, 23 November 2009


It is now just over one month since the new unit became fully operative. Time flies by so fast and though I had hopes of being able to slow down a little once the unit was opened this has not been the case.
On Monday 19th October we started the big move from the old to the new unit. Although only 200m distance it was a huge job making sure that patients and equipment were transferred in the right order. We had planned for it to be done over three days but in the end we were able to complete in two. The last to move was the operating theatre and the sick babies on nursery. There was a period of 12 hours when we were operating two labour wards, two theatres and two nurseries! With an already depleted staff this was no mean feat. Most of the equipment and furniture had been supplied new or good quality second hand from a large container from Norway. This meant that only a few essential items that had not arrived or others that could be put to good use from our old wards, would need to be transferred. In practice that was not the case as we found that although basic needs were covered it was good to ‘double up’ on many items from the old and the new. Our 146 bedded unit soon became a 180 bedded unit as we pushed extra beds and cots into all areas. We are hoping that with the imminent opening of the new high risk unit on the Kamuzu Central Hospital site our numbers will reduce and we can use the buildings as intended. It is true to say that even with the extra beds we still have infinitely more space than we ever had at the ‘Old Bwaila.’
The ‘move’ didn’t all go exactly to plan but then it wouldn’t be Malawi if it had! By the end of day one almost everything was prepared but the resuscitaires for the babies had not arrived ( and still havn’t ...another long story...I believe they are somewhere between Brazil and Malawi on a container ship...if they havn’t been hijacked by pirates!) By 4pm. most of the staff were finishing their shift. There was no transport to be found. Refusing to allow the nursery and labour ward to be working without the necessary equipment Dr . Kind ( our new German obstetrician) and myself were to be seen pushing these machines over the bumpy ground all t5he way into the new unit tobe installed. The following day the same thing happened but this time with theatre equipment. Once again he and I manually transferred the anesthetic machine and huge oxygen cylinders into the new theatre. What a sight to see two ‘msungus’ (white people) pushing a huge oxygen cylinder on a patient trolley!
And so it was that at 8.50am.the first baby was born in our new delivery rooms. I just missed that one, arriving as the head popped out. But I was not to miss number two at 9.50am. I proudly assisted the birth of a boy to Ndaona Jonathan, weighing in at 3.600kgs.
Since then things have been totally hectic. All the usual problems heightened by the new environment which although completely superior, is, to most of the staff, totally unknown. Of course many building, electrical, plumbing faults became obvious when starting to actually use the buildings. Mostly these have been solved by the constructors whilst under guarantee, but others have been due to poor use of the services. We have continually found the drains blocked by bits of cloth and other debris. Many of our women are not used to mains drainage and flushing toilets, thus dispose of their rags, as they would at home, into the hole! We have had a couple of emergency runs for oxygen cylinders when the electrics failed in nursery and labour ward. We have an automatic generator which cuts in when the power supply fails. Unfortunately if it just ‘trips out’ in one area this does not happen. If I did not know before, I am now fully aware where the electric box is situated on every ward. I have assured that the ward staff know where to find the switches in an emergency and how NOT to lock the door to the room where it is situated and then not have the key available! Is has been good to see some enthusiastic and motivated midwives who are taking care and pride in their new work area.
Having spent the past months sorting out the buildings, equipment, training, etc. interacting on all levels with just about everyone involved it should not have been surprising to find that after the opening of the unit I continued to be called upon to sort out and solve everything! It soon became clear that many of these responsibilities could and should be taken on by others. In any case all I wanted to do was get back on labour ward where it became very obvious that the organization of the new environment was something of a challenge for the senior staff. With the new possibility of each woman birthing her baby in an individual room with intimacy and privacy came the probability of her birthing alone behind closed doors. The presence of a guardian/partner to accompany her HAD to be encouraged. But this too was a new concept.
Just at the right time appeared Brenda! She is British ICU nurse who had come to ‘help out’ She had no idea what she had come do but without her we would not have achieved the half of what we have during the past month. She became my personal assistant as well as using her ICU skills to train up some of the staff in the use of the new equipment. I shall be forever grateful to her. Realizing that I should off load man y of my more administrative tasks I set about meeting with the District health Authority senior managers and we were able to put together a new Organigram for the unit. This I presented to the staff on 12th November. Although this does not mean everything gets done, it does mean that there is some structure as to who is responsible for what and who is ‘in charge of what.
I still have many administrative things to clear up and supplies to chase as some furniture and equipment has still not arrived. Getting the telephone system working has been one of my biggest achievements and although now in working order some thought (and money) needs to go into supplying extensions to other areas. The oxygen instalment has been a constant head ache for me. The company that supplies this has a complete monopoly in Southern Africa which I guess allows them to do what they like, when they like and how they like! This is still not over but we are VERY near to completion!
On the Staff training side, it has been great to work with our partners CESTAS (an Italian NGO.) They have accommodated ALL the on- going in service training, that has been necessary, with very generous funding. This has allowed me to set up training for all different cadres. Midwives, ward clerks, cleaning staff and clinicians are all being covered. We are also continuing our weekly Team Leaders sessions where we are able to discuss the challenges that are occurring daily in the ward situation as well as recognizing the positive aspects and rejoice in them!
Finally on 16th November I donned my ‘scrubs’ and went back on labour ward. Just for the record, my name has been incorporated in the Organigram as one of the charge nurses on labour ward. This is hugely significant for me as I am formally accepted as one of the management team. Having worked my way into this role alongside my Malawian colleagues gaining their respect and trust I have now been rewarded with a formal recognition. The first week I seemed to be more off than on the ward but I guess that was to be expected. It would have been impossible to drop all my previous responsibilities so I am gradually handing over. Today I have spent nearly all day there and have been very encouraged to see the midwives respond to the new challenges. As time passes it has become evident where the short falls are and I have tried to introduce simple ways of dealing with them. These have been well accepted and mostly implemented.
Overall things are going well. We still have many challenges not the least to reduce our cases of birth asphyxia. We are approaching this in our training sessions and in the clinical areas. We will keep trying.
I have never been so in need of ‘timeout’
I believe our planned trip to Europe over Christmas will be beneficial both for me and for the unit. I will rest and recharge surrounded by the love of my children and family and Bwaila will learn how to be without Rachel!
As a footnote......I popped in to see my triplets last week and they are doing just fine. Strong and healthy a credit to their Mum and extended family.