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?