Its been two weeks since I was last able to have access to my mails and to my blog. Its been one week since I was able to work on labour ward. I have felt frustrated, out of touch and very low.
As can be seen by all my writing over the past months Malawi is not the place to be in need of health care. I am strong I am healthy. I have a natural capacity to look for and find the positive side of even the most difficult situation but during the past week I have been severely tried and tested. I have entered a Malawi operating theatre, as a patient, only minor surgery but how much better it feels to be wearing the nurses uniform and not the patients gown. As a nurse and midwife for so many years the familarity of the hospital feels like home, the ward my bedroom, the operating theatre my kitchen. Its not strange, not worrying, its known, its familiar at least untill I became a patient. What a lesson it has been to me to have this insight into how these uneducated village women must feel as they confront the unknown sights and sounds of the labour ward and especially, of the operating theatre. I think I am mending though the process will be slow and I will need a great deal of patience... this will be another lesson for me. With the help, support and love of my family and of my good friends I will achieve this..
Alasdair arrives with Lucas on Tuesday.... at last! Just what I need at this time. I had already decided to take some time off work and had planned a small trip so it will be a wonderful convalescent period for me. I need to be fit and well, I need my health restored my strength so that I may continue to give of myself, to love and to care for the women and babies at Bwaila.
I have recently informed my employers in Acuario (Spain) that I will be staying here untill the end of the year. My work here is still not done, I feel I have more to do/to share, it is too soon to return, I search and pray for guidance. In the same way that it became so totally clear when I made my decision to come to Malawi I am confident I will know when it is time to leave.
Today I will share with you the experience of my Norwegian midwife colleague.
We are continually receiving referred cases from the outlying health centres, it is the first place the woman will be taken when things go wrong with the attention of the TBA ( traditional birth attendant) in the villages. Nina decided to spend a day in one of these places. We know they are extremely understaffed very often without a doctor or medical cover. There have few materiales and only the minimum of emergency supplies.
The mother was carried into the centre by her husband accompanied by the TBA who was attending the birth of her twins. Twin pregnancy is considered high risk and therefore one of the reasons that they are advised to have a hospital birth. She was stiff and unconscious. She was having and eclamptic fit. The two nurse/midwives on duty began life saving tasks with the limited equipment and drugs available. They phoned for an ambulance for immediate transfer to Bwaila. This would take a minimum of one hour. On examining the woman they realized that the child had already been born, though the placenta was still in place. When? Yesterday.....and... the 2nd twin was still inside the uterus! More than 24 hours had passed! Why hadnt she bought her before? Because she will not be paid if she doesnt deliver the child!
Eclampsia demands the immediate delivery of the baby as it is the only way to save the mother. In these cases mothers life is always considered before the child. But it was not possible to deliver the 2nd twin . At last the ambulance arrived, the mothers condition had not improved, No one even thought to listen for a fetal heart beat ..what was the point? Did she live or die?
We dont know, as she was taken to a mission hospital that was closer. We shall try to find out. But no one else will. The mission hospitals are paying hospitals so many women cannot afford to go.They do attend emergency cases without payment. Nina came to see me that evening at home. She was noteably distressed. She said she will not go back again to the health centres as although she knew Bwaila hospital was not always adequate she could not cope with feeling so utterly alone and unsupported with not even the basic necessities for life saving tasks. We talked, we hugged, I was able to support her and give her the assurance she needed that she had done all that she could. Yes we are doing all that we can...not enough..never enough ... but all that we can.
Saturday, 12 July 2008
Sunday, 29 June 2008
ZIMBABWE AND MORE
Zimbabwe is a sad place to be at this time. That was my feeling after spending 4 days there. I did not feel threatened or afraid but there was a noticeable tension and fear in the eyes and the behaviour of its people. There was little chatting in the bare, half empty shops as we queued to pay for our kilo of carrots costing billions of Zim.dollars. Yes, I became a billionaire overnight, though when I paid 5 billion dollars for a postcard and stamp I realized it wasn't worth much!
Life in Harare continues as best it can, the city people going about their business and everyone wondering what will happen next. There was a definite state of insecurity and those that would talk with their conjectures of what may happen but not really knowing what tomorrow would bring.We heard many distressing stories of torture and violence and many rumours which all led to a sense of the fear and the unknown.The people feel intimidated and controlled but by what and by whom? Who might be listening who could be trusted? The people are tired of living this way. They just want a normal life but they dont know how it can be nor who will find the way to create this change. They are looking for help .From where? from whom? They are praying to God, they are asking for help, to the rest of Africa, to the rest of the world, they dont know when this will end but they still have hope. I too hope and pray that the world and its powers will not desert them, that a way will be found to ease their pain and their fear and change this totally unacceptable situation that is life in Zimbabwe.
The long road to Harare was a wonderful experience for me. As I was not driving I was able to really take in the beautiful changing scenery as we passed over the Malawian border through Mozambique and down to Zimbabwe. We were able to break our journey with an overnight stay in Tete boths ways. We were wonderfully entertained by friends and I was able to enjoy a truly Mozambique experience as we climbed up high in the evening to watch sunset over the Zambezi river. It was interesting to see and feel the differences between the 3 countries their dress, their villages and their cultures. I was suprised to find the city of Harare so much more of a developed city than Lilongwe with its tall buildings, good roads, lighting etc. The infrastucture is still there, very obviously still present and that is what the people rely on to bring it back to prosperity, as and when this dire situation resolves.
My visit to Zim.was made possible by my good friend Sandy who invited me to accompany her on this trip. She was able to take food and provisions to her family and staff whom without this trip would have been sadly lacking in basic food stuffs and as in the case of the staff become very hungry. They were the lucky ones. As we crossed the border on our return journey we realized that we were the lucky ones. There are many Zimbabweans in the surrounding countries who have not given up hope of things coming right and are just waiting to go home. I hope that will be soon for them.
My best story from my visit is as follows...
When asked "How are you?" doesn't everyone answer "Fine thankyou"
Well it was the same in Zim.
Untill one day I asked the Zimbabwean housemaid at a families' residence.
"I'm not good " she replied.
Full of concern I asked as to what was her ailment.
" My body is fine thankyou" she said, " but my country is not fine, my country is sick and I pray for it to become well"
On Friday I was back on labour ward. My first task was to assist at the birth of triplets. It was a great experience for me and more so as I was able to team up with a young Norweigian obstetrician and work together to achieve a positive outcome for both mother and babies. Just 32 weeks pregnant so the babies would be small and premature. After a quick scan we confirmed they were all presenting breech. (or more acurately feet first) This shouldn't be a problem as it was her 3rd pegnancy and they would be small. As I got to work to deliver the three babies the doctor was scanning and checking heartbeats and positions. We soon had a audience of young Malawian clinical officers and interns looking on. It was great to show, by our example, how to actively manage safely this type of siuation. First a girl weighing 1.400kgs. Then 2 boys both weighing 1.500kgs. I checked up on them yesterday in nursery and they seemed to be doing ok. Its early days yet so I am not being too optimistic but at least they have a chance of surviving. I will continue to follow their progress and offer to help out with clothing, blankets and formula milk, if it becomes necessary.
Due to lack of medical staff and experienced clinical officers I have now learnt and am becoming capable of performing assisted birth with vacuum extraction. I have spent many years assessing the conditions and safety of performing this intervention so have now moved on to take this extra responsibility.
I was particularly pleased with yesterday's events. When taking the decision for an urgent vacuum extraction for fetal distress and finding that the only clinical officer available was involved with an eclamptic mother, I was able to
to perform quickly and safely this procedure and save the baby's life. Alongside me was a young Noweign midwife who had been caring for the mother and recognized the problem. We both felt good after that!
When things are difficult and black we can pull on these moments to keep our spirits up and know that what we are doing is worthwhile.
I have been feeling rather sad and lonely these days.( though my friends are great) I am missing all my children and my family. Its been 6 months now since I last saw them. I know it feels more exaggerated by not having Lucas around but I can't help wondering if I'm doing the right thing being so far away?
How difficult it is at times to see clearly where we should be and what we should be doing. How torn between our responsibilities and our needs. Responsable to who? Needing who and what? I feel I have so much to give so much love to share. Whose needs are more important? I have gifts, we all have gifts, I am enjoying using those gifts but its confusing ......I look for clarity, I pray for guidance. I am thankful for what I have and for where I am, so many people needing help, needing care, needing love..........
Life in Harare continues as best it can, the city people going about their business and everyone wondering what will happen next. There was a definite state of insecurity and those that would talk with their conjectures of what may happen but not really knowing what tomorrow would bring.We heard many distressing stories of torture and violence and many rumours which all led to a sense of the fear and the unknown.The people feel intimidated and controlled but by what and by whom? Who might be listening who could be trusted? The people are tired of living this way. They just want a normal life but they dont know how it can be nor who will find the way to create this change. They are looking for help .From where? from whom? They are praying to God, they are asking for help, to the rest of Africa, to the rest of the world, they dont know when this will end but they still have hope. I too hope and pray that the world and its powers will not desert them, that a way will be found to ease their pain and their fear and change this totally unacceptable situation that is life in Zimbabwe.
The long road to Harare was a wonderful experience for me. As I was not driving I was able to really take in the beautiful changing scenery as we passed over the Malawian border through Mozambique and down to Zimbabwe. We were able to break our journey with an overnight stay in Tete boths ways. We were wonderfully entertained by friends and I was able to enjoy a truly Mozambique experience as we climbed up high in the evening to watch sunset over the Zambezi river. It was interesting to see and feel the differences between the 3 countries their dress, their villages and their cultures. I was suprised to find the city of Harare so much more of a developed city than Lilongwe with its tall buildings, good roads, lighting etc. The infrastucture is still there, very obviously still present and that is what the people rely on to bring it back to prosperity, as and when this dire situation resolves.
My visit to Zim.was made possible by my good friend Sandy who invited me to accompany her on this trip. She was able to take food and provisions to her family and staff whom without this trip would have been sadly lacking in basic food stuffs and as in the case of the staff become very hungry. They were the lucky ones. As we crossed the border on our return journey we realized that we were the lucky ones. There are many Zimbabweans in the surrounding countries who have not given up hope of things coming right and are just waiting to go home. I hope that will be soon for them.
My best story from my visit is as follows...
When asked "How are you?" doesn't everyone answer "Fine thankyou"
Well it was the same in Zim.
Untill one day I asked the Zimbabwean housemaid at a families' residence.
"I'm not good " she replied.
Full of concern I asked as to what was her ailment.
" My body is fine thankyou" she said, " but my country is not fine, my country is sick and I pray for it to become well"
On Friday I was back on labour ward. My first task was to assist at the birth of triplets. It was a great experience for me and more so as I was able to team up with a young Norweigian obstetrician and work together to achieve a positive outcome for both mother and babies. Just 32 weeks pregnant so the babies would be small and premature. After a quick scan we confirmed they were all presenting breech. (or more acurately feet first) This shouldn't be a problem as it was her 3rd pegnancy and they would be small. As I got to work to deliver the three babies the doctor was scanning and checking heartbeats and positions. We soon had a audience of young Malawian clinical officers and interns looking on. It was great to show, by our example, how to actively manage safely this type of siuation. First a girl weighing 1.400kgs. Then 2 boys both weighing 1.500kgs. I checked up on them yesterday in nursery and they seemed to be doing ok. Its early days yet so I am not being too optimistic but at least they have a chance of surviving. I will continue to follow their progress and offer to help out with clothing, blankets and formula milk, if it becomes necessary.
Due to lack of medical staff and experienced clinical officers I have now learnt and am becoming capable of performing assisted birth with vacuum extraction. I have spent many years assessing the conditions and safety of performing this intervention so have now moved on to take this extra responsibility.
I was particularly pleased with yesterday's events. When taking the decision for an urgent vacuum extraction for fetal distress and finding that the only clinical officer available was involved with an eclamptic mother, I was able to
to perform quickly and safely this procedure and save the baby's life. Alongside me was a young Noweign midwife who had been caring for the mother and recognized the problem. We both felt good after that!
When things are difficult and black we can pull on these moments to keep our spirits up and know that what we are doing is worthwhile.
I have been feeling rather sad and lonely these days.( though my friends are great) I am missing all my children and my family. Its been 6 months now since I last saw them. I know it feels more exaggerated by not having Lucas around but I can't help wondering if I'm doing the right thing being so far away?
How difficult it is at times to see clearly where we should be and what we should be doing. How torn between our responsibilities and our needs. Responsable to who? Needing who and what? I feel I have so much to give so much love to share. Whose needs are more important? I have gifts, we all have gifts, I am enjoying using those gifts but its confusing ......I look for clarity, I pray for guidance. I am thankful for what I have and for where I am, so many people needing help, needing care, needing love..........
Tuesday, 17 June 2008
LUCAS LEAVES
I didn't write about Grace's baby last time. There are always so many things to tell. During her stay in the pediatric ward at the central hospital here in Lilongwe her condition seemed to deteriorate daily. It was impossible to make a diagnosis as neither the technology nor the experienced operators can be found here in Malawi. As her breathing became more and more difficult and laboured they could only treat with antibiotics, just in case she had a chest infection diuretics for her pulmonary and cardiac congestion and oxygen to help her breath, to try and keep her more comfortable. It didn't work and although I visited daily and she received more medical care and attention than any other baby on the ward Grace's baby Angela died last week. She was just 4 months old. Maybe her little lungs were too immature? or maybe she did have that congenital heart defect? Whatever.... the necessary neonatal care and attention were not available and another Malawian baby dies. Born too soon and in the wrong place.
I was invited to attend the funeral and visit her house the following day. It was a sad day, I could only give Grace a hug and tell her how well she had loved and cared well for her beautiful baby. That she had been a good mummy. Baby Angela would remain forever in her heart...and in mine.
I am challenged daily and that is exciting and stimulating. Labour ward continues to be busy and many bad things happen that are avoidable but I think that now after nearly 6 months I am finding my way to work, to care and to live with the reality of the situation that faces me daily.
I dont like it, I will never like it. Its not acceptable, it will never be acceptable but I am happy in my work and enjoy great pleasure when it goes right. I do everything I can to make it go right and with the support of my friends and a few colleagues, I cope when it goes wrong.
There are always many students to teach and many inexperienced young clinical officers. They now come looking for me as they know I will always be kean and eager to share as much of my knowledge as I can. Today I arrived just in time to find one midwife attending a breech birth very obviously without even the most basic knowledge of how to assist. I was able to instruct her as to the different manouvers necessary and them take over when it became difficult. It was satisfying to achieve a healthy baby and a better informed midwife.
Last Sunday I said goodbye to my little Lucas for a month. He left on his own to go to spend some time in England with my family and then on to Spain to be with his Dad, with Alasdair and with Fiona. Just 7 years old but with so much confidence as he bade me goodbye and went off to board the plane for the long flight to London. I had given him a small wooden crocodile necklace. Everytime he touched it he was to think of me. We spoke on the phone whilst he was waiting in Nairobi for his connection. " I've touched the necklace twice he told me!" He will have a wonderful time but I will miss him.
On the way back from the airport I went to visit Pilirani and her twins, Edward and Alex. I am always a little nervous as I never know if I will find them healthy and well. They were doing incredibly well but are still very vunerable. As usual the children from the village came running to greet me and carry my bags. 20mk ( 200mk/1 euro) for looking after my car...thats normally at least 4 of them and 20mk for carring the bag! The boys were fit and well. Both weighing well over 4kgs. now with chubby cheeks and more chins than me! Pilirani is still supplementing her breast feeding with 2 formula feeds a day so she needs me to continue taking the milk. At nearly 1.000mk a tin she could definitely not afford it. As I got up to say goodbye the Aunt came out of the house carring the twins elder sister,age 4 years. She was obviously sick. I examined her as best I could and asked many questions. It seems she had been sick for 3 weeks. She was covered in a rash that she had been scratching and was bleeding. Her skin was dry, she refused food and took little water. I'm a midwife and a nurse but not a doctor. I could not diagnose her condition but I knew she needed help. I gave them money for transport and made them promise to take her to the hospital the following day. I am anxious to know how she is. Talking to medical friends it may well be a vitamin deficiency ...this would not suprise me. The diet for the majority of the village people is maize flour made into dumplings and little else. Not dying of hunger but of malnutrition.
I have been invited to accompany a good friend and her family to Zimbabwe for 5 days this weekend. My family are very concerned for my safety due to the political situation at this time in that country. My Zimbabwian friends are in constant contact with their families living in Harare and feel it will be OK for the trip to go ahead. I will tell you all about it when I return. We will drive through Mozambique and onto Zimbabwe. I am looking forward to seeing more of Africa. It is a beautiful and fascinating continent its places and its people. I feel very lucky to be here.
I was invited to attend the funeral and visit her house the following day. It was a sad day, I could only give Grace a hug and tell her how well she had loved and cared well for her beautiful baby. That she had been a good mummy. Baby Angela would remain forever in her heart...and in mine.
I am challenged daily and that is exciting and stimulating. Labour ward continues to be busy and many bad things happen that are avoidable but I think that now after nearly 6 months I am finding my way to work, to care and to live with the reality of the situation that faces me daily.
I dont like it, I will never like it. Its not acceptable, it will never be acceptable but I am happy in my work and enjoy great pleasure when it goes right. I do everything I can to make it go right and with the support of my friends and a few colleagues, I cope when it goes wrong.
There are always many students to teach and many inexperienced young clinical officers. They now come looking for me as they know I will always be kean and eager to share as much of my knowledge as I can. Today I arrived just in time to find one midwife attending a breech birth very obviously without even the most basic knowledge of how to assist. I was able to instruct her as to the different manouvers necessary and them take over when it became difficult. It was satisfying to achieve a healthy baby and a better informed midwife.
Last Sunday I said goodbye to my little Lucas for a month. He left on his own to go to spend some time in England with my family and then on to Spain to be with his Dad, with Alasdair and with Fiona. Just 7 years old but with so much confidence as he bade me goodbye and went off to board the plane for the long flight to London. I had given him a small wooden crocodile necklace. Everytime he touched it he was to think of me. We spoke on the phone whilst he was waiting in Nairobi for his connection. " I've touched the necklace twice he told me!" He will have a wonderful time but I will miss him.
On the way back from the airport I went to visit Pilirani and her twins, Edward and Alex. I am always a little nervous as I never know if I will find them healthy and well. They were doing incredibly well but are still very vunerable. As usual the children from the village came running to greet me and carry my bags. 20mk ( 200mk/1 euro) for looking after my car...thats normally at least 4 of them and 20mk for carring the bag! The boys were fit and well. Both weighing well over 4kgs. now with chubby cheeks and more chins than me! Pilirani is still supplementing her breast feeding with 2 formula feeds a day so she needs me to continue taking the milk. At nearly 1.000mk a tin she could definitely not afford it. As I got up to say goodbye the Aunt came out of the house carring the twins elder sister,age 4 years. She was obviously sick. I examined her as best I could and asked many questions. It seems she had been sick for 3 weeks. She was covered in a rash that she had been scratching and was bleeding. Her skin was dry, she refused food and took little water. I'm a midwife and a nurse but not a doctor. I could not diagnose her condition but I knew she needed help. I gave them money for transport and made them promise to take her to the hospital the following day. I am anxious to know how she is. Talking to medical friends it may well be a vitamin deficiency ...this would not suprise me. The diet for the majority of the village people is maize flour made into dumplings and little else. Not dying of hunger but of malnutrition.
I have been invited to accompany a good friend and her family to Zimbabwe for 5 days this weekend. My family are very concerned for my safety due to the political situation at this time in that country. My Zimbabwian friends are in constant contact with their families living in Harare and feel it will be OK for the trip to go ahead. I will tell you all about it when I return. We will drive through Mozambique and onto Zimbabwe. I am looking forward to seeing more of Africa. It is a beautiful and fascinating continent its places and its people. I feel very lucky to be here.
Monday, 2 June 2008
BEING ACCOUNTABLE
I'm begining to think Thursday is my unlucky day, or more correctly unlucky for those little babies and mums on labour ward.
That's why I didn't write last week. You see I felt just too responsable and responsabilty weighs heavy at times.
It was a busy morning, starting at 7.15am. yet another 2nd twin born over 2 hours after the first. I found him on the resussitaire barely alive just a small heart beat and nothing else. Oh no not again! Each and every time it happens I try to find the person responsable but no one feels responsable. I try to explain how we should have cared for that mother and her babies, what was the correct procedure for a better outcome but I am obviously not being heard or I'm not speaking loud enough.
I did report the case loudly and clearly on the ward round. The clinical officer who attended told me he didn't want to do a c/section because the baby was well presented. Well presented and almost dead! He died at 4pm. that afternoon...thankfully....as the level of brain damage would have been huge.
Two rather complicated referred cases both with prolonged labour needed my attention. They had been fully dilated and pushing for how long? Together with the students I started sorting out how to deal with these women. Their was no immediate urgency as both babies were fine, but neither could they be left without constant care and observation. Unfortunately I have to leave the ward on Tuesday and Thursday to lead our workshops. At 10.30am. I handed over to a senior midwife and to the clinician on duty. I explained everything to the young student who had been working with me and reluctantly left their side. My instructions were clear. One woman could be encouraged with the help of a drip for just 30 minutes more, before assisting with a vacuum extraction, and the other should birth within the hour or be seriously considered for a c/section.
It was not untill I returned two and a half hours later that I realized my mistake.
Both babies had been born vaginally. Both had been born 1-2 hours after I left. Both in poor condition needing intensive resusitation. Both had been admitted to nursery. Both these outcomes could have been avoided.
So what had been my big mistake?
I suddenly realized that 3 midwives from labour ward had been present in the workshop, plus myself. This had left just one midwife on the ward with all the students and a very inexperienced clinical officer.
What was the point of teaching them in the workshop when there were distressed babies and birthing women unattended just 20 metres away?
It still lays heavily on my shoulders, I still don't understand how this can have happened. Of course its not really my responsability, I was not in charge of labour ward. There was a clinician on duty. But that's what I am hearing just too often. Of course I take responsability, we must all be responsable, we must be accountable. Accountable to such a degree that we realize that what we do, that how we act, does and will always make a difference.
This morning I arrived in labour ward and was greeted with the usual " bed 6 is pushing'
I hurriedly ( I think I'm the only person in Malawi who hurrys) collected what I needed and came to her bedside. How long had she been pushing? A referred case with prolonged 2nd stage. She had arrived on labour ward at least 20 minutes ago. Why hadn't anyone done anything? Listening to the fetal heart I knew that this baby needed to be born quickly. I encouraged her to push, performed a good size episiotomy ( incision to facilitate a greater vaginal opening and therefore a quicker birth) and with 3 pushes the baby was out. Floopy baby..not breathing, slow heart rate....not again! I quickly resuscitated the little one and slowly but surely he came round. When I took him to nursery later for a 24 hour observation period he had already had a good breast feed with his happy mum.
Ok so where do I go next? " There's a twin in bed 10...fully dilated...we know you like twins" the night staff called out to me, glad to be able to hand over after a long and busy night.
Twin one came out head first with no problem. Twin two was a breech and needed more care and attention but with active help on my part was born just 10 minutes later.
Before the night staff left they had all become aware that twins can and should be managed actively and safely. I said nothing, but hope that this would be an example to them.
" Good work, thankyou " commented the midwife in charge at night.
I felt positive and pleased. It was enough to keep me going for what turned out to be a long and difficult morning.
Lucas ' ran for his life ' on Saturday! Well actually he ' Ran for Wildlife' but he got the name wrong !! It was a sponsored run in aid of preserving the Malawian wildlife and endangered species. He had to run round the athletics track for one hour and would be sponsored according to the number of laps completed. I was very proud to see how he never stopped however tired and managed to complete 10 laps. This was an excellent run and more than most who were much older than him. He too was proud of himself, especially when he went round collecting money. I might find it more worthwhile to collect for health related projects but Lucas definitely finds it a worthy cause and as we are hoping to enjoy a safari with Alasdair and then Katy and Fiona when they come to see us I guess we should pay attention to other issues too.
That's why I didn't write last week. You see I felt just too responsable and responsabilty weighs heavy at times.
It was a busy morning, starting at 7.15am. yet another 2nd twin born over 2 hours after the first. I found him on the resussitaire barely alive just a small heart beat and nothing else. Oh no not again! Each and every time it happens I try to find the person responsable but no one feels responsable. I try to explain how we should have cared for that mother and her babies, what was the correct procedure for a better outcome but I am obviously not being heard or I'm not speaking loud enough.
I did report the case loudly and clearly on the ward round. The clinical officer who attended told me he didn't want to do a c/section because the baby was well presented. Well presented and almost dead! He died at 4pm. that afternoon...thankfully....as the level of brain damage would have been huge.
Two rather complicated referred cases both with prolonged labour needed my attention. They had been fully dilated and pushing for how long? Together with the students I started sorting out how to deal with these women. Their was no immediate urgency as both babies were fine, but neither could they be left without constant care and observation. Unfortunately I have to leave the ward on Tuesday and Thursday to lead our workshops. At 10.30am. I handed over to a senior midwife and to the clinician on duty. I explained everything to the young student who had been working with me and reluctantly left their side. My instructions were clear. One woman could be encouraged with the help of a drip for just 30 minutes more, before assisting with a vacuum extraction, and the other should birth within the hour or be seriously considered for a c/section.
It was not untill I returned two and a half hours later that I realized my mistake.
Both babies had been born vaginally. Both had been born 1-2 hours after I left. Both in poor condition needing intensive resusitation. Both had been admitted to nursery. Both these outcomes could have been avoided.
So what had been my big mistake?
I suddenly realized that 3 midwives from labour ward had been present in the workshop, plus myself. This had left just one midwife on the ward with all the students and a very inexperienced clinical officer.
What was the point of teaching them in the workshop when there were distressed babies and birthing women unattended just 20 metres away?
It still lays heavily on my shoulders, I still don't understand how this can have happened. Of course its not really my responsability, I was not in charge of labour ward. There was a clinician on duty. But that's what I am hearing just too often. Of course I take responsability, we must all be responsable, we must be accountable. Accountable to such a degree that we realize that what we do, that how we act, does and will always make a difference.
This morning I arrived in labour ward and was greeted with the usual " bed 6 is pushing'
I hurriedly ( I think I'm the only person in Malawi who hurrys) collected what I needed and came to her bedside. How long had she been pushing? A referred case with prolonged 2nd stage. She had arrived on labour ward at least 20 minutes ago. Why hadn't anyone done anything? Listening to the fetal heart I knew that this baby needed to be born quickly. I encouraged her to push, performed a good size episiotomy ( incision to facilitate a greater vaginal opening and therefore a quicker birth) and with 3 pushes the baby was out. Floopy baby..not breathing, slow heart rate....not again! I quickly resuscitated the little one and slowly but surely he came round. When I took him to nursery later for a 24 hour observation period he had already had a good breast feed with his happy mum.
Ok so where do I go next? " There's a twin in bed 10...fully dilated...we know you like twins" the night staff called out to me, glad to be able to hand over after a long and busy night.
Twin one came out head first with no problem. Twin two was a breech and needed more care and attention but with active help on my part was born just 10 minutes later.
Before the night staff left they had all become aware that twins can and should be managed actively and safely. I said nothing, but hope that this would be an example to them.
" Good work, thankyou " commented the midwife in charge at night.
I felt positive and pleased. It was enough to keep me going for what turned out to be a long and difficult morning.
Lucas ' ran for his life ' on Saturday! Well actually he ' Ran for Wildlife' but he got the name wrong !! It was a sponsored run in aid of preserving the Malawian wildlife and endangered species. He had to run round the athletics track for one hour and would be sponsored according to the number of laps completed. I was very proud to see how he never stopped however tired and managed to complete 10 laps. This was an excellent run and more than most who were much older than him. He too was proud of himself, especially when he went round collecting money. I might find it more worthwhile to collect for health related projects but Lucas definitely finds it a worthy cause and as we are hoping to enjoy a safari with Alasdair and then Katy and Fiona when they come to see us I guess we should pay attention to other issues too.
Friday, 23 May 2008
TIME OUT
Today I'm taking "time out" I can do this. I need to do this
Teaching is going well . My twins and my miracle babies are just fine. But yesterday was just
awful!
Labour ward was as busy as it gets. We were 5 midwives and many students. With 1 midwife in admissions and another nearly all day in theatre we remained just 3 on the ward. The students, with little experience, were attending births with little supervision. I moved from bed to bed trying to keep abreast of each situation, helping out when things were going wrong whilst also trying to care for the more complicated "referred " cases. I had to drag myself away for 2 hours to teach in my workshops, and found on arriving back the situation was no better, it was worse. We only have one operating theatre at Bwaila hospital so please tell me what to do when we have 4 very serious cases waiting for a c/section? Just please tell me which one has priority?
The woman with the cord prolapse who was referred from a health centre. The cord was still pulsating, the baby was still alive ..but for how long? Or maybe the young primigravida who was sent by the TBA (tradition birth attendant) from her village. She had been "pushing "for more than 24 hours, her baby was still alive but severely distressed and she could rupture her uterus at any minute? Or the woman on her 10th pregnancy with 4 live children and severe fetal ditress? or maybe the woman who arrived with ruptured uterus with a dead baby but in risk of loosing her own life?
Someone just tell me, just please tell me who has preference? Who should make this decision? What are the priorities ? Who should live and who should die? Whose life is more important ? What should be our criteria?
Nobody told me how to make such decisions, it wasn't part of my training, yet I found myself there alongside the doctor doing just that.
That woman has already 4 children and her life is not in danger...Yet...That one is her first child and she may rupture. Was that a good enough reason for taking her first?
By 5.30pm. they had all been attended. I had been at work since 7.15am. without taking a break. And even as I tried to leave a student called me to help her with some difficult shoulders and another to suture a perineum. So it was gloves on and "just these 2 more and I must go" We left the ward full of women in labour for the night shift. As I walked away I heard comment. "At least with all that we only lost 1 baby" It was true, but that was someones baby, some mothers child she had loved and carried for 9 months, she had laboured and pushed for two days. Some fathers son, some grandmothers grandchild. It was one loss too many. It was avoidable if the conditions had been right and adequate, if these women really did have the right to decent proper health care if these women and babies really did have just some basic human rights.
TBA's form an important part of Malwian health care. There is such a huge shortage of midwives a least someone is attending the women in the rural areas. These women have no official training but will have learnt their skills from other women in the village. Passed on by the older women as tradition allows. Some will be good wise women who work skilfully and have achieved great knowledge and art. Unfortunately, others will have little or no skills and can be downright dangerous. The ministry of health has a problem. On the one hand they need them as they cannot supply enough trained nurses or midwives so they wish them to have some formal training. On the other hand they would like all women to be attended in health centres or hospitals so don't want to encourage them by giving training. Malawi is not supplying sufficient health care to do without them and does have not the means to do that. It is a problem. I have already made contact with a NGO who are looking at a project to provide these women with basic skills. I find this an exciting and interesting challenge. I will keep you posted.
Grace's baby is back in hospital with another chest infection. She is just 3 months old, weighs 2.800kg. and has been in hospital twice. I still wonder if she does have that underlying congenital heart condition but it seems impossible to get anyone to do any further investigations. Could it be that its just not worth it? There is no pediatric cardiac surgery available in Malawi so why bother making a diagnosis?
Today I had breakfast with some good girl friends and tonight we will go out to supper with other friends. I feel loved and supported. Today I had a good moan to Tarek too. Of course he understands perfectly. Has seen and heard it all before. But he's a good listener and I thank him for that.
Luki is having fun. He's looking forward to being in Spain with his dad and brother and sister next month, though I shall miss him terribly. I manage to talk to my other children regularly and that makes me feel so good. I have started to make plans and bookings for Alasdairs visit in July it will be such fun to visit new parts of this beautiful country. Sometimes its hard to believe the things that are happening behind the walls of Bwaila hospital. We must not close our eyes and pretend they are not there, that they do not exist. That is why I write, so that you too can know the reality of the very poor, the powerless, the defenceless, the women and babies of Malawi. Only then can something be done, can we begin to encourage, to force, someone to take notice, can we begin to make a difference.
Teaching is going well . My twins and my miracle babies are just fine. But yesterday was just
awful!
Labour ward was as busy as it gets. We were 5 midwives and many students. With 1 midwife in admissions and another nearly all day in theatre we remained just 3 on the ward. The students, with little experience, were attending births with little supervision. I moved from bed to bed trying to keep abreast of each situation, helping out when things were going wrong whilst also trying to care for the more complicated "referred " cases. I had to drag myself away for 2 hours to teach in my workshops, and found on arriving back the situation was no better, it was worse. We only have one operating theatre at Bwaila hospital so please tell me what to do when we have 4 very serious cases waiting for a c/section? Just please tell me which one has priority?
The woman with the cord prolapse who was referred from a health centre. The cord was still pulsating, the baby was still alive ..but for how long? Or maybe the young primigravida who was sent by the TBA (tradition birth attendant) from her village. She had been "pushing "for more than 24 hours, her baby was still alive but severely distressed and she could rupture her uterus at any minute? Or the woman on her 10th pregnancy with 4 live children and severe fetal ditress? or maybe the woman who arrived with ruptured uterus with a dead baby but in risk of loosing her own life?
Someone just tell me, just please tell me who has preference? Who should make this decision? What are the priorities ? Who should live and who should die? Whose life is more important ? What should be our criteria?
Nobody told me how to make such decisions, it wasn't part of my training, yet I found myself there alongside the doctor doing just that.
That woman has already 4 children and her life is not in danger...Yet...That one is her first child and she may rupture. Was that a good enough reason for taking her first?
By 5.30pm. they had all been attended. I had been at work since 7.15am. without taking a break. And even as I tried to leave a student called me to help her with some difficult shoulders and another to suture a perineum. So it was gloves on and "just these 2 more and I must go" We left the ward full of women in labour for the night shift. As I walked away I heard comment. "At least with all that we only lost 1 baby" It was true, but that was someones baby, some mothers child she had loved and carried for 9 months, she had laboured and pushed for two days. Some fathers son, some grandmothers grandchild. It was one loss too many. It was avoidable if the conditions had been right and adequate, if these women really did have the right to decent proper health care if these women and babies really did have just some basic human rights.
TBA's form an important part of Malwian health care. There is such a huge shortage of midwives a least someone is attending the women in the rural areas. These women have no official training but will have learnt their skills from other women in the village. Passed on by the older women as tradition allows. Some will be good wise women who work skilfully and have achieved great knowledge and art. Unfortunately, others will have little or no skills and can be downright dangerous. The ministry of health has a problem. On the one hand they need them as they cannot supply enough trained nurses or midwives so they wish them to have some formal training. On the other hand they would like all women to be attended in health centres or hospitals so don't want to encourage them by giving training. Malawi is not supplying sufficient health care to do without them and does have not the means to do that. It is a problem. I have already made contact with a NGO who are looking at a project to provide these women with basic skills. I find this an exciting and interesting challenge. I will keep you posted.
Grace's baby is back in hospital with another chest infection. She is just 3 months old, weighs 2.800kg. and has been in hospital twice. I still wonder if she does have that underlying congenital heart condition but it seems impossible to get anyone to do any further investigations. Could it be that its just not worth it? There is no pediatric cardiac surgery available in Malawi so why bother making a diagnosis?
Today I had breakfast with some good girl friends and tonight we will go out to supper with other friends. I feel loved and supported. Today I had a good moan to Tarek too. Of course he understands perfectly. Has seen and heard it all before. But he's a good listener and I thank him for that.
Luki is having fun. He's looking forward to being in Spain with his dad and brother and sister next month, though I shall miss him terribly. I manage to talk to my other children regularly and that makes me feel so good. I have started to make plans and bookings for Alasdairs visit in July it will be such fun to visit new parts of this beautiful country. Sometimes its hard to believe the things that are happening behind the walls of Bwaila hospital. We must not close our eyes and pretend they are not there, that they do not exist. That is why I write, so that you too can know the reality of the very poor, the powerless, the defenceless, the women and babies of Malawi. Only then can something be done, can we begin to encourage, to force, someone to take notice, can we begin to make a difference.
Friday, 16 May 2008
MAKING A DIFFERENCE
I arrived at labour ward yesterday ay 7.15am. By 7.45am. I had attended 2 births, performing vacuum extraction for fetal distress on one and resuscitating both babies. Thats how it is in the morning. The night staff are tired after their long 15 hour shift. Those that are unlucky enough to need attention between 5.30 and 7.30am. will be at risk. I never quite know what may have happened during the night which makes it difficult take over in the morning. How long has she been pushing? Are these signs of fetal distress recent or is this baby in its final stages of coping?
Was this woman with a previous c/section really in labour all night with a baby that is just too big to come down or should I wait a little longer and risk a uterine rupture? It is very often difficult to make the right decision so I try to watch her closely and hope that Tarek or one of the "real" doctors will be along soon to discuss the case. Protocol is to call for the clinical officer.It sometimes works, most are now quite willing to listen to me, but so many of them have so little experience I find it difficult to refer to them. The charge midwife called to say she would be late as her transport had not arrived. As the most senior midwife I took charge. Assessing the women, organizing the students, trying to ensure that they are suitably supervised ( difficult with just 2 other trained staff!) Then there is the ward round. At 8.30am. the obstetricians plus a whole host of CO's, students and others, patrol from bed to bed discussing each woman, taking the opportunity to teach the students or make decisions on difficult cases. I insist on maintaining as much intimacy and privacy as possible for the labouring women.This is a huge task. The curtains that should hang between the beds to give just a pretence of privacy are either broken or torn, many are just not there. Up to 20 persons trying to fit round the bed..most of them male.. make it almost impossible, but we try. Covering the women with their colourful cloths (chitenges) putting ourselves physically between her and the crowd, we achieve something. Yesterday was full of problems. Everyday we receive many women referred from other centres. By the time they reach us at Bwaila they have already passed through the health centre and maybe a local hospital. After waiting for transport between each centre these "emergencies"arrive on labour ward. We were just finishing the "round"
" Ruptured uterus" I heard them cry, as they wheeled in this poor, shocked, traumatised woman. Without waiting I went to the bedside. Luck was on her side as all the medical staff were still on the ward. The decision was made for immediate c/section and hysterectomy. I knew we should move fast. But "fast" is not, evidently, part of the Malawian vocabulary! IV line, urinary catheter..she was bleeding from the urethra..not a good sign, Consent signed, take blood for laboratory, she would most certainly need a transfusion. I got hold of the trolley and started pushing her down the corridor towards theatre, administring her IV antibiotic on the way. Later I heard that one of the CO's had gone to theatre to inform them and shouted loudly that they had better get on and stop laughing and talking there was a ruptured uterus on its way! It is so unusual and so pleasing to hear that someone understood the emergency.
The operation was quickly underway and whilst I stood waiting to receive the baby I realized that we had not listened for fetal heart sounds. I remember reading in her referral notes that they were not sure if it could be heard. What the heck! What difference would it make? We couldn't move any faster and we were saving the mothers life. I commented to the surgeon. "I dont know if the baby is still alive but I doubt it" It was not an easy c/section, intense hemorrage made things difficult. The baby was well down in the pelvis, stuck in the bony outlet for how long? Completely stuck for enough time to cause her uterus to rupture in its intent to push it out. I pushed upwards on the head whilst the surgeon tried to pull through the abdominal opening. It took a while, I thought it would never come, but then I felt it come loose and the baby was delivered.
" Its alive! " the surgeon exclaimed as the baby made a small noise. I knew it was now up to me. This baby deserved chance! I must do a good job on resuscitating. As I inflated its little lungs with oxygen and sucked the liquor and mucous from its nose and mouth I really prayed for this little one to make it, to find the strength to live. And it did! Small gasps at first then stronger and it started crying. Turning a lovely shade of pinky brown I knew it was on its way. Boy or girl ? they asked me. Its a girl. Of course it would be! Everyone knows that girls are stronger, real fighters! You may laugh, we all laughed in theatre but its true, the girl babies do fight harder ( comments welcome!) The outcome of that story will keep me going for a week. You see it made me realize that it can be done in Malawi, it can be done in Bwaila. It justs needs the whole team to work together, to move fast, to really believe that the way they work that what they do WILL and DOES make a difference. That it is in their power to save lives not once or twice but many times. Before I left theatre with that baby and put it into the outstretched hands of the guardian I thanked them all, the doctors and nurses and theatre staff and told them what a wonderful job they had done. Later I used this example in my workshop to illustrate once more that what we do and how we act can make a difference. They need to be told. I think that they often think that what ever they do nothing will change.I dont believe it ...not yet...please.. not ever.
Befoer I left today I went to post natal ward. There I found her. A strong looking woman lying on her side with her little girl suckling at her breast. I wonder if she realizes how lucky she is to be alive and to have a live baby?
I've bought my car! Its blue, its little and its nippy! Its a four wheel drive and much higher off the ground, just right for my vivits to the villages. Next week I shall try it out as I go to visit my twins and my miracle baby. Now I have another miracle baby.... I hope I will have many more.
Some of you have asked how you can help my mums and babies how you can get involved. I refer you to my friend Carol who is supervising my sponsorship and continues to raise money for Bwaila hospital. SOS Malawi carolarad2000@yahoo.com I'm sure she will be pleased to hear from you.
Was this woman with a previous c/section really in labour all night with a baby that is just too big to come down or should I wait a little longer and risk a uterine rupture? It is very often difficult to make the right decision so I try to watch her closely and hope that Tarek or one of the "real" doctors will be along soon to discuss the case. Protocol is to call for the clinical officer.It sometimes works, most are now quite willing to listen to me, but so many of them have so little experience I find it difficult to refer to them. The charge midwife called to say she would be late as her transport had not arrived. As the most senior midwife I took charge. Assessing the women, organizing the students, trying to ensure that they are suitably supervised ( difficult with just 2 other trained staff!) Then there is the ward round. At 8.30am. the obstetricians plus a whole host of CO's, students and others, patrol from bed to bed discussing each woman, taking the opportunity to teach the students or make decisions on difficult cases. I insist on maintaining as much intimacy and privacy as possible for the labouring women.This is a huge task. The curtains that should hang between the beds to give just a pretence of privacy are either broken or torn, many are just not there. Up to 20 persons trying to fit round the bed..most of them male.. make it almost impossible, but we try. Covering the women with their colourful cloths (chitenges) putting ourselves physically between her and the crowd, we achieve something. Yesterday was full of problems. Everyday we receive many women referred from other centres. By the time they reach us at Bwaila they have already passed through the health centre and maybe a local hospital. After waiting for transport between each centre these "emergencies"arrive on labour ward. We were just finishing the "round"
" Ruptured uterus" I heard them cry, as they wheeled in this poor, shocked, traumatised woman. Without waiting I went to the bedside. Luck was on her side as all the medical staff were still on the ward. The decision was made for immediate c/section and hysterectomy. I knew we should move fast. But "fast" is not, evidently, part of the Malawian vocabulary! IV line, urinary catheter..she was bleeding from the urethra..not a good sign, Consent signed, take blood for laboratory, she would most certainly need a transfusion. I got hold of the trolley and started pushing her down the corridor towards theatre, administring her IV antibiotic on the way. Later I heard that one of the CO's had gone to theatre to inform them and shouted loudly that they had better get on and stop laughing and talking there was a ruptured uterus on its way! It is so unusual and so pleasing to hear that someone understood the emergency.
The operation was quickly underway and whilst I stood waiting to receive the baby I realized that we had not listened for fetal heart sounds. I remember reading in her referral notes that they were not sure if it could be heard. What the heck! What difference would it make? We couldn't move any faster and we were saving the mothers life. I commented to the surgeon. "I dont know if the baby is still alive but I doubt it" It was not an easy c/section, intense hemorrage made things difficult. The baby was well down in the pelvis, stuck in the bony outlet for how long? Completely stuck for enough time to cause her uterus to rupture in its intent to push it out. I pushed upwards on the head whilst the surgeon tried to pull through the abdominal opening. It took a while, I thought it would never come, but then I felt it come loose and the baby was delivered.
" Its alive! " the surgeon exclaimed as the baby made a small noise. I knew it was now up to me. This baby deserved chance! I must do a good job on resuscitating. As I inflated its little lungs with oxygen and sucked the liquor and mucous from its nose and mouth I really prayed for this little one to make it, to find the strength to live. And it did! Small gasps at first then stronger and it started crying. Turning a lovely shade of pinky brown I knew it was on its way. Boy or girl ? they asked me. Its a girl. Of course it would be! Everyone knows that girls are stronger, real fighters! You may laugh, we all laughed in theatre but its true, the girl babies do fight harder ( comments welcome!) The outcome of that story will keep me going for a week. You see it made me realize that it can be done in Malawi, it can be done in Bwaila. It justs needs the whole team to work together, to move fast, to really believe that the way they work that what they do WILL and DOES make a difference. That it is in their power to save lives not once or twice but many times. Before I left theatre with that baby and put it into the outstretched hands of the guardian I thanked them all, the doctors and nurses and theatre staff and told them what a wonderful job they had done. Later I used this example in my workshop to illustrate once more that what we do and how we act can make a difference. They need to be told. I think that they often think that what ever they do nothing will change.I dont believe it ...not yet...please.. not ever.
Befoer I left today I went to post natal ward. There I found her. A strong looking woman lying on her side with her little girl suckling at her breast. I wonder if she realizes how lucky she is to be alive and to have a live baby?
I've bought my car! Its blue, its little and its nippy! Its a four wheel drive and much higher off the ground, just right for my vivits to the villages. Next week I shall try it out as I go to visit my twins and my miracle baby. Now I have another miracle baby.... I hope I will have many more.
Some of you have asked how you can help my mums and babies how you can get involved. I refer you to my friend Carol who is supervising my sponsorship and continues to raise money for Bwaila hospital. SOS Malawi carolarad2000@yahoo.com I'm sure she will be pleased to hear from you.
Friday, 9 May 2008
HOT GUYS AND GIFTS
Firstly I would like to say to all those who send comments to my blog "Thankyou" Yes I do receive them. Yes I do read them. It feels good to know that you are out there sharing with me these amazing experiences and supporting me with your love and thoughts and words.
"Keep them coming"
Its two weeks since I last wrote and many things have happened since then. Last week Linda ( from Scotland) came to visit. Linda is responsible for a small charity called MUMS ( Malawis underpriviledged mums) She/they have done amazing things in raising huge sums of money to directly support Bwaila hospital and in particular the new hospital buildings. They are also involved in other projects here in Lilongwe. MUMS is one of my sponsors who along with one other private businessman have and are making it possible for me to be here. It was good to spend time with her. Apart from having a fun time together we were also able to make some useful and rewarding contacts with others involved in our area of work. I was particulaly impressed by the director of the Nurses and Midwives Association ( who act as a trade union supporting and caring for the carers) A strong passionate woman not afraid to speak out in favour of the health workers, doing a wonderful job at local and government level to try and improve things for nurses and midwives. Looking for ways and incentives to keep these valued professionals here in Malawi. I hope to keep contact with her. It is unusual to find a Malawian of her kind , especially a woman.
I cannot let Lindas visit pass with out telling you of the ' dance ' we attended . We were invited to attend a dance with local music and including a famous Malawian singer. It was to be in aid of the 'national nurses day' to be celebrated this week. We both imagined a large hall filled with midwives and a traditional band, so we deciced it should be fun. To our amazement, when we arrived, the venue was full of young men! I mean 100 men and no more than 10 women! Why should we back out now? We took a deep breath and entered. Well it was like bees to a honey pot! Most of the guys were young enough to be our sons but what the heck ! In the absence of greater and more beautiful talent we spent the entire evening dancing with and being surrounded by young, good looking, girating, black men! It did wonders for our ego but when several hours later the drum beat started hotting up and the beer taking effect ( its amazing how even an older white woman can suddenly become very attractive to these young guys in search of free beer!) we decided it was time to leave. I became slightly worried when one guy told me that the one I had been dancing with was only a 3rd year student whilst he already had a proper job earning 100.000MK ( 500 euros) a month . Definitely time to go !
I must tell you about my little miracle baby. The one whose mother arrived with the umbilical cord prolapse and I thought would never survive. I try to follow up the mums and babies that I attend who have special needs. It is impossible to remember all of them. So on Monday morning I went straight to nursery to see how this little one was getting on. It is with some trepidation that I enter. I always fear the worst as so many of those little ones just dont make it. I couldnt find him! On asking of his whereabouts I was told that the mother and grandmother had signed his discharge against medical advice and that he had gone home on Sunday. I was determined to find out how he was, so took note of the name of his mother and the village where they lived. My opportunity came the following day. After finishing my workshop I found labour ward was quiet and one of the midwives who had attended the training was eager to accompany me. So we set out for the village. I had asked directions but after following this route down a dusty mud road for more than 6 km. and still not finding the village, we decided to go back. I was not to be beaten. Its always good to have a native Chichewa speaker to ask directions and soon we were on the right track. This took us right through the middle of a typical mud hut village where as usual I caused a stir as the children ran out to the car shouting "msungu..msungu" ( white woman)
At last we found the village and asked for the family ' Luko' We were taken to the hut and welcomed with huge smiles by the whole family who were amazed to see me. My midwife companion was able to translate as she told us the story of her journey to the hospital via the health centre . The grandmother said when she saw the cord protruding she knew that it was dangerous for the baby. The mother had talked of the white midwife who had helped and been kind to her. They knew that we had saved the life of her baby. I asked to see the baby. We were invited to enter her hut and a cane mat was spread on the floor. We took off our shoes and sat down. I had taken some gifts of fruit and vegetables but hadnt dared to take baby clothes. I half expected the little one to have died. There he was lying on the ground, round and fit and healthy. Tears came to my eyes, I really did feel that he was a miracle baby! I was asked to give the baby a name, this is quite a honour, a bit like being a god parent. One is expected to maintain an interest in that child as he grows bringing gifts and food. ( so maybe there was a ulteria motive?) Never mind, I felt proud and priveledged ! At first I thought of Lucas but Lucas Luko was not a good idea! I said I would think of a name for next time. Maybe he will be called Joseph ( son of Rachel in the bible) certainly he was a lucky guy!
On Wednesday I was invited to attend a meeting at the District Health Office. These are monthly sessions to discuss maternal mortality rates. (The rate in developed countries will be around 5-10deaths in 100.000 whereas in Malawi it can be as high as 1.800 in 100.000) Cases are presented, discussed and questioned. Positive critiscism is encouraged to try to evaluate where, why and at what level there may have been a lack of care, materiales, information etc. This evalution will be returned to the health facilities involved in an effort to reduce maternal deaths and improve care. There must have been 50 or 60 health care workers present. I think that not more than 6 made any contribution to the discussion and one of those was me! The case studies lacked vital information. The recording of care is a real problem, one never knows if it wasnt done or wasnt recorded. One of the cases was a young 14 year old girl, married and in her first pregnancy. She died of Streptococcal meningitis, an illness perfectly treatable in the developed countries. We found a delay in taking her to the health centre on the part of her family..reasons unknown. A lack of care at the health centre who did not examine her fully and did not begin treatment of any kind. They immediatly referried her to the hospital. It was not recorded as to how long it took for transport to arrive. An overnight delay in her being seen by a clinician once admited in the hospital was evident so that when correct treatment was started it was too late.
This story is not uncommon, stories like this are heard everyday somehow along the way they have become acceptable. We are not suprised but for some of us we are sad, we are frustrated, we are angry. What were her rights to health care ? To good health care ? What were her human rights? What are Human rights? Where are they in Malawi ? What do they really mean in Malawi for these poor women?
Witchcraft is very much part of Malawi. It is very much part of day to day life. Superstitions and 'traditional medicine' is often where the people go to, turning only to the health care and hospitals when that has failed. There is, nominally, a move to educate the people away from this but it is slow and not terribly effective. On discussing the second case I was surprised when no formal diagnosis or cause of death was recorded or seemed to be necessay. I suggested that if the medical profession bothered to give families a real cause of death this would make it hard to blame it on some witchcraft or bad omen or as a result of evil behaviour. This was taken down and recorded. It seems that nobody had ever thought of this before!
This weekend we are going to Dwangwa sugar plantations. It is good to get away from Lilongwe every now and again. I need this time to forget for a while, to refresh and recharge. I am grateful to the good friends I have made who make this possible.
Last big news...I have found a small, jeep type, car to buy. I hope to take possesion of it on Tuesday. It will be better for my village visits and hopefully more economical than renting.
"Keep them coming"
Its two weeks since I last wrote and many things have happened since then. Last week Linda ( from Scotland) came to visit. Linda is responsible for a small charity called MUMS ( Malawis underpriviledged mums) She/they have done amazing things in raising huge sums of money to directly support Bwaila hospital and in particular the new hospital buildings. They are also involved in other projects here in Lilongwe. MUMS is one of my sponsors who along with one other private businessman have and are making it possible for me to be here. It was good to spend time with her. Apart from having a fun time together we were also able to make some useful and rewarding contacts with others involved in our area of work. I was particulaly impressed by the director of the Nurses and Midwives Association ( who act as a trade union supporting and caring for the carers) A strong passionate woman not afraid to speak out in favour of the health workers, doing a wonderful job at local and government level to try and improve things for nurses and midwives. Looking for ways and incentives to keep these valued professionals here in Malawi. I hope to keep contact with her. It is unusual to find a Malawian of her kind , especially a woman.
I cannot let Lindas visit pass with out telling you of the ' dance ' we attended . We were invited to attend a dance with local music and including a famous Malawian singer. It was to be in aid of the 'national nurses day' to be celebrated this week. We both imagined a large hall filled with midwives and a traditional band, so we deciced it should be fun. To our amazement, when we arrived, the venue was full of young men! I mean 100 men and no more than 10 women! Why should we back out now? We took a deep breath and entered. Well it was like bees to a honey pot! Most of the guys were young enough to be our sons but what the heck ! In the absence of greater and more beautiful talent we spent the entire evening dancing with and being surrounded by young, good looking, girating, black men! It did wonders for our ego but when several hours later the drum beat started hotting up and the beer taking effect ( its amazing how even an older white woman can suddenly become very attractive to these young guys in search of free beer!) we decided it was time to leave. I became slightly worried when one guy told me that the one I had been dancing with was only a 3rd year student whilst he already had a proper job earning 100.000MK ( 500 euros) a month . Definitely time to go !
I must tell you about my little miracle baby. The one whose mother arrived with the umbilical cord prolapse and I thought would never survive. I try to follow up the mums and babies that I attend who have special needs. It is impossible to remember all of them. So on Monday morning I went straight to nursery to see how this little one was getting on. It is with some trepidation that I enter. I always fear the worst as so many of those little ones just dont make it. I couldnt find him! On asking of his whereabouts I was told that the mother and grandmother had signed his discharge against medical advice and that he had gone home on Sunday. I was determined to find out how he was, so took note of the name of his mother and the village where they lived. My opportunity came the following day. After finishing my workshop I found labour ward was quiet and one of the midwives who had attended the training was eager to accompany me. So we set out for the village. I had asked directions but after following this route down a dusty mud road for more than 6 km. and still not finding the village, we decided to go back. I was not to be beaten. Its always good to have a native Chichewa speaker to ask directions and soon we were on the right track. This took us right through the middle of a typical mud hut village where as usual I caused a stir as the children ran out to the car shouting "msungu..msungu" ( white woman)
At last we found the village and asked for the family ' Luko' We were taken to the hut and welcomed with huge smiles by the whole family who were amazed to see me. My midwife companion was able to translate as she told us the story of her journey to the hospital via the health centre . The grandmother said when she saw the cord protruding she knew that it was dangerous for the baby. The mother had talked of the white midwife who had helped and been kind to her. They knew that we had saved the life of her baby. I asked to see the baby. We were invited to enter her hut and a cane mat was spread on the floor. We took off our shoes and sat down. I had taken some gifts of fruit and vegetables but hadnt dared to take baby clothes. I half expected the little one to have died. There he was lying on the ground, round and fit and healthy. Tears came to my eyes, I really did feel that he was a miracle baby! I was asked to give the baby a name, this is quite a honour, a bit like being a god parent. One is expected to maintain an interest in that child as he grows bringing gifts and food. ( so maybe there was a ulteria motive?) Never mind, I felt proud and priveledged ! At first I thought of Lucas but Lucas Luko was not a good idea! I said I would think of a name for next time. Maybe he will be called Joseph ( son of Rachel in the bible) certainly he was a lucky guy!
On Wednesday I was invited to attend a meeting at the District Health Office. These are monthly sessions to discuss maternal mortality rates. (The rate in developed countries will be around 5-10deaths in 100.000 whereas in Malawi it can be as high as 1.800 in 100.000) Cases are presented, discussed and questioned. Positive critiscism is encouraged to try to evaluate where, why and at what level there may have been a lack of care, materiales, information etc. This evalution will be returned to the health facilities involved in an effort to reduce maternal deaths and improve care. There must have been 50 or 60 health care workers present. I think that not more than 6 made any contribution to the discussion and one of those was me! The case studies lacked vital information. The recording of care is a real problem, one never knows if it wasnt done or wasnt recorded. One of the cases was a young 14 year old girl, married and in her first pregnancy. She died of Streptococcal meningitis, an illness perfectly treatable in the developed countries. We found a delay in taking her to the health centre on the part of her family..reasons unknown. A lack of care at the health centre who did not examine her fully and did not begin treatment of any kind. They immediatly referried her to the hospital. It was not recorded as to how long it took for transport to arrive. An overnight delay in her being seen by a clinician once admited in the hospital was evident so that when correct treatment was started it was too late.
This story is not uncommon, stories like this are heard everyday somehow along the way they have become acceptable. We are not suprised but for some of us we are sad, we are frustrated, we are angry. What were her rights to health care ? To good health care ? What were her human rights? What are Human rights? Where are they in Malawi ? What do they really mean in Malawi for these poor women?
Witchcraft is very much part of Malawi. It is very much part of day to day life. Superstitions and 'traditional medicine' is often where the people go to, turning only to the health care and hospitals when that has failed. There is, nominally, a move to educate the people away from this but it is slow and not terribly effective. On discussing the second case I was surprised when no formal diagnosis or cause of death was recorded or seemed to be necessay. I suggested that if the medical profession bothered to give families a real cause of death this would make it hard to blame it on some witchcraft or bad omen or as a result of evil behaviour. This was taken down and recorded. It seems that nobody had ever thought of this before!
This weekend we are going to Dwangwa sugar plantations. It is good to get away from Lilongwe every now and again. I need this time to forget for a while, to refresh and recharge. I am grateful to the good friends I have made who make this possible.
Last big news...I have found a small, jeep type, car to buy. I hope to take possesion of it on Tuesday. It will be better for my village visits and hopefully more economical than renting.
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