This week was again quite exciting! Another one in the hospital but this time I was much more moving around. The week started in Antenatal Ward and just for the beginning of the day the students (again it seems like the students are doing all the work while the nurses do the chatting) gathered all the pregnant ladies together in the big hall of the ward and have a prayer. Then there is a little education lesson to give some information about delivery, how to prepare, what to expect, what kind of pain relief is available (only pethedine when you´re less then 4cm dilated, epidurals not available) and of course family planning, HIV/AIDS and ideas how to get the few days off home for delivery and recovery after. After that they sing and I tell you it gives you such an Africa feeling! The rhythm and voices are so breathtaking, I loved it! The rest of the day we went on ward rounds with the joking around doctor who was some 2 years younger then me and started asking me to confirm all his diagnosis and plans. So I ended up confirming PSROMs and breech presentations not exactly knowing why.
Not so nice is to see these AIDS patients who are pregnant. They keep the tough cases like HIV and Malaria in an extra room, you just know there is not much you can do for them or the baby. Sad to see it, they´re in such bad condition because everyone has given up on them already. But Antenatal was a good day, I enjoyed it especially because it was kind of organized compared to delivery, but maybe I´m just getting used to it? I dont know.
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| thats the lesson |
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Tuesday and wednesday then I spent in postnatal ward. Here it was much more confusing and not so organized so I didnt get used to and I just got a bit spoiled in antenatal. So the days in postnatal I spent listening to the nurses chatting in Chichewa, watching them renewing wound dressings and giving out drugs which are not really written up. It was interesting to see how different the skills are between the midwifes and midwife students. The students are much more hygienic and logic in doing things, so there is hope for the health sector. This orientation really helps me to figure out what are the problems and the things which can be improved. Definitely documentation and logical/problem solving thinking! I cant wait to start teaching the new midwife students. I also went to the college every now and then to show my face and not get forgotten about, also the new nursing students arrived and a new teaching year started but no sign of the midwife students yet. In Malawi they have to do a three year nursing training first and then after that they can do another upgrating year to become midwifes. Men and women both and most of the nurses want to do the extra year because then they earn more money. This is what my job is going to be like, teaching and superwises these nurses to become midwifes. At the moment I´m lined up for the Midwifery Skills 1 teaching which is physiological antenatal, delivery and postnatal and also anatomy. So there´s a lot for me to prepare for.
In terms of getting to know the malawian culture a bit better it was quite interesting in postnatal. I had this long chat with one of the nurses who asked me a lot of questions about Germany in comparison to Malawi. She couldnt believe that there was also a big culture in Germany with traditional clothing, houses with roofs made of branches and also flies and mosquitos in Germany. But of course the difference is huge and our houses are mostly made of stone. But still I think I could get the point across that the western world doesnt only excist of skyscrapers and businiss, most important for her that we also believe in God. Anyway God is what most people here are really believe in but I guess when you cant believe the politics or economy, when all your hopes for better times are mostly getting destroyed whats left then but your believe in God or anything what makes you not to give up. I have a huge respect of all these poor people living here. Its a hard life! And you dont forget where you are, there are alive pigeons in plastic bags in the ward office, keeping them fresh for dinner. They´re the nurses cooking Mzima in their lunch break, eating it by hand the traditional way, there´s a lot of talking going on anyway (I wish I could understand Chichewa and long chats with mothers or guardians about all kinds of topics.) Its just more personal and they follow some invisible ruels propably from which tribe they´re from because sometimes women come in kneeling into the office and some seem to not need to give this respect and just come in easy. It was interesting to just watch and observe. One nurse told me she has been in London because she won this dinner with prince charles on a tombola. So she went with her husband and stood in a posh hotel and then went into the bukingham palace for meeting the prince. I dont know if this story was true but she seemed very convinced. She couldnt get over the fast moving city London and the underground which carries you a distance of Blantyre to Limbe in 5 minutes. "So fasti, my friend, I was always confused I was! Oh Lord!" she said. Only people and cars and dogs on the street, no goats, no chicken, no markets. It must have been such a weird experience for her. She preferes Malawi although its poor, but at least not so hectic.. Right she is!
This is postnatal ward
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| waiting for getting seen |
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| the staff of postnatal and me |
On Thursday I went to the antenatal clinic with a lot of singing and praying in the morning again.. Thursday is high risk clinic so all these twins and breech pragnancies, high blood pressure and previous c/sections. It was really interesting but unfortunatly there were no doctors around so they wanted me to do all the ultrasounds and confirmation. So I practised my ultrasound skills but only as much as figuring out if its breech or head first, twins or no twins and where the placenta is, where the babies back and if there is maybe a bit to much liquor. But it is not going as far as messuring the baby or checking the placenta function. Anyway it is hard to gather information. There is always the problem of documentation and 90% of them are referrals from health clinics and district hospitals. You dont know when their due date is when it wasnt recorded because most of them dont care anyway and cant remeber when they most have got pregnant. Then you dont know how many weeks they´re in and all that so you just go with the size of the belly, but thats kind of tricky with twins. Anyway in the end what is the consequence. If there is fetal retardation, post dates or things like that there would be nothing you do about it anyway. So just hope for the best and wait what happens. The clinic was only on for half a day, the afternoon clinic was cancelled because of lack of doctors. So I took the afternoon off after having a long lunch break together with Elleana, a canadian midwife I met on the lake of stars. She is in Malawi for a year as well and has her orientation started a week after me. So she was in delivery this week and kept me updated whats going on there. The usual madness I suppose. Its good to have a chat with another midwife from the west and even getting to know her better as a friend. I´ve been to her house for a free Chichewa lesson and met her younger sister and two brothers who are also all staying in Blantyre with their parents. Her father is a minister in the prespeterian church here in Blantyre and also here for nearly two years. I finally got to see the red brickstone built church you would see pictures of in Wikipedia when you look up Blantyre. Its beautifull especially in sunset! Her mom is also here and working with kids, so it was a little break from being on my own and have a bit of family life with watching their new born baby goat, a big dinner, pool dipping and they even have a piano and lots of other instruments in their house so I got to play a little tune. A lovely evening! I miss my family!!!!! I´m sure I will stay in touch with her although she is going to be working in a district hospital an hour south - Melanje - but will be "home" over the weekends.
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| getting started with prayers and infos |
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| check ups |
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| Iron Tablets |
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| ultrasound from 50 years ago |
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| visiting Elliana in delivery |
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| baby goat and family |
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| the curuch in sunset |
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| cool down |
Friday was my horror day though. The last day I spent in the special care baby unit and it was just shocking! The day started with a referral of a really sick newborn, two days old, with sepsis. That poor baby was about to die, in really bad condition, an enormous swollen belly and a Temp. of 40°C. He needed surgery but wasnt stable enough so we did what we could with giving him Paracetamol and Glucose-Infusion. Again in "nursery", as they call it, only the students are trying to fight their way through all these sick babies, brestfeeding or milk expressing mothers and do some supportive work. They seem completely overwhelmed and so was I, you just dont know where to start! Nearly 50 babies in two different big rooms, one as sick as the other and no organisation whatsoever. Most of them are crying and having high temperature but thre is just not enough staff and time to take care of all of them although each of them would need a lot of attention. All they do is weighing and checking temperature but if they gained weight or lost it, if temp is high or low it doesnt really lead to any treatment, its just surviving of the fittest and if their mothers are comeing in frequently to feed them. The morning I spent just being completely shocked and not knowing what to do so I just decided to assist the doctors (4 volunteers and 2 actual from Malawi) and the mothers with their preterms. No incubators, only wooden boxes, flies everywhere and on each resus are laying 3-4 tiny newborns on oxygen. Not intubated or c-pap just a tube in the nose and one in the stomach is all they can get. No meds either. Its horrendous! The room I spent most of the day in was the special care for really sick ones and preterms, the other rooms is for long term cases and phototherapy (no record keeping on how long they´re under the lights or if they´re drinking enough). I saw nearly everything you know out from the books. Hydrocephalus, spina bifida and so many chromosomal abnormalities. Most of them on waiting lists and already forgotten about. It was terrible. One baby died and that was just normal, the mother cried but it was a preterm girl so she will try again for a boy and just deals with it. I still cant really get used to the way it just doesnt bother the people so much in most cases. :(
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| incubators |
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| hydrocephalus |
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| spina bifida |
I was delighted, even though I feel a bit bad about feeling this way but I was, to leave thhis prehell and to leave Blantyre for the weekend. Just to leave all this behind and go out of the city felt so good. I think there´s only so much you can take in for a time, so now some time to digest and then back on monday. I took a minibus to Zomba, a beautifull ride, to visit Anna, Moni and Nick who´re placed here. We will also meet up with Maaike and Woiter, the belgian couple, to go for a walk in the plateau all together. I try to put some pictures up next time. I keep on borrowing cameras hehe. Noone stops an adicted person right!
So thats all for now but I will be back soon..
the sister in charge and one midwife who worked all night and day
