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

Village adventures - Part 1

Hi guys

So after a long journey up into the hills of Africa we arrived at our accommodation for the rest of the week - village style! You could call it a little African village resort. It had little bungalows set in a tropical garden and a little bar, what more could a girls want! The views were stunning, we were in the heart of Africa now with beautiful banana and coconut tress everywhere and hills that just went on and on. My room was basic and kind of clean! Thank god for wet wipes, thats all I can say. I had to give the sink a once over as it was pretty dirty. My only real complaint would have been the toilet - it was a sink in the ground. Anyone who says squatting to go to the toilet is natural - they are liars!!! It felt like the most unnatural thing in the world. I now officially apologise to all those birthing women over the years, I have encouraged to squat to give birth, lol. Here I am squatting over this sink in the ground trying not to touch anything as it stinks and doesn’t appear very clean (no way I was getting my wet wipes in there!). I look up and there are these 2 eyes looking down at me. It was a rather large lizard on the ceiling, I nearly fell in the toilet at this point.




After settling into our accommodation we set off in the local ambulance for a drive further into the villages. From here on in the tarmac rd turned to a 4x4 rd so we couldn’t go any further in our poor little Rav 4. The ambulance had been purchased for the villages by the program I am working for, to help encourage them to transfer their patients to the main hospital earlier, I was later to find that it was not used as often as it should have been!

So we set off along this rd with the 4 of us sat in the back of this ambulance, we had no seat belts (sorry mum!) and the rd just got worse and worse. We were bouncing around like were on a bouncy castle, we were laughing our heads off for the first 10 minutes, after that we were over it. There were huge pot holes and craters in the ground made from the rain which created big holes. We went up and down these big slopes and tilted to the side like it was going to tip over. It was an interesting hour long journey that was for sure. Not sure if the suspension was gone on it or not ( Dad we could have done with you help here to have a look at it for us) but it was the roughest journey I have ever had (note to self- wear sports bra tomorrow, lol).

 

One of the ozzie midwives had bought a giant kangaroo with her, whom she had named Ruth - we are doing the adventures of Ruth! She comes with us everywhere and has her photo taken in all these weird places - she was our patient in the ambulance and even Ruth who is used to bouncing all day was not happy (lol), but the locals loved her. We are using her to demonstrated the idea of kangaroo mother care (non midwives may need to goggle this concept - although prob can guess!).

We visited 3 villages and met all the local nurses and doctors at the local clinic’s/hospitals there. Each clinic was small but had 2 labour beds and 2 postnatal beds. They obviously did everything here from GP clinic’s, child health, maternity to A&E. We met some of the villagers and saw how they lived in these amazing mud huts. Everyone was so friendly and pleased to see us. I don’t think some of them had ever seen a white person as they were all staring and looked shocked to see us. The kids were especially funny laughing and staring and trying to touch us like we were aliens or something, it was funny to see. We arranged with them the training which we were going to provide for the rest of the week and then headed back to our accommodation along the same bumpy rd!

Back at base camp we sat and had a Savannah dry and watched the sun set over the hills of Africa - awesome day had by all.

　
Will blog again soon xxx
　

Pit falls of living in Tanzania

Hi guys

Without taking away from the fact that I know I am very lucky and appreciate everything I have both here in Tanzania and at home and the fact that I know I live 5 star compared to the locals. I wanted to share some funny things with you all about living here.

Firstly, my shower is in my toilet - literally. I could sit on the toilet and have a shower at the same time (see photo)! Paul this would be an amazing idea for you as you spend so much time in both the toilet and the shower you could now multi task and been ready in half the time! Think if we ever build again I will add this innovative solution for you!

My bra is a money tree (no photo of this! LOL). Because it is not safe to take a bag out we put our money down our bra’s. The other midwives with smaller boobs are pleased about this bust enhancement and also put their phones and keys down there. I, on the other hand need no extra help in this department! Almost every night I forget about the money I have hidden down my bra and get undressed only to find all this money falls to the floor! Anyone would think I’d been working at a strip bar!

Mosquito’s eat me alive every night! No mater how much mossie spray I put on I get bitten every night. I get dressed and then spray all my naked skin (which isn’t a lot due to having to cover up). I get home and I find mossie bites on my neck, on my skin where my cloths have been, any where you possible. Today’s bites include hip and buttocks. How is that even possible LOL.

Our house is two doors down from a mosque. Four times a day this man comes on a speaker phone singing some Muslim prayers, including 4.30am! I wake up every morning thinking it’s Paul talking in his sleep again!

I go to work in the hospitals and dress up like a person working in a nuclear planet and lose half my body weight in fluid!

I’m sure there are many more to tell you but that is all I can remember right now. Hope it made you chuckle.

Take care xx

 

Graduation and party time

Hi guys

Well today was the last day of our 2 week course and what a day it was.

We had a little test for the participants in the morning and then in the afternoon we had ‘graduation’. We told them all to wear their best frocks and that we would have a party. We made cakes for them and took drinks and sweets and asked them to bring in some African music.

The day went really and we had an amazing graduation party. The classroom went off! We had African dancing and they were so please with the course that at the end they presented us with a kanga (sarong) and home made card and sang/chanted for us.

It was so sad to say goodbye to them as they were all so lovely and keen/interested to learn. I am keen to go back and see them again at their hospitals and do some more shifts with them before I go home, hopefully I will have the chance.

I went back and saw the ‘yellow hat’ baby who is thankfully still alive and doing ok. Still not sure where/how it’s mum is though. They said he was doing really well as its temperature was now 35.9! It was 34.1 two days ago so I guess that is an improvement!

We are off to the villages tomorrow so will have no phone/internet signal for a week. Apparently there is nowhere to buy food there and only a BBQ type thing to cook on so all we will get is rice and spinach, interesting. I have already lost 4kg in 2 weeks so looks like I may loss a few more, easy way to diet when there is nothing to eat LOL. Louise K, I may have fitted into that bridesmaid dress after all - who needs surgery!

　

Will update you next when I can.

Take care xx

Millenium development goals

This is what we are working towards.

http://www.youtube.com/watch?v=w3pbbTx1xY8

Teaching Midwifery in Tanzania

Hi guys

Things are going well here. This week we have continued to teach the 16 participants (nurses) on our 2 week course. They are doing really well and are very pleased with what and how we are teaching them. They all seem extremely grateful for the course and all are very keen to learn. We have mainly focused on Adult and Neonatal resus and obstetric emergencies.

Yesterday I went and worked in the hospital again with the participants on the course. Whilst there I managed to assist the them to teach other nurses and doctors the things we have taught them on the course. The idea behind this course is a ‘trainer the trainer’ notion, in the effort to up-skill the staff so they can then up-skill other staff. It was an amazing day and between myself and another aussie midwife I think we managed to train about 150 nurses and doctors in Adult/Neonatal resus and obstetric emergency (see the pictures attached). It was an extremely interesting day and hard to comprehend that basic resus is not a skill they have, yet they have far more need for it than we do, with very high maternal and neonatal death rates than the western world.

Whilst I was on the neonatal ward teaching I helped care for a very tiny baby - 1.5kg. They said it was 34 weeks gestation but I think it must have been a lot younger! It was hardly breathing, very pale and looked very sick. It was left wrapped in a sheet on a cot bed. It’s mother was very sick too, so unable to help care for her baby. I managed to talk the nurses though a baby check and discuss the signs and symptoms which this baby was demonstrating which shown respiratory distress (struggling to breath). We did some basic observations including a temperature - which was very low. This baby clearly needed specialist care in a neonatal unit but I looked around the nursery and there was no real equipment to help treat this baby. I managed to assist them to set up oxygen therapy, discussed the use of antibiotic’s (which they did have) and talked to them a lot about keeping the baby warm, I gave the baby a yellow hat an boots (which one of you have knitted for them) to help improve the baby’s temp. I also talked to them about ensuring that it was fed. I got the impression that as the mother was sick the baby was not being fed but was not sure about this? It was very hard due to the language barrier and as formula is very expensive, like many things it is not available in the hospital. I tried to discuss donor milk but with such a high HIV rate that had it’s own issues. In the end they gave the baby some fluid and glucose via a syringe - that will have to do I thought! I will go back soon and check that baby is still doing OK and keep you posted.

My attempt at learning the native language Swahili is not going very well LOL. All the staff in the hospital keep taking the mick out of me as I am terrible! Think I may regret not doing a crash course before I left next week when I get down to the villages as I think there English may be as good as my Swahili!

I will post again soon. Take care and keep life in prospective. xxx

Day in the life of the hospital

Hi guys
Well I survived my first day working in a hospital, and what a day it was!
After an orientation of the entire hospital I worked for 3 hours on labour ward. The labour ward was about the size of 1 birthing room at Kings Eddies or STMH. It had 8 beds, between every second bed was a half wall (so if you were stood up you could see over it but lying down you couldn’t). Each bed was so close that whilst assisting a women to birth on my left I could touch the women to my right. There were no curtains between the beds so each women could see each other giving birth. For this reason & cultural reasons they birth alone without a support person or partner. I did not see anyone have any pain relief and am unsure if they even have any available but will find that out next week I’m sure.

During the 3 hours I was there I assisted with 5 births and tried to teach 1 nurse to stitch (as they have no training but just get on with it!). There were five other nurses there and I think about 10 babies were born in those 3 hours. The hospital has 60-70 births a day! With 4-5 midwives per shift and 1 doctor - I will never complain about staffing levels again in UK or Oz!! We literally went from one birth to another.

Picture this - “I have a hair net on, goggles, a huge white apron, face mask and gloves. It’s 35 degree’s with 85% humidity and I am sweating my ass off. I have sweat dripping down my gloves and when I take one pair off I can’t get the next set on as my hands are dipping wet.” When I finally took it all off I had droplets of water on my name badge and pocket bag I had on under the apron, my clothes were wet through! Think I lost my body weight in fluids that day!

Once the women gave birth they stood up, put on their pants and a sarong and went and sat on a wooden bench to breastfeed their baby. Within 30 minutes of giving birth they are taken to the ward (walked |I must add!) where they share a bed with 3-4 other women. If all is well was well they would probably be discharged home after 6-12 hours.

Thankfully whist I was there all mothers and babies were well. They have an interesting set up as the women stay on the ‘pre-labour ward’ until they are 7cm then they are moved to the labour ward to give birth. They either have natural vaginal births or caesarean’s - they do not do ventouse or forceps births. They do appear to do quite a few caesareans and do classical incision (for my midwifery friends - I have pictures!).

The mothers have to bring in all their own stuff for the birth - to include a syringe, cord clamp, blade (to cut the cord) and a huge role of cotton wool to mop up the mess! Nothing is supplied by the hospital. One women forgot to bring her cord clamp so we improvised with a piece of a plastic glove to tie the cord off! Worked extremely well and very cost effective I’m sureJ may have to bring that in at CMP - LOL.
They also bring in 4-5 ‘kangas’ (or to us sarongs) 2 for the baby and 2 for the mum & 1 to help mop up the mess. All of this in a little hand bag - none of this western world crap of turning up to hospital to give birth with 2 suitcases full of stuff!!

After this I went to the neonatal ward for a short while to see the tiny babies again. I gave them some of the knitted hats and booties which some of you knitted for them. They were so please with the gifts it was lovely to see - so thank you heaps for those of you that knitted stuff. With the children’s gifts and other baby clothes you have all given I have made up little gift bags (as you can see above) We have already given some away but are going to take the rest to the village which we are going to for a week on the 12^th May as they are even more deprived there.

Next week I am teaching 2 days and in the clinical areas for 2 more days so will have more to tell then I’m sure.
Thinking of you all, take care xxx