Work

It is time to write about work. I have been avoiding it but think I can do so no longer. It may not be for the faint hearted amongst you. I work short hours; I usually get to the hospital about 9am, sometimes later and leave by 3. Today I left about 1.30 as I had had enough. No-one chases me and I am deciding my own work. My mission (should I choose to accept it; oh no, I have already) is to increase the capacity of the staff in maternity and to provide on the job training. So I spent the last 2 weeks observing and just trying to understand what is going on. I don't think I have succeeded in that, but maybe it will come with time. My main concern is the maternity ward, as the ante natal clinic runs fairly well. The Mat ward has anyone on it who is pregnant, in labour, delivered or what ever. So today we have 12 out of 13 beds full with cases from abortion (illegal here), to post natals of about 3 weeks. We have very little equipment. I saw that baby checks were not being carried out and so I started training staff how to do them and in the first 2 days we picked up one septic baby and one with birth asphyxia. The first one got the only suitable size cannula for his IV, so when the 2nd one needed an IV line we had problems. Then we found one in my office, but the dr. missed the vein first so had to use the same one again. Then I saw the following day that the cannula was in the baby's foot; it must have been the same one as we had no others. I read before I came out here that medical care for mothers and babies is free. Let me tell you it is not. They pay for their paper notes when they come in, they pay for equipment and drugs. A few drugs are supplied by the hospital but they run out quickly. So the babies only got some of their antibiotics as the parents could not pay for the full course and this is bad practice as regards resistance to anti biotics. They both improved. The delivery room is terrible; high hard tables in an unclean room. Everything is unclean. There is one bottle of 'soap' in the delivery room and we wash our hands with chorine water. There is nothing to dry them on. None of the toilets flush or have soap. The patients go outside to the loo. We have electricity only when the generator is one (for operations) so it goes without saying there are no CTGs or drug pumps or anything like that. I have not yet seen a birth here (pain relief only for CS) so that will be interesting. The reason I left early today was that we had a 21 year old in who had delivered her first twin on 11th Nov. in the afternoon in a maternal and child health post out in a village somewhere. She came in with someone in a uniform of sorts who had done the delivery (so I think not an untrained trad. birth attendent) but the second twin was not yet born. What followed was not good. The baby will certainly be dead. Why leave her for nearly 2 days before coming in??? She was transferred out just before I left to another local (and better) hospital. Still with the baby unborn. My aim is to get some organisation into the ward before I can do anything else. It is run by unqualified staff and the odd student, while the midwife in charge is elsewhere (often asleep). They do not allocate staff to patients, so 'care' is extremely haphazard. Drugs don't get given, sutures not removed etc.etc. They have wonderful staffing levels; 10 staff for 13 patients (excluding me) but they all move about the ward together like a shoal of fish. The consequence is that no-one has any responsibility. There are other things; labours of 6 days resulting in ruptured uterii, eclamptic fits. It's all good learning!