Malawi experience: Ntcheu

This time I´m writing from Ntcheu, a District about 2 hours away to the North, between Blantyre and Lilongwe. I´m staying with two fellow volunteers, Ashtin, a surgeon from the UK, originally from Mauritius (he actually studied in Newcastle and knows Hans Fuchs!!! Small world!) and his wife Janet who is a Microbiologist from UK (she will move in with me for a while as she and Ash are looking for a flat in Blantyre). Then also Henry, a guy from Uganda who´s working in HIV/AIDS and Liora, the Dutch medical student. A good crowd with lots of stories.

I came here to supervise the “old” students in their last placements and just to check out the District Hospital. The way here was already an experience! Liora was in Blantyre to visit some Dutch friends so we took a bus together. After 2 hours waiting for it to fill up (it was already getting dark) we started our trip with what felt like 100 other passengers, all Malawians, squeezed in between maize bags and chickens, babies and a preacher who gave the whole bus a lecture in Chichewa about Jesus and the holy spirit! His voice was even louder than the “good-mood” music and the roaring engine of the old bus. Toped up with some gospel songs, the whole bus was singing! Amazing!

The district supervision went well, the students are about to qualify so they are already well skilled and able to handle situations themselves. The problem is not the theory, it is the whole organization, the lack of staff and equipment, no monitoring, no prevention, to deal with the problem when it comes along. So if it´s busy and there are 10 women in labour half of them pushing and just 3 midwifes so bad luck, let´s just hope the babies pop out one after the other. Of course there is no point to start focusing on privacy, good midwife to client relationship, painrelief, different birthing positions, one to one care or other luxury like this. What is important is that you catch the baby when it comes out and if it needs resuscitation - which can be the case if you didn’t know that it had a bradycardia for the last 20 min during pushing. Survival of the fittest it was comes to my mind every time and me I don’t know where to start.

As a supervisor I am supposed to focus on “my” students and their working skills and not distract myself to other cases. But it is not easy when behind the curtain next to you all in a sudden things are getting really hectic and everyone looks at you as if you should know what to do. During these 3 days I´ve spent with the students in labour ward I also helped with one flat baby who needed resus after a normal delivery and just barely came back to life with me and Liora doing bag and mask and heart massage for like 15min! Thank god it worked but who knows how this baby is going to end up, probably handicapped and abandoned. A fresh stillborn because of cord prolaps at home where I ended up doing the delivery because the woman suddenly started to push and everyone else seemed to have disappeared. Another dead baby during emergency c/s because of hand prolaps, wrongly diagnosed as a breech, another emergency c/s with undiagnosed breech on first baby presented fully dilated from home and an emergency c/s because of logged twins, first breech second cephalic but both babies happy and well besides obvious undiagnosed twin to twin transmission syndrome (one baby was 2.2kg and the other 3.8kg). CRAZY!! Seriously there were more complications then normal deliveries during the time I´ve spent in labour ward but regarding my work with the students I think it was a real helpful time. I had also time to observe them in postnatal and antenatal clinic where I learn a bit more about the Malawian health system every time, very interesting!

At the last day Amanda came back from Lilongwe and we went to labour ward together so she could see a delivery. That was really nice and without complications thank God! It is just so hard to prediagnose anything or prevent emergency situations when continous monitoring is no option because there are no CTGs and frequent monitoring seems not to be possible properly because of lack of staff. There is definitely potential to improve at least the interpersonal skills, awareness of responsibility each and everyone has and hopefully increase of professional health workers as there are more students then midwifes around at the moment. So there is hope and I am happy to be in this post and have the opportunity to motivate, supervise and teach the students and future midwives to make the effort and feel responsibility, be aware, have good skills and work as best as possible to have some good results for Malawi in the long run. So these few days really motivated me a lot! After the last week in the college where there was really nothing for me to do I started thinking what on earth am I doing here? Now I feel much more motivated again! That’s good and it wasn’t even so difficult as I thought to get things organized for me to go to the District Hospitals. It turned out really handy with having a place to stay and a few days with the students. Next week I will go to Mulanje to do the same again but unfortunately Elleana just left for a family trip to Zimbabwe and Victoria falls so she won´t be around. I will miss her! But I can stay with Alex, a German guy who volunteers as a nurse in the Mulanje Missionary Hospital.

Besides the development in my placement, Malawi is really putting a new face on as well. After a week of nearly constant rain the nature is just exploding! Everything what was dry and dusty before is now juicy green and lush, trees are blooming, the crops are growing, the earth looks even more read now being soaked with water. The hills and mountains are covered with a light green carpet and neat little fields with perfect rows after rows of little maize, potato or tomato plants are dominating the landscape. It is absolutely amazing how the whole face of a country can change during two weeks of rain! As putting some makeup on for a feast Malawi has changed from a desert like red and yellow to now lush juicy viarities of green, red, purple, orange and pink. The air is humid and the mountains around Ntcheu and Blantyre are surrounded by clouds and fog. Beautiful picturesque and the air smells like rain. That is so refreshing after all the heat but I hope it won´t rain all the time when Andrea and Clara are coming. 10 days!!! Aaaaaaahhhhhh!

Here are just some pictures from the hospital (still no own camera) enjoy!