Tanzania, Dar es Salaam (Oyster Bay) – June 2014
Dearest Mikey, Micheala, Family, Friends, the team back at work, midwife colleagues in 1A and fellow midwives at Amana,
Its late and I’m tired, and jetlaged, but I wanted you all to know we gave out some the beanies today (and the baby socks) it was such a moving and beautiful (mnzori in Swahili) privilege and the mothers were so grateful and so humble – they have so little it was received with tears, laughter ….lots of hugs and mostly of all the joy on their faces when they showed us the wee babies. But I am getting ahead of myself.
I’ll add pictures to let you experience the moments.
Where does one start with such an amazing experience both culturally and professionally and all the while with Chase in her first year of study and soaking up what is an intense experience. The trip took us a long time – we had 9 bags
Let’s start with Dar as Salaam, we are staying in any area called Oyster Bay – diplomatic and western area in a house with security, a cook and 36 other people…mostly 22 year olds, all women but one guy Jack! Layout – Shared bunks, bathrooms, cold showers, hand washing clothes in buckets, power outages, local food for dinner –the chef is sweet guy …eating a lot of rice and fruit.
Swahili lesson three nights a week which is hilarious but a must to really immerse yourself in the language is to know a people, they are wonderfully generous of spirit and very we had have some laughs.
First two days we took the dala dala which is the name for bus in Swahili for bus – but really the bus resembles an overcrowded, standing room only, death-trap, crammed in with locals with babies, food, baskets and an intensity of heat, smells – true three day old sweat, flies, dust and roads that would make 4 WD safari look like a walk in the park…..two hours from the house to the hospital and then two hours back…did that for two days and gave that away – we now have taxi guy who takes us in 20 minutes in a car with windows and seat belts – and we can sit with our bags and enjoy the view. – all for $10 – the dala dala is only 80 cents !!!! but in balance $10 seems cheap!
Mothers all in labour waiting for a bed
Every day we have so much stuff to carry to the hospital it was almost impossible to carry it in the dala dala.
We take our own gloves, masks, alcohol wipes, hand sanitiser our scrubs to change into water, and of course all the baby beanies …
Chase is with me on labour ward…it’s not called birth suite here because one cannot in any shape for form call it as suite.
It’s a room with 8 delivery beds plus two high risk beds – Eclampsia,(fitting due to pregnancy induced hypertension – high Blood Pressure) obstructed labour, APH, etc
There is an antenatal pre – labour ward which is effectively a booking place and you assess the patient – start a partogram (special chart for labour and delivery) – it’s a very busy ward.
There is 80-120 babies born every day, which I know defies belief but its true- the mothers travel far and wide because they are encouraged to have safe delivery – they have very little but are wonderfully happy and I have fallen in love with many of them.
The sisters on the ward – Midwives – they are highly skilled and care for a great deal of women every day and see every imaginable pregnancy outcome, and boy do they have full days.
There is no tea room or break room , because they never seem to have a break on shift – there are few lulls in the constant stream of mothers.
Post resuscitation…good outcome…
So day One – we arrive at the hospital – change into scrubs – get our ID badges – go to the ward – and the sister comes in to greet us and says please come we will show you orientation later….. We are busy – please bring your gloves.
We walked into the labour ward and was immediately involved in a delivery of a women on the floor – managed to get her on the bed …she delivered quickly – lady next door pushing – delivered…within 20 minutes 7 babies had been born.. We were in the zone….by one o clock Chase & I lost count after number 26 deliveries, 2 full resuscitation’s…with great outcomes 80 % meconium liquor ……Sister Rose was fantastic and I worked with her all, day, she taught me so much and it was Sister Rose who gave such encouragement to me that I could be of help here.
One lost …..at 28 weeks…C section for APH – ( haemorrhage) the baby died …wee angel…..the wee 28 week baby – I placed it next to lusty crying babies …I wanted him to have company in his passing…..
It was hot – 32 degrees, no fans, no fly screen so flies everywhere – the sweat is dripping down my back – no breaks, no time to eat – going to the toilet is like a major expedition.
There is no tea room or break room, because they never have a break on shift – there are few lulls in the constant stream of mothers.
After being supervised and trained, Chase is now giving injections of oxytocins, we need the help because there are so many deliveries going on – draws up the drug & checks with another RM and gives it IM – sets up delivery packs, weighs and records the babies – helps at resus. In fact I have come to rely on Chase being beside me in a Neonatal Resuscitation.
Chase will tap out the heart rate of the baby, I usually give bag and mask if required (mostly it is required) – If I needed to start cardiac compression, Chase could take over the bag and mask. Its wonderful having Chase beside me and we work well together. Routine during the day is – Restock the limited supplies – constantly through the day run out of drug we use post delivery to actively manage the delivery of the placenta and also to prevent the mothers bleeding, its a drug called oxytocis – IV bottles are rigid plastic – IV running sets – having to count drips for – augmented labour it’s a whole new skill (we use pumps) in Australia – no soap at the basins – hand sanitizer you have to provide.
Lignocaine in large bottles – methylated spirits to swab tops.
A room with 8 delivery beds plus two observational beds or high risk beds – Eclampsia
The set up in the mothers must buy their delivery pack which consist of 10 IU of Oxytocins ( a drug that helps contract the uterus after delivery), two pairs of sterile gloves one for delivery & one to take the baby after you deliver it and cut the cord, a package of sterile suture material in case they require stitches after delivery, a cord clamp, and a large roll of cotton wool wadding.
They must bring three kanga’s large colourful cotton sarongs.
We place one Kanga under them on top of a plastic sheet about 3 feet square – (which the hospital kindly provides) they are soaked in vats of chlorine and hung out to dry. See below in the picture .
A plastic sheet about 3 feet square – (which the hospital kindly provides)
they are soaked in vats of chlorine and hung out to dry.
The other kanga we place on their chest and deliver the baby to the chest – then upon clamping the cord (delayed clamping of the cord) the baby is placed into a clean dry kanga – taken to be weighed and antibiotic ointment in each eye – wrapped and placed under a two bar heater on the wall – a piece of tape in placed on the chest with name of mother, and sex and weight.
Meanwhile back at the mother – Oxytocins given at cord clamping – the third state ( delivery for placenta) very very quickly after that.
Beanies and Baby Socks
Check if she requires any repair – repair then with 5 mls local anaesthetic – suture using the same clamps you used to clamp the cord.
There are no scissors – only scalpel blades with no handles for all cutting of cords and suture material. Suture material is cat gut – dissolvable but it’s very stiff.
The sharps bins are thin card board overflowing – all placentas go into the other bin, all equipment used in delivery is washed and re – sterilized immediately by an old man who runs this autoclave all day long.
The mother is asked to get up and we walk her to the sitting area – a wooden bench where she immediately breast feeds her baby – along with all the other mothers.
We wash down the bed – place a new plastic sheet on the bed and receive the next mother.
If the mother wants to eat she must wait for her family to bring her food – she must provide it all.
The kanga she delivers on is given to her still soiled in a plastic bag which she must provide and she gives it to her relatives to clean. There is no fuss – no carry on.
During labour there is no pain relief, no gas, no epidural – there is nothing – the hospital often has no blood for transfusions; women are often anaemic due to malaria and malnutrition. The mother’s birth plan is survival of herself and her baby – some young mothers would say as they labour “I don’t want to die….”
The midwifes are incredible and they deal with many many difficult cases – there is a ward round twice a day during the morning shift and about 2.30 – 3.00 pm – decisions are made on progress and they follow the partogram “Alert line” and “Action line” with times placed next to the times based on the initial examination and labor progress.
One of the doctors is a quiet mannered man who has a constant look of intensity as he deals with so many mothers and babies. Yesterday they had to transfer two women to another hospital, because they ran out of sterile instruments for C sections. They rarely do LUSC.
Today I delivered three babies – 4.2, kg, 4.3, kg, 4.1, kg – in the delivery beds and one which we nicknamed “floor baby” – I delivered it on the floor – darling wee things with Apgars of 9, 9 – the mother a young 16 year old – first baby and she did well – head on view – push baby delivered as she sat down – Chase asked to draw up synocinin – – find the cord clamp in the bag – clamp cord – cut cord – show mum the sex of the baby – hand over baby to Chase ( named floor baby as didn’t get time to get to know the mother name at this stage) – deliver the placenta – check fundus – check perineum – all good, help mother up – tell her to go to the toilet and pass water- she come back sits on the bench and breast feeds – just cleaned up the floor and Sister Rose (midwife with whom I’d worked with yesterday – and is in antenatal) brings another women in and says to me “Sister Mamma Jenny – “fully and on view “– which means for the non- midwifes – baby is on its way.
Chase said my G string hanging out the back of my scrubs was not a good look …but I must say I wasn’t planning in delivering on the floor – bare floor!
Delivery on the bare floor. Where are all the other midwifes you may ask-?? Delivering babies as well – even student nurses delivering.
Marian delivered within 6 minutes, third stage shortly after…..and so it goes on…..there was a lull of about an hour when we only had 8 women in labour and no deliveries for 67 minutes ( I counted) lost count at 33 babies and that was at 3 pm ….
Today we also had cord prolapse – good outcome, I delivered a baby of a young mother who had been sadly circumcised, other cases today were pre term labour, obstructed labour , PPH, failed vantouse then delivered in swat position.
Communications can be a challenge with broken English and Swahili all mixed in together – – my Swahili is limited to words like Push = Sakuma….stop (acha) , breath good relax, darling, beautiful baby, sorry, slowly slowly – etc etc.
But let me tell you all the best part of today…
Mother and healthy new born baby
So the baby’s beanies and baby sox’s…..
I am not sure I can convey in words the generosity and love you all gave in your gifts of money, equipment – baby clothes, knitted beanies, it was a beautiful and very moving privilege today – they soaked up today the love and Golden strands of love infused into every stitch knitted or crocheted for them….the mothers…. given by you all as total strangers 1000’s of miles away –
Each stitch infused with love and these gifts for me were just a breath away from being one of the moments in one’s life when you are glad your own dreams came true – that I have a profession that allows me to connect to my fellow midwifes a world away from home –
Being a helicopter pilot – pure freedom and professional growth – and our business which is a sum of stunning people who work within its whole mechanism ….without the success of so many of our team in making the company what it is today – I would have been able to be here …
It feel wonderful to be part of something that is bigger than yourself …..its refreshing to be embraced so generously by these midwives, the mothers and privileged to be make a small contribution to some of these little tackers first moments of live.
The girls in the postnatal ward are 4-5 to a bed – they share and sleep together.
With one of my mother’s whom I delivered her baby
The popular beanies – these ones from Kayla and Granny Helen
Chase and I to a tonne of medical equipment which they have lapped up and the single use equipment came into its own ad they run out all the time – so please my midwife colleagues back in 1A please save the single use equipment including single use resus bags – suture kits, delivery packs- they are just desperate here and I feel so very guilty about how much we use once and throw away….in fact at one point today I just wished I could have bought more – contributed more …..We are so very blessed in Australia, NZ, UK, Europe…..
Chase with new born baby
One thing I bought that Becker Helicopters donated was educational material in Swahili and resus babies for practise, booklets.
It was amazing as we went through the golden minute – the babies first minute of life – and it’s a Helping Baby’s Breath program to assist health care workers ….the charge sister (they still call them that here) she ran a teaching session with all her staff during the lull we had that day – then the teaching flip charts were put up on the resus machine that no one uses and can’t work because of power cuts all the time and no wall suction and no oxygen cylinders) ….the posters were placed on the walls, student were trained during the day by their tutors…I was very moved and proud to have provided this training material all from a USA sponsored initiative and was so involved in the teaching of these students because there are so many resus everyday.
Golden Minute – the babies first minute of life – and it’s a helping baby’s breathe program to assist health care workers
Pass that torch to the next generation of midwives
With Much love and heartfelt thanks,
Jan & Chase
(Dar es Salaam, Tanzania)
