I am just not going to apologize any more for writing so infrequently. I really don’t find the time as my work here continues to diversify. From catching babies on labour ward, to teaching both in and out of the classroom, co-ordinating for the set up and running of the new maternity unit and a mountain of others areas in which I seem to have become involved, writing my blog seems to have dropped very low on my list of priorities. I know it is the only way that some of you manage to keep in touch so I will continue as often as I can. I do think of you all often even though you don’t hear from me.
Wednesday was a particularly busy day on labour ward. I am finding it increasingly difficult to find a day when I can spend my whole time on the ward without the interruptions of my other responsibilities. I do enjoy it very much and am therefore reminded where my true love lies. It was one of those days when nothing seemed to go normally. I attended more obstetric pathology in that day then many would see in a month or more! I continue to be reminded of the awful situations that women are facing daily through lack of money, education and resources. At one point in the afternoon we had 4 women queuing up for their emergency c/section. There was great debate as to who should go first. The woman who had arrived with us in such a critical state we just didn’t know how we could save her life. Her 30 week fetus had been dead for some time. She had started to labour a few days ago in her village. The labour became obstructed and her uterus ruptured spilling out the infected necrotic matter into her abdominal cavity .The only answer was surgery to remove the baby and the uterus, but her condition was so critical it would be dangerous to operate. We had no choice, so she went to theatre. As I prepared her, pumping her full of antibiotics, I talked to her and caressed her poor distended semi conscious body hoping she would at least understand the tone of my voice or the touch of my hands if not the words that I spoke. It still amazes me that women can reach such a severe state before finding their way to our doors. Another mother had arrived at the same time. Her labour had been obstructed for many hours. She was exhausted and the baby was severely distressed, but it was alive......so she went first!
My priority on labour ward at this time is the clinical teaching of our midwifery students. There are many students and few trained staff. It is difficult to ensure that they are always supervised and mistakes occur due to their inexperience. I spend my time passing from bed to bed watching over them, asking questions, giving explanations, teaching, showing, guiding, repeating the same things over and over again, but I never tire as I see them respond and improve and learn. This particular woman had been labouring all day. About the same time as the 2 emergencies arrived she was showing signs that she may not be able to deliver vaginally. We had been watching the baby carefully and were starting to think of sending her for a c/section. This was now out of the question. She would have to wait her turn which as things were looking could be more than 3 hours. I waited as long as I could but the baby’s condition continued to deteriorate. I decided to try a vacuum extraction. Thanks to my years in Acuario where I had truly been learning the ‘art’ of midwifery and learnt to develop and trust my instincts as a midwife, I had become able to judge whether a baby could be born vaginally even in some of the most difficult circumstances. (There are still times when one never can be sure so would therefore opt for a c/section, just in case) But I had no choice. It really wasn’t easy and there were moments when I felt like giving up but that would be condemning the baby to certain death, so I slowly, very slowly continued. I should also say that our equipment is not the best. Parts are missing and pumps don’t work. It’s all manual no machines and no modern stuff. ( Do you realize the amount of second rate, out of date, what no one else wants things we receive......it’s not good enough for the rich but it’s OK for Africa stuff!) Eventually the little one was born. My colleague resuscitated the baby and I took him to nursery. This morning he was off oxygen and suckling at his mother’s breast! Amazing! Yes it feels good, but no, it’s not good. They should have had the possibility of a c/section.
The director of The Rose Project will arrive in Malawi on Monday. Discussions will take place to finalize the details for the handing over of the new unit to the District Health Authority. The buildings are nearly ready and the equipment and furniture is starting to arrive. These are exciting but scary times. Staffing, or lack of, is still a problem. Adapting to the new environment is going to be a huge challenge. I am spending much time confronting these issues on all levels and in all aspects.
Lucas returned to school after his Easter break. He was happy to be back. This term his after school activities include athletics, chess, cross-country running and kick-ball (whatever that is?)When we arrived last year he found it difficult to express himself in English. Now there’s no stopping him! We have a deal whereby at least 2 days a week we only speak Spanish and of course Aragorn, Legolas and Gimmle only speak Spanish!
Thursday, 23 April 2009
Tuesday, 31 March 2009
QUIET TIMES KEEPING BUSY
I can't really believe it has been so long since I last wrote to you all. Did you think I had forgotten you?Its nearly Easter and school holidays. I am hoping to take a few days off to go away to the lake with Lucas.Labour ward has been remarkably quiet this past month. This means that we have been attending around 25 births a day instead of the usual 40 and above. In many ways that is good as it gives the midwives a chance to rest and breathe but as we have around 10 midwifery students on the ward doing their practical placement it some times feels as if they are fighting for deliveries! We also have 4 midwives who are in training for obstetric emergencies they are also desperate to gain experience. I wonder how many vacuum extractions have been done just so they could learn? All these students need close supervision and bedside teaching so it has been a pleasure for me to spend time with them, to share my knowledge and experience. I am continuously reminded as to how much I enjoy clinical teaching.This morning I was contemplating the decreased number of births in the month of March and wondering what could possibly be the cause? Remembering back to this time last year this was not the case. I wondered if it could be a much needed drop in birth rate? the greater use of condoms? increased education in birth control? Are things beginning to change? But then as I thought more I realized that we are still in the rainy season and the month of March has been particularly wet. Roads and bridges have been washed away. Many villages have been unreachable. Access to the more remote areas is now only by foot or ox cart. So I began to wonder, could this be the reason that the hospital has been so quiet? I hope not. What would this mean? The reality of the situation began to dawn on me. If the villages are inaccessible and the rain has prevented the women from coming to receive our care, who has been attending them? Where have these babies been born? What has been the outcome? These questions are almost impossible to answer. Most of the births and deaths that occur in the rural areas, unless they have been referred to a health facility, will never be registered. So we will never know how many have been born and how many have died.
Two weeks ago I was called from labour ward to nursery twice in one day. I was introduced to an old ( or at least she looked old) woman cradling a small baby in her arms. Her daughter had died in childbirth and she had no money or means to buy formula milk to feed the child. I was able to reassure her that through our feeding program to aid the orphans from Bwaila nursery we would be able to support her. She took her tins of milk and we promised to visit her the following week. The second call was a grandmother with twins of nearly one year old. These babies had been born in our hospital, prematurely and been cared for in our nursery. All was well until her 20 year old, unmarried, mother died suddenly. The grandmother could not look after the twins so came back to the only place where she had found care and attention. We were also able to help her, at least for a while. March is a particularly difficult time of the year for the poor people of Malawi as some of the maize is not ready to harvest and the rains are causing crop damage. This is the time that many are starving. There are so many people who need help the task is overwhelming.
Luiza was brought in to labour ward one morning, on a trolley, from an outlying health centre. Her baby had been born at home, in her village, assisted by a TBA. (traditional birth attendant) The birth had taken place without incident but the placenta was still inside her uterus. She had been bleeding profusely. When I first saw her I thought she was dead. She was so thin and gaunt I wondered how she could possibly be alive. My immediate reaction was to wonder how on earth could she have carried a baby to full term? Why had she stayed in her village to birth her baby when she was so obviously seriously sick and how was it she had not found help earlier? But those were questions for later, first we had to resuscitate her, but even if we did, would she really live more than a few hours? We started to care for her. We decided not to remove the placenta, at this time, as she was not bleeding more importantly we needed to stabilize her condition. I took blood samples and sent then to the laboratory. We slowly rehydrated her and awaited blood to arrive for transfusion. It didn't come. Eventually I was told that the centrifuge machine was not working so the blood could not be matched. The samples should be taken to the central hospital in the ambulance. By now it was almost lunch time and lunch time is sacred. Not an ambulance was to found and no driver answering his phone. Leaving Luiza with my colleagues I got in my car and drove the 5 kms. to fetch blood. I was lucky to find a technician in the laboratory who could process the samples and supply the blood. It also helped to mention that my good friend and neighbour, Bibiana, is a quality control supervisor in that department! I rushed back with a bag of blood (only 1 bag not 2) and started the transfusion. Slowly Luiza started to regain consciousness and began to talk to her guardians. I cared for her the rest of the afternoon. Later I was able to successfully remove the placenta with no further bleeding. When I left that evening the 2nd bag of blood that I had been promised had still not arrived. I phoned to check.'Yes they would send it'Her baby was small 1.9kg but strong and healthy. I went to nursery to get formula milk as Luiza was still critically ill and could not breast feed. I couldn’t stop thinking of her that evening wondering how it was possible and what were the beliefs and customs that allowed that young woman not to seek help for her illness. Yes she was HIV positive but testing and treatment is readily available, free of charge and often very successful. Despite our care and attention I didn’t think that Luiza would last the night. The best I hoped for was that my fellow midwives would care for her well in her last hours.Luiza was still alive the following day but still critically ill. The blood that was promised arrived at 9am. Whilst it was still transfusing Luiza died. Her baby was taken to be cared for by her family. That is the best we can hope for as so many are abandoned to be cared for in orphanages.
Do you remember the story of Laureen? Or maybe I didn’t tell you? She was the 2nd child of a educated mum. Her grandmother was also present at her birth as she is a midwife in Zomba. What should have been an easy 2nd birth turned into an emergency when Laureen, who weighed over 4kgs. got her shoulders stuck. The head was born with a huge effort and then no more. It didn’t matter how much her Mum pushed or I pulled she wouldn’t come. I quickly performed the appropiate manouvers for a shoulder distocia but she was truly stuck. I managed to get her Mum into another position and tried again. Eventually I got her out but in the process I managed to break her right arm. Well you can imagine how bad I felt? OK, so I had saved her life but I had BROKEN her arm! In the following days I managed to get her arm x-rayed and seen by an orthopaedic specialist who assured me all would be well and she would heal perfectly. I'm not sure I believed him at the time, but he was proved right and Laureen is now 6 months old bonnie and beautiful with no sign of the trauma she experienced at birth. Last Sunday I was invited to her baptism, I even bought her a frilly dress to wear. I was the only white face in a congregation of over 300 but what the heck!
So, as usual, its ups and downs, good and bad, happy and sad.Last night I read love described as 'agony and ecstasy'That just about sums it up.
Two weeks ago I was called from labour ward to nursery twice in one day. I was introduced to an old ( or at least she looked old) woman cradling a small baby in her arms. Her daughter had died in childbirth and she had no money or means to buy formula milk to feed the child. I was able to reassure her that through our feeding program to aid the orphans from Bwaila nursery we would be able to support her. She took her tins of milk and we promised to visit her the following week. The second call was a grandmother with twins of nearly one year old. These babies had been born in our hospital, prematurely and been cared for in our nursery. All was well until her 20 year old, unmarried, mother died suddenly. The grandmother could not look after the twins so came back to the only place where she had found care and attention. We were also able to help her, at least for a while. March is a particularly difficult time of the year for the poor people of Malawi as some of the maize is not ready to harvest and the rains are causing crop damage. This is the time that many are starving. There are so many people who need help the task is overwhelming.
Luiza was brought in to labour ward one morning, on a trolley, from an outlying health centre. Her baby had been born at home, in her village, assisted by a TBA. (traditional birth attendant) The birth had taken place without incident but the placenta was still inside her uterus. She had been bleeding profusely. When I first saw her I thought she was dead. She was so thin and gaunt I wondered how she could possibly be alive. My immediate reaction was to wonder how on earth could she have carried a baby to full term? Why had she stayed in her village to birth her baby when she was so obviously seriously sick and how was it she had not found help earlier? But those were questions for later, first we had to resuscitate her, but even if we did, would she really live more than a few hours? We started to care for her. We decided not to remove the placenta, at this time, as she was not bleeding more importantly we needed to stabilize her condition. I took blood samples and sent then to the laboratory. We slowly rehydrated her and awaited blood to arrive for transfusion. It didn't come. Eventually I was told that the centrifuge machine was not working so the blood could not be matched. The samples should be taken to the central hospital in the ambulance. By now it was almost lunch time and lunch time is sacred. Not an ambulance was to found and no driver answering his phone. Leaving Luiza with my colleagues I got in my car and drove the 5 kms. to fetch blood. I was lucky to find a technician in the laboratory who could process the samples and supply the blood. It also helped to mention that my good friend and neighbour, Bibiana, is a quality control supervisor in that department! I rushed back with a bag of blood (only 1 bag not 2) and started the transfusion. Slowly Luiza started to regain consciousness and began to talk to her guardians. I cared for her the rest of the afternoon. Later I was able to successfully remove the placenta with no further bleeding. When I left that evening the 2nd bag of blood that I had been promised had still not arrived. I phoned to check.'Yes they would send it'Her baby was small 1.9kg but strong and healthy. I went to nursery to get formula milk as Luiza was still critically ill and could not breast feed. I couldn’t stop thinking of her that evening wondering how it was possible and what were the beliefs and customs that allowed that young woman not to seek help for her illness. Yes she was HIV positive but testing and treatment is readily available, free of charge and often very successful. Despite our care and attention I didn’t think that Luiza would last the night. The best I hoped for was that my fellow midwives would care for her well in her last hours.Luiza was still alive the following day but still critically ill. The blood that was promised arrived at 9am. Whilst it was still transfusing Luiza died. Her baby was taken to be cared for by her family. That is the best we can hope for as so many are abandoned to be cared for in orphanages.
Do you remember the story of Laureen? Or maybe I didn’t tell you? She was the 2nd child of a educated mum. Her grandmother was also present at her birth as she is a midwife in Zomba. What should have been an easy 2nd birth turned into an emergency when Laureen, who weighed over 4kgs. got her shoulders stuck. The head was born with a huge effort and then no more. It didn’t matter how much her Mum pushed or I pulled she wouldn’t come. I quickly performed the appropiate manouvers for a shoulder distocia but she was truly stuck. I managed to get her Mum into another position and tried again. Eventually I got her out but in the process I managed to break her right arm. Well you can imagine how bad I felt? OK, so I had saved her life but I had BROKEN her arm! In the following days I managed to get her arm x-rayed and seen by an orthopaedic specialist who assured me all would be well and she would heal perfectly. I'm not sure I believed him at the time, but he was proved right and Laureen is now 6 months old bonnie and beautiful with no sign of the trauma she experienced at birth. Last Sunday I was invited to her baptism, I even bought her a frilly dress to wear. I was the only white face in a congregation of over 300 but what the heck!
So, as usual, its ups and downs, good and bad, happy and sad.Last night I read love described as 'agony and ecstasy'That just about sums it up.
Tuesday, 10 March 2009
SOME CHANGES BUT SAME DIRECTION
It’s now over 2 weeks since I last wrote to you all. Life just gets busier and busier. I remember someone saying to me many years ago with reference to my Mum, “If you want something done, ask a busy person!” It was true then and still is now!
Since I arrived over 1 year ago I have been following the progress of the new maternity wing at Bwaila hospital. As I have explained before we are at present running a high risk, centrally run unit on a district site. The buildings are old and dirty. Conditions are bad and back up services are mainly at the Central Hospital several kilometres away. The initiative for the building of our new wing plus a larger one on the central site was taken by Tarek several years ago. The central unit is being funded by The Hunter/Clinton Foundation whilst ours by The Rose Project from Ireland. During the past months I have become involved with their work becoming their representative here in Malawi. Over the last 2 weeks I have been working closely alongside the director and members of the board during their visit to Lilongwe. As the buildings near completion there are a huge number of details to be checked on ground level. As my input is as a midwife I am able to see things on a purely workable basis which is important. I will be helping to organize and aid a smooth change over to the new wing. It is a hugely challenging task into which I have thrown myself. Trying to co ordinate the various parties that are concerned has turned into a largely administrative and managerial task which has taken me away from labour ward for the time being. I must admit I really miss the contact with the women, babies and my colleagues but I know I will get back to that later. I am still closely involved in the workshops/teaching twice a week and am taking this opportunity to introduce the new working conditions and hospital lay out to the midwives. The delivery rooms have been built on European based designs. Each woman will have her own individual room. This is totally innovative here in Africa. It may be found in a few private maternity hospitals but never in a public service. Our ‘poor’ mothers will have a greatly superior environment and they deserve it! Being with Mary Donahoe (Rose Project) has introduced me to other areas and given me new contacts. I was particularly interested in our meeting with the school of nursing and midwifery. They are hugely short of tutors and clinical teachers which only comes second to the fact that many midwives cannot be trained due to lack of funding. Recently one of the training courses was delayed as the government funds were not received. The school was closed until such time as the money became available. This is now a problem for the integration of these graduates into our new units. We are relying on these new midwives as part of our team. The most challenging area to be faced is that of staffing. Everyone seems aware of this crisis but nothing seems to be effective. Short term, we need midwives from ANYWHERE and long term, we need to train more midwives here in Malawi. There are many reasons for this tremendous shortage. Those that go overseas, those that move into the private/NGO sectors, where the pay and conditions are better, and not least, the high number of nurses who are dying. Believe me not a week seems to pass when they are not burying a colleague. Life expectancy remains under forty in Malawi and this is seen equally in the nursing profession. This morning I heard that one of our ‘old’ midwives had died. On enquiring as to how old they thought she was I was seriously told “In her fifties!” The Rose Project is also sponsoring a clinic for health workers in Lilongwe. This centre will serve all health staff. They will be attended in confidence and counselling and treatment will be given. This is especially important for our HIV positive nurses who find it difficult to visit a public clinic as they will be seen by their patients and possibly thereafter be unable to work due to stigma and lack of knowledge of the condition and its implications. There is much to be done and few to do the work but there are also many trying to help from afar. Aid to Africa has and is suffering due to the global economic crisis. I ask you please not to forget us. However difficult it may be for you over there it is not comparable to the poverty and suffering in Malawi.
Lucas and I keep strong and happy. We have much to be grateful for. Compared to the many in Malawi we are extremely fortunate. We sometimes miss our European roots especially our family and friends. My lovely children so far away, Lucas’ Dad his brother and sisters and Branston Pickle!
But for the moment we are in the right place doing the right thing...at least that’s how it feels at present. We send our love and thoughts to you all.
Since I arrived over 1 year ago I have been following the progress of the new maternity wing at Bwaila hospital. As I have explained before we are at present running a high risk, centrally run unit on a district site. The buildings are old and dirty. Conditions are bad and back up services are mainly at the Central Hospital several kilometres away. The initiative for the building of our new wing plus a larger one on the central site was taken by Tarek several years ago. The central unit is being funded by The Hunter/Clinton Foundation whilst ours by The Rose Project from Ireland. During the past months I have become involved with their work becoming their representative here in Malawi. Over the last 2 weeks I have been working closely alongside the director and members of the board during their visit to Lilongwe. As the buildings near completion there are a huge number of details to be checked on ground level. As my input is as a midwife I am able to see things on a purely workable basis which is important. I will be helping to organize and aid a smooth change over to the new wing. It is a hugely challenging task into which I have thrown myself. Trying to co ordinate the various parties that are concerned has turned into a largely administrative and managerial task which has taken me away from labour ward for the time being. I must admit I really miss the contact with the women, babies and my colleagues but I know I will get back to that later. I am still closely involved in the workshops/teaching twice a week and am taking this opportunity to introduce the new working conditions and hospital lay out to the midwives. The delivery rooms have been built on European based designs. Each woman will have her own individual room. This is totally innovative here in Africa. It may be found in a few private maternity hospitals but never in a public service. Our ‘poor’ mothers will have a greatly superior environment and they deserve it! Being with Mary Donahoe (Rose Project) has introduced me to other areas and given me new contacts. I was particularly interested in our meeting with the school of nursing and midwifery. They are hugely short of tutors and clinical teachers which only comes second to the fact that many midwives cannot be trained due to lack of funding. Recently one of the training courses was delayed as the government funds were not received. The school was closed until such time as the money became available. This is now a problem for the integration of these graduates into our new units. We are relying on these new midwives as part of our team. The most challenging area to be faced is that of staffing. Everyone seems aware of this crisis but nothing seems to be effective. Short term, we need midwives from ANYWHERE and long term, we need to train more midwives here in Malawi. There are many reasons for this tremendous shortage. Those that go overseas, those that move into the private/NGO sectors, where the pay and conditions are better, and not least, the high number of nurses who are dying. Believe me not a week seems to pass when they are not burying a colleague. Life expectancy remains under forty in Malawi and this is seen equally in the nursing profession. This morning I heard that one of our ‘old’ midwives had died. On enquiring as to how old they thought she was I was seriously told “In her fifties!” The Rose Project is also sponsoring a clinic for health workers in Lilongwe. This centre will serve all health staff. They will be attended in confidence and counselling and treatment will be given. This is especially important for our HIV positive nurses who find it difficult to visit a public clinic as they will be seen by their patients and possibly thereafter be unable to work due to stigma and lack of knowledge of the condition and its implications. There is much to be done and few to do the work but there are also many trying to help from afar. Aid to Africa has and is suffering due to the global economic crisis. I ask you please not to forget us. However difficult it may be for you over there it is not comparable to the poverty and suffering in Malawi.
Lucas and I keep strong and happy. We have much to be grateful for. Compared to the many in Malawi we are extremely fortunate. We sometimes miss our European roots especially our family and friends. My lovely children so far away, Lucas’ Dad his brother and sisters and Branston Pickle!
But for the moment we are in the right place doing the right thing...at least that’s how it feels at present. We send our love and thoughts to you all.
Sunday, 22 February 2009
CHIMWEMWE MU'BEREKI
Chimwemwe mu’bereki means ‘joyful motherhood’ It is the name that Joanne my American midwife friend gave to the small charity she set up whilst working here at Bwaila. Its purpose is to provide support for the needy families whose babies have been cared for in Bwaila nursery/neonatal unit. Some will be premature or HIV positive babies others orphan babies whose mothers have died in childbirth at our hospital. We try to support and encourage other family members to take on their care. This may be a grandmother or an aunt who may already have other dependants. Breast feeding is recommended for all babies irrespective of the mothers HIV status. It is the best protection against gastro intestinal infections which kill many neonates and children under five. But these orphans have no mother and therefore no breast milk. The cost of a tin of formula milk powder is around 800 MK (about 4euros) The small baby will need at least one tin a week to start with. This cost is totally outside the possibility of many of our families. As the child grows the cost of artificial feeding increases and the babies begin to starve. I have become involved in Joanne’s work and am seeing ‘first hand’ some of these problems. The families will either return to Bwaila on a monthly basis to collect milk powder or will be visited by a nurse/midwife who works for the project. The baby’s weight and progress will be documented and the family will be educated in health and hygiene issues. It is difficult to insure that the feeding cups are kept clean and the milk prepared in the correct way. I was concerned that these babies were not getting the possibility to suck, neither at the breast nor the bottle. We know this an important part of a child’s development. I had to learn that the risk of becoming infected by dirty bottles and teats outweighs the lack of sucking stimulation. Our most recent orphans are... a set of twins. These are the youngest siblings of a family of 3 sets of twins! The mother died on our unit after a problem with her blood transfusion. ...Triplets all weighing under 1.600kgs. The grandmother is staying in the hospital and learning to care for them. We hope that with our financial help and support the little ones will be able to stay with her so as not to be separated into the care of the already overcrowded orphanages. On Friday I was called to nursery see Flora and her grandmother. Born in November of last year, prematurely, her young mother died of Eclampsia during her birth. She weighed 1.400kgs. at birth and now 12 weeks later she weighs 2.500kgs. Last month we had supplied 8 tins of milk which should have been more than sufficient for this month, but she had travelled for more than 2 hours to receive more. When I saw Flora her face was pinched and thin. Her eyes seemed to stick out of her head, a round bloated belly and no surplus covering of fat. Anxious and crying she was desperately searching for food. I prepared some milk which she gulped down furiously. Afterwards she lay contented in her grandmother’s arms. Where had all that powdered milk gone? I presume that while the little one went hungry the other children of the family were being given her food. Or maybe they were sold to buy maize so other mouths could be fed? And how can I blame that grandmother? These are some of the dilemmas we confront daily. I said to just give her 4 tins this month and meanwhile we would visit her home to assess the conditions and the number of dependants that were being cared for . My role in this project was just to be supportive of the Malawian nurse and in an advisory capacity but I see myself getting daily more involved. Is there no end to the desperate needs of these people
Friday was the usual busy day on labour ward. My feeling of dread as I arrived early in the morning was justified. Prolonged labours, distressed babies and a queue for operating theatre. Who needed their emergency c/section first? The pre-eclamptic who could convulse any moment with a blood pressure of 210/140? The woman with 2 previous c/sections who had been in labour for many hours and was in danger of rupturing her uterus? Or the baby with fetal distress ?
All got their c/sections and all mothers and babies are alive!
Later that day I attended a surprise twin birth. I noticed that the mother had fever and the baby showed signs of infection. Its heartbeat normally at 120-140 per minute was consistently 200. I treated her infection with intra venous antibiotics and began to prepare her for a c/section. It became obvious by her behaviour that she was a victim of aggressive sexual practices and probably her pregnancy a result of rape. Although she tested negative for HIV at her last test she certainly had a severe STD. ( sexually transmitted disease) I was not keen to send her for surgery due to her physical condition but I feared for the life of her baby. I re-examined her just before taking her to theatre and found that she was almost fully dilated. I judged the situation and opted for an assisted vaginal delivery. It wasn’t easy as she found it very difficult to co-operate. It wasn’t easy as a vacuum extraction requires maximum co-operation from the mother. The baby was born and was taken to be resuscitated by another midwife. As I turned to assist the delivery of the placenta I noticed that the uterus was still rather large. “There must be another baby! “ I exclaimed. And sure enough there was. I quickly ruptured her membranes as I felt the 2nd head engage in the pelvis. The mother was reluctant to push. I called for someone to explain to her that she had another child to push out. I don’t think she was very pleased to hear this! I applied the vacuum cap once more and quickly extracted the 2nd little girl. This one cried loudly as if complaining about having been forgotten! 1.500kgs. and 1.650kgs. were reasonable weights for these twins. I sent them to nursery to be treated with antibiotics to prevent neonatal sepsis. I will check on them on Monday morning.
I will end by sharing two quotes from this week.......
As I wandered round the Ministry of Finance building trying to find my way out, after an unsuccessful visit to procure an extension to my visa. I enquired from an employee as to how to find the exit and commented that I was lost. “ No! ” he told me. “You can never be lost where there are people”
Each morning we listen to BBC Africa whilst having breakfast. There is always a moment called ...wise words. “ Great success comes from great belief “ we heard. “That’s you mummy” remarked Lucas. I didn’t quite understand what he meant so enquired as to his understanding of the quote? “ Great success comes from great BELLY!” he exclaimed.
Now that one needs thinking about!
Friday was the usual busy day on labour ward. My feeling of dread as I arrived early in the morning was justified. Prolonged labours, distressed babies and a queue for operating theatre. Who needed their emergency c/section first? The pre-eclamptic who could convulse any moment with a blood pressure of 210/140? The woman with 2 previous c/sections who had been in labour for many hours and was in danger of rupturing her uterus? Or the baby with fetal distress ?
All got their c/sections and all mothers and babies are alive!
Later that day I attended a surprise twin birth. I noticed that the mother had fever and the baby showed signs of infection. Its heartbeat normally at 120-140 per minute was consistently 200. I treated her infection with intra venous antibiotics and began to prepare her for a c/section. It became obvious by her behaviour that she was a victim of aggressive sexual practices and probably her pregnancy a result of rape. Although she tested negative for HIV at her last test she certainly had a severe STD. ( sexually transmitted disease) I was not keen to send her for surgery due to her physical condition but I feared for the life of her baby. I re-examined her just before taking her to theatre and found that she was almost fully dilated. I judged the situation and opted for an assisted vaginal delivery. It wasn’t easy as she found it very difficult to co-operate. It wasn’t easy as a vacuum extraction requires maximum co-operation from the mother. The baby was born and was taken to be resuscitated by another midwife. As I turned to assist the delivery of the placenta I noticed that the uterus was still rather large. “There must be another baby! “ I exclaimed. And sure enough there was. I quickly ruptured her membranes as I felt the 2nd head engage in the pelvis. The mother was reluctant to push. I called for someone to explain to her that she had another child to push out. I don’t think she was very pleased to hear this! I applied the vacuum cap once more and quickly extracted the 2nd little girl. This one cried loudly as if complaining about having been forgotten! 1.500kgs. and 1.650kgs. were reasonable weights for these twins. I sent them to nursery to be treated with antibiotics to prevent neonatal sepsis. I will check on them on Monday morning.
I will end by sharing two quotes from this week.......
As I wandered round the Ministry of Finance building trying to find my way out, after an unsuccessful visit to procure an extension to my visa. I enquired from an employee as to how to find the exit and commented that I was lost. “ No! ” he told me. “You can never be lost where there are people”
Each morning we listen to BBC Africa whilst having breakfast. There is always a moment called ...wise words. “ Great success comes from great belief “ we heard. “That’s you mummy” remarked Lucas. I didn’t quite understand what he meant so enquired as to his understanding of the quote? “ Great success comes from great BELLY!” he exclaimed.
Now that one needs thinking about!
Thursday, 12 February 2009
CARING FOR THE CARERS
What a privilege it is to be here! To be working in a place where amongst all the pain and suffering the appalling conditions, the dirt and poverty, miracles happen! How many of you can say that? Not a week goes by when I cannot say “ I HAVE SEEN A MIRACLE” Could it be that in the affluent world everything is so controlled, so much technology and knowledge , so many answers and logical explanation for everything that you wouldn’t recognize a miracle even if it slapped you in the face?
I believe in miracles more than ever before in my life. Why is that? Because I see them!
Let me share them with you........
Having been attended at a Health Centre several kilometres away from the hospital this mother was referred to us at Bwaila with a prolapsed cord. Those of you who have read my other blogs will understand that this is an emergency situation. It means that the baby’s umbilical cord, its life line, is coming first and is in danger of being compressed by the presenting part either the head or the breech( bum!)This will cause its death before being born. Apparently no ambulance was to be found so she was brought to us on the back of a bicycle! It is a common form of transport as most people will not have a car and the minibus may be too expensive or not available. When she arrived she was examined and taken straight to theatre for a c/section. The operation was performed and the baby was extracted alive and well! The baby was badly positioned in the uterus, meaning that as there was no presenting part in the pelvis there was no cord compression! Mother and baby are doing fine!
Yesterday another cord prolapsed. Yes, it is not uncommon to see this and many prove fatal for the baby. On examination she was found to have a foot and head presenting plus a long loop of umbilical cord. The doctor and midwife rushed to attend. The cord was still pulsating! What should she do? The head would compress the cord but was still high up. Quickly she made her decision and caught hold of the foot. Then with the help of abdominal palpation she was able to catch the other foot. It wasn’t easy but it was worth a try. It took some time, the baby was delivered, they feared it was dead, it looked dead. But no.... there was just a small sign of life. The midwife rushed the baby to the resuscitaire and began work. It took a while, but 30 minutes later it was sucking contentedly at its mother’s breast. Today it’s doing fine!
Now do you believe in miracles?
It’s not uncommon to hear the recently delivered mothers praising God for a safe birth. Mother and baby alive, hallelujah! “ Thankyou Jesus “ they say. I have to agree, but thanks to US, just a little, I say!
These last few days there have been more than 25 births overnight with just 4 midwives. The night shift starts at 5pm and finishes at 8am. This is of course much too long for any person to work continually. This means that they have to take turns to sleep for a while thus leaving the ward covered by 2 or three midwives only. There is one clinician on duty who may be operating or attending patients on the ante natal or post natal ward. It is not difficult to see how some women or babies will be missed and tragedies occur.
Arriving on labour ward early in the mornings is still a difficult time for me. Having greeted the night staff I always ask if they have any particular problem cases, prolonged labours or any referred patients. These I attend first. However very often the problems have not been recognized and a quick assessment shows women exhausted from labouring too long and babies struggling to resist. Although these situations continue to frustrate me it is also rewarding to solve the problems, perform the appropriate interventions and give the correct care. My knowledge and experience is increasing as each day presents a new challenge.
The work on the two new maternity wings is progressing well. Some of the buildings are already finished. It’s an exciting time but also full of worries and concerns as to how the change over will take place and particularly as to staffing matters. Malawi has a huge deficit of health workers especially nurses and midwives. We will be opening two units simultaneously with just one skeleton staff. This is our biggest concern. Malawi is not training sufficient nurse/midwives to cover its needs. Many of the more highly trained are being taken up by the private hospitals or NGO organizations and others are leaving the country for greener pastures. How to make working in Bwaila hospital attractive to the nurses and midwives is proving to be a huge challenge. The new buildings and working conditions will of course be tremendous but will that be enough and for how long?
Last week I attended the launch of an iniciative to lobby politicians to commit to reducing the enormously high maternal and neonatal death rate here in Malawi. It was well attended and an appeal was made to government , in light of the impending presidential elections, to increase funding and resources to this end. A young mother told her story of how she nearly died in childbirth. This woman had been attended at Bwaila hospital. According to her story she was badly treated and neglected. The blame once again was aimed at the midwives. It is true we must be accountable, it is also true that women and babies don’t always receive adequate care but it is also true that the midwives are working under great pressures and stress. Appalling conditions, huge lack of staff in all areas, miserable wages not to mention the vast personal problems and loads that many of the midwives carry .Many are responsible not only for their own family and children but also that of their extended family after the death of a sister, cousin or family member. Life expectancy is still less than 40 years. HIV AIDS, malnutrition, hunger, TB and many other illnesses are killing off the poor people of Malawi and leaving vast numbers of orphans to be cared for by others. These sort of public attacks do nothing to raise the moral or encourage the nurse/midwives. CARING FOR THE CARERS is the motto of the National Organization of Nurses and Midwives of Malawi.
I will be an advocate for the midwives of Malawi. We must find ways to support and encourage them not to criticise and demoralize. This is our only way forward.
I believe in miracles more than ever before in my life. Why is that? Because I see them!
Let me share them with you........
Having been attended at a Health Centre several kilometres away from the hospital this mother was referred to us at Bwaila with a prolapsed cord. Those of you who have read my other blogs will understand that this is an emergency situation. It means that the baby’s umbilical cord, its life line, is coming first and is in danger of being compressed by the presenting part either the head or the breech( bum!)This will cause its death before being born. Apparently no ambulance was to be found so she was brought to us on the back of a bicycle! It is a common form of transport as most people will not have a car and the minibus may be too expensive or not available. When she arrived she was examined and taken straight to theatre for a c/section. The operation was performed and the baby was extracted alive and well! The baby was badly positioned in the uterus, meaning that as there was no presenting part in the pelvis there was no cord compression! Mother and baby are doing fine!
Yesterday another cord prolapsed. Yes, it is not uncommon to see this and many prove fatal for the baby. On examination she was found to have a foot and head presenting plus a long loop of umbilical cord. The doctor and midwife rushed to attend. The cord was still pulsating! What should she do? The head would compress the cord but was still high up. Quickly she made her decision and caught hold of the foot. Then with the help of abdominal palpation she was able to catch the other foot. It wasn’t easy but it was worth a try. It took some time, the baby was delivered, they feared it was dead, it looked dead. But no.... there was just a small sign of life. The midwife rushed the baby to the resuscitaire and began work. It took a while, but 30 minutes later it was sucking contentedly at its mother’s breast. Today it’s doing fine!
Now do you believe in miracles?
It’s not uncommon to hear the recently delivered mothers praising God for a safe birth. Mother and baby alive, hallelujah! “ Thankyou Jesus “ they say. I have to agree, but thanks to US, just a little, I say!
These last few days there have been more than 25 births overnight with just 4 midwives. The night shift starts at 5pm and finishes at 8am. This is of course much too long for any person to work continually. This means that they have to take turns to sleep for a while thus leaving the ward covered by 2 or three midwives only. There is one clinician on duty who may be operating or attending patients on the ante natal or post natal ward. It is not difficult to see how some women or babies will be missed and tragedies occur.
Arriving on labour ward early in the mornings is still a difficult time for me. Having greeted the night staff I always ask if they have any particular problem cases, prolonged labours or any referred patients. These I attend first. However very often the problems have not been recognized and a quick assessment shows women exhausted from labouring too long and babies struggling to resist. Although these situations continue to frustrate me it is also rewarding to solve the problems, perform the appropriate interventions and give the correct care. My knowledge and experience is increasing as each day presents a new challenge.
The work on the two new maternity wings is progressing well. Some of the buildings are already finished. It’s an exciting time but also full of worries and concerns as to how the change over will take place and particularly as to staffing matters. Malawi has a huge deficit of health workers especially nurses and midwives. We will be opening two units simultaneously with just one skeleton staff. This is our biggest concern. Malawi is not training sufficient nurse/midwives to cover its needs. Many of the more highly trained are being taken up by the private hospitals or NGO organizations and others are leaving the country for greener pastures. How to make working in Bwaila hospital attractive to the nurses and midwives is proving to be a huge challenge. The new buildings and working conditions will of course be tremendous but will that be enough and for how long?
Last week I attended the launch of an iniciative to lobby politicians to commit to reducing the enormously high maternal and neonatal death rate here in Malawi. It was well attended and an appeal was made to government , in light of the impending presidential elections, to increase funding and resources to this end. A young mother told her story of how she nearly died in childbirth. This woman had been attended at Bwaila hospital. According to her story she was badly treated and neglected. The blame once again was aimed at the midwives. It is true we must be accountable, it is also true that women and babies don’t always receive adequate care but it is also true that the midwives are working under great pressures and stress. Appalling conditions, huge lack of staff in all areas, miserable wages not to mention the vast personal problems and loads that many of the midwives carry .Many are responsible not only for their own family and children but also that of their extended family after the death of a sister, cousin or family member. Life expectancy is still less than 40 years. HIV AIDS, malnutrition, hunger, TB and many other illnesses are killing off the poor people of Malawi and leaving vast numbers of orphans to be cared for by others. These sort of public attacks do nothing to raise the moral or encourage the nurse/midwives. CARING FOR THE CARERS is the motto of the National Organization of Nurses and Midwives of Malawi.
I will be an advocate for the midwives of Malawi. We must find ways to support and encourage them not to criticise and demoralize. This is our only way forward.
Thursday, 29 January 2009
MUM AND MIDWIFE
How to be a good Mum and still continue to give to the women and babies in my care?
This has been in my thoughts almost permanently during the past few days.
On Saturday Lucas started to feel unwell. Most of the night was spent trying to keep down his fever and encourage him to drink. Living in Malawi means that every fever is possible Malaria. By Sunday he was weak and drowsy, had no appetite and just wanted to sleep. He refused all food and it was difficult to persuade him to take fluids. I was concerned but as the symptoms were very different to when he had Malaria last year I decided to wait and see. I am loath to treat without a pretty definite diagnosis. He continued to fell unwell but was not deteriorating. Monday morning he was not well enough to go to school nor did he want to eat but I felt that he was slightly improved. Instinctively I felt that it was not Malaria but could not find any reason for his persistent fever. I called by to inform his teacher. To be expected she was unable to support my decision to wait and see encouraging me to take him for Malaria testing. I began to doubt myself. The test was done much to Lucas’ disgust who also reassured me that it was not Malaria! I was negative. Leaving him with the nanny I went to work. A busy morning on labour ward then a meeting with Tarek and the project manager of the new maternity units to make some last minute changes to the theatres.
Arriving home at 5pm I found Lucas with fever and still feeling unwell. I had asked his nanny to inform me of any changes but she hadn’t. That night the fever continued and we passed another restless night. Tuesday he still wasn’t fit for school but he was somewhat better than the previous day. I still felt I should wait and not rush into unnecessary treatment which I truly believe would be detrimental in the long run. I left him once again with his nanny. Tuesdays are workshop days. These times together with the Bwaila midwives have become enthusiastically attended. They form an important part of my work here in Malawi. We had undergone a ‘quality control’ assessment during the past week and we now had to hear the outcome and discuss its relevance. It was not a surprise to any of us to find that the results were extremely unfavourable. Much can be attributed to the dreadful environment and facilities in which we are working but of course not all. There are so many areas for improvement. I was encouraged to see how quickly and openly the midwives began to participate in the discussion. It is so important that the solutions or recommendations come from the midwives themselves. I was able to stress the importance of working as a team and try and find small attainable goals on which to start improving. We have actually put some of these into practice already. We are also using these workshops to audit maternal death files of which we have four since the beginning of the year. We look at the details surrounding the death picking up any areas of poor or insufficient care or attention. Lack of staff or materials including laboratory or blood transfusion services. We then decide on actions to be taken and personell to be informed. This is proving to be a strong teaching aid. It confirms my belief that most of the midwives have the knowledge but very often are not converting this into everyday situations. How to achieve this has become my greatest challenge. So I returned home after another busy day. Lucas still had a slightly fever. He was now eating small amounts but as he explained to me “ Mum, I feel strange” Now I was beginning to feel insecure. Was I making a big mistake? Did he need to see a paediatrician? Was I withholding necessary medication? Was I being stubborn? Did I really know what I was doing? I made a decision there and then......If he continued to have fever the next morning we would go hastily to consult a specialist.
We both slept well that night. The best night’s sleep in days. On awaking this morning I could tell that he was better. No fever, hungry for breakfast and willing and keen to go to school. What a relief! I arrived on labour ward soon after 7.30am. The ward was full of women, many waiting for beds. It was going to be another crazy day! Our Norwegian obstetrician was calling for help. The placenta had separated from the uterine wall and the woman was bleeding profusely. The baby was already dead but she feared for the life of the mother. She quickly delivered the child with a vacuum extraction. We were prepared with IV lines, medication and most importantly with a ‘team’ of people. The massive haemorrhage was controlled, blood was available for transfusion, her life was saved. On another bed Stella had pushed out a 24week foetus (abortion) totally unattended. She was lying in a pool of blood, amniotic liquid, urine and faeces. I gave her the appropriate medication to prevent bleeding and began to clean her up. If she decides not to take away the foetus it goes in the bin along with the placentas.....that was the hardest part for me. That was just that was just the start of the day. Then came the usual pre eclampsias, post partum haemorrages, obstructed labours, foetal distress, birth on the bathroom floor ( not to be recommended ..the floor is filthy) I performed 2 vacuum extractions for foetal distress and fortunately just before leaving for home at 4.30pm.one nice straight forward uncomplicated birth. No babies died, though some had to be resuscitated, nor did we loose any mothers. My legs were aching, my throat was dry, I suddenly remembered I hadn’t eaten all day.
The best was arriving home. Lucas came running out to meet me. No shirt, no shoes with his arms open and a big smile. He was obviously better. He stopped when he saw me “I’m not going to hug you with all that blood and stuff on you” The troubles of the day disappeared, the tiredness left me as I took him up in a big hug despite the smelly uniform!
This has been in my thoughts almost permanently during the past few days.
On Saturday Lucas started to feel unwell. Most of the night was spent trying to keep down his fever and encourage him to drink. Living in Malawi means that every fever is possible Malaria. By Sunday he was weak and drowsy, had no appetite and just wanted to sleep. He refused all food and it was difficult to persuade him to take fluids. I was concerned but as the symptoms were very different to when he had Malaria last year I decided to wait and see. I am loath to treat without a pretty definite diagnosis. He continued to fell unwell but was not deteriorating. Monday morning he was not well enough to go to school nor did he want to eat but I felt that he was slightly improved. Instinctively I felt that it was not Malaria but could not find any reason for his persistent fever. I called by to inform his teacher. To be expected she was unable to support my decision to wait and see encouraging me to take him for Malaria testing. I began to doubt myself. The test was done much to Lucas’ disgust who also reassured me that it was not Malaria! I was negative. Leaving him with the nanny I went to work. A busy morning on labour ward then a meeting with Tarek and the project manager of the new maternity units to make some last minute changes to the theatres.
Arriving home at 5pm I found Lucas with fever and still feeling unwell. I had asked his nanny to inform me of any changes but she hadn’t. That night the fever continued and we passed another restless night. Tuesday he still wasn’t fit for school but he was somewhat better than the previous day. I still felt I should wait and not rush into unnecessary treatment which I truly believe would be detrimental in the long run. I left him once again with his nanny. Tuesdays are workshop days. These times together with the Bwaila midwives have become enthusiastically attended. They form an important part of my work here in Malawi. We had undergone a ‘quality control’ assessment during the past week and we now had to hear the outcome and discuss its relevance. It was not a surprise to any of us to find that the results were extremely unfavourable. Much can be attributed to the dreadful environment and facilities in which we are working but of course not all. There are so many areas for improvement. I was encouraged to see how quickly and openly the midwives began to participate in the discussion. It is so important that the solutions or recommendations come from the midwives themselves. I was able to stress the importance of working as a team and try and find small attainable goals on which to start improving. We have actually put some of these into practice already. We are also using these workshops to audit maternal death files of which we have four since the beginning of the year. We look at the details surrounding the death picking up any areas of poor or insufficient care or attention. Lack of staff or materials including laboratory or blood transfusion services. We then decide on actions to be taken and personell to be informed. This is proving to be a strong teaching aid. It confirms my belief that most of the midwives have the knowledge but very often are not converting this into everyday situations. How to achieve this has become my greatest challenge. So I returned home after another busy day. Lucas still had a slightly fever. He was now eating small amounts but as he explained to me “ Mum, I feel strange” Now I was beginning to feel insecure. Was I making a big mistake? Did he need to see a paediatrician? Was I withholding necessary medication? Was I being stubborn? Did I really know what I was doing? I made a decision there and then......If he continued to have fever the next morning we would go hastily to consult a specialist.
We both slept well that night. The best night’s sleep in days. On awaking this morning I could tell that he was better. No fever, hungry for breakfast and willing and keen to go to school. What a relief! I arrived on labour ward soon after 7.30am. The ward was full of women, many waiting for beds. It was going to be another crazy day! Our Norwegian obstetrician was calling for help. The placenta had separated from the uterine wall and the woman was bleeding profusely. The baby was already dead but she feared for the life of the mother. She quickly delivered the child with a vacuum extraction. We were prepared with IV lines, medication and most importantly with a ‘team’ of people. The massive haemorrhage was controlled, blood was available for transfusion, her life was saved. On another bed Stella had pushed out a 24week foetus (abortion) totally unattended. She was lying in a pool of blood, amniotic liquid, urine and faeces. I gave her the appropriate medication to prevent bleeding and began to clean her up. If she decides not to take away the foetus it goes in the bin along with the placentas.....that was the hardest part for me. That was just that was just the start of the day. Then came the usual pre eclampsias, post partum haemorrages, obstructed labours, foetal distress, birth on the bathroom floor ( not to be recommended ..the floor is filthy) I performed 2 vacuum extractions for foetal distress and fortunately just before leaving for home at 4.30pm.one nice straight forward uncomplicated birth. No babies died, though some had to be resuscitated, nor did we loose any mothers. My legs were aching, my throat was dry, I suddenly remembered I hadn’t eaten all day.
The best was arriving home. Lucas came running out to meet me. No shirt, no shoes with his arms open and a big smile. He was obviously better. He stopped when he saw me “I’m not going to hug you with all that blood and stuff on you” The troubles of the day disappeared, the tiredness left me as I took him up in a big hug despite the smelly uniform!
Sunday, 18 January 2009
THERES NO HIDING THE TRUTH
"Megan's mummy died at Christmas so she could have her presents in heaven"
This was Lucas' news after his first day back at school. How easy how simple it was for a child to accept the unacceptable, to rationalize the unrationable, to fathom the unfathomable.
Is this why we hide the truth from our children? To protect them from reality, from the pain of knowing too much?
"But she died at the wrong time" he continued.
Now I was confused... I thought he had it sorted out? What did he mean now?
"Well you're supposed to die when you are old and she was just forty or fifty!"
That night he found it hard to get to sleep, we talked and we cuddled. He demanded I stay with him. I held him tight and he slept.
Being in Europe during our Christmas vacation was a bit like that... it made me realize how easy it is to hide from the truth, from the reality of Africa. Most people didn't want to know, didn't ask. They didn't want to hear of the poverty, the appalling conditions in the hospital, the critical shortage of nurses and doctors, the preventable deaths.... No, that would upset their comfortable world, so better not to ask. But not all ...some like Lucas knew there was more, that they wouldn't and shouldn't be protected from the pain. Here I found great generosity of spirit and of love. I found both financial and emotional support and for that I am grateful. You know who you are.. I don't need to put names but I do thankyou from the depth of my heart.
Christmas in Spain was all I expected and more. Being together with all my four children is such a priviledge and a joy. I am such a proud mum! How I miss them...but how lucky I am! Lucas spent many happy hours with his Dad which was just what he needed. He was pleased to find that he hadn't forgoten how to speak Spanish and even communicated with his Spanish family in Valenciano with ease.
We then spent time in UK visiting my family and a few old friends. I was so pleased to find my Mum in good health and spirits despite her recent operation. Its so much easier to be working here, however difficult it might be at times, knowing that these people love and care for me/us.
And so we arrived back in Malawi after a long and tiring flight through Nairobi and Lusaka. It felt good to be met at the airport by our good friend Mina, she and her family have adopted us since the day we arrived.
Going back to labour ward felt good. I was received with such warmth. Cries of how much I had been missed and lots of hugs. It's strange how one feels after being away, that things should have changed, but then you find they havn't and that makes you feel comfortable. Of course there is so much room for change at Bwaila I should have been happy to find some signs of improvement but no things were just the same.
Thursday was a public holiday. I knew we would be short staffed so decided to start work early.
It was probably one of the busiest days ever with just a skeleton nursing staff and one clinician. From 7am untill I left, exhausted at 2.30pm women were delivering their babies anywhere and everywhere, On the floor, between the beds, on unwashed matresses finding space whereever they could. I spent my time caring for mostly high risk mothers although couldn't help but catch two or three as they popped out unaided and unaccompanied on the next door bed. During these times its all about prioritising, I can't attend you all so who needs me most? Sometimes its the one who shouts loudest but thats not always the right one. How difficult it is to ignore their cries of "nursey, nursey, pain, pain!" but they are often ignored. She was just 17 years old and already HIV positive having her first baby, what were her chances of surviving to see her child grow. ?
Another 20 years old also HIV positive with chronic anaemia aborting her first pregnancy at 24 weeks. Luckily we managed to find blood to transfuse ,the following day she was still alive. Then there was the woman carrying her 10th child but with no living child. Now 2 weeks past her due dates and with a dead child. And so it went on and on that day. When I left the beds were stll full but I could do no more.I was phisically and mentally exhausted. The hardest thing is to walk away. I dont think I will ever learn how to do that well.
Then I came down with a rotten chesty cough and cold. I remember thinking as I listened to that man on the plane coughing loudly I wonder how many of us will catch that? Well I did!
Friday no labour ward. I left my cosy bed to attend our weekly 'Quality Improvement' meeting.Tarek and I arrived both arrived on time at 2pm. By 2.40pm we were still waiting. When the first attendants started to arrive 45minutes late we were so discouraged by the lack of interest we postponed the meeting until next week. Saturday morning I was to meet with other nurses to audit the maternal death files. This is supposed to take place regularly with the aim of critically reviewing the circumstances around the death focusing on where the problems are and taking the appropiate actions. Once more no one arrived. I set about organizing the files and taking a brief look at some of them. I was eventually joined by one of the senior nurses. We only audited one file. For me that was enough. This maternal death was purely and simply due to absence of blood for transfusion from the central blood bank and delay in organizing family donation which may have saved her life. This must be difficult for you to believe but it is the continuing reality of Malawi.
Tomorrow is another day. I will do what I can...that is all.......
,
This was Lucas' news after his first day back at school. How easy how simple it was for a child to accept the unacceptable, to rationalize the unrationable, to fathom the unfathomable.
Is this why we hide the truth from our children? To protect them from reality, from the pain of knowing too much?
"But she died at the wrong time" he continued.
Now I was confused... I thought he had it sorted out? What did he mean now?
"Well you're supposed to die when you are old and she was just forty or fifty!"
That night he found it hard to get to sleep, we talked and we cuddled. He demanded I stay with him. I held him tight and he slept.
Being in Europe during our Christmas vacation was a bit like that... it made me realize how easy it is to hide from the truth, from the reality of Africa. Most people didn't want to know, didn't ask. They didn't want to hear of the poverty, the appalling conditions in the hospital, the critical shortage of nurses and doctors, the preventable deaths.... No, that would upset their comfortable world, so better not to ask. But not all ...some like Lucas knew there was more, that they wouldn't and shouldn't be protected from the pain. Here I found great generosity of spirit and of love. I found both financial and emotional support and for that I am grateful. You know who you are.. I don't need to put names but I do thankyou from the depth of my heart.
Christmas in Spain was all I expected and more. Being together with all my four children is such a priviledge and a joy. I am such a proud mum! How I miss them...but how lucky I am! Lucas spent many happy hours with his Dad which was just what he needed. He was pleased to find that he hadn't forgoten how to speak Spanish and even communicated with his Spanish family in Valenciano with ease.
We then spent time in UK visiting my family and a few old friends. I was so pleased to find my Mum in good health and spirits despite her recent operation. Its so much easier to be working here, however difficult it might be at times, knowing that these people love and care for me/us.
And so we arrived back in Malawi after a long and tiring flight through Nairobi and Lusaka. It felt good to be met at the airport by our good friend Mina, she and her family have adopted us since the day we arrived.
Going back to labour ward felt good. I was received with such warmth. Cries of how much I had been missed and lots of hugs. It's strange how one feels after being away, that things should have changed, but then you find they havn't and that makes you feel comfortable. Of course there is so much room for change at Bwaila I should have been happy to find some signs of improvement but no things were just the same.
Thursday was a public holiday. I knew we would be short staffed so decided to start work early.
It was probably one of the busiest days ever with just a skeleton nursing staff and one clinician. From 7am untill I left, exhausted at 2.30pm women were delivering their babies anywhere and everywhere, On the floor, between the beds, on unwashed matresses finding space whereever they could. I spent my time caring for mostly high risk mothers although couldn't help but catch two or three as they popped out unaided and unaccompanied on the next door bed. During these times its all about prioritising, I can't attend you all so who needs me most? Sometimes its the one who shouts loudest but thats not always the right one. How difficult it is to ignore their cries of "nursey, nursey, pain, pain!" but they are often ignored. She was just 17 years old and already HIV positive having her first baby, what were her chances of surviving to see her child grow. ?
Another 20 years old also HIV positive with chronic anaemia aborting her first pregnancy at 24 weeks. Luckily we managed to find blood to transfuse ,the following day she was still alive. Then there was the woman carrying her 10th child but with no living child. Now 2 weeks past her due dates and with a dead child. And so it went on and on that day. When I left the beds were stll full but I could do no more.I was phisically and mentally exhausted. The hardest thing is to walk away. I dont think I will ever learn how to do that well.
Then I came down with a rotten chesty cough and cold. I remember thinking as I listened to that man on the plane coughing loudly I wonder how many of us will catch that? Well I did!
Friday no labour ward. I left my cosy bed to attend our weekly 'Quality Improvement' meeting.Tarek and I arrived both arrived on time at 2pm. By 2.40pm we were still waiting. When the first attendants started to arrive 45minutes late we were so discouraged by the lack of interest we postponed the meeting until next week. Saturday morning I was to meet with other nurses to audit the maternal death files. This is supposed to take place regularly with the aim of critically reviewing the circumstances around the death focusing on where the problems are and taking the appropiate actions. Once more no one arrived. I set about organizing the files and taking a brief look at some of them. I was eventually joined by one of the senior nurses. We only audited one file. For me that was enough. This maternal death was purely and simply due to absence of blood for transfusion from the central blood bank and delay in organizing family donation which may have saved her life. This must be difficult for you to believe but it is the continuing reality of Malawi.
Tomorrow is another day. I will do what I can...that is all.......
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