Teaching continues

Hi Guys

On return from Zanzibar we set back to work in the main city, continuing to train the local nurses and doctors at the local hospitals. The train the trainer idea was in full swing now and all our nurses were doing a great job at training other nurses and doctors.

One day I went to a hospital to assess the nurses on our course. They had to teach a skill and be assessed doing this. I went to all the maternity wards and assessed several nurses who were on our course. They all did very well, I had the props with me like a baby doll for resus and a mini Annie for adult resus etc. Then I got to the pre-eclampsia (high blood pressure) ward (yes pre-eclampsia is such a problem here they have a whole ward of women with it!). This one nurse was going to teach her fellow nurses and doctors how to manage an eclamptic fit. When I got their she was all prepared, she had all the equipment they used ready and took me over to a women who was 39 weeks pregnant and had been admitted with pre-eclampsia a few days ago. All the staff huddled around and the nurse started to provide me with a case review about this women. I was stood there wondering that this was a little strange as we were with an actual women and I was unsure how she was going to do a drill in this ward as it was extremely busy and there was no spare bed to use.

As I was considering this the women started pretending to fit!!! I was mortified, the nurse had actually asked a real women who actually had pre-eclampsia to role play her situation. All of a sudden all this equipment was being pull out and I was actually worried they were really going to use it (for real!). At one point as I was stood there I actually had to check with the nurse that the women was not actually fitting! My face must have said it all I was so shocked - morally and ethically this is something we could never do in the UK or Oz!

The poor nurse who I was assessing, bless her she thought she had failed as my face must have been a picture. Fair play for her to use her initiative though it currently lead for an interesting a real to life role play - one I will never forget! After that I felt so bad for the poor woman that I conducted an antenatal check on her and checked her blood pressure and talked through with the doctors her plan of management to ensure she was being well looked after. She was very great full - they see white people and assume they are in safe hands, so that was one good thing that came out of it.

Another day whilst working on the ward I met a 19 year old girl who was 37 weeks pregnant and had been admitted the previous day with pre-eclampsia. Her BP on admission was 160/110 (this is very high, for all you none medical people). She had also just discovered she was pregnant with twins. Whilst teaching the nurses about pre-eclampsia and assessing this woman, I checked her record (which are practically nothing) and her blood pressure was still the same. She had apparently been in hospital for 12 hrs and had 3 lots of medication and yet her BP had not actually changed. Her BP during this time had not been checked since admission, even though they all knew it was supposed to be checked 4 hrly on this ward. I found this hard to understand that despite 3 x medication nothing had changed. I tried to explain this to the nurses and they told me her BP had been checked but just not documented (Hmmm...?).

When I finally got to the bottom of things, I discovered that not only had this women not had her BP checked in 12 hrs she had also not had any further medication since admission. The nurses do not seem to talk to the women. There are so many women on the wards the nurses do not even know who they are. The have no name bands on, all share beds and have no charts on the beds. The only way they could identify the women was by pulling their charts and shouting out their name from the front of the ward. I have no ideal how they even know who's chart they are writing in or who they are giving the medication to. It was mind blowing! Eclamptic fits are so common here, I have seen many already. I wonder if just through simple management and organisation these could be reduced. I don't even think basic observations like a BP is being done and this may be all it takes to save many more lives.

Take care all and I will see you all soon. xx