delivery

The weekend went past so fast and it was the perfect way of relaxing before my week in labour ward started. The festival (Lake of Stars 2010) was absolutely wonderfull! We arrived after a 3 172 hour ride at around 2pm at our campsite near Mangochi, directly at the Malawi Lake. The tents we borrowed from VSO were massive! Two 6-man-tents for 4 people. Nick brought his own little one. So it was Anna, Amanda and me in one tent and Mark (the dude) in the other. Luxury!!! Hazel, Nikki and the about 30 other volunteers were camping in the garden of someones lodge so it was only us 5 "newbees" on the campsite. Mark arrived a bit earlier and he picked the perfect spot: directly at the seafront! Only problem was the grass pitch was full of tiny ants! At least not the big ones..
So the weekend started on Friday afternoon, after the tents were built up and the group complete we made our little walk along the beach towards the festival area. It is a big event not only for the reggae lovers and artists on the festival, also for the locals who sell material, food, beautiful handcarved wooden goods all kind and of course all the red-green-yellow striped bands, flags, hats and so on. It was like on a market approaching the festival. Then also hundred of kids and women just coming to lookk whats going on. I took so many pictures but unfortunately my camera got stolen so no pictures here for a while :(
As the sun went down the music started, the atmosphere was just so relaxed! Africa-feeling, sand, palm trees, the lake, a cider in my hand, just perfect! On two different stages we saw a lot of different acts. Most of all raggea with artists from Malawi, Tanzania, Simbabwe and even Jamaica. Its just one big family man! But also African dance groups - now I know what a Malawi dance is, I´m telling you its fantastic! Like a cross over from belly dancing and shake your booty- drummers from Tansania and a coir from a local orphanage with beautiful solos! This is what a festival should be like, dancing in the sand till the early morning and days spent just laying in the sunshine. I didnt get much sleep but it was totally relaxing. One of the last gigs were the Noisettes which I really enjoyed, and an artist called Nkomba. Very interesting music and good to meet up with all the volunteers. It was a fantastic weekend! I wish I could show  you some pictures :(

Now I´m back in Blantyre and the weekend seems already ages away! I´ve started my orientation in delivery ward and what I´ve seen last week for 10min is so much more intense when you´re actually there for a whole day. Shift starts at 7:30am and ends at 5pm. When you´re lucky there are about 8 students and 4 midwifes for 28 delivery beds. Labouring women everywhere, most of them referred from other health clinics or district hospitals around Blantyre so mostly high risk. My day started with the admission room where five ladies were sitting with pains waiting for assesment. Its a long progress getting the papers, taking the history and checking everything out. As well as everywhere else in Malawi things are going slowly. I decided to follow one of the students around because they seem to be the only ones who admit patients. Only when they have a question they go and ask the midwife in charge. Of course if you dont have any staff who else can do the work. One of them told me that there were only two midwifes on the ward the other day. Crazy!
We admitted a woman with a breech presentation but then got taken away by a quick preterm delivery of 36 wks coming in from a hospital about 20km away. Just to get an idea of the situation you´re in at that moment. There is not one single CTG monitor in the whole ward and no doptones either. All they have is about 5 pinards, 3 bloodpressure mashines and one ultrasound which is locked away in a room only the doctor has the key for. Unfortunatelly this doctor is always busy with other cases.
Anyway this lady delivered and her baby was in a very bad condition, looked more like 30weeks then 34 and needed some resuscitation. No pead (there are none on labour ward or theatre), no doctor (he was busy), only the student (who´ve done the delivery), another student (who´ve watched), the midwife in charge and me. The resus was a chellange. The midwife clapping the baby on the belly and trying to suction it but without success because the suction wasnt working and the oxygen either. Only by trying to provide at least a bit stimulation with a too big bag and mask and rubbing and definitely a lot of good will from above or somewhere the baby started to breathe. But it didnt look well so we had no other chance then running to the so called nursery with the baby in my arms where we hoped to find at least a paed and a working resus.
The nursery was crowded. Women sitting on the floor fingerfeeding their preterms and jaundiced babies, in every cot 2 of them, on every resus three. Women expressing milk, breastfeeding, nurses in between trying to assist. A complete chaos. So we shuffeled our way through and found a few inch on one of the resusc with a canadian sweating paed who looked like crying. As much as I could see in these few minutes it looked like about 20 babies and 5 wooden boxes (=incubators) and 3 baby units. Anyway I stood a while to assist the poor Canadian. Luckily the baby recovered but it didnt look good at all. Back in delivery I attended the breech presentation from earlier. Again a total shocker! The student who´d done the delivery was absolutely overstrained. The midwife next to her seemed to be as well. With a good bit of pressure from above the baby finally delivered but again was very floppy. So on the not working resus again and again hoping that this one will cry. I didnt know if I should laugh or cry but I felt like in a bad dream or something. The ones where you want to wake up but cant and then dont know if its reality or just a bad dream. Again being lucky the baby recovered and everyone was happy. Just as if nothing had happened. It seems like the attitude is just that if a baby dies it was not ment to be living and when it lives everything went just perfect. It seems like there is no questioning about the things that are happening, no looking back or thinking ahead, no prevention or reflection of things. I dont know, is it maybe because they dont know it better or is it because they dont want it different or maybe dont know that it can be different. Of course its all the little things, the abscence of equipment, the redicolous wages, the poor motivation, the dirt, the poverty, the culture, the religion, just everyone has to look after their own lifes. Why should they care so much. There is no expectation whatsoever.
I had two more normal deliveries I attended, thank god this time the babies and mothers were well. I fell into my bed that night totally exhausted. Thats not what I wanted. I just wanted to be observing, I didnt want to be involved but I guess that was just unrealistic.
Oh I also have two new flatmates for 6 weeks. Jennifer (GP) and Chris (Paed) from the UK are also doing an orientation in the hospital. They both started with me in Lilongwe and then were sent to their placement down south in Nsanje Trinity District Hospital. It is a very rural place so they have to come to this central hospital to see whats happening. Well its good to have some company!
Today then was the second day. This time I knew that my original plan of just observing wouldnt work out so I had to just get over it and not hold back if there is something to be done. I ended up doing a breech delivery with extended arms and head because again the students and midwifes were just standing around buffeled because the head wouldnt come out. Again guess what? The baby was floppy, but this time at least the oxygen was working.. There also was an admission of a 17year old girl with an eclamptic fit in early labour in a hospital in Limbe (just 10km away) who came for c/section. This very section was done 5 hours later because there was no theatre available, on fairness she wasnt bleeding. I asked to attend the operation just to find myself being the only midwife in theatre. I called for help as there was no Paed or other midwife and I´ve never been in that theatre before. The section was done in ITN so mother was sleeping, there are no epidurals whatsoever. With me there were only 5 people in the room: doctor=operateur, OT nurse who´s also co-operateur, anaethesist and the patient. It took them 20min to get the baby out, the doctor was jumping up and down on the ladies belly to squeeze the baby out, it was tremendous! Of course the baby was half dead when it came out, maybe because of the narcotics, maybe because of the eclamptic fit 6 hours ago, maybe because of the squeezing or maybe because of all of that or nothing of that I dont know. I was alone with it, I called for help again but the only person coming was a scrub nurse who didnt speek much english. The midwife I called earlier arrived about half an hour later when all was done, the baby unbelievable but true, recovered after resuscitation. You´re just on your own and have to make the best out of it, at least I know a few basics but I dont have the experinece and who is suffering are the patients. Its just not fair!
Giving up? No way! Now I really want to know, now I´m looking forward to teach and hopefully make a little difference in care and management. And if its just a tiny bit.
I feel sorry for the people here, the women in labour, the babies, the midwifes and doctors! All the staff, everyone who has to deal with these conditions! I hope the hope is not without success.
Now I go to bed, happy that I am able to talk to my family and friends about this.
Good night!

P.S. My phone also got stolen so here my new number: 00265-991-527786