babies, babies, babies

So for the last couple of months in Malawi i have been based on the medical ward - which i may describe later if time allows. this consisted of a lot of malaria, lots of meningitis, lots of HIV related illness etc. Katy - one of the MIMP girls, had come back from Zambia, and the pair of us are both interested in doing obstetrics - pregnancy and labour- so we decided to have a wee shot at it out here. We have been there for a week now and are having an awesome time.

The labour ward is small with only 12 beds for a huge area - the capital and beyond. Between beds, there are poor excuses for curtains, with woman being left completely exposed to the world! Outside the ward, there is a queue of very heavily pregnant woman who are in labour - you would never think by looking at them all waitng patiently for a bed, sitting still on a bench. when their turn comes around, they come in and make their own bed with a plastic sheet and chitenje - cloths. they are not allowed a birthing partner - the ward doesnt have enough space, so they lie there on their own, until a staff member becomes free to help them. They make very little noise - and in fact if you here a woman making a noise it probably means that baby is coming now! on my second day, i went to a woman who was obviously in a bit of distress and before i knew it i had delivered a baby! It was amazing, and she was fine with luckily no damage done to perineum - i am obviously not skilled enough to do manouevres which avoid tearing!

Many of the girls who come in are very young, (50% of malawian girls are married by 18) and we delivered 15 and 16 year olds last week. Can you imagine being a 16 year old girl in labour by yourself in a very strange setting - ie - the hospital setting, the poor girls are frightened and just holding their hand goes a long way. They are absolute troopers. once baby is born they lie with them for half an hour and put them to the breast before getting up to shower and wash all their sheets, pack their things and head for postnatal ward. all done themselves, alone. It is unbelievable.

Of course its not all happy smiling babies. I think every day there has been at least one case of intrauterine death - often coming from home or far away health centres, where the history often suggests that it could have been prevented. Many of the mothers are HIV seropositive, and we therefore give them prophylactic medications at the onset of labour and the babies prophylaxis immediately after delivery.

today we had several emergency cases which was exciting and i felt a bit more useful as was needed to insert IV lines, take blood, collect transfusions etc etc . The woman were all coming from distant health centres/home where complications are not able to be dealt with.

i have a lot more to write on this topic, so will do asap but this post is getting too long!

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