Thursday, 25 March 2010


Stress and exhaustion caught up with me this week making what should have been a simple cold and cough develop into a full blown chest infection. So here I am taking a ‘forced’ rest at home swallowing huge antibiotic tablets, cough mixture and copious amounts of fluids. The drugs make both me and my digestive system feel rotten but after battling away for over a week with a cold then cough then laryngitis then bronchitis I began to realize that things were looking serious and started the dreaded antibiotics. I am pleased to say that now 4 days into the course I am starting to feel the positive effects and although rather weak and tired I am on my way to recovery. I am surrounded by caring friends many of whom are also in the medical profession so have not lacked good advice and treatment. Unfortunately, in the end, it is me that has to TAKE the advice and that is where the problem starts!
I truly find it incredibly difficult to be away from the hospital and even more difficult to REST.
I have had time these past days to reflect on the above statement and to be honest I have even been avoiding doing that. How easy it is to give the right and correct advice to friends and colleagues.....’Take time off, look after yourself, make a full recovery before going back, you’re not getting any younger, take care of your body, you’re no good to anyone if you are sick, your health is important, just stay home and rest, they can manage without you...........etc.etc. We say them so easily and so lightly but how many of us really manage to take our own advice?
As I write I am thinking of all the things I could be doing at Bwaila. The women and babies to attend to, the midwives to mentor, the matron to support, the student midwives to supervise, the new Spanish midwives to orientate and more and more and more. As I sit here at my laptop biting my nails and writing of my dilemma I ask myself once more, ‘Why Rachel, why?...why can’t you switch off and rest ? Why can’t you switch off and recover?’ Where is the peace when I’m not doing enough, today, I’m not doing anything today? I’m resting...I’m recovering!
How arrogant of me to think myself so needed, so irreplaceable! Do I really lack so much in humility? The reality is there is SO much to be done and so few to do it. But I can’t do everything, I can’t be everywhere? What a conflict in my head, in my heart! My world is so small, just Bwaila, just Lilongwe, just Malawi. And what about the rest? Such a tiny part of the whole! Oh how I wish I could change it all make it better for everyone. Where is the justice in this world that means these poor people in Malawi are not and cannot expect to be cared for and attended to in the same way and to the same level as you do back there? How naive, how immature..... just my thoughts.
What if we all really loved enough, cared enough to make things better? Ok, so it doesn’t mean we all have to dedicate ourselves to the poor and the under developed countries but with each and every person we come in to contact with today. Our family members, our work colleagues, the person in the shop or restaurant anywhere, everywhere.....How many times this has been said by how many people? Is it really achievable? Is it really sustainable? So let’s go back to me, in my little world here in Malawi and think small then it becomes achievable for me, it becomes sustainable for me and that is enough.

If I am sick I cannot do this, if I am weak it is not possible. So I must be healthy and I must be strong. I will search for the peace that is not in the physical not in the ‘being there’ but in the spiritual, being here in this moment.
‘We are not a physical body with a spirit but spirit with a physical body.’
I will rest and I will recover so better I can serve others once more.
I am now fully recovered and back on labour ward. The past week has been exceptionally busy as I continue to make the supervision of students a priority. They are only with us for 4 weeks and during that time they have so much to learn and must become competent in all areas of normal physiological birth. Finding sufficient ‘normal’ births so that they all may reach their quota has proved to be extremely difficult. We are attending so many complicated births and seeing so many pathological situations that would never be seen in the first world. Foetal abnormalities that would have been picked up on scan but are not diagnosed until labour, premature births, dangerously high blood pressure are just some of the many situations we encounter daily. So I try my best to teach, to repeat, to show and to encourage the students so that they too in the future will teach others.
My days start at 6am. After dropping Lucas at school I am at Bwaila by 7.15am. This is always a difficult time as the night staff are very tired after their 15 hour shift and keen to get home often leaving many problems to be sorted out by the first day staff to arrive. And that is usually me! After a quick handover when I try to take stock of the situation I start to prioritize. On many occasions I find that there are a least 3 or 4 women who need immediate attention. The day staff have still not arrived and I find myself alone. A grand multipara (8th baby) in room 6 has been pushing for 3 hours, A primipara (1st baby) in room 2 has been fully dilated with foetal distress since 5.30am. In room 3 another primipara has not progressed in 6 hours and Room 4 has been waiting to go to theatre for 2 hours for a c/section but the theatre is busy. I am not exaggerating....this is the reality of Bwaila almost every day. The next time I look at the clock it is nearly 11am. Deciding which to attend myself, which to delegate and which to teach can be difficult. I try to look at the bigger picture and share my knowledge and expertise but very often it just seems so much quicker, easier and more effective to do it myself. The hours and days fly past and the weekend comes round again. How I love to spend time with Lucas, my friends and in my home for those 2 short days before going back to the never ending succession of needy women and babies at Bwaila. This still remains the hardest part of working at Bwaila. Never finishing, never doing enough, always with the feeling that there is so much more to do, so many more women and babies to attend.
Although the new unit has 2 operating theatres we have not been able to open the smaller one due to lack of staff. It would need a totally separate team of nurses, doctors and anaesthetist and this we do not have. As a result we are daily having to make choices as to which mother or baby should go first. The choice is often extremely hard as taking one may lead to the death of another. We have found ourselves in this situation many times this past 2 weeks and women have been waiting for up to 4 hours or more for their ‘emergency’ c/section.
As the main referral unit for the whole of the Lilongwe area, which can stretch up to 80kms away from the hospital, we are daily attending the mothers and babies sent from these outlying areas. The road access to these centres is almost inaccessible especially now in the rainy season. The journey to the main road may be as much as 20 to 30 kms. thus delaying the arrival of these women to our unit. I was horrified to receive 2 women both in the last stages of labour after a delay of 6 hours. The referral was made at 8.15am.... they arrived at 2pm. I always treat these referrals as a priority. On examining the first women I found her to be fully dilated and ready to push. She had been referred as her labour was not progressing. ( at 8.15am!) I could not hear the foetal heart, I quickly scanned here to confirm my findings. Just 10 minutes later she pushed out a dead baby.The second woman had been pushing for many hours.The theatre was busy so I decided to try and assist with vacuum extraction. I tried and I failed. Already prepared for theatre she was taken at 3pm. The baby was extracted alive but died minutes after birth. Two transfers two dead babies. I needed to know why? Why had it taken so long to bring these babies to us?
The ambulance had to negotiate more than 20kms. of dirt road full of pot holes and mud. It had crossed two rivers. The ambulance broke down on the way. The women were waiting for 4 hours on the side of the road for another ambulance to arrive. This is the care that the poor women of Malawi are receiving. They have no voice to complain and their cries of sorrow are not heard.
The problems with my funding are still not totally solved but I have been promised that it will be sorted this week. Things are getting a little tight as I wait for the money to be made available but I remain positive and confident that I am still in the right place, I am still where I am most needed and will therefore continue to love and care for these women and babies as best I can
Thanks to the amazing generosity of our good friends and neighbours Zaida and Vincenzo we were able to spend a beautiful weekend in their cottage on the shores of Lake Malawi. This is just what I needed to reflect, rest and prepare myself for the following week. A trip out in their boat to a small island where we could swim and snorkel in the clear fresh water of the lake, appreciate the beauty of nature and remind myself once more how much we have and how rich our lives are... for that I am grateful.