Day and Night.....26/04/2010

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!