CHALLENGES AND ACHIEVEMENTS

I am writing from the executive lounge, Nairobi airport. We very soon learnt that by paying 20usd we could make use of the lounge. Comfortable sofas to lie out on, drinks and snacks, internet access and a rather more peaceful atmosphere than the busy 'corridor' of duty free shops that makes up Nariobi airport. Any of you who have travelled through Kenya from Malawi will understand the how well spent are those dollars to achieve a rather less stressful 6 hour wait!
The past few weeks have flown by as I bravely struggled to achieve my three main aims before leaving for Christmas holidays. 1. The newly installed autoclaves would be up and functioning.
2. The oxygen supply would be piped to the resuscitation areas. 3.The 7 resuscitaires ordered several months ago would have finally be delivered. Well I didnt actually fully achieve any despite all my incredible attempts, phone calls, e mails, personal visits. I think 'frustrated' will be the word that describes how I have felt recently! Nothing went according to plan, delays due to shortage of FOREX or fuel were constantly cited as valid reasons for not delivering anything. True or false? I don't know but 'This is Africa' and therefore to be expected. Once more I am leaving having tried to 'organize' everything and leave all 'under control' How it will be when I return ? I dont know. No expectations, no disappointments! everything is promised and everything is nearly there!
Inevitably we are experiencing some minor problems with the constructionsince we opened. The contractors are not on site which makes it much more difficult to solve the daily difficultied which arise. The electric installation in Labour Ward seems to have some more serious underlying problem which I am hoping will be solved whilst I am away. The e;ectricians have been called on numerous occasions including nihts and weekends but don't seem to have actually found the root cause of the blackouts that we are experiencing all too often. I was amazed at the ability of the midwives to cope on the occasions that the electrics have failed in the middle of the night and they have failed to contact the electrician. During one of those occasions they were also without water as the tap had fallen off in the shower and the plumber had helpfully turned the water off to prevent the flooding thus leaving the whole Labour Ward dry. That night three midwives and one clinician delivered 28 babies, 4 c/sections, 2 breech births and twins all without electric or water. Unfortunately the night did not pass without incident and as often happens, whether to lack of staff or services all outcomes were not good.
Our in-service training program continues. We are loooking once more at very practical everyday situations that occur on our wards to keep the midwives updated and familiar with emergency procedures. I also set up a full day training on Neonatal Resuscitation which was attened by around 50 members of staff. We repeated the sessions 5 times during the day spending the greater part of the time on practicing on our special resuscitation dolls. This was well received, hopefully leading to better techniques on the ward.
Our results have not been good during the past two months. Birth asphyxia is an all too common occurance. Our nursery is overloaded with babies, up to 60 babies in a unit intended for 20. We delivered a record of over 50 babies in 24 hours last week with just 4 to 6 nurses on each shift. Lack or midwives continues to be a huge concern. The Malawian government are reducing funding in 2010 for midwifery training so we are wondering how we will cope and what the future will hold. Trying to get the Malawian midwives to openly admit that they CANNOT do their job well with so few staff is very difficult. When considering our staffing needds for the new unit we decided that we needed a minimum of 8 midwives on Labour Ward , day and night to be able to attend the women and babies SAFELY. This is not being taken seriously. Most health workers of all levels find it almost impossible to be seen to be criticising the government. I have been involved in negotiating for the funding of midwifery training for next year and so far we can sponsor 31 candidates. If anyone is interested in supporting this please contact me. It costs 2.000 euros to sponsor one candidate for the one year midwifery speciality.
On a personal note we moved into our new house on 1st November and have settled in well. What a difference it has made to us both to have a house and garden of our own. Lucas spends all his time collecting all manner of insects and reptiles and putting them in boxes. He has space to play football and run freely. The terrace looks out over the Lilongwe river and open fields so most of the day we feel a welcome breeze. I have had to take on the responsibilty of 'staff' which is a new challenge for me. Lucas' nanny is still with us but has taken over as nanny/housekeeper. I dont know what I would do without her. Alex and his wife live in the 'staff quarters' and serve as day guard and gardener. Actually he hasnt got a clue how to garden,nor much else either but he is friendly honest and always happy! We took over 'Mr.Phiri' as night guard from the previous tenant. Rather older, supporting 9 children (he apprently had14 but the rest died) he works 7 nights a week all the year round and apprently has done for many years ( who says babies are made at night!). He has taken quite a 'shine ' to me, washes my car daily, tells me when the curtains arent completely drawn, controls the outdoor security lights, and reminds me to set the alarm when I go out. I have increased his wages supplied him with tea and sugar and biscuits every night so in return he has taken to truly 'looking after me!'
We hosted our first party in two years for all our friends. I spalshed out on hiring a live band who really made the party a great success. I even stood up and sang some Simon and Garfunkel so it must have been good!
It has been an intense, tiring, challenging, frustrating but happy few months. Despite the huge challenges I have faced I believe much has been achieved. I am ready for a time of recovery and reflection before starting again in the new year. I am looking forward to our family Christmas of fun, laughter and lots of love.
Wishing you all the same....................