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)

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!’

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!