‘Its not about trying to reconcile two different worlds, it’s understanding that’s its one'.

26/06/2010

Well I made it……… But not with out all the love and support I received from you all. I want to thank you all for the guidance and strength you have given me, without which my time here would have been somewhat harder.

As I wait for my plane, I am desperately trying to prepare myself for the contrast that awaits me! It’s hard to adjust completely to this life, but in a way I feel it may be even harder to adjust back! I guess we will see!

I hope I have in someway brought you closer to the harsh reality of life here. Thank you for following my journey and for your open hearts.

It’s hard to summarise such a experience… but keeping up traditions I found a perfect quote that says it all…….

‘Its not about trying to reconcile two different worlds, it’s understanding that’s its one’.

All my love, Kate x

‘Sometimes, the best story is in the space between the words.’

10/06/2010

‘Sometimes, the best story is in the space between the words.’

There are so many stories to tell…. so much I would love to share with you all, but lately I have been struggling to find the right words! The words that would do justice to the people to whom I work with, to the patients I care for, and the stories we share.

My brain has become an endless catalogue of events, but in them I have also seen myself! I have lived and live in them, between them and though them. Some I am hopeless in my ability to help, and therefore feel a mere spectator, and some I am able to do more, so feel apart of it. But with all… I feel connected and responsible.

During the silence that has pre-occupied me over the past few weeks, I have spent time reflecting, trying to piece together the wrongs and the rights, the do’s and the don’ts, the why and the why not’s. But this has only left me in confusion, so I have found myself fixating on small, insignificant things. But things that are real, tangible and understandable, the things that I can fully make sense of! This is in someway soothing and helps build the bridge between illusion and reality!

As I struggle to distinguish between the two, I realize that the reason is of course that my illusion is also my reality! Its just easier to digest and less damaging to the soul to focus on the small things, the things that don’t matter. It helps me to grasp a sense of normality, or at least the normality that I know!

So I find myself filing away these events, to a dark and dusty part of my brain! A part that I have come to realize should only be accessed fully when I am back home, surrounded by my dearest friends and family. Its not that I have forgotten, or that I want to forget, but more that I need a coping mechanism, one that I can rely on to keep me strong, focused and productive.

We had the election here not long ago…. although on the face of it, it appeared to pass by peacefully it did not pass silently. Consequently, I have learnt a lot about the political situation here, some of which I would rather remain naïve about, but some that I feel privileged to have an understanding of, an understanding that I did not learn though reading a book!

It has taught me to question the relationship between humanitarianism and politics.
What I have seen is how Politics, cannot be avoided and how it dictates and shape’s humanitarianism.

‘Humanitarianism is about the struggle to create the space to be fully human’ (James Orbinski) and sadly that struggle is closely linked to politics whether we like it or not! The blurring boundaries is something I find myself frustrated by, but unavoidable as it is, and the very fact that I am a aid worker, I can’t help but find myself in some way part of, …. I ask the question….. ‘Can there be healing without social justice?’

I have learnt so much from my time here, not only in medical ways, but also in ways I had not expected to explore. I wanted to do something practical to relieve the suffering of others, and although I feel I have, I think there has been much more to my journey. It has not only given me an understanding of the circumstances of such suffering, but also an understanding of my relationship to it.

I am given unhindered access to some of the most intimate experiences in people’s lives. Experiences I will treasure and hold close to my heart for the rest of my life. Experiences I will act on, whilst being the voice for those that otherwise wouldn’t be heard. Experiences I will do my best to do justice by.

I have witnessed the good, of which we as human beings are capable,
……..the good that calls the mother to feed her child, regardless of how unbearable her own suffering is. The good of a husband who carries his wife some 25km by foot to the hospital. And the good of a community who work together to bring a better tomorrow.

However, some days I feel so frustrated by the very small difference I am making here. So deflated by the hopelessness that I often question the use of my being here.

But I recently received some wise words from a dear friend…..
‘The effects seem invisible not because no one can feel it, but because they are immeasurable’.

So In creating a world of practical possibility, there is hope, and that hope is what gives a country a soul! And that hope is what we live for, what we work towards, and what we fight for! So if hope is all I give, all we give……. Then I guess there is a point to all of this!

Just another manic Monday…….

17/05/2010

Just another manic Monday…….


So my day went like this…..

I was woken up at 5am by the monosyllabic sound of the mosque; it is then impossible to get back to sleep! It’s kind of like when you get woken up by that terrible Nokia standard tune that just automatically puts you in a rubbish mood! But worse, because its 5am!!!

Anyway it was cool because I was forced out of bed, only to discover what I have been massively missing out on for the last 6 weeks….. The most beautiful sunrise!!! And that coupled with wonderful Ethiopian coffee… made the most perfect morning!

So I walk my 140 steps across the compound to work…..

As I entered the labour ward I trip over three boxes stacked on top of one another, one labeled F3, the other F7, and the last F13, these are bed numbers! And inside are the baby’s belonging to the mothers lying on those beds!

On to the labour ward… I’m greeted with three labouring women, one breech, one cord presentation and the other premature! There are also two other’s with sever pre-eclampsia!

I took the hand over and started yet another manic day!

We have a fantastic obstetrician here, but only one! He works night and day trying like the rest of us to save the lives of hundreds of mothers and babies! But with only one doctor and one operating theatre we are stretched! Some days… like today it seems every women who comes though the door is needing emergency treatment, and when the doctor is already occupied in the only theatre then it’s really up to us to do what we can.

I carried out my first ventouse delivery today! I was petrified! IV seen it done many times, but hadn’t really thought that I would ever be on the end of the vacuum, trying to pull the baby out! But when that fetal heart is dropping below 50bpm and just not recovering, and our only doctor is busy, there is just no other option, so I guess you just do it! And so I did….! And apart from a having a sore head which is slightly cone shaped, the baby is doing well!

As an attempt to try and cure my ‘Cabin fever’ I took a trip out at lunch time to the market…..

Just outside the hospital gates I was met by a man with withered legs that were folded on to his chest, he was holding blocks of wood with a handle in each hand, he looked at me with another pair of hopeless eyes that I have become so familiar with! I walked on, moments later with curiosity I turned back to look at him, with his blocks of wood planted firmly on the ground, and his bottom swinging forward he moved in a kind of ‘M’ shape in the opposite direction.

Another thing I couldn’t help but notice was the huge amount of people suffering with elephantitis! A really nasty painful infection in the leg. I later leant that it is a real problem here, both with the amount of people suffering with it and the social exclusion that it causes. Apparently the high prevalence has something to do with the altitude, the type of soil, the penetrating sun and the simple fact that people can’t afford shoes! It’s really sad, especially when it can be so easily avoided!

The last thing that really made me think today was seeing a few of kids who had had their heads shaved, leaving just a tuff at the front! It was strange and when I inquired about it with my colleagues at the hospital I was told that the children were sick and the tuff was to help God lift them to heaven! Its mind blowing, I mean that this is the best hope they feel they have….To hope that the child goes to heaven! I can’t help but feel we are letting them down, they are children, they have mothers and fathers, they have hopes and dreams, they have imaginations and the desire to learn… they are our future, and all we can give them is the hope of heaven! It just seems so unfair!

So I returned to the only world I know right now, a terrifying world, but one which has become my home, and my friend…. The labour ward!

I’m back in for no more than two minutes and a woman gets rushed in on a stretcher! She had been discharged that morning after 3 days, following a C- section! She was vaguely responsive; I look down to see that her scar had completely opened! This lady like most had left the hospital on foot, she lived 4 hours away! It’s hardly surprising when you think of it! So what can we do? We did our best to safely deliver her baby; we cared for her in the hospital! But then that’s it! Is it enough though? I just wish we could do more!

Then another stretcher…. This time a young women having a massive antepartum hemorrhage! We rush her to theatre, with the main priority of saving her life; we will of course try to save the baby too! She had a uterine rupture and lucky for her had made it to hospital in time! And like a total miracle for the baby too! There are so many women here who end up with a ruptured uterus. They push for hours, some times days, on a cervix which is not fully dilated or with a mal-positioned baby when there is just no hope for delivery! So the uterus inevitably becomes exhausted and ruptures! It’s horrible and it’s a massive killer! Maybe with better skilled birth attendants out in the rural clinics we have a chance to reduce it, but even then what happens to all the women who don’t have the means to access the clinics?
Well we know what happens… they die! It is just so unfair!
Safe pregnancy, childbirth and motherhood are basic human rights! But there are just so many people, too many people, who don’t have it! I wish we could change that, I wish we could do more!

But there are lives we are saving, and there are futures we are giving hope to….In an otherwise forgotten corner of the world we are changing things. It’s beautiful to see and it’s a privilege to be apart of it.

A World of Possibility?....... Or an Impossible World?

So IV been here a month today…Although really I have lived a whole life…. But in another world!

I decided I would look at statistics…

According to the World Health Organization (WHO) ….

· Globally every year at least 350 000 women die due to complications in pregnancy or childbirth. More than a quarter of these figures come from Africa

· 10,000 babies per day die within the first month an equal number of babies are born dead.

· In Africa alone neonatal mortality is 45 per 1000 live births.

So here are my statistics over the last month…..

· 149 births
· 2 dead pregnant mothers
· 28 dead neonates within the 1st week of life

Now I am no mathitician ….

But according to The WHO neonatal mortality works out to be around 1 in 28.

My statistics from here are more like 1 in 5.

I’m not sure how statistics are obtained and measured but I’m pretty sure they don’t have people carrying out direct observation over a period of time! Theses figures come from records right! Now how many records are kept? Well only for those who attend health services! And we know that only around 2% of the population here are able to access adequate health services!

It’s pretty hard to obtain accurate records even within the hospital, as many births go un-recorded and records of baby’s that are born alive but die before discharge are not amended! This comes from first hand observation! And what is going on out in the rural areas? Well know one knows for sure….. But we do know that the reason people do not attend health services is not because they don’t need to, it’s because they can’t!

So I maybe wrong… and I am only going by a month of work but I reckon it is a whole lot worse than we think!

For those of you who know me so well I’m sure you’re thinking the same as me…. Statistics?? Well I guess I just find it kind of therapeutic, a sort or escapism! I guess numbers somehow aren’t as painful as actually living it… Witnessing it!

I like the majority of the west, can’t really imagine the reality behind these numbers…. So I thought if maybe I just shared the odd story with you then maybe I could bring you closer….

I guess in a selfish way I also hope by sharing my burden it will somehow be lifted, give me strength to carry on fighting for whatever it is that I’m fighting for…. A human right I guess! Because sometimes it just seems so impossible!

Two days ago I delivered a beautiful baby girl into the world …. Today I watched her leave!

During my morning ward round I noticed she was struggling, her resps were up, she had a temperature and was not feeding! I took her to the labour ward and started her on oxygen and antibiotics; I put a NG tube in to feed her and monitored her closely. During the day her condition deteriorated and she was completely dependent on oxygen.

At 6pm we had a power cut…. She was helpless and I was helpless to help her! So after some time of watching her gasp for air, her eyes blinking in and out of consciousness, I made a decision that may haunt my dreams forever but somehow felt like the right thing to do.

I stopped…. I gave up…. I pulled out all her tubes, I wrapped her in a blanket and I took her to her mother. I held her mother whilst she held her baby, her tears fell so gracefully…. as she died in her arms.

So I have joined hundreds of other aid workers around the world fighting to save the lives of the most vulnerable…. In a world of possibility! But after days like today, that world just seems so impossible!

Its like we are here with our patients but the treatments aren’t! So this beautiful baby girl will join the estimated 24,000 people who die around the world of preventable or treatable neglected diseases! (WHO).

And so in some twisted circle of life way…… we are back to statistics…. She is now a number!

Maybe because she never had the chance to discover what it means to live, to know what it means to be happy, to be sad, and to be free; then maybe she is exempted from qualifying for the most basic human right??

But I disagree……..She knew what it meant to be loved…. And in my eyes, that qualified her with the right to life!

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!

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!

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)