Village adventures - Part 2

Hi guys

The next day we set off back to the village hospitals to do some teaching (see pic of a labour ward at one of them below). I went to the maternity section to do some ‘teaching on the run’ - in neonatal resuscitation and shoulder dystocia management. Whilst teaching neonatal resus 2 women were in labour.

It is typical for no observations to be performed during or after labour - no one listens to the baby’s heart beat or checks the mothers blood pressure/pulse. Most of the time you don’t really have any idea what gestation (weeks pregnant) the baby is and nearly all the time there is meconium stained waters (baby has had a poo before birth and water goes green/brown). For this and many other reasons many babies are born and require resuscitation. I therefore used the opportunity to my advantage and went in and assisted with the birth. The baby (as I suspected) was born in very poor condition. I talked the nurse through the resus procedure which I had just been teaching her and we worked together to resus the baby. It took a while but the baby finally starting breathing on it’s own. It was amazing to teach in real life and know that you have possibly helped save a baby’s life. I am unsure if I had not been there what they would have done, as they seemed no hurry to act on the very obvious signs of this baby requiring resus - nothing is a hurry over here! This is one of the babies I helped resus.

 

So many babies die over here. In one hospital, one morning I went in and 5 babies had died overnight - it was difficult to determine the cause. I wondered had I been there to help if things would have been different? The nurse did an amazing job though, and gained huge experience in this emergency. I hope that when she is next faced with that situation she will know how to manage it better. Over the next few days this situation became a frequent event and we resuscitated many babies. See pictures below with the hats and booties I gave them - every resus’ed baby I gave a hat/bootie’s and clothes too - figured they deserved it!

 

Following this we went onto the other 2 villages and continued to do the same teaching. We managed to teach heaps of doctors and nurses in all sorts of emergencies. Whilst at one of the hospitals we visited the labour ward which consisted of 2 beds in a room. Two women were in labour, one of which had ruptured her membranes (waters had broken) 3 days ago. She was not in labour and had been contracting on and off for 2 days. Whilst there I assessed both women to make sure they were ok and there were no problems that I could assist with. I discussed with the nurse and doctor about management of ruptured membranes and the importance of antibiotic cover and augmenting the labour (inducing labour). I managed to get the doctor to prescribe antibiotic’s and then had to arrange the family to go and buy the drugs (nothing here is free!) from the hospital pharmacy and bring it back for her so we could administer. They did not want to augment the labour as it was the women’s 7^th child and they said this was risky, this would usually be done in the main hospital - a 2 hour drive. I then tried to encourage the doctor to transfer this women for this procedure rather than wait any longer as the risk of infection was too high and there were no facilities here for the baby should it be unwell. Thankfully when I returned the next day I discovered the women had been transfer.

The other women was HIV positive, she was in labour with her first baby and was very distressed and scared. She looked about 17 years old. HIV is very common here I have been told the figures are anything from 10-70% and apparently higher in the villages. I have learnt a lot about HIV management and drug therapy in pregnancy, labour and after birth and have met more HIV positive women and babies in four weeks than I have or ever will in my career. The next day when I returned this women had birthed a beautiful baby girl. I gave her a hat and some clothes and congratulated her.

Tonite we are planning a small party for some of the locals at the accommodation we are staying at. Our food usually consists of rice and spinach, tonite they are cooking a special meal! Hmmm… I will let you know how that goes.

　
Cherish your life and your children, because no mater the difficulties we face at home we have to be thank full for the awesome health care and access to drugs/experience medical professionals we are all so lucky to have, compared to here. I know several of you who know this all to well. xx