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Reisverslag Hate and Love
4 november 2017
Hate and Love
I love it….
In the morning when I enter the hospital, mothers and babies, grandmothers and attendants sitting outside in the morning sun, totally different persons than the day before. Smiling, greeting and proudly showing their newborns. Thank you sister!
When I enter the ward and a mother with a very big belly is laughing when I’m making a joke that I really believe that there has to be two babies inside, we will have a surprise when you deliver…..nooooo, she hopes not. The ward is laughing. Or when I let a dedicated spouse listen to one of his babies with a fetoscope, he is shocked and happy: I can hear my baby!
Another mother, I tell her that her baby is coming today! Nurse, will you help me!? And an hour later a beautiful baby girl lies in her arms….sister, what is your name? This baby will have your name! This will be a good year for the name Maria…. Also there are babies with the name of my dad, my brother and some other names I came up with (when their boys)
Yes, than I’m happy and I love this people, even after a day of hard work, no lunch, no rest, sore feet, I’m still walking home with a big smile on my face! I say no to the bodadrivers fighting to bring me home: I’m walking, I need the exercise and the sun on my face….
It can be so easy: give them a smile, a kind word, show them compassion, patience, kindness and you really make difference here!
A new group of students arrives. They don’t know a thing about deliveries or babies, but still they perform procedures without any knowledge, nobody is teaching them or guiding them. And apparently this is the way how it works here. I teach the students, coach and guide them and they are very enthusiastic. If I start talking, explaining things, within a minute 20 students stand around me, asking questions. Such a shame that the midwives, my colleagues are too proud or too stubborn to pick up, ask and learn….well, that’s what it looks like….but there is hope….!
After last week I’m hopeful again…another training given to a group of midwives at my ward. Very enthusiastic, wanted to learn and change. And what was the biggest surprise this week…!? When I ask them questions(and I know for sure they didn’t know before I arrived, and they didn’t perform well) someone gives me an answer, and I hear myself talking….. Funny, she was at the ward the day I was talking about that subject to the students, and I noticed already that she was listening behind the curtain, but didn’t want to show it….. but apparently she listened!!! So, I’m learning too…probably this is the way how it works, not teaching or coaching the midwives directly but through showing, telling and teaching students, and if they are present they will listen and pick up without losing face.
About those students, it is so different here. At home as a student you can’t do procedures without guidance of a midwife or prove that you can do it. In Uganda they just try. Mothers are practice material it looks like. So that’s how they learn the wrong way and never get any feedback. Nurses and midwives sign their books with procedures without witnessed it, and in favor for it they get payed by the students (in secret) the students already know that I’m not signing, only when they show me…. No, I don’t sign the 4 deliveries today, you only assisted one!!
Students love it when you help them and assist them with a delivery. The medical students are more stubborn, they do physical exams without asking. And if I ask them what the result was, they say: 9 cm….so this baby is almost coming….well it doesn’t look like it….better to check again by myself….4 cm….big difference…the student is disappeared, scared of me!?
Sometimes it’s funny to see how they perform…
Registrations….a whole other world. It’s all about registrations…it doesn’t matter if it’s right or wrong, just registrate. I see on partographs that someone wrote down that they counted contractions every half hour, and also listened to fetal heartbeat…strange, most people don’t have a watch, so real counting is difficult and never I see someone standing next to the mom and count contractions, except for me. Also students and colleagues fill in that they measured temperature, BP and pulse rate, well…I’m the only one with a thermometer in my pocket, and the BP measurement is broken for weeks…(or maybe it is true and are those the ones who stole my thermometers. Ok, ok, one I lost myself when I poured the placenta’s in the pit outside, it just felt into the smelly hole…) But, just registrate…. Except off course babies dying, better not to registrate that….shocking to see that they don’t registrate dead babies. Can you imagine how many babies really die…!? We think it’s probably twice as many than the official data. If it happens in this hospital, with mzungu’s present and watching, definitely it happens in other hospitals!
For example: I visit the postnatal ward and see a woman which was in labour the day before, lying in the bed, still a big belly…I ask her why she is lying between mothers and babies and not in antenatal. Nurse, I delivered last night and my baby died. Nobody told me, nowhere it is written down and I hear from the woman that the heart of the baby was not fine for a couple of hours, but that they didn’t took any action. When the baby came out it didn’t breathe. So sad. I’m so sorry! Well nurse, it’s Gods will…..
Working in the bush… sometimes it really feels like it…
No sterile equipment’s because of power cuts and laziness, no scissors, no BP measurements, no thermometer, a plastic fetoscope, no tape to secure an Iv line, lack of sterile gloves so you have to safe them and always hide one in your pockets. No catheters, so using an IV set for empty the bladder. No IV holders, so using a plastic packaging, make a wire to hang it. A syringe to rupture membranes because there is nothing to use. So I carry a lot in my pockets: headlight for suturing, thermometer (already my third one because if someone use it, they don’t give it back, and nobody knows where it is) BP measurement, electrical doptone for a suspected IUFD, a stopwatch to count the fetal heartbeats, my own supply of gloves, razorblades, tape, pencils (they also disappear after use) soap leaves to wash my hands, desinfectans…full pockets…
No sterile gauze for suturing, so you have to use fluffy cotton what itches your nose and stays in the wound and at your suture wire…
A baby is not breathing, I just come in starting my dayshift, the nightduty waited too long to deliver and take action. Just before I saw an ambubag, but when I want to start resuscitate it is gone! I ask a student to run to the NICU to borrow an ambubag there. She comes back, off course not running, without an ambubag….they wouldn’t give me….I’m pissed off…running with the baby in my arms to the NICU and start ventilating there myself….why why why….why don’t you work together and help each other, it’s a dying baby, have some compassion! No, we don’t loan things, because they never give it back…..but a baby is dying! Don’t mind….frustrating!
Sometimes your too late, the baby pops out before you know it…one baby almost jumped out, with sack and everything….and here I really need to put on some gloves, because of the big chance of HIV, sorry baby, one second, You have to wait…
Or a referral from a health center, they say it’s a breech presentation(buttocks first) pushing for hours, when I feel inside something strange, pursed lips, swollen eyes face presentation! Luckily the 5th baby, the mother pushed out, but the baby looks terrible, will this ever be normal again? But babies here are so strong and resilient, two days later it almost looks like a normal baby. The parents are so happy and grateful, and me too!
One day it was truly crazy (most of the times it’s terrible busy)
I take over from the nightshift, and they are in a hurry to leave. My colleague is always late, and all the beds(6) are full with penting and moaning mothers. Before I can start to check fetal heartbeats the first mom is already screaming and pushing. Than a foot pops out and half of the buttocks…the intern who is standing next to it already grasp it before I can shout not to touch the baby, too late, the baby already reached the hands up. Very difficult delivery follows, I ask for a scissor to do an epsiotomy and what a surprise they come with it! I’m not thinking about hygiene now, I just want a healthy live baby! After some actions and grapping the arm I can deliver the baby. It’s a bit shocked, but after some ventilations it starts breathing….no time to breath for me, because the next mom is pushing. After that one (I still have to suture the first one) a big mom is pushing. She deliver a healthy baby, but when I’m reaching for the placenta I feel another foot! A healthy twin is lying on the belly of the mom, I’m happy, but still no time…the next and the next and the next…no colleague appears, no doctors and no students in the ward(it is rare) when one delivered, she has to make room for the next one. Two women are lying on the ground, because there are no beds free. When the evening duty comes I delivered nine moms. But still not finished, other moms came in, at 18:00 I try to get out after 12 deliveries. But they won’t let me go, there is a mother already the whole day in labour, but no result. I asked the doctors to take care of her and do a vacuum or cesarean, but they didn’t and I didn’t had the time to follow up. The doctor on call asks me: Mariann, can you help me with this one, I never did it before. So at 18:30 I deliver a baby with the ventouse(vacuum). Not a healthy one, I resuscitate it for a long time (I know it is not useful, but I feel responsible, even if I handed it over and I really didn’t had the time and it was the doctors responsibility, still…) the baby starts breathing again, but it took too long, so the next day I heard that the baby died. The mother is mentally disabled and comes to me the next morning. She sits on her knees before me to thank me (out of respect people do that here). I can’t stand it, I go on my knees with her, put my arms around her and say I’m so sorry and sad for you. On a moment like that I can cry…
African speed….most challenging thing for me (people who know me, know about my time management)
A breech, but first baby, a tiny and young mother, not even 16 years and a big baby…one of the interns want me to see how I perform the breech so he can learn, but no, we don’t do that, too much risk, another mother the baby is in stress, the heartbeat goes up and down, so another cesarean section. Today only cesarean sections.
Strange traditions: a mom can’t touch her baby boy the first 3 days by the hips, because it will cause impotence… maybe that’s why some mothers don’t look at their baby and don’t want to touch it after the delivery? Take it away, give it to the attendance… but how do they give it breastfeeding, hug it? Skin to skin contact is difficult to do here, mothers are not cooperating…
Maybe that’s where the even stranger tradition comes from: if a man suffers from impotence, he goes back to his parents hut, wearing a diaper, feed by the bottle or breast, kept in a dark room until his moods are back again…(just heard this story from one of our colleagues, can’t almost believe it)
When you’re traveling, it’s an experience.
When the car or bus stops, people come running to sell you all kind of stuff! Tomatoes, papaya, pineapple, Irish potatoes, chicken(life or roasted on a stick) pork or liver on a stick, maize, cassava, soda…name it and you can buy it. So when you come home, you’re fully packed with vegetables and stuff without setting a foot outside.
Little boys stand on the side of the road, jumping and screaming because a mzungu is passing. One of the boys is so enthusiastic that while he is jumping his pants goes down, totally naked among his friends, ashamed he pulls his pants up….funny
On the way a big truck for cattle passes, not transporting cows, but loaded with people, the truck is so heavy loaded hat it’s shifting on the road.
We visit the surrounding health centers to check on the midwives we’ve trained. It’s already hard for people to imagine how it looks like in the hospital when you never visited a developing country before. The health centers are most of the time even worse. Only one delivery bed, most of the time half broken, always lack of equipment’s, equipment’s are rusted, but everything is better structured than in the hospital. One of the patients visiting the postnatal clinic recognized me from the hospital, she was referred and I did her delivery. What a coincidence! A healthy big baby survived! At another health center we help with distributing medication. Lots of it is not available, and then the people have to buy their medication: wila wila’(buy) tjenna pe(no money) and so stumbles and old man back home, obviously very sick, without medication probably to die from a simple pneumonia. All other medication we just put in a paper wrap, and then the patient has to found out how and when to take it..
Power cut for four days, no fridge, food spoiled, but that’s not the worse part, also no power in the hospital, so no autoclave, no sterile equipment’s…
Babies die at the NICU because the incubators are not working and no oxygen…
Working with a nurse who is a little bit lazy. Sitting on her ass the whole day or disappearing. Than the head nurse of the hospital comes in, I’m busy doing a delivery, I see her jumps up, putting on gloves and pretending she is working…. The head nurse makes a conversation and leaves. She sits down, panting…pfoeh….hard work…..
Also students are not really active, you have to tell them what to do, and give them things to do, and even than it doesn’t come with a lot of joy…. Sometimes I’m the only one working, sometimes I’m to tired or too hopeless to do anything about it. And at the end of the day I’m walking home, delivered lots of babies, but with a big smile!
I’m coming home and my smile is maybe even bigger! I hear the fridge running…..power is back! How happy can you be with something so simple!
Also really nice to wake up in the morning, start your day with a cup of nespresso, what else, in the morning sun outside.( someone is sending small packages of nespresso to Gerieke on postcards, really sweet) and then on the way up to work, nabors are greeting me, children screaming: mulu bye, mulu bye.. and when I come back in the afternoon again everybody is greeting me, I think they accepted the fact that the weird mzungu is living in their naborhood. Sometimes they try to look through the gate, to see what I’m doing, but don’t come too close, because than they run, very scared!
Small things what makes life worthed:
A hot, big shower when you’re in a hotel so you can properly wash your hair
A white sandwich (not sweet) covered with speculoos crunchy(someone send)
A cup of real pickwick herbs tea (a few to go before it runs out)
A nice real cafe latte at my favorite restaurant
Self-made fries with homemade mayonnaise
Receiving email or post
Skyping with family and friends and see happy faces of the kids
4 november 2017 18:25 | Door: Marijke Bremmer
Hoi Marianne, wat een fantastisch verslag heb je geschreven en wat maak je veel mee.
Als je op 1 dag bij 12 geboortes kan helpen is dat geweldig, maar ook te veel voor 1persoon op 1 dag. Het blijft moeilijk als er in de organisatie en met te weinig goede uitrusting van materiaal zo veel mis gaat, maar je maakt met je ijver en optimisme het verschil.
Al zal het niet snel gaan, het kan haast niet anders dat er heel geleidelijk toch iets zal veranderen. Veel sterkte en dat je nog vaak met een lach op je gezicht naar huis mag lopen.
Alle goeds en groeten van Gertjan en Marijke