Thursday, 22 July 2010

Bwaila is great! I am so encouraged by the way things are progressing. The atmosphere on labour ward is one of enthusiasm and fun. The feeling of team spirit is noticeable, even to an outsider, as the staff begin to respond to their colleagues and help each other out in the more difficult and challenging situations.
This may seem like ‘normal’ to you but I can assure you this is new and exciting at Bwaila.
We are attending an ever increasing number of women and babies. Sometimes up to 50 births in 24 hours! Word has spread around the district of the new unit and the women prefer to come to us than attend their local health center. We have started up our in-service training sessions again and are looking at the problem of birth asphyxia. That is, the babies being born in need of resuscitation to a greater or lesser degree. Our Quality Improvement Team is meeting regularly and putting forward new initiatives to address this. The results so far are positive.
July 6th was a public holiday (Independence Day) There were only 3 midwives on the ward and just 1 clinician so I decided to work that day. I started as usual at 7.15am. By midday I had assisted 9 births and by the time I left at 5pm. I had attended 13 deliveries. It was a crazy day. Had it all been straight forward and easy it would have been extreme, but as usual, Bwaila sees all the referral cases from the whole district plus our own often very High Risk mothers so it was far from normal. I counted 4 vacuum extractions, 2 breech births and 2 sets of twins amongst the women l attended, plus the usual prolonged labours, eclampsias and such like. A total of 52 babies were born during those 24 hours. I was the most experienced person on the ward. It was exhausting but highly rewarding.
I came home yesterday feeling good…..
It was after 4pm. when I was called loudly and urgently to Room 2 to assist a newly arrived, referred patient with ‘cord prolapse.’ The woman had been accompanied in the ambulance from a local health center by one of their midwives. She informed me that the cord was presenting in front of the baby’s head but that the bag of waters was still intact meaning that as yet there was no pressure on it and therefore it was still pulsating. The baby was still alive! The protocol for’ cord prolapse’ is inevitably cesarean section, but in our circumstances, with only one theatre and less highly qualified staff the decision has to be ‘which is the quickest way to get the baby out?’ It was her 3rd delivery which makes the situation a little easier as she would be able to push the child out more rapidly. I assessed the situation a found that although the head was high, in this case it is what had saved the baby from hypoxia due to cord compression, the cervix was fully dilated. The contractions were coming hard and fast. The baby and the mother pushed down with each and every one. I knew that it would not be long before the bag of waters broke bringing the baby down onto its lifeline...its umbilical cord. I made a fast decision to deliver the baby vaginally as I believed this would be the quickest and safest way. It is not easy, but I know that I can knowledgably and instinctively follow my decision once I have made it. It was so amazing to see how the other midwives and students responded to my decision. (Apart from the midwife from the health center, who doesn’t know me!) The IV line was placed, the bladder emptied, the vacuum extractor and delivery pack brought and the resuscitaire prepared. Just in time as the membranes broke spontaneously with a huge contraction and the head came down. Trying to fix a vacuum cup onto the head of a baby rather high up in the pelvis with a long loop of umbilical cord in the way is not an easy task but I had done this several times before so I knew I could do it again. Several attempts and time was passing, I knew I needed to do this quickly to avoid oxygen deprivation. At last I got it well placed, the oxytocin was in the IV line to increase the strength and effectiveness of the contractions, another midwife aided by pushing down on the top of the uterus and in one big long push/pull the baby entered the pelvis rotated into the correct position and was born. The student clamped and cut the cord and I rushed the baby to the resuss. area leaving my colleague to attend to the mother. With some quick and effective resuscitation management the baby began to breath. Around me there had been 5 student midwives, 2 clinicians, 2 young interns and 2 of my fellow midwives. The team came together and the result was excellent for both mother and child. The smiles and enthusiasm of each and every one was a joy to behold. This is what I will remember and will keep me going in the tough frustrating times. Yes… I had done the vacuum extraction but it was the true team work that saved the life of that little one.
This is probably the sort of response that you would expect in your well staffed, well equipped, well qualified, well organized hospitals over there…but I can assure you that this is new and amazing for us here at Bwaila.
And what of my darling and amazing children…….
Lucas has been away in Spain visiting his Dad, Fiona and Alasdair for over 1 month. He will return on 10th August which is still 3 weeks away. I miss him a lot but am happy to hear that he is very much enjoying his time there, experiencing some of the luxuries of being in Europe such as the cinema and McDonalds!
It has been wonderful to be able to spend some real quality time with Fiona during her two visits here in Lilongwe during the past three months. She would have liked to stay longer but had to fulfill her obligations as a teacher in a summer school in Valencia during the month of July so it was a sad goodbye for us both. I miss her too!
Katy keeps me updated as she and Nick prepare for their wedding at the end of the year. I shall be saving all my holiday for that time and am so looking forward to spending some time with them in December before celebrating their marriage on 30th. What a wonderful way to end the year.…Happy times ahead! Imagine me…. The Mother of the Bride!
Alasdair needs to be well congratulated for graduating from university. He is now a fully qualified Vet. I am very proud of the way he has ‘stuck at it’ even through the long, hard times when I think that even he wondered if he would ever get through. I never doubted his determination nor his ability….
It’s so good to read back over what I have written and realize how positive I am feeling . I am happy here in Malawi, I am challenged and rewarded and full of energy to continue. Thank you all for your support and love.