Tuesday, 1 June 2010


I wrote this almost three weeks ago but it has taken me all this time to be able to get a decent internet connection in order to send it to you Hopefully the next one wont take so long!

Plans? Future plans? Where am I going? What will I be doing?

Do I need to know? How far am I able to plan anyway? How much control do I really have? Things can change from one day to the next, from one moment to the next and all those plans go out the window and we start again.

Life is an unknown journey that leads us to places we never expected and the directions change along the way. The excitement, the possibilities are all out there waiting for us as we make our plans and follow our dreams knowing that at any time it may all change.

As I plan for the next few months I am aware how much happier I am and how much easier I feel when I put away the anxiety of ‘future plans’ and allow life to guide me in the correct path. That doesn’t mean I sit back and do nothing; I try and test all the doors to see if they are open for me but am aware that the path will become clear as I go along. It’s not always an easy path and needs a good dose of positive thinking and faith but it is there in front of me and I will follow where it leads.

Plan 1. I will sign a contract to stay here at Bwaila for the next 2 years. I truly believe that the commitment and continuity I can offer to the maternity unit is my best way of serving the women and babies of Malawi.

Plan 2. I will be spending the month of December in Europe to celebrate the marriage of my eldest daughter Katy. What a pleasure and what I joy this will be. What a privilege, as a Mum, to be involved in this wonderful occasion, to be part of the excitement, the plans, the love, the sharing and caring as Katy and Nick commit themselves to each other and a future together.

Plan 3. Lucas will travel to Spain in June to spend the long holidays with his Daddy in Spain. I shall surely miss him for those 6 weeks but his Dad will have the pleasure of being with him and strengthening their relationship.

So that’s it for now…I wonder what else will come my way this year.

I slept and I dreamt that life was JOY

I awoke and I saw that life was SERVICE

I acted and behold SERVICE WAS JOY.

I think that this sums up how I am feeling at this time.

Life goes on at Bwaila with all its challenges, upsets, difficulties and conflicts. It is impossible to run our unit safely with the constant shortage of staff in all areas but especially midwives and clinicians. I can continue to tell you the stories of the women that have to wait more than 3 hours for their emergency c/section putting either their life or the life of their baby at risk .We find us constantly in this situation.

The woman had been referred from one of our Health Centers. It had already taken more than 3 hours to arrive from the moment of referral, due to distance and transport issues. When she arrived I quickly summed up the situation and realized she needed an emergency c/section. The baby was severely distressed and I was not sure how much longer it would cope. Unfortunately we had just taken another mother to theatre so she would have to wait. The surgery complicated which meant she would have to wait longer. I decided to attempt a vacuum extraction as she was fully dilated and it was her fourth child. It didn’t work and maybe I made the situation worse but I just couldn’t stand by and do nothing, I had to try something. She was still waiting 90 minutes later when another woman was admitted. At 34 weeks pregnant and actively bleeding the baby was alive but she continued to bleed. Placenta Previa was diagnosed (the placenta lying in front of the baby’s head) this was a priority as both the baby and the mother were at risk. Mother’s life takes priority over baby so she was taken first. By the time that operation was completed my original baby was dead. How to explain that to a mother who had been prepared for c/section nearly 3 hours before and told it was to save her baby’s life? More than 40 births in 24 hours and just 4 midwives on night duty. Little wonder that when I arrived at 7am. Many babies had not been monitored for at least 5 hours. I continue to spend the first 2-3 hours in the morning trying to sort out the problems brought over from the night. The labours that have gone wrong, the babies that just won’t come, the women that are totally exhausted. With so many births to attend there is little time to sort out the problems as just attending to those who push them out on their own will take up most of their time.

Let me tell you the story of the woman who set off walking, on her own, from her village more than 15kms. away to give birth at Bwaila. She had been told it would be safer as she was carrying twins. The labour progressed quickly and she found herself by the side of the road with no money for transport and the birth imminent. She tried to stop the few passing cars but nobody heeded her. Fortunately 2 local women assisted the delivery, in the bush, of triplets. They then left her by the side of the road. This was now 9am. At 4.30pm she was picked up by a passing motorist and brought to Bwaila. Both she and ALL the babies were alive and well although she was dehydrated and exhausted. The babies had all been breast fed. We took her into the ward and the babies to nursery where they continued to do well. She is now at home back in the village and being supported by a small organization that try to follow up our orphans and needy mums and babies .I will personally be visiting them over the next weeks.

Or maybe I should tell you of another woman who was accompanied by her mother. She too birthed her twins on the side of the road with the help of the grandmother then caught a minibus to our hospital straight after.

These are amazing women, worthy of our love and respect, our care and support.

I stand humbled in their presence. Just imagine this happening to one of our European mums?

Improvement is our aim and as such I have played an active role with our Quality Improvement partners to this end. It’s not easy to find the time just to meet and discuss these issues as time and midwives away from the ward means women less attended. We have rejuvenated the team and now have some enthusiastic members. Our goals for the next few months are to reduce Neonatal deaths due to Birth Asphyxia. (Especially related to prolonged labour). We have designed some posters for our delivery rooms reminding the staff to monitor closely the baby during labour.

‘Please listen to my heart beat every 30 minutes to make sure I’m OK’

Although our Maternal Death Rate, due to bleeding post-delivery, has reduced we have also decided to address the monitoring of the women in the first hour post- delivery to prevent this type of hemorrhage going un-noticed. We have designed a check list for this purpose and hope that these initiatives will bring results.

So labour ward remains incredibly busy. Time just flies past and there are never enough hours in the days. Each and every procedure I perform, each and every birth I attend I use as a teaching opportunity for someone. Whether it is a student midwife or clinician or one of our trained staff the purpose is to share knowledge. If I know something then it is my obligation to ensure I pass this knowledge on to someone else. What use is it to keep my knowledge and experience for me?

Little by little, small steps, don’t expect too much, keep positive and ENJOY!

If anyone wants to donate a music system to labour ward this is my next plan!

NEXT PLAN: Getting the women off the bed, out of their pain and suffering, dancing with the midwives and hopefully achieving a better birth.