at the hospital

After all the stories about our day-to-day live here in Motta, I think it is time to tell about our work at the hospital again.
When the first foreign gynecologists and midwives came to Motta, there was a very high number of mothers dying from pregnancy- or childbirth related complications. Luckily this has been changing. Though, compared to Europe, there is still a high number of mothers dying. Our current gynecologist, Dr. Adrienne, remembers one case in the begin of her career in Holland. Here we lose 1 or 2 mothers per 100 deliveries, the reasons is mostly some form of bleeding or eclampsia. Those women lose their life while they should be birthing new life. But even though the mother survives, we still many times lose the little ones. In most of the cases, the babies are already dead when the birthing women arrives at the hospital or very much distressed. And some of them are premature.
But last night we had a very special case. Our phone went off in the middle of the night. One of the midwives told us a laboring woman had come in with the cord hanging out of the vagina. This is a very much feared situation for midwives: when the water breaks and the cord comes out with the water, the baby’s head will then press onto the cord and cut the baby cuts itself of from its oxygen supply. So, after getting the phone call, we rushed to the hospital. And indeed the cord was visible in the vagina, no pulse of the baby felt. We checked with the ultrasound and it appeared, that this mother was carrying twins, of about 8 months, judging by their growth. The first one was head down (as it should be), but the second one was buttocks down and had is foot below the other baby’s head. We could not find a heartbeat in neither of the babies. So first we had to tell the mother that she was carrying twins (which nobody ever realized during her antenatal checkups), then we had to tell her that none of the babies was alive and the worst thing was that we had to do a cesarean section because the babies were entangled in a way they could not be born vaginally. It is terrible to leave a woman with a scar that could cost her live during a following childbirth “for nothing”. But that is a Western point of view. Because without the operation, this situation would have cost her live anyway. So we went off for surgery. We did not rush, because there was no need. The first baby, a girl, was born and I took it over and placed it in a little box.
Then it took a while. The second baby appeared to be in a transverse position and it took quite some of minutes to get it out. The gynecologist said: “Luckily the baby is already dead, because it would probably die from this.” They had to push and pull a lot.
And then the miracle happened: when they got the baby out, it started crying (we had been checking thoroughly with the ultrasound, but still had not seen that). We thought it would be of no use to resuscitate, because, the baby was premature and had probably many broken bones and other injuries. But the baby took the decision from us: it just cried and cried and showed an amazing will to survive. So I wrapped the little boy up and brought him to his grandmother for some kangaroo-care, which means that a baby has skin-to-skin contact with someone. In a western setting this is usually the mother or sometimes the father of the child. Here it is whatever female relative is available. The granma of the baby eagerly took of her dress and held the baby against her breast, afterwards wrapping herself and the baby into her huge gabi. The baby is doing it quite well considering the circumstances, there are no broken bones and as far as I could tell no injured organs. He weights 2000 gram and during the day he started sucking at mama’s breast as well.
By the way: I can never tell the names of the babies, because they do not get a name that soon. I was told that the girls are baptized after 80 days and boys after 40 days (according to Ethiopian-orthodox believes, this has to do with the time Eve and Adam respectively spent on earth) and then they get a name (I still did not figure out how the Muslim population handles this exactly, but also these children do not get a name straight away).
So we were all very happy to have a little happy ending. And in the hour after the operation another 2 babies were born into our world without complications for them or their mothers. We thus had a busy night, but also a fulfilling experience.
On the pictures below you can get an impression of some parts of the hospital. The dark pans belong to the hospital kitchen, where 2 meals daily are prepared for patients as well as staff. And all the trying sheets are from the hospital laundry department. Every day, except of Saturday and Sunday, the washing girls come and get the dirty laundry and bring it back in the evening, washed and dried. The weekends can be a problem, because we do not have enough sheets for all mothers if it is busy. There are spare sheets in the storage room, but it appears that they are a bit different from the ones we usually use. So we do not get them back from the laundry after washing and that is why they are not used at all.
One of the pictures shows students folding gauzes. We get rolls of gauze which we cut and fold and then put them into metal drums and sterilize them. At the moment we have 23 midwifery students on the ward. This is far too much for our little hospital. Especially as they do have to learn basically everything within 3 months. We all have our doubts of they will all be able to pass the final exams, even the Ethiopian midwives (much more relaxed in those things) have their doubts. But some of them, usually the boys, are very eager and want to learn new things. So we train them on the model as far as possible about how to do internal examinations, delivery breech babies and so on.
The system in Ethiopia has 3 ways to become a midwife:
1. a Bachelor degree at a university (4 years)
2. a diploma (basic midwifery training, at a school not university), 3 years
3. 3 years of nursing school and then 1 year specialization for midwifery
Our current students belong to the last group. Their education -except of those 3 months at Motta Hospital- is based on only theoretical learning. Some of the students seem to never had put a glove on or measured a temperature, let alone that they able to perform special midwifery activities. During the teaching, for about every second situation they tell me it requires cesarean section to be performed. And then I try to show them that there are other solutions (and that by the way in most of the settings there is no cesarean available). But it can be challenging to teach them (and I think I am not a born teacher anyway).
So currently I am mostly busy with the students and furthermore trying to keep all the formerly introduced improvements effective, which can also be quite challenging.
But I believe that it takes a long time to really establish changes and that we should keep up a positive attitude. So this is what I try to do (e.g. a properly filled in patient file can be a real joy for me)
And for now I will enjoy a quiet evening and listen to the sounds of the night. Amazing which volume all the insects can produce, but it is so much more appealing than the sound of cars driving by all night, as we usually experience in our western countries. And the stars… unbelievable how many there are! So beautiful!