Day and Night….
I feel I have now lost tract of time…. I’m living in a kind of inner space, the one between here and there and the there and now! All I know is that it’s light and then it’s dark! When it’s light I’m awake and working and when it’s dark I hope to be asleep! All the days seem to blend into one and the night’s, well they just seem too short!
Every day seems to be relentless with obstetric emergencies!! There is little rest bite on the labour ward, and when there is the ward is always heaving with patients desperate for care!
There seems to be a huge amount of face presentations here! I think the main cause is due to the high volume of multiparous women, and their slack abdominal muscles! but it doesn’t account for all! I can’t really work it out, other than I think maybe a lot of African women have contracted pelvis’s! I also think that a possible cause is that women here carry a ridiculous amount of stuff on their backs, mainly fire wood and perhaps this leaning forward posture has permanently altered the direction of their uterine axis, causing the fetal buttocks to lean forward, resulting in extension of the head! I’m not sure but if any midwife’s out there have any bright ideas then I would love to hear them! There also seems to be a lot of twins here! Again I have no understanding as to why this may be! I can only think that nature is somehow very clever and it somehow knows that a huge amount of babies don’t survive here, so chances of survival are greater if two are produced!! I’m not sure, maybe there is a genetic thing that I should know; maybe we covered in one of our uni lectures, the one when I was dreaming about what I would say if I ever met Johnny Depp!
It has become one of my greatest skill…. Diagnosising presentations that is! Firstly because every case seems to have an interesting one and secondly because you just have to know! You have to know if it is possible to deliver vaginally and you have to decide fast!
Some days I feel like it is all just hopeless, this week we did not have a single day without a dead baby! And when you are scrambling around for the third time that day to find a cardboard box big enough to put the baby in, a pen to label the box with, and you stack then on one another in the corridor, you just start to feel… I’m not even sure what I feel anymore! But I didn’t cry today, not even when I got home and lay on my bed, trying to somehow make sense of the madness that seemed to occupy us for ten hours solid. Maybe all my tears have dried up? Maybe I have no more to shed? Or maybe I have become numb! Maybe I can’t cry anymore because it’s too exhausting, and I won’t find the strength to go back tomorrow… to do it all again!
The women here are beautiful, strong and courageous, to think that they don’t even have so much as a paracetamol! Even for instrumental deliveries, all they have is the cloth between their teeth to bite down on! They are inspirational, and I have an overwhelming deep respect for each and every one! There is an enormous amount of love here, love for the patients, love for your colleagues, love for your family, your friends, its everywhere and its contagious! When a women needs to come to hospital she will be carried on a make shift stretcher. I wish I could draw you a picture or show you a photo! But most are a chair with two wooden poles holding it upright and then she is carried like one would imagine a queen was before the Rolls Royce was invented! She is carried from her village, often more than a 6 hour walk, in the heat of the day or the darkest of the night! It’s so sad as by the time we get to see them, that love is sometimes all they have left.
A young women arrived on a stretcher yesterday, she was in a extremely poor condition! And with a cold prolapse on route her baby had died. With a fast assessment it was clear she was also abrupting! We rushed her to theatre and managed to save her, she was within minutes of dying, and extremely lucky! Actually ‘lucky’ seems to be the wrong word to use, she is not lucky at all. In-fact she is extremely unlucky! Unlucky to be born in a place where she has no health care available, unlucky to be born on land which is impossible to grow food on, unlucky to be born into a community who have no way of making any money, and unlucky that because of this they have to walk for 6 hours, and unlucky that for her baby…. She was just too late!
I was reading some documents by the World health Organization (WHO) the other day and came across a quote that really summed up the complexity and importance of improving maternal and child health!
‘The Survival and well-being of mothers and children are not only important in their own right, but are also central to solving much broader economic, social and developmental challenges. When mothers and children die or are sick, their families, communities and nations suffer as well. Improving the survival and well-being of mothers and children will not only increase the health of societies, it will also decrease inequity and poverty’.
So basically I think we are hugely responsible for improving the health of mothers! It’s a heavy task, but defiantly within reach! So I want to thank everyone for showing an interest by reading my blog’s and for everyone who has so kindly made a donation to Maternity Worldwide! Together we are all making such a difference!
So I thought maybe I would finish with something a little lighter, maybe something about the local cuisine!!! – Which is injera, a pancake like food made from a grain. A batter infused with fresh eucalyptus leaves is poured over a huge flat griddle which sits on three bricks with a fire underneath. When it’s ready, it is peeled off and folded once, twice and then once more, then some kind of weird sauce with raw meat [if you can afford it] is placed on top and you are set to go! No cutlery needed! I can’t say I enjoy it, but I’m defiantly learning to tolerate it!
Tuesday 27 April 2010
Sunday 18 April 2010
16/04/10 ‘A tough day in paradise’
The local language ‘oromifa’ seems to compromise of a set of sounds, rather than words! So for example the sound…’sheeesh’ means okay, and a kind of gasping for air sound means ‘yes’! so I guess it’s a sort of morse code, and it’s a tough one to break!
The last few days have been so mental, I’m not sure where to begin really?! In the space of 2 days I delivered twins, a breech, had a shoulder dystosia, a face presentation, deep transverse arrest, uterine prolapse, placenta abruption, and numerous normal delivery’s. Some babies made it and some didn’t!
I would love to tell you the story of all but my mind can only think of one! A beautiful young women of around 20 years of age was brought in at around ten in the morning, in the middle of all the chaos. She was carried in on a stretcher in an extremely poor state. With no history, apart from the fact that she had been incoherent for three days! She was unresponsive and was in severe respiratory distress! All symptoms pointed to eclampsia apart from her blood pressure which was low, but a suspected placenta abruption would explain this! Her condition was deterioting fast, she was not fit enough to survive surgery and so we treated her with magnesium sulphate, and fluids, we intribated her and before long started CPR. She went in to DIC, took her final gasps and that was it…. We lost her!
It was a rubbish day! And sadly not a rare one! This happens far too often and the main contributing factor being that these women have no antenatal care! They live far away from medical help, and they have no money for transport and they are living in such extreme poverty. We can not change all that over night but we can work at providing a good service that is assessable for all women regardless of their financial status! At the moment we are struggling! We have limited resources. A lack of equipment, a lack of trained staff, a lack of medicines, and electricity that comes and goes like a fire works display! This is basic stuff and it is crazy that women are dying because of it. Sadly this as always comes down to money!!! It’s a sad fact of life! I don’t want to make this blog into a fundraising exercise but seriously if anyone have a few spare pounds floating around in the bottom of their pockets then please donate them to maternity worldwide (just giving link on my home page) I can give you first hand reassurance that your money will not be lost though administration, or fancy land cruisers! It ends up her! As a NG tube to feed a malnourished baby, or as a vile of ergometrine to save a mother from bleeding to death! It’s only a few pounds to us but the difference between life and death for these women and babies!
Our maternity unit covers a population of around one million! And with only one fully trained midwife it is clear to see the challenge! When I am not covering labour ward I am planning a training program to improve the skills of the local staff. Its hard to find the time as we are always so busy but the staff are so keen, and willing to attend outside of there shift! So I am set to start them next week.
I am also preparing for a needs assessment program, that I will carry out over a month, during June. This will be a community project to assess the existing health services in western wollega (the distict where I am). I will be collecting information from all over regarding what is available, and what is missing! With this we hope to put forward a proposal to expand our maternity services, and take this care to the women! Only around 1-2 % of women deliver in the hospital so you can see how this will undoubtedly save hundreds of lives!
It’s a strange feeling to think that I only arrived two weeks ago! It honestly feels like two years! My other life feels like a fading memory. I have good days and I have bad days but everyday I feel home sick, and every day the space between us seems to grow! It really is hard to be here, but even harder not to be when I know the difference that I am making!
The last few days have been so mental, I’m not sure where to begin really?! In the space of 2 days I delivered twins, a breech, had a shoulder dystosia, a face presentation, deep transverse arrest, uterine prolapse, placenta abruption, and numerous normal delivery’s. Some babies made it and some didn’t!
I would love to tell you the story of all but my mind can only think of one! A beautiful young women of around 20 years of age was brought in at around ten in the morning, in the middle of all the chaos. She was carried in on a stretcher in an extremely poor state. With no history, apart from the fact that she had been incoherent for three days! She was unresponsive and was in severe respiratory distress! All symptoms pointed to eclampsia apart from her blood pressure which was low, but a suspected placenta abruption would explain this! Her condition was deterioting fast, she was not fit enough to survive surgery and so we treated her with magnesium sulphate, and fluids, we intribated her and before long started CPR. She went in to DIC, took her final gasps and that was it…. We lost her!
It was a rubbish day! And sadly not a rare one! This happens far too often and the main contributing factor being that these women have no antenatal care! They live far away from medical help, and they have no money for transport and they are living in such extreme poverty. We can not change all that over night but we can work at providing a good service that is assessable for all women regardless of their financial status! At the moment we are struggling! We have limited resources. A lack of equipment, a lack of trained staff, a lack of medicines, and electricity that comes and goes like a fire works display! This is basic stuff and it is crazy that women are dying because of it. Sadly this as always comes down to money!!! It’s a sad fact of life! I don’t want to make this blog into a fundraising exercise but seriously if anyone have a few spare pounds floating around in the bottom of their pockets then please donate them to maternity worldwide (just giving link on my home page) I can give you first hand reassurance that your money will not be lost though administration, or fancy land cruisers! It ends up her! As a NG tube to feed a malnourished baby, or as a vile of ergometrine to save a mother from bleeding to death! It’s only a few pounds to us but the difference between life and death for these women and babies!
Our maternity unit covers a population of around one million! And with only one fully trained midwife it is clear to see the challenge! When I am not covering labour ward I am planning a training program to improve the skills of the local staff. Its hard to find the time as we are always so busy but the staff are so keen, and willing to attend outside of there shift! So I am set to start them next week.
I am also preparing for a needs assessment program, that I will carry out over a month, during June. This will be a community project to assess the existing health services in western wollega (the distict where I am). I will be collecting information from all over regarding what is available, and what is missing! With this we hope to put forward a proposal to expand our maternity services, and take this care to the women! Only around 1-2 % of women deliver in the hospital so you can see how this will undoubtedly save hundreds of lives!
It’s a strange feeling to think that I only arrived two weeks ago! It honestly feels like two years! My other life feels like a fading memory. I have good days and I have bad days but everyday I feel home sick, and every day the space between us seems to grow! It really is hard to be here, but even harder not to be when I know the difference that I am making!
Monday 12 April 2010
12/04/2010 ‘The tomorrows stretch towards forever, and today is nearly done!’ (James Maskalyk)
This world I am living in is so real, I can touch it with my hands. I can taste it, I can smell it and I can change it! Little by little… but I can see we can change it and we are changing it!
I was asking before why it mattered to me so much? And why I find myself here? The answer is now clear… I am needed here! And as long as I am, I will continue to care and I will continue the work that I have begun. Although we don't share the same colour, language, or culture, we share a time!
I delivered a breech today…. A footling breech! A woman came in having been carried by her husband and brother for 3 hours from a remote village! You can’t quite imagine it, but believe me its true! She had been pushing for hours, and she was frightened. As I went to examine her, her membranes ruptured…..and a foot followed! Just one foot! Oh how I wished this was a skill drill, but no it was real, it was happening and it was happening to me!!! The rest was a bit of a blur, but some how I remembered all those maneuvers and some how I delivered a baby boy! He did need resuscitation but not much! He was a healthy beautiful lucky boy weighing a whopping 4kg! I have been smiling ever since!
There is a young eighteen-year-old girl on the ward who delivered her baby a few days ago. He had horrible abnormalities and didn’t survive. She has developed an almost definite DVT (we don’t have the means to diagnose it, but her symptoms are very indicative.) Her condition is worsening and her future is looking bleaker by the minute. We don’t have the drugs to treat her here and can’t get them released from the hospital in Addis. She has to go for treatment! But the journey is long and expensive, and so is her treatment! Her husband earns 6 bir a day which is equivalent to around 10p, the rest of her family the same; so it is completely impossible for any relatives to pay! So we do what we can, but essentially we have to wait… wait for her to die???
Can’t we just pay? Can’t today just be her lucky day! Can’t we just spend the money we have today and worry about tomorrow… tomorrow??
But we don’t. We are measured, and careful. It is what tomorrow’s patients expect of us… and "the tomorrows stretch towards forever, and today is nearly done!" (James Maskalyk)
Thursday 8 April 2010
06/04/2010 Hope not only meets despair in equal measures….. It drowns it!’[James Maskalyk]
Gimbie looks different in the light! It’s beautiful, much greener than I imagined and a lot poorer than I have ever seen before. The people of Gimbie tell a story with their eyes. A story I hope to learn and I hope to be apart of.
I woke up feeling a little like I have been hit by a bus and smoked 100 cigarettes in my sleep… I hadn’t of course, so wondered why I felt like I had! So I sat for a while… then it made sense as I looked out over or above Ethiopia! We are 2000 meters above sea level here!!! I think it may take a little time for my body to adjust, well I hope a little time, as I don’t have a lot of time… I’ve got to hit the ground running, no time for slow adjustment!
It’s about 140 steps to the hospital, I will of course count them soon and tell you exactly… but I think I will go with 140 for now. I couldn’t believe it, walking up those steps felt like finishing a marathon. My lungs being vacuumed to the size of a small walnut, leaving me with no air to breath! I think I will train hard and set myself a goal… By the end of my trip I will jog the 140 steps to the hospital… okay actually maybe just walking them without flaking out and needing a rest every 6 steps; this feels like a good challenge!
I had a warm welcome to the maternity unit; people here are, as expected, as friendly as you could wish for! Big smiles, lots of hugs and a language that I of course have no understanding of!
The unit is busy, my first patient is having twins, the first baby arrives… Dead! I can’t believe it… not my first delivery here. Can I go though this again? How much pain can one feel before they become numb? I hope I never know the answer to that! But I’m here, I knew it wasn’t going to be easy and so I will take that deep breath and give all that I have to give and hope that in some way I can make a difference.
The next baby arrives…. Oh god, please breathe…. We spent a while inflating his small lungs with air and then came the sound all midwifes long to hear… a cry!
I think now comes the perfect opportunity to tell you my favorite quote by James Maskalyk. A quote that has become my mantra and will keep me strong, focused and here!
‘Hope not only meets despair in equal measures… It drowns it!’
I woke up feeling a little like I have been hit by a bus and smoked 100 cigarettes in my sleep… I hadn’t of course, so wondered why I felt like I had! So I sat for a while… then it made sense as I looked out over or above Ethiopia! We are 2000 meters above sea level here!!! I think it may take a little time for my body to adjust, well I hope a little time, as I don’t have a lot of time… I’ve got to hit the ground running, no time for slow adjustment!
It’s about 140 steps to the hospital, I will of course count them soon and tell you exactly… but I think I will go with 140 for now. I couldn’t believe it, walking up those steps felt like finishing a marathon. My lungs being vacuumed to the size of a small walnut, leaving me with no air to breath! I think I will train hard and set myself a goal… By the end of my trip I will jog the 140 steps to the hospital… okay actually maybe just walking them without flaking out and needing a rest every 6 steps; this feels like a good challenge!
I had a warm welcome to the maternity unit; people here are, as expected, as friendly as you could wish for! Big smiles, lots of hugs and a language that I of course have no understanding of!
The unit is busy, my first patient is having twins, the first baby arrives… Dead! I can’t believe it… not my first delivery here. Can I go though this again? How much pain can one feel before they become numb? I hope I never know the answer to that! But I’m here, I knew it wasn’t going to be easy and so I will take that deep breath and give all that I have to give and hope that in some way I can make a difference.
The next baby arrives…. Oh god, please breathe…. We spent a while inflating his small lungs with air and then came the sound all midwifes long to hear… a cry!
I think now comes the perfect opportunity to tell you my favorite quote by James Maskalyk. A quote that has become my mantra and will keep me strong, focused and here!
‘Hope not only meets despair in equal measures… It drowns it!’
Wednesday 7 April 2010
So it starts...
Where to start? Well I’m here and safe… eventually after a long exhausting 15 hour journey of bumpy roads, broken vehicles, you name it, we had it! So yeh…. I’m a little dumb struck to be honest, I’m lying here under my mosquito net with my head torch on trying to imagine my next four months; my work; my colleagues; my friends; my home; my life!
I had an odd moment earlier… I got smacked in the face with what we call reality! It finally hit me…. I’m here, you're there and the rest of the world is somewhere in between!
It's pretty daunting, and I guess I found myself questioning the reasons for being here. Why does it matter to me so much? For most of us, we are too far away to feel its ripples, so perhaps it matters less? But if I can make it seem closer, maybe you can sense that it does! Decide for yourselves…. Decide for me!
I had an odd moment earlier… I got smacked in the face with what we call reality! It finally hit me…. I’m here, you're there and the rest of the world is somewhere in between!
It's pretty daunting, and I guess I found myself questioning the reasons for being here. Why does it matter to me so much? For most of us, we are too far away to feel its ripples, so perhaps it matters less? But if I can make it seem closer, maybe you can sense that it does! Decide for yourselves…. Decide for me!
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