When I was in Sierra Leone I made a commitment that I would do an 'in memoriam' page on this blog for all the women who died on our ward (or occasionally having just left it) while I was in Makeni Government Hospital. These women were all poor, rural Africans. I hope by publishing this they will lodge in your heart and not be forgotten by the outside world.
2009
Babylove Kargbo aged 18 died 20 October from postpartum haemorrhage
Isatu Kanu aged 17 died 21 October from eclampsia
Kadiatu Kamora aged 22 died 22 October from a ruptured uterus
Saffiatu Sesay aged 24 died 26 October from eclampsia
Finah Marrah aged 35 died 27 October from 'prolonged labour'
Saffie Bangura aged 22 died 15 November with retained 2nd twin
Kadiatu Kamara aged 23 died 21 November from hepatitis
Finah Adamo aged 25 died 20 December from anaemia
Harba Conteh aged 32 died 26 December from eclampsia
Fatmata Bangura aged 17 died December 29 from eclampsia
2010
M'balu Koroma no age given died 24 January from antepartum haemorrhage
Fatmata Mansary age 17 died 26 January from obstructed labour
Nancy Conteh aged 35 died 8 February from postpartum haemorrhage
Thursday, 16 September 2010
Friday, 20 August 2010
Back home
My dear readers
The observant amongst you will have noticed that I have not written a blog for some time. In fact, the last one was April 1st and it is now August 20th. This is because I returned home to the UK unexpectedly on May 10th and this blog has not been uppermost in my mind. Only now am I getting round to saying farewell to you all.
I do miss Sierra Leone and, forgive the cliche, it was a life-changing experience. To have been able to uproot myself and live in relatively basic conditions was a real eye-opener and I am amazed at how I adapted to it. It did take me about 3 months to do so but then it all became my life and it was just normal.
The things I found difficult were: living in fear that the water would run out, not being in easy contact with friends and family back home, finding food that I wanted to eat, the heat which was pretty relentless and I was constantly wet, travelling and I expect there were other things once upon a time but I seem now to have forgotten them.
But then there were the extraordinary things. I always felt part of a group of supportive friends and if any of them read this, it was great to know you all. I have written elsewhere about the starry sky which is a thing we hardly ever see in the UK (or not my bits of it, anyway). It was fascinating to see how the local people took their pleasure and fun where they could and usually in ways that we westerners would scorn. They dance at any opportunity - if there is any music anywhere such as in a shop, then they will dance. And no-one looks at them and thinks 'nutter' like they would here and move away. No, it was quite normal and acceptable. Most ordinary people have no access to television. On some evenings there would be a big crowd around one of the street stalls in Makeni; someone would have a tiny, tiny tv screen and this large crowd would be craning their necks to try to watch it.
One of the things I miss most is the morning hymn singing in the midwifery school. I would wait in the library for the students to finish their prayers and would hear, drifting through the corridors, the inimitable sound of African women singing with passion.
I will be uploading photos over the next few weeks, so please keep an eye on my blog still.
Africa, I miss you.
The observant amongst you will have noticed that I have not written a blog for some time. In fact, the last one was April 1st and it is now August 20th. This is because I returned home to the UK unexpectedly on May 10th and this blog has not been uppermost in my mind. Only now am I getting round to saying farewell to you all.
I do miss Sierra Leone and, forgive the cliche, it was a life-changing experience. To have been able to uproot myself and live in relatively basic conditions was a real eye-opener and I am amazed at how I adapted to it. It did take me about 3 months to do so but then it all became my life and it was just normal.
The things I found difficult were: living in fear that the water would run out, not being in easy contact with friends and family back home, finding food that I wanted to eat, the heat which was pretty relentless and I was constantly wet, travelling and I expect there were other things once upon a time but I seem now to have forgotten them.
But then there were the extraordinary things. I always felt part of a group of supportive friends and if any of them read this, it was great to know you all. I have written elsewhere about the starry sky which is a thing we hardly ever see in the UK (or not my bits of it, anyway). It was fascinating to see how the local people took their pleasure and fun where they could and usually in ways that we westerners would scorn. They dance at any opportunity - if there is any music anywhere such as in a shop, then they will dance. And no-one looks at them and thinks 'nutter' like they would here and move away. No, it was quite normal and acceptable. Most ordinary people have no access to television. On some evenings there would be a big crowd around one of the street stalls in Makeni; someone would have a tiny, tiny tv screen and this large crowd would be craning their necks to try to watch it.
One of the things I miss most is the morning hymn singing in the midwifery school. I would wait in the library for the students to finish their prayers and would hear, drifting through the corridors, the inimitable sound of African women singing with passion.
I will be uploading photos over the next few weeks, so please keep an eye on my blog still.
Africa, I miss you.
Saturday, 3 April 2010
Children
I seem to live in a sea of children; in our neighbourhood there seem to be loads of them all over the place and usually calling 'oporto' (white person) after me. It gets very tiresome - see blog about political correctness - and whenever I open the front gate they come rushing over in whatever state of dress/undress and ask for 'dirty'. This means the waste, rubbish, trash, garbage or whatever you want to call it: I pay them to take it away. I have no idea how I would get rid of it if they didn't take it. They are always very keen to earn money, of course, so it matters not one bit if I gave one of them 3 bags of 'dirty' 10 minutes ago, they will still come running asking for it as though I make an endless supply of rubbish. I have no idea what they do with the stuff I give them and, quite honestly, I don't want to know. They are all poor and live in very basic housing into which I have never ventured. Quite a lot of them have malnutrition as evinced by the gingery tinge to their hair and they are often completely naked but not always. One girl this afternoon was dressed up an a princess outfit. There are an awful lot of umbilical hernias here and I would like to know why. I have heard theories about low protein diets causing weak abdominal muscles and various other things, none of which is overly convincing I think. They show great ingenuity in creating toys for themselves: you see boys dragging along a tin can on a string, pretending it's a car and they make kites out of black bin liners attached to a piece of string. Also they do that thing I have only seen in Victorian children's books; they have an old wheel or tyre and run down the road pushing it along with a stick. I'm not sure I have explained that very well and it must have a name - hoop and stick maybe? - I know I never did it. They love playing football and usually have rubbish balls to do it with. When I was walking here this evening a boy was calling after me 'give me a ball' time and time again (please not being a word in their vocabulary) as though I had lots of them stashed about my person. In addition to asking for balls they ask outright for money and food -'oporto emadi' or 'white person feed me'. If they see you with anything, they want it. If you are drinking water from a bottle they will come up and ask for it, if you buy something at a roadside stall they stand beside you and expect to be given what you buy, or at the very least given the change. These are not children of famine or war. Quite a few of them look at me and burst into tears; they are frightened of white people as their families tell them if they don't behave a white person will come and take them/eat them/what you will. It's always good to be cast in the role of the villain. The organisation I am with tells us not to do anything to promote or condone child labour but the reality is that after school many of them walk around with a tray on their head, selling stuff and if we didn't buy from them their lives would be worse, not better. So that's the kids done and dusted.
Tuesday, 2 March 2010
Animals
When I first got here I thought everything would try to kill me. I no longer think that. But I know some things wouldn't mind trying.
I shall start with the small beasts: ants. We have lots and lots of teeny, tiny little ants that want to be in our food and everywhere else. They don't bite. They are so weeny you can hardly see them but you feel them running over your arms and hands and it feels like a little tickle. Then you look: no, it's ants. So you squash them. We do have house flies but not that many really, well not considering the general lack of hygiene. There are some particularly nasty bee-type things which have such a narrow waist as to look almost in two separate halves and some have been making a nest out on my back porch ever since I have been here. But they are Sierra Leonean and are working slowly. I asked our cleaner Mohammed how I could get rid of them. He said to go out to the porch at midnight with a can of insecticide, leave the back door open, spray the nest and run like hell back into the house. I haven't done it yet; I think they fit into the group of animals that may try to kill me.
Have I told you about our cat Ginger? He keeps the rats down and he does sometimes catch them. I opened the back door a couple of weeks ago to find a fresh kill right where I was about to put my foot. Nice. Most mornings I go on rat patrol to scoop up any bodies and I put them in an empty milk tin, pour petrol over them and set it alight. But I have never managed to burn the whole body and rat tails seem particularly resistant... Ginger likes to play with lizards and I found a dead one yesterday which he then proceeded to eat. And five minutes later sicked up. I think they taste bad as he always drinks water after playing with them. He caught a bat and eviscerated it a couple of weeks back, quite neatly, I must say. Later I saw him being a bit odd so kept my eye on him for a while in case he had rabies but he seems ok.
Oooh! Snakes! I have seen 3 so far I think and 2 were dead. 2 of them were black mambas which had been found in the fields near the house and had been decapitated by some brave soul. The other one was a really bright green one crossing the road one Saturday morning (probably out shopping or something) and we drove right over it. Someone said you should never drive over a snake as it can get up into the engine and into the vehicle, but I really don't think this one could have survived a 4 wheel drive truck going over it at right angles. Besides, should you brake for a snake?
What else to tell you about? Chickens are absolutely everywhere. Sometimes young ones come under our garage gate and Ginger 'plays' with them; I haven't seen him hurt one yet but they sqwak a lot and then I have to chase them around the perimeter of the house with a towel to throw over them and put them back outside. Chickens strut around all over the hospital and no taxi ride is complete without one in a plastic bag. Talking of the hospital, I have seen in the grounds (beside the chickens, of course) a goat tethered to a post, a cow tethered to the same post after the goat had gone, lots of dogs just lying around and the odd cat. And spiders. My sometime housemate Kiki works part-time in a hospital about a half hour drive from Makeni. One day she and the hospital administrator came to Makeni to do some shopping in the ambulance (yes, that is what they are for) and, while up near our lorry park, he saw his goat that had been stolen the previous night so he put it in the ambulance and took it home. Would that ever happen in England? We do have lots of mosquitos, but it is not their breeding season at the moment so they are not causing too much trouble to me now.
DOGS. I do not trust the dogs here at all; they are generally very lazy and in bad condition but I don't like being barked at by them as I think they will attack me and give me rabies. You will see I am very concerned about rabies. When I was out in a car late one night just after I got here there were great packs of dogs just roaming the streets; I would shoot them all. Someone told me they are guard dogs but they don't seem to do much guarding to me.
You will note that I am generally very unsentimental about animals and am even more so here.
I am told they eat cats, but I draw the line at that.
I shall start with the small beasts: ants. We have lots and lots of teeny, tiny little ants that want to be in our food and everywhere else. They don't bite. They are so weeny you can hardly see them but you feel them running over your arms and hands and it feels like a little tickle. Then you look: no, it's ants. So you squash them. We do have house flies but not that many really, well not considering the general lack of hygiene. There are some particularly nasty bee-type things which have such a narrow waist as to look almost in two separate halves and some have been making a nest out on my back porch ever since I have been here. But they are Sierra Leonean and are working slowly. I asked our cleaner Mohammed how I could get rid of them. He said to go out to the porch at midnight with a can of insecticide, leave the back door open, spray the nest and run like hell back into the house. I haven't done it yet; I think they fit into the group of animals that may try to kill me.
Have I told you about our cat Ginger? He keeps the rats down and he does sometimes catch them. I opened the back door a couple of weeks ago to find a fresh kill right where I was about to put my foot. Nice. Most mornings I go on rat patrol to scoop up any bodies and I put them in an empty milk tin, pour petrol over them and set it alight. But I have never managed to burn the whole body and rat tails seem particularly resistant... Ginger likes to play with lizards and I found a dead one yesterday which he then proceeded to eat. And five minutes later sicked up. I think they taste bad as he always drinks water after playing with them. He caught a bat and eviscerated it a couple of weeks back, quite neatly, I must say. Later I saw him being a bit odd so kept my eye on him for a while in case he had rabies but he seems ok.
Oooh! Snakes! I have seen 3 so far I think and 2 were dead. 2 of them were black mambas which had been found in the fields near the house and had been decapitated by some brave soul. The other one was a really bright green one crossing the road one Saturday morning (probably out shopping or something) and we drove right over it. Someone said you should never drive over a snake as it can get up into the engine and into the vehicle, but I really don't think this one could have survived a 4 wheel drive truck going over it at right angles. Besides, should you brake for a snake?
What else to tell you about? Chickens are absolutely everywhere. Sometimes young ones come under our garage gate and Ginger 'plays' with them; I haven't seen him hurt one yet but they sqwak a lot and then I have to chase them around the perimeter of the house with a towel to throw over them and put them back outside. Chickens strut around all over the hospital and no taxi ride is complete without one in a plastic bag. Talking of the hospital, I have seen in the grounds (beside the chickens, of course) a goat tethered to a post, a cow tethered to the same post after the goat had gone, lots of dogs just lying around and the odd cat. And spiders. My sometime housemate Kiki works part-time in a hospital about a half hour drive from Makeni. One day she and the hospital administrator came to Makeni to do some shopping in the ambulance (yes, that is what they are for) and, while up near our lorry park, he saw his goat that had been stolen the previous night so he put it in the ambulance and took it home. Would that ever happen in England? We do have lots of mosquitos, but it is not their breeding season at the moment so they are not causing too much trouble to me now.
DOGS. I do not trust the dogs here at all; they are generally very lazy and in bad condition but I don't like being barked at by them as I think they will attack me and give me rabies. You will see I am very concerned about rabies. When I was out in a car late one night just after I got here there were great packs of dogs just roaming the streets; I would shoot them all. Someone told me they are guard dogs but they don't seem to do much guarding to me.
You will note that I am generally very unsentimental about animals and am even more so here.
I am told they eat cats, but I draw the line at that.
Monday, 22 February 2010
The New Midwifery School in Makeni
I think I did briefly mention the midwifery school that opened here last month and that brevity does not do it justice as it's been a really big thing. There is only one other training school for midwives in SL and that is in Freetown over 100 miles away. It is very difficult to get any qualified staff to stay anywhere outside of Freetown; they all flock there and consequently there are hardly any qualified health workers in the provinces/regions and still fewer in the remoter parts. I think there are only 95 qualified midwives in this whole country (pop. around 6 million with a high birth rate and, as you may know, the worst maternal and infant mortality rates in the world); our school is currently training 75 and we have another intake in July. Lots of them have problems finding accommodation here, as they come from all over the country, and we have not built our student hostel yet. They are bonded to work in the outlying districts for 2 years after qualifying, where they will find themselves probably the most educated and highly qualified person around for miles. They will be expected to deal with all sorts of problems with very little support. Maybe a mobile phone. They have my utter admiration for being prepared to do that. I have added some photos of the students on the day of the opening.
The school itself is a new building and quite extensive. It sits fairly high up in Makeni, so we get some breeze, and is next door to a hospital; I think it was built on the site of an old hospital. We have a wonderful skills lab. which is much better than anything I had when I was training, and computers and a library. Most of the funding has come from the Netherlands. We do need more textbooks, so if anyone can help get us some, please get in touch. We have only one copy of a standard midwifery textbook for all of our students and tutors. I have been teaching anatomy and physiology and also computer studies. This latter will make my children laugh, but as most of the students had never sat in front of a computer before, I have managed to teach them some useful things. Like how to switch it on and off.
We had the official opening a couple of weeks after the students started. The students were all there in their mauve uniforms (which they have to wear in class too) and I was very proud of them. They did what they called a 'skit' which was a mini play about a labouring woman in the bush going to a traditonal birth attendent (TBA), who referred her to the health post, who referred her to the hospital where the staff all ignored her, but too late anyway; she bled to death. There was supposed to be a countering positive story about going to hospital in good time, but time was, unfortunately, not on the students' side so it was jettisoned. One of the students was sitting near me throughout the proceedings with a bottle of whisky and a bottle of water on a tray on her lap. They were heating up nicely in the boiling sun and I wondered who would be suffering them later. I saw something on the programme called 'libation'; the Paramount Chief and someone else poured of these liquids over the front step. I suppose it was the equivalent of breaking a bottle of champagne over the door. The President's wife, who cut the ribbon, and the Vice President's wife came as well as the Paramount Chief, so it was very high-profile. I took a photo of the PC in all his finery, which I would love to show you and him (as he wanted a copy) but can't manage it. Probably best to try to stay on good terms with him as far as I can, though.... We also had some traditional drummers in costume, who kept starting too early with the drumming, such was their enthusiasm but finally they were allowed to do their stuff around libation time. And we got to eat, too, so a good time was had by all. Then the hard work started.
People often, very kindly I think, tell me my blogs are funny and make them laugh. This one is not one of those, as the work ones cannot be either. This school is so badly needed, the midwives are so badly needed too and it is possible to turn their appalling mortality stats around. We have a British booklet in our library which describes how this was done over a 6 year period in a Lancashire town which had the worst maternal mortality rates in the UK in the 1920s and early 1930s. Over that relatively short period they reduced it by about two thirds by using every opportunity for education about the importance of ante natal care and looking critically at their own practices. We have 4 male students; one of them told me that he decided to do this course after his sister died last June, giving birth to her twins, who also died.
So next time, maybe a bit lighter ...
Tuesday, 2 February 2010
Communication
What aspect shall I take first? Phones: as may know, there are no landlines in this country. We do have telegraph poles but no lines between them as they were cut down during the rebel war (ended 2002). So we rely on mobile phones and thank heaven for them. But coverage is patchy so people often have up to 4 handsets on the different networks and, as far as I can work out, they only have pay as you go, not contracts. Well, that would make no sense because there is no postal service (see below) so they couldn't send out bills and I suspect the banking system is not very sophisticated so direct debits and suchlike may be unknown for all I know. Anyway, most people don't have a bank account. Most people have no money. I am on Zain network as I was given their sim by my organisation when I arrived here. I phoned my daughter last week as it was her birthday and I ran out of credit. When I tried to buy more, there was none! Nowhere in this town could you buy Zain credit for several days. So I was incomunicado for almost a week. Don't forget: no landlines.
Internet: we do have modem sticks (or dongles perhaps you call them) but they are very expensive and I discovered they do not work with the operating system I have on my laptop (Linux). There are only 2 places I know of where they have internet facilities - I am sitting in one of them now - and sometimes the server is down. One of them - the other one - is a bike ride away, so you pay for a taxi up there, discover you can't use the internet and have to have a taxi back again. This can happen time after time. Why not phone them first? Because there is no phone! There are also a few dodgy looking places that say 'internet cafe' (believe me, 'cafe' would not come into it) but they usually have unbelievably loud football on and somehow I don't think a respectable lady would want to be seen in them.
Postal service: none. We do have a post office, a lovely old colonial type building and they do have a post office box system, which I may investigate, as it would be better to send post there instead of via my organisation. But I would have to go to collect anything, rather like if the postman in the UK can't deliver your parcel and you have to go and get it. But if you don't know something is coming for you (uncertain phones and email access, don't forget) you would leave things there for ever. I got 3 letters early this month, unfortunately from Revenue and Customs, which had been posted in November, and one Christmas card was hand delivered by my organisation when they visited on the final Saturday in January. It was postmarked 2nd December. Yes, I know that happens at home, too.
I will include photos here as they are a form of communication and I had hoped very much to post some on this blog. I still have hopes, in fact, but they are fading. Most internet access is very slow and the only time I have managed to upload any photos it took quite a long time and I regretted not choosing the pictures a bit more carefully. I had imagined I could upload lots of them and could not. When I tried with the modem stick on a friend's laptop, we aborted mission after 40 minutes trying to upload 2 pictures. Also, they do not believe in viruses here, or they have no virus protection anyway. So I am worried if I put my memory card from my camera into one of their computers it will stuff up my lovely digital camera. So those are my excuses.
Internet: we do have modem sticks (or dongles perhaps you call them) but they are very expensive and I discovered they do not work with the operating system I have on my laptop (Linux). There are only 2 places I know of where they have internet facilities - I am sitting in one of them now - and sometimes the server is down. One of them - the other one - is a bike ride away, so you pay for a taxi up there, discover you can't use the internet and have to have a taxi back again. This can happen time after time. Why not phone them first? Because there is no phone! There are also a few dodgy looking places that say 'internet cafe' (believe me, 'cafe' would not come into it) but they usually have unbelievably loud football on and somehow I don't think a respectable lady would want to be seen in them.
Postal service: none. We do have a post office, a lovely old colonial type building and they do have a post office box system, which I may investigate, as it would be better to send post there instead of via my organisation. But I would have to go to collect anything, rather like if the postman in the UK can't deliver your parcel and you have to go and get it. But if you don't know something is coming for you (uncertain phones and email access, don't forget) you would leave things there for ever. I got 3 letters early this month, unfortunately from Revenue and Customs, which had been posted in November, and one Christmas card was hand delivered by my organisation when they visited on the final Saturday in January. It was postmarked 2nd December. Yes, I know that happens at home, too.
I will include photos here as they are a form of communication and I had hoped very much to post some on this blog. I still have hopes, in fact, but they are fading. Most internet access is very slow and the only time I have managed to upload any photos it took quite a long time and I regretted not choosing the pictures a bit more carefully. I had imagined I could upload lots of them and could not. When I tried with the modem stick on a friend's laptop, we aborted mission after 40 minutes trying to upload 2 pictures. Also, they do not believe in viruses here, or they have no virus protection anyway. So I am worried if I put my memory card from my camera into one of their computers it will stuff up my lovely digital camera. So those are my excuses.
Friday, 29 January 2010
Work 2
So back to work. I have not written about that for some time so it's about time I picked it up again.
Do I have a typical day at work? Probably not, but I will try to describe one.
I get up about 7 and walk to work, about 10 minutes away, past the local people washing at the public tap and the (semi) naked children, past the fish market and into the main road where I dodge the traffic and all the kids shouting "oporto" (white person) at me. I sometimes give them a regal wave. When I get to work I am usually very hot and sit in the office for about 15 minutes drinking water. We buy packets of it; there is no safe drinking water in the hospital. There is not really any water at all. I therefore want to avoid using the loo there. Then I steel myself and go to the maternity ward where I do a bed round and make notes about the patients. Some of the staff - or most of them - have no idea why I want to write notes about the patients and cannot understand why I find it helpful to know about the patients. Hmm. We have only had one maternal death this month; she had an antepartum haemorrhage, they wanted 3 units of blood to transfuse but they could only get one and she bled again and so died. They get the blood from relatives. We have now got a system for notifying maternal deaths and this is just starting up now. The 2005 figures were 2100:100,000 maternities against a UK figure of 9:100,000. I have been trying to organise the maternity ward but to no avail. I tried to get them doing a proper handover and write notes about the patients but it did not work out. Literacy is a problem here and I found they were unable to pick out the relevant details, so that foundered. I tried to get a system of named staff caring for named patients, which seems so obvious to me, but this proved impossible. I have also tried to instigate daily baby checks, again this has not worked out. The babies do not get checked over when they are born nor on a daily basis, as they would at home. I tried this back in November and it failed then. Someone said that they don't bother about babies here because so many die before they are 5 but maybe, just maybe, some of them would survive if anyone did bother about them. Silly idea of mine. Most of our babies are at the lower end of the normal birthweight range, most likely because of maternal anaemia. This is due to malnutrition and/or malaria. Less than 2.5kg is low birthweight and we have lots about 2.6 or so and we have had some about 1.7kg. Needless to say there is no neonatal care unit. How could there be? No electricity! So, after a while of reading about the drugs and care not given, I go back to the office and write stuff.
In order to feel I am achieving something, I have started some teaching sessions for anyone who is interested. This is actually what I am supposed to be doing: it is called 'capacity building'. They are about maternity/midwifery but open to anyone as the staff rotate around the hospital in 6 month batches. So twice on Mondays I hope some people will show up and they have so far. I did last Monday's session on pre-eclampsia and eclampsia and had 8 to the first session at 11am and 5 to the 3pm show, so not too bad. Only 2 from maternity though. Next Monday's sessions willl be on antepartum haemorrhage. Apt, I think.
The other things is that the new Midwifery school opened here a couple of weeks ago with a lot of razzmatazz. I am also working there, teaching anatomy and physiology which is great because I have to learn it before I can teach it! I did learn it once for exams but really have forgotten so much, but the best way to learn something is by teaching it. We have electricity and ceiling fans and a staff room with a fridge and a skills lab with lots of models and teaching aids ... Can you guess where I would rather work? They do have big classes here and I have 73 in one class. I had thought it would be more daunting than it actually is standing up in front of that lot, but I a manage. They are all nurses who are on a 2 year midwifery course and they have lots of experience already. They all recognise me when I am out, of course, as we white people stick out like sore thumbs, and so I am forever pretending I know who they are when I don't. I think they probably know that.
I seldom work more than a 6 hour day, which is the norm here. 8 hour days are called 'white people's hours', but it is very hot here, don't forget. I walk home from the hospital and get an ocada (motorbike taxi) back from the school. And then I have a very exciting evening in the bar with whatever other expats turn up! We get our cat Ginger some meat or fish on the way home, grab an ocada and go home and are often in bed about 10. How's that for an exciting life?
Do I have a typical day at work? Probably not, but I will try to describe one.
I get up about 7 and walk to work, about 10 minutes away, past the local people washing at the public tap and the (semi) naked children, past the fish market and into the main road where I dodge the traffic and all the kids shouting "oporto" (white person) at me. I sometimes give them a regal wave. When I get to work I am usually very hot and sit in the office for about 15 minutes drinking water. We buy packets of it; there is no safe drinking water in the hospital. There is not really any water at all. I therefore want to avoid using the loo there. Then I steel myself and go to the maternity ward where I do a bed round and make notes about the patients. Some of the staff - or most of them - have no idea why I want to write notes about the patients and cannot understand why I find it helpful to know about the patients. Hmm. We have only had one maternal death this month; she had an antepartum haemorrhage, they wanted 3 units of blood to transfuse but they could only get one and she bled again and so died. They get the blood from relatives. We have now got a system for notifying maternal deaths and this is just starting up now. The 2005 figures were 2100:100,000 maternities against a UK figure of 9:100,000. I have been trying to organise the maternity ward but to no avail. I tried to get them doing a proper handover and write notes about the patients but it did not work out. Literacy is a problem here and I found they were unable to pick out the relevant details, so that foundered. I tried to get a system of named staff caring for named patients, which seems so obvious to me, but this proved impossible. I have also tried to instigate daily baby checks, again this has not worked out. The babies do not get checked over when they are born nor on a daily basis, as they would at home. I tried this back in November and it failed then. Someone said that they don't bother about babies here because so many die before they are 5 but maybe, just maybe, some of them would survive if anyone did bother about them. Silly idea of mine. Most of our babies are at the lower end of the normal birthweight range, most likely because of maternal anaemia. This is due to malnutrition and/or malaria. Less than 2.5kg is low birthweight and we have lots about 2.6 or so and we have had some about 1.7kg. Needless to say there is no neonatal care unit. How could there be? No electricity! So, after a while of reading about the drugs and care not given, I go back to the office and write stuff.
In order to feel I am achieving something, I have started some teaching sessions for anyone who is interested. This is actually what I am supposed to be doing: it is called 'capacity building'. They are about maternity/midwifery but open to anyone as the staff rotate around the hospital in 6 month batches. So twice on Mondays I hope some people will show up and they have so far. I did last Monday's session on pre-eclampsia and eclampsia and had 8 to the first session at 11am and 5 to the 3pm show, so not too bad. Only 2 from maternity though. Next Monday's sessions willl be on antepartum haemorrhage. Apt, I think.
The other things is that the new Midwifery school opened here a couple of weeks ago with a lot of razzmatazz. I am also working there, teaching anatomy and physiology which is great because I have to learn it before I can teach it! I did learn it once for exams but really have forgotten so much, but the best way to learn something is by teaching it. We have electricity and ceiling fans and a staff room with a fridge and a skills lab with lots of models and teaching aids ... Can you guess where I would rather work? They do have big classes here and I have 73 in one class. I had thought it would be more daunting than it actually is standing up in front of that lot, but I a manage. They are all nurses who are on a 2 year midwifery course and they have lots of experience already. They all recognise me when I am out, of course, as we white people stick out like sore thumbs, and so I am forever pretending I know who they are when I don't. I think they probably know that.
I seldom work more than a 6 hour day, which is the norm here. 8 hour days are called 'white people's hours', but it is very hot here, don't forget. I walk home from the hospital and get an ocada (motorbike taxi) back from the school. And then I have a very exciting evening in the bar with whatever other expats turn up! We get our cat Ginger some meat or fish on the way home, grab an ocada and go home and are often in bed about 10. How's that for an exciting life?
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