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Reisverslag Survived the first month!
11 juni 2017
Survived the first month!
The temperature is hot, but they say it will be more hot at the end of the year. Because its rainy season, almost every day there is heavy rain. I have to learn to read the signs, because I'm too late every time. Before it starts raining and lightening the power goes off, thats mostly the first sign. After than its gonna blow heavenly and a few minutes later the rain starts. Several times I was already soaky wet! Big waterfalls on the street, mudpools, unbelievable! So when you get home, all your clothes red of mud and soaked! Also because of the powercuts its dark as the night, so you don't see where you're walking, a bit dangerous when you step into a hole.
In here we have a lot of powercuts, almost every night power goes off untill next morning around 10:00am.
On tuesday I start at the hospital Fresh and full of energy. It's a bit familiar because it has the same things as in Ethiopia. To give an impression, there is a small sign on the main road that there is a hospital. Don't make it too big because you don't want to encourage people to come? Than you enter a gate, no paved road, small dirty roads leads to my ward, the maternity unit. If you come in the morning, lots of people, family and patients, sitting outside, doing laundry, cooking, washing...The hospital doesn't provide any of these things, so the family has to take care of the patients. They sleep outside, also when its raining. Most of the time people come from far and can't travel back every night.
The first day I first have to meet the medical director and the head nurse. It depends on your status and education what kind of uniform you can wear. For me its not so clear, but I know that dark blue is an important color....
When I'm entering the ward, there is a small curtain which devides beds and give a sort of privacy.
The theatre is outside, so if you have an emergency, you have to go with an iron trolley, off a hill, unpaved road to the theatre, not so comfortable. There is a theatre next to the delivery room, but its not open because there is only one anesthesist in the whole hospital.
Postnatal room is at the end of corridor, so if its busy, you don't have the time to check up on those patients.
Neonatology is at the other end of the corridor, and there is another pediatric volunteer working. Together we will give trainings and try to train trainers so that they can take over in time to train their own people, in the hospital and outside in healthclinics.
It's rainy season, so sometimes everyday it raines, but most of the time it rains in the night or only for a short time in the evening.
After I had diner with some other expats, I walked home. It's really dark and it starts raining. The road is slippery and I can't see a thing. I'm blinded by motobikes coming towards me and than I miss a pothole. Almost with my face in the mud, everything hurts, brewsed and dirty I arrive home where the guard had a bit too much alcohol, so standing in front of the gate waiting till he hears me and open up.
In the morning it started raining so much, the street changed into a waterfall. But I have to go to the hospital. Well, I'm the only one on the street, nobody else, soaking wet when I arrive...but on time! Nobody else arrives untill the rain stopped...
I started working at the maternity ward, its quit different than our own developed countries. The antenatal care is not bad, they have at least 3 check-ups in the pregnancy. Most of them take folic acid, so you don't see a lot of spina bifida or anencephalic children. Not so much as in Ethiopia. In the morning when I come, most of the time as first one, they are cleaning the floors of the ward. I never see them cleaning beds unfortunately. So there is a lot of infection. Especially post cesarean section patients, but also little baby's got sepsis. So that is one of the goals we have to change.
If someone die, they can ask a boda driver( a motobike) to bring the dead body home, so they will sit in between the dead body, and thats how they get home to bury the body. They only have to pay 1000 shilling extra.
A bit of a problem is that they need to keep charts and registrations, but they don't really do check ups, only writing it down afterwards. So they make it up, just to have the right registration.
I have to give the better example: be on time( not coming at 10am, well the shift starts at 8:00am) work hygienic, really count contractions and fetal heartbeat, not only estimate, give skin to skin contact, and don't take the baby away after two minutes and than write down that you gave skin to skin contact. So you see: there is a lot to do, and it will take a lot of time and effort and patience.
Some examples what I've seen in here. First day a twin delivery referred from a health center, the second baby retained. There was no transport available, so the woman came on a motobike with the clamps and umbilical cord still outside. In the form was written that there is no fetal heartbeat, just for checking I try to listen, and a big surprise, but there is still a heartbeat after 4 hours! But things are not going that fast in here, so after two hours finally they did a cesarean section, but at that time the baby died already, it took too long. Children here are strong, but there are boundries.....two days later the same story, just because they are slow, and they don't take any responsibility.
A mom deliver from a death baby, really sad and not much compassion. They put the baby in a box under the table. The family has to pick it up to bury it.
In a day time there are only one or two midwifes for the delivery room, postnatal ward and antenatal ward. And also to assist when there is a cesarean section in theatre. So very busy, and they disappear often from the ward doing....? They leave the ward with delivering women alone. I think they like it that I'm here, because they don't have to work so hard...well, that's not really the case while I'm here, but to build up relationships and giving a good example it is ok for now.
Most of the times the beds are full and several women are delivering at the same time. So than the women which are not pushing yet have to make space for pushing ladies. And if the ward is full, they have to lay on the ground after delivering.
I think the midwifes know a little theory but they don't bring it into practice. After a delivery they take the baby away to a wooden, dirty table where they tie the cord, weigh them and give tetracycline as prevention for eyeinfections. Vitamine K is not available for weeks. After that they wrap it in towels they leave it on the table under a open window. All that time the woman is laying without attention on the bed, so she can bleed a lot without notice.
A lot of baby's needs some stimulation or ventilation. Maybe because they don't really use the partogram in the right way, so sometimes it take days before they deliver. I still think its amazing how strong the children are in here.
In the meanwhile a mom comes in, fall on her knees and starts pushing. Luckely I can get her into a bed on time, a minute later a baby is born. The mother takes my hands and start praying in Acholi, the local language, so with all the hectical things going on, the mom is praying and a lot of women joined her, after that she thanks me for helping her...
Another woman walks to the toilet after the delivery and collaps, panic! The midwife thinks its psychoses...we know better, its just a vagal reaction of the body.
So, after a day of really hard working( 8 hours standing on my feet, no food, no drinking) I'm glad to be at home. Than I'm lying in my hammock, in the shadow of a palmtree, having a cold water and watching the little and beautiful coloured lizards. Also hearing children playing outside the gate, women carrying water to their round huts, peaceful.
Today its a bit more quiet, so I started to clean the storage...what a mess....you can't imagine.... lots of unused materials with expiring dates, rats and cockroaches all over the place eating the materials. I think they didn't clean for years! Hopefully they maintain it for a while, but I won't hold my breath for it...
In a daytime there are lots of students, medical officers all kinds of people in the ward. So no privacy here, everybody is watching.
Suturing is not a thing they often do, the good thing is that they almost never do an episiotomy, but they always do manual placenta removal without painmedication or antibiotics. So that's also a thing we have to change.
Women has to bring their own materials like cotton, razorblade, plastic and sterile gloves.
A woman is brought in, I felt a prolapsed cord, so I prepared her for theatre and pushed the head of the baby up and like that we walked with a trolley to theatre. But it took so long before they got ready to do the 'emergency' cesarean section, luckely this kid survived!
A mother with already 5 boys deliver a twin, both are boys again...she looks disappointed and don't want to hold her baby...maybe she has to start thinking about familyplanning?
After worktime I have to go to the market to get some fruits and vegetables for cooking, because I don't have a fridge(yet) I think I become a vegetarian, because if you see the meat at the market, my need for meat is gone...goats and other animals hanging sometimes with their tales still attached, lots of flies enjoying the meat too, so I pass...
I have a guest for a few weeks, its another volunteer who is waiting for her house to be ready.
In the nighttime I feel something moving, its a babylizard who sneaked into my mosquitonet..I hope it will catch some mosquito's. I will sleep with my mouth closed.
Just finished my first month! Still alive, still full of enthousiasme!
11 juni 2017 18:51 | Door: Rob
Wat een heerlijk stuk om weer te lezen! Your dutchenglish is great!
Zo te lezen is er nog een hoop werk voor je daar weggelegd. Blijf genieten van het leven!
En de kilo's zullen er al afvliegen denk ik.