Monday, May 30, 2011

PV exams? Hakuna matata.

May 18th-

Whoops- I've sort of failed at journaling.

Back on the 12th..

I helped the Korean intern with some admissions. I copied antenatal cards to hospital charts and watched her techniques. She always warmed her hands before touching a Mama's belly.

One woman came in with a BP of 220/140 and had 2 previous IUFD due to pregnancy induced hypertension. She was given magnesium sulfate , other medications and sent to antenatal for monitoring.

Sister Shao also helped me complete my first vaginal exam (PV)! It wasn't overly difficult, minus my short fingers. I even accurately estimated the cervix dilation.In total, I helped deliver 5 babies - 33 in total now.

That night we enjoyed another DELICIOUS BBQ (the most amazing beef I've ever had). Steph, Kate and I ended up going to Via Via- we had a blast. There was excellent people watching. The Alex look-a-like was scary (later to be known and loved as "Dancing Man")! There was also an Indiana Jones.

Who needs expensive Baby Bjorn's when I've got a konga...

May 11-

It was POURING RAIN this morning. We took a taxi to placement- the road was way too muddy.

Placement was quiet today. We had 2 births very close together- I conducted one on my own and the other one I assisted with. We didn't have another until hours later.

It was also a somber day in OG, as one of the nurse's died this morning. She was young and well liked. She was found unconscious in her shower- a suspected ectopic pregnancy.

We finished the day at the orphanage. I LOVE all of the children. When I offered to hold baby Dayo so the little girl could go and play, she insisted I tie him to m y back. One of my goals for this trip crossed off my list. I will never buy an insanely expensive baby sling now that I know how to tie a konga instead. Kailey is getting one for sure.

I can only hope my heart is as big and open as Babu's is when I grow old. He is an elderly man, who along with his wife care for these 20 children. I really hope my home will be filled with so many beautiful children needing love one day.

Ryerson, my application will be coming

I've decided 100% that I will apply for the fast track midwife program. I've never felt more confident and happy. There isn't an ounce of anxiety. It is almost peaceful amongst the screams, groans, feces, blood and fluids. It is humbling yet exhilarating. It is so pure and natural yet powerful and dynamic. It is how I have always seen myself- a bit of each extreme. Maybe that's why I feel so at home while catching babies.

When a C-section is really needed...

May 10-

Saturday we went to the Tengeru Cultural Tourist Centre. It was an incredibly cool place. They showed us their Biogas production- using cow manure to create methane gas and fertilizer.

We then went on an 8k hike through the Mt. Meru forest. The exciting journey down to the waterfall was so much fun. It made me want to visit Algonquin more at home. It was challenging, but I kept up with the guide (thanks to my Vibrams!)

That night we returned to a surprise cake for Steph! It was her 21st birthday. We went out for dinner at an outdoor place where you could order from many resturants. Innocent and Emmanuel joined us.

Sunday was a Lala Day. I DID MY OWN LAUNDRY!! May I add, by hand. We made a delicious meal of homemade tomato sauce and apple-pineapple crumble with custard for dessert.

Monday was a quiet day at the hospital and home.

However, today made up for the quiet day. Anyone who knows me, knows my frustration with c-sections and the insanely high rate at which they are used in the Western world. Today, I got to see patients who truly needed "emergency" c-sections.

1. Eclampsia

The mama was an 18 year old patient brought in by wheelchair barely conscious. She had been complaining of headaches. Her feet were edematous. And then she began fitting (seizing).

The theatre was already VERY busy (at least 10 c-sections scheduled). This woman was in desperate need of one. She had to wait until it was free. She received 20 units of magnesium sulfate and a Ringer's Lactate drip. We took her BP once with an inaccurate cuff (145/110), and the monitoring was limited until she went to the OR.

At home, I probably would have stepped back. FROZEN. Here, it is almost like it isn't real, meaning I don't need to be scared. I jumped in to do her blood pressure, held her during a fit. It was just part of the day.

2. Obstructed Labour

I will cry later about this. It was deeply disturbing in so many ways. I will think about her tonight. I will focus my energy on her.

She was 14. Literally a child. She appeared to be the same as the other mamas. Full, round, bulging belly topped by breasts ready to nourish a child. And then you saw her face. Her shaved black hair topped a child's face. Her bravery was not thick enough to hide her need for her own Mama. Never should a child lay in a bed with a dead fetus wedged in their vagina.

You could see the thick tufts of hair belonging this girl's unborn child; resting within her painfully swollen labia. Her body appeared tragically inadequate when viewed from this angle, compared to her full breasts and belly. Her baby had died during the 36 hours of ineffective labour. Perhaps a blessing, but most likely a curse.

This poor little mama will probably never bear any more children after the current body is removed. Either infection or a urethral/recto-vaginal fistula will leave her as a useless piece of her community. I'm not actually able to allow myself to comprehend the pain and tradegy. All I know is that this poor, sweet girl is not coming to the end of her nightmare anytime soon.

3. Malposition

A labour not progressing due to the fetus in a transverse position.

4. 2 Previous C-sections

... many more were awaiting scheduled c-sections for that day.

I delivered a baby on my own today. I learned a very important lesson- be very careful with the cord! I broke one while trying to remove the placenta. Whoops.

Sister Shao- being every so kind and helpful, just dug up to find the remainder of the cord and instructed me to mix 40 units of oxytocin in 500ml of ringer's. I hung it and waited for my next step. The oxytocin induced strong contractions that helped the placenta come out easily. I was grateful she didn't become angry. I know I am more confident now because of it.

She calls me Emmi. I really like it- I don't find it weird. I can tell she's taken a liking to me. She will be a woman I will remember many years from now. Especially when I teach someone else. Her patience is inspiring.

I also met a friend of the girls'who was a combo of the entire Foster family. Mark, Jane, Mike, Sammy and Jay. No joke, one British girl named Kat was them all. It freaked me out.


May 6th-

Today was a Lala Day (sleep day). Which means, after a late night dancing and drinking Konyagi at Via Via sleep was needed.

After lunch at Picasso's (a very muzungu place), 5 of us went to the orphanage. Paradiso is home to 20 orphaned children from the Arusha area. They were all so sweet and beautiful. I was immediately handed a baby by another child so she could go to play. I held Mary almost the entire time. I got to sit and sing while the other children played with my hair.

I also met Naomi, a brilliant 12 year old girl. Her English was excellent, delivered with a very confident and assertive tone. She told me about school and how she wants to become a pastor. It wasn't so much the cute little babies toddling around that interested me as much in Paradiso's work, but Naomi. When I mentioned writing her, she liked the idea a lot. I also began to inquire about school costs and uniforms. An entire year is 190,000 tsh and 2 uniforms are 42,000 tsh ($1 US = 1500 tsh).

It also made me think about Gramma. The orphanage is ran by a Babu and Bibi- a Papa and Gramma. Naomi would have been a favourite of Gramma's. I know where to send money in her memory to this year. I hope to keep in touch with Naomi for years to come. Her energy is contagious. This little girl is going to make change happen in her community.

Monday, May 9, 2011

Catching babies is my favourite passtime

I skipped writing for one day. It was nothing short of amazing. I delivered 4 babies- one of which was all on my own! Birth is getting to be easier and easier. Its quite neat how it feels so natural.

I was able to help 2 med students support the mamas they were working with brestfeed. Because in the UK midwives care for women and post-natal related things- they didn't have any intro to breastfeeding. The latch of the first baby was PERFECT. It was very beautiful. I was able to show them how to help a baby latch, what a poor latch is, how long to nurse for etc.

Even though aspects of care are questionable (no sterile technique, no vital sign monitoring, lots of fetal distress and mec staining) it makes me feel uneasy how extreme Western birth is. Mama's here do not come to OG until they are 4 cm dilated. They birth altogether in one room without partitions and are up getting dressed themselves within 5 minutes (no husband, mother, or sister around to help)of delivering the placenta. They are so strong. I like how it isn't a big show like at home. Its part of life.

Today, my first birth was done all on my own. I performed an episiotomy-not well- but Sister Bakari helped to fix it. I also sutured the cut on my own. I need to practice tying the first stitch.

Babies were popping out everywhere. In total, I was in on 5 deliveries. 2 were independent. The 2nd episiotomy I did and was going to repair w as very complicated. There was extensive internal tearing and a midline tear in addition to the lateral episiotomy. Another nurse took over for the suturing.

One birth had a nucal cord and some difficulty delivering the shoulders. I w asn't sure if she was alive. She was so blue and limp. After a lot of stimulation she began to make some noises. She was taken to be suctioned (very weak machine) and to be given oxygen. She began to cry once she was turned upside down and rubbed vigorously. Once she was taken up to the Post Natal ward she was very quiet and groggy. It was the Mama's first baby.

Jambo, Mt. Meru Hospital

It didn't scare me away from birth. I upset or really disturbed by their practices. It is what it is, a baby is born, and the world continues to turn. Just the way I like it.

Sister Shao is a wonderful teacher. She is very kind and direct.

In total, I helped deliver 4 babies on my first day. In the span of about 3 hours I doubled the number of births I had seen at home.

During the first birth I fainted. Between the heat, smell, sights, nerves and watching an episiotomy performed with dull scissors, I apparently couldn't handle it. A few nurses helped me up. I caught my bearings in another room and jumped right back i n. I made it in time to remove the placenta. It is not checked to ensure it is all intact or damaged.

The mtotos (babies) are wrapped in congas brought by the mama. They match the ones the mamas have. I'm already mastering swaddling with congas. They are so much cooler than regular old receiving blankets. Nice women would stop me to critique my wrapping. My own babies will be wrapped in congas.

I was able to suture a small posterior vaginal tear. It was nerve wracking. The mama had no freezing! Sr. Shao is a good teacher- she coached me. I also helped this mama deliver her baby.

The last baby was delivered with an episiotomy-I noticed a small anterior tear happening and the cord around the baby's neck. It was tightly wrapped around 3 times. He was attempting to breath spontaneously, then stopped. We were able to stimulate him to cry.

Another thing I noticed was that the majority of amniotic fluid was stained with meconium. Something that would be an emergency at home was just a normal occurrence here.

All blood p ressures are recorded at 120/70 (no BP cuff on the ward), APGARS are 9-10 (even if the baby is almost blue and limp). That bit will take some getting used to.

I love it here already.