The Maasai Midwife!

So I spent 3 days living with a Maasai tribe in a mudhut, peeing in a long-drop that was dug specifically for us mzungu visitors, trekking 6km in blistering heat to the dispensary each day, then home again, learning some of the Maasai language, about their traditions, history and observing a goat slaughter - then eating some. I loved my time there so much I arranged to go back for another 3 days after all the other students had headed back to the UK. I will write another post about life at Maasai, and working at the isolated dispensary but first I want to share the experience I had meeting the Maasai midwife.
The basics that you need to know is our Maasai guide was a warrior named Alais, the day I met the midwife his brother Festo took over his duties. Their village has over 800 inhabitants but the village is spanned over 50+km. Each family lives at a Boma, a small collection of mudhuts and an enclosure or two for the livestock.
So after my last day at the dispensary, we went back to our Boma, had some food then trekked about 2km to a nearby Boma to see the midwife. As well as being a shorter walk, it was mostly flat and much more pleasant...also due to the fact it was a cooler day so I didn't feel as though I was melting!
When Festo, Fred and I arrived we were greeted and shown to some small 3 legged stools in the shade of one of the huts - they took a little concentration to keep balanced on them! Then a girl aged about 10 guided an elderly woman around to us with a pole and assisted her to her seat. This was the midwife; aged 72 and blind. Yes. Blind!

Me and the Maasai Midwife

When she sat down she spoke at some length to Festo, then he spoke at length to her. This was how Maasai greet one another, after saying hello one person would give an in depth update of how they and their family is, and then the second person would do the same. Shortly after, Fred then gave his update to the midwife. Then I was introduced and told to ask anything I wanted.
I started by asking how long she'd been a midwife, how she became a midwife and how many women she'd cared for. Fred translated my questions to Festo in Swahili, who then translated them to Maasai for the midwife, and her answers were translated back along this route to me. I was told that when she was in her late teens she began attending births with other women of her village, a relative of her's was midwife at the time and she began asking questions and developed an interest. This relative encouraged her to get involved; palpating the uterus, supporting women, observing what was done during a birth. She then had her first baby and said she now understood birth better. She continued to learn the knowledge and skills her relative shared and as time went on got more involved then began taking on the role herself. She told me she's delivered thousands of babies and has no idea of a specific number as it's been too long!
I asked how she copes without her eyesight, especially in situations where I for one would completely depend on my vision such as external signs of descent of the fetus, observing for signs of placental separation, and assessing blood loss for hemorrhage. Her response was that birth has little to do with sight, she uses touch and sound. I continued to ask how she deals with emergency situations without her sight, to which she replied she has never had a woman hemorrhage, a shoulder dystocia, a cord prolapse or abruption. I asked if with her experience she's able to identify signs of any of these emergency situations and transfer the women to the dispensary or district hospital before they advance, she told me no, there has never been an emergency situation and no woman or infant has died in her care!

Inside a hut, the little doorways are sleeping areas, which almost
completely prevent a woman from being cared for in bed

She talked me through a typical birth, that when a woman is in labour a warrior from her Boma will go to the midwife's Boma and escort her back, guiding her with the pole that was used earlier to guide her to us. She said that this could be up to a 30km walk in the dark. This means she has to put so much trust in the warrior leading her, with it being dark he may not see as many obstacles in her path as he may in daylight...add to that the added risk of lions and other predators and wildlife freely wandering about the Savannah! She told me that the hut will be kept extremely warm for when the baby arrives, there will be other women there supporting the labouring woman and offering assistance to the midwife.
She palpates to check the contractions and presentation and sometimes does vaginal examinations - but not always. The woman's body then leads the birth, the midwife gives no time limits to birth but her experience tells her that things are progressing. Sweet chai is given to the woman to give her energy and positions including kneeling and squatting are encouraged to help fetal descent. She told me how the head is delivered, she waits for the head to turn and with the next contraction the baby arrives. She told this all in 1 long explanation and I kind of felt for Festo and Fred for having to remember everything she was saying before translating. However, as she spoke, she gestured and used her hands and knees as props...as she was talking Fred spotted me nodding knowingly in agreement. He quietly asked if I understood her and I told him what I thought she was saying. When Festo translated to Fred he kept smiling at me and said I was right. He then told Festo and the midwife that I'd understood without the translation. She said that midwifery doesn't need words just like it doesn't need eyes.
I asked what she does once the baby is born, when does she cut the cord and what is done with the placenta? Again, from her movements I figured out most of her response :) The baby has immediate skin to skin and is encouraged to breastfeed ASAP. The cord is tied when it has stopped pulsating and cut. Then she waits until the mother has a contraction and the urge to push and deliver the placenta. In retrospect I wish I'd have asked what's the longest time she's waited for third stage to be completed. Then the placenta is buried near to the Boma. This made me a bit nervous as not too long before this meeting I was being told about the lions and other predators that wander around...and they're putting 'bait' near their homes...reallllly hope they're buried very deep lol! I told them how some people consume the placenta either by cooking it, having it made into a type of smoothie or reduced into capsules...Fred couldn't believe what I was telling him...Festo's face suggested shock and the midwife began spitting and waving in disgust. Her view is that the placenta was part of the baby and part of the mother, if someone can eat that then what's to stop them eating their baby! That topic didn't go much further.
Out of curiosity I later asked what were her reasons for waiting for the cord to cease pulsating, as I assumed her practice wasn't based on current evidence. I was told that it's how she was shown when she was younger, she's always done that, as did the midwife before her...and why would you cut the cord when it's still doing a job? If the cord has a pulse then it has life running through it. I must admit I adore the simplicity in her reasoning and I really love that for her and the midwife before her, they have complete faith in Mother Nature and the ability of a woman's body.
This midwife provides some antenatal care too, if women are unwell during pregnancy she will advise them on traditional Maasai herbal remedies. Still dubious about her saying she's never had a woman with any complications I asked what does she do in situations such as malpresentation or premature labour. With the latter I was told that labour happens but nothing further was discussed regarding the wellbeing of the infant. Again with gestures that I understood, she told me that she turns babies that are the wrong way - basically performing External Cephalic Version (ECV). I said that where I am training it's only obstetric consultants who perform this procedure while the mother has pain relief (entonox) and a ultrasound scanner is used throughout the procedure to ensure the fetus is well, and if the procedure is unsuccessful then most women opt for a cesarean section. "If it doesn't work? Why wouldn't it work? It's easy? Why don't midwives do it? It's basic. Just need hands and grease." Again, a very frank response which focused on the hands on skills surrounding childbirth.
The three of them told me about some of the tradition surrounding childbirth; when a woman is at approximately 12 weeks gestation a large bombfire is built outside the hut. This is basically the pregnancy announcement and a way of telling family and friends that they are welcome to come and give their well-wishes. I'm not sure at what stage the fire is lit though. From this gestation the woman and her husband will not have sex again until the baby is 3 years old - as her body has to continue growing the child and to then give the body time to heal.  When the woman is in labour her female relatives support her and assist the Maasai midwife and once the baby arrives the women sing for hours and the warriors slaughter a goat and the whole Boma celebrates. The woman is brewed a traditional Maasai medicine (like a herbal tea) to give her strength to recover and provide for her baby.

A bonfire in front of a hut to indicate the woman was pregnant. 

In all honesty the midwifery this Traditional Birth Attendant (TBA) spoke of was generally what I expected to be observing during my placement - more focus on normality and low risk, women uniting to support each other, keeping birth a natural physiological process surrounded in practice that's based on cultural traditions.
Now in the dispensary clinic I'd met several women who had lost babies in the past while delivering at home and the doctor had told me of situations where Maasai women had died in childbirth that could have been prevented if they had a trained professional present rather than a traditional birth attendant, so I don't completely believe that she has never had an emergency but can understand that she wouldn't want to openly advertise any fatalities she's had to an outsider like myself.
The doctor at the clinic told me about outreach programmes that are being launched in more remote areas of Tanzania, where nurses and midwives use motorbikes as the quickest form of transport over rough and changeable terrain. In Tanzania 57% of women give birth without a healthcare professional in attendance (in the UK it's <1%) (White Ribbon Alliance, 2012) and this is mostly due to the remoteness that some families live in. Logistics and costs of improving this and increasing the number of formally trained midwives undoubtedly lie in the government's hands...another issue we have in common.
There is discussion surrounding TBAs and providing them with training to help deal with emergency situations. But after meeting this TBA, I personally wonder whether they would be receptive and engage with this...or take offense, declaring they don't need to be trained in such matters because their traditional practice has served them well. And from what I was told, why would a TBA want/need training when she claims to have never had an emergency situation? Speculation on my part of corse!
This woman was an absolute inspiration. Her ethos pretty much covered the Promoting Normal Birth campaign by the RCM here in the UK and I would have loved to have had the opportunity to attend a birth with her - to see a home birth, Maasai style! I adored my time at Maasai for various reasons and would go back in a heart beat, but meeting the Maasai midwife was really the icing on the cake!

a new song 'it must be love (love, love)'

Day off!
And this day is better shared in pictures - enjoy!
Beverley and I were due to be collected at 8.30, but we'd already learnt that punctuality isn't exactly a priority here! However, our guide arriving at the house at 12.30 was much later than expected, Neil was extremely apologetic and had brought us each a little gift as an apology - a weaved bracelet saying 'HAKUNA MATATA' and for those of you that aren't familiar with the phrase from Disney's Lion King, it means 'no worries' and is a mantra that many people here live by!
Anyway we set off towards the main road as Neil continued apologising and explaining what held him up. We got to the main road where he was planning on getting a taxi to our destination to make up some time, while we weaved through the dala-dalas and taxis we spotted Tom, our driver, and he offered to take us. In we climbed and off we drove.

(the dala-dala/taxi stop)

We came off the main road (the highway was the only tarmac-ed road around), onto a dirt track, past the hospital where we had our placement and up a hill. Up a very steep hill, the further we drove the more grateful I became that Neil was late and Tom was driving us lol. Tom pulled in by a house to drop us off, the road ahead was a bit too steep-time to continue on foot. 

(onwards and upwards)

(looking back down the hill - really doesn't represent how steep the hill was! lined with banana trees and in the distance towards the horizon is where Tanzanite is mined)

We were surrounded by gorgeous, lush, green vegetation - most I could identify as banana trees...but it wasn't until later into our trek that I discovered there are so many different types of banana and how every part of the banana tree is used for something from food to gift wrapping to building material to cattle feed.

(two different types of banana)

We got to the top of the hill, through a village, over a bridge then off the track, under a branch and over a boulder. To the left was a ravine - we could see the opposite side, we could see the tops of the trees growing from below but we couldn't see the bottom. Neil said the waterfall we were heading to was at the bottom and this was where we started our descent. I laughed - he'd been very humorous along our walk so far so I figured this was a joke...how wrong was I! 

(you can't quite make out the sudden drop at the bottom of this picture, but trust me it's there! And that's the far side of the gorge)

(some very steep parts of the climb down - no helmets, safety ropes or padding (other than what I already have) just hands, feet and branches)

As we were descending we were joking 'Indiana Jones, eat your heart out' and sang the theme tune. Then we finally made it down alive and were next to a river. We ventured upstream clambering over rocks and crawling under massive boulders until we came to a pretty fast flowing part of the river which was where we needed to cross. 

 Trousers rolled up, socks and shoes off and tied to my bag and tentatively finding my footing across some slippy rocks.

Made it across, had a brief break where we put our footwear back on, then as we went to move on I lost my footing and my foot slipped into the river! It was very refreshing! Again lol

We moved on a bit further and stepped between another two large boulders and that's where we found the waterfall.

It was beautiful and not a single photo I have does it justice. Well worth the scrapes with death we'd just faced! Neil pulled out some cakes - a mix between a taste of yorkshire puddings and donuts - sticky, sweet and delicious. 

Then it was time to go back up the opposite side of the gorge. That was much trickier but much quicker. At times the only thing we had for stability were bamboo stems and vines - Tarzan eat your heart out! We even did a couple of Tarzan calls to help disguise our fear of tumbling back down. But we made it to the top and were met by a bull, I got the impression he didn't like company but at least he was tied to a tree while we left his field and before I knew it we were back on the bridge we'd crossed. Neil pointed down towards where the waterfall was...again we couldn't see it!

We ventured back through the village, across a football pitch which was being trimmed by cattle and goats, past a cemetery which was covered in wild flowers in full bloom, under an avacado tree, through some maize fields and under more banana trees which were providing shade for the Arabica coffee plants. Neil told us about the perfume of the white coffee flowers, the coffee berries which were mostly green at the moment but were beginning to ripen to red; how the berries are picked by hand and the beans inside.

(a large guava berry, smaller green coffee berry, 2 red ripe coffee berries and the white coffee beans)

We ventured on and met lots of locals along the walk, having short conversations with them;

'Jambo' (Hello)

'Poa' (Hi)

'Habari?' (How are you?)

'Mzuri sana' (very good)
'Safi' (cool)
'Karibu' (welcome)
'Ah, asante sana' (thank you very much)

At this point they were impressed we knew Swahili and talked on, but unfortunately this was the limit of our vocabulary...we amused most people! Neil then introduced us to someone who was making a local brew and offered us a sample of his banana beer. It looked like porridge, smelt like a whiskey brewery, had a gritty texture and tasted incredibly strong and not of bananas!

To the brewers amusement neither of us could handle much more than the sip we tried, despite pouring us a huge beaker full. We thanked him 'asante' and bid him farewell 'kwa heri' and after some time we arrived at Neil's mama's house. She'd made us tea - homegrown (and brewed) lemon and ginger tea, with homegrown (and roasted) peanuts and fresh popcorn (also homegrown and popped). After a chat she served lunch - an amazing and very generous buffet of spiced-beef stew, chapatis, fresh veg, salad and masses of fresh fruit. I wanted to gobble up the whole table it was all so tasty and we were sat in such a beautiful garden in the middle of a jungle of banana trees! Neil then told us how the the beans are sun-dried, then need shelling, which we did in a big pestel and mortar. 

 We then had to sieve the beans from the shells by tossing them in the air with the hope that the wind would catch the shells while we caught the beans...however this is quite an artform which Neil made look effortless!

 Beverley and I accidentally created our own little coffee plot in the garden...we had to pick up all the beans we'd dropped!

The beans were then roasted for quite some time and then back into the pestel and mortar where they were ground into the fresh coffee we're familiar with.

Tom had come and joined us on this side of the hill, started grinding the beans but then decided to leave the grinding to the professionals - Neil and his Mama.

 This couldn't get any fresher! Added to a pan of boiling water, heated and ready for sampling! So delicious and almost as strong as the banana beer! We were given a little bag each of the coffee we had made, then purchased some more ground coffee and coffee beans (my bag still smells divine).

We were then given some fresh sugar cane to munch on - home brew, freshest coffee ever, sugar...I was beginning to buzz on our drive to the finale of our day.

We arrived next to a lake which reflected the far side as clear as a mirror, so serene. We were helped into a canoe where plastic patio chairs had their legs cut off for seating, then our oarsmen pushed off from the shore. Gently paddling around a gorgeous lake, singing 'row, row, row your boat...' it was sunset and it was beautiful. Neil and our other paddler pointed out wildlife to us - lizards, eagles, herons, snakes, vultures, kingfishers...

 It was so so beautiful and such an amazing day. I was beginning to fall in love with Tanzania and the smile couldn't be swiped off my face as we floated along. Then our attention was directed to the opposite side of the lake and we were told Kilimanjaro was visible. 'Where?' I asked, 'I can only see white clouds.'
'It's not clouds - that's the snow on top of Kili.'
That was it! My heart had fallen head over heels for this country...and the love affair was only just beginning :)

'every little thing' (part 2) *upsetting*

The ride to the hospital wasn't as jovial as it had been the day before. Beverley and I felt very anxious about the outcome of the little girl we'd met the day before.
We arrived, got changed and the sister greeted us. Tense on the events from the day before we immediately clocked there was a new resident in one of the incubators. Beverley glanced in reluctantly and said by the face this baby looked ill too. As it happened the doctor was already writing a care plan. The mother was lying in the bed adjacent to this incubator receiving a blood transfusion. It had been a home birth and the mother had a retained placenta followed by a hemorrhage.
The doctor asked Valerie to take the baby to NCU and that it was to have a 40ml blood transfusion, IV antibiotics, have it's Hb checked and be warmed. At this moment I felt relieved that everything that had happened the day before wasn't "normal" or a regular occurrence. There was a plan for an ill baby.
While the doctor had been discussing this Beverley had gone to the baby, then called the midwife. The midwife unwrapped the blankets and appeared to nudge the baby. Beverley caught my eye and immediately I felt deflated. The midwife called 'Daktari? Daktari?' The doctor appeared, they peered into the incubator, nudged the baby again while talking in Swahili. The mother began to stir and turned over to see. From where I was stood I could see a limp limb...the midwife spoke to the mother and while I couldn't understand what was being said, her tone was 'matter-of-fact' rather than sympathetic. The woman slumped down and began sobbing. The doctor went to her, patting her head as he spoke. Beverley checked for a heartbeat. While it appeared lifeless we were stunned that they had broken the news to this woman that her baby had died without certainty. The infant was wrapped back up, face covered, only the care plan the doctor had just written laid on top as identification. The mother was left with her bereavement.

After we'd asked, we were given the history of this mother and child. The baby was born 5pm the night before, then mother and child were transferred in due to the obstetric emergency. We were told that the baby had lost blood from the cord; that the string hadn't been tied tight enough. I asked why, if the baby had been born the night before, hadn't it been reviewed before now, or even gone straight to the NCU when they arrived? I was told they were busy looking after the mother. I continued to ask, while the midwives and obstetric team had been attending to the mother, why hadn't someone taken the baby to NCU to receive treatment at the same time? Why was this doctor writing a plan when he'd not even reviewed the infant? The midwife looked blank and couldn't give any reason. Nobody had been caring for the baby despite the baby needing attention too. Beverley went to the woman to try and give her some comfort. I couldn't hold it together, I went outside and wept. A poor baby that could still be alive if adequate care had been available. A poor mother who was lying in a bed, oblivious that her child was slipping away next to her. I was so angry that this child had been allowed to die. Angry that this was allowed to happen. And I couldn't be angry at anyone specific, it wasn't that the staff here just weren't bothered, just such huge demands on their time that they really have to prioritise their time. The mother had taken initial priority when they arrived and I don't know what other events happened through the night to keep them away from that particular baby. I was angry that the midwife and doctor seemed so unaffected by finding this lifeless infant. Again, I didn't perceive that they were two uncaring individuals, I got the impressions that it was more that these events were normal to them and they had no emotion left for situations like this. This was their normal working environment. I was angry that this was allowed to be normal - anywhere! That the staff had no other choice than to become passive - for their own emotional grounding. 
While I was sat outside the wind turned, the smell and smoke from the nearby incinerator hit me. I felt I might throw up. I went back in and busied myself with some cleaning, I couldn't handle anyone face to face. I was now dreading going to NCU to see how the little girl from the day before was, if she was still with us. Beverley appeared, we gave each other a hug and agreed to go to NCU. We told the sister where we were heading and I shook as we walked over.
We couldn't initially find a member of staff on the pediatric unit so went to the tinted glass door of NCU. In a bedroom before we spotted the mother, she looked relaxed which relieved me slightly. We went in, donned our hair nets and shoes and went to see the little girl. She looked better than the day before, was still having oxygen, but now had some tone to her muscles, occasionally moving her her hands or feet and responding to stimulus and her chest sounded much clearer and heart stronger. A nurse appeared and told us they'd been continuing with the antibiotics and NG feeds of the EBM. Things, thankfully, were looking up. We went to see the mother and I can't remember the exact details but we found that she'd not seen her daughter since I took her the previous day, so again we led her into NCU. It seemed unfair that all the other women came and tended to and nursed their babies as they pleased in the warm room, but this mother hadn't had that opportunity. I'd remembered to take my phrase book so with broken Swahili I introduced myself and told her that her daughter was beautiful. She told us that she'd named her daughter Mercy. I told her Mercy and I had become friends. She still kept her distance so again we both encouraged her to have some contact with her daughter. She started whispering to Mercy. We left them to get to know one another better.

When we returned to the labour ward, the woman from the morning was still receiving a blood transfusion and there was a labourer in the bed next to her progressing through second stage. We pulled the curtain around the bereaved mother so she didn't have to face a new mother and live baby. Although, we couldn't stop her from hearing the baby crying or the new mother praising and thanking God for the safe arrival of her child. 

After this new mother had moved into the postnatal ward I told the sister how at home in the UK, when there is a neonatal death we give the woman and family the opportunity to see and hold the baby, to say goodbye and how, for some people, it is a way of acknowledging there was a life, no matter how short and how this can help with their grieving. The midwives looked at me as though I had three heads, so the three of us mzungu tried explaining how some women appreciate this and find peace in at least having time with the child they nurtured and grew. The sister nodded towards the woman and said, 'she knows it's gone. It's dead.' They simply kept saying 'No' as if what we were telling them was not an option. Ever. The midwives could not understand why anyone would want to hold a dead body, one even told us that women there would be too scared to see a dead child. In a way, by not offering this closure, they're protecting women from having to face death. It was one of the cultural differences I least expected but one I found easier to understand and accept. 

I knew it was inevitable that I'd encounter death while here in Tanzania. But I didn't expect to feel such anger and frustration about it. It seems so unfair that lives are being lost just because of the lottery of where they are born and the resources and facilities available there. I knew before travelling that in Tanzania the neonatal mortality rate was 25 per 1,000 live births and even though I'd mentally prepared myself to encounter neonatal deaths I wasn't prepared for the circumstances surrounding the deaths. Unfair, unjust and tragic.

The day continued and a relative came to collect the body of the infant. On the way home we asked Tom to stop at the local supermarket; we needed a strong drink that evening, Konyagi was our poison of choice-the local gin! As the drive continued the sun was shining and the sky was the clearest it had been since I arrived. Instead of getting a glimpse of Mount Meru, we saw her in all her glory. Tom pulled over for us to admire, while we took some photos some locals working in a field were shouting and waving to the east...I think they thought we were crazy mzungu and were in awe of the wrong mountain-KIlimanjaro was to the east, but not at all visible. We got home and all had a little time to ourselves to digest the events of the day, Beverley went for a lie down, I did some washing in a bucket on the porch with the help  and guidance of some of the local children while Valerie read in the living room. Then we gathered on the porch, soaking up the evening sun, reflecting on our thoughts and indulging in our Konyagi. I was glad to be off the following day.

sing with me: 'Every little thing, Is gonna be alright' (part 1)

This following story takes place across my first week. For me it was very emotional. Possibly the toughest week of my life and the other girls really pulled me through.

Again Valerie, Beverley and I went to placement for my second day while the other 3 were away on an excursion. Everyone was quite bright on the journey to the hospital with jokes, laughs and reggae music which came to be the theme of the trip thanks to Fred and Tom's love of reggae. We all sang along to Bob Marley's "Three Little Birds". Not long after we arrived it was Valerie's turn to go and observe a caesarean. There were 2 labouring women occupying both beds. After we'd done some mopping I spotted a piece of equipment humming away that I'd not seen before, when I went over to look I noticed that one of the incubators was occupied and the machine was an oxygen pump. Beverley looked in and said it didn't look well, we asked what was wrong with this baby and we were told that it needed help breathing.

The baby from the caesarean returned from theatre and was placed in the incubator next to it. As this younger baby had been carried from another building where the theatre is, I decided to check it's temperature, it was cooler than it should be. At the same time Beverley felt the cheek of the first baby and said it felt cold, she felt the chest as this gives a truer indication of the core temperature. Still cool, got a thermometer and it was at this point we found the kanga closest to the skin surface of this infant was damp, I tried to listen to the heart but couldn't even make out the sound due to the sound of the lungs- which sounded very crackled - clearly had a lot of mucous on the chest, temp of 35.3•C and visual signs of respiratory distress. We reported this to the sister who suggested we get more blankets to keep both infants warm. We asked if this first baby had been fed since delivery and were told no as it needed oxygen so couldn't go on the breast. Beverley and I moved quickly to get a fresh dry kanga, get a hat and knitted cardigan around the baby, turn the incubator temperature up, from 'low' to 'high' as skin to skin wasn't an option due to oxygen therapy. The mother was asked to hand express some breastmilk to give the baby some energy and she managed some that was put into a syringe. Beverley tried giving this to the baby, it had no suck reflex so the tiny drop of colostrum remained in the cheek. I rechecked the temperature after 15 minutes and it had dropped to 35•C and all other observations sent alarm bells ringing. We got hold of one of the midwives and told her this infant needed reviewing by a pediatrician but she told us there wasn't a pediatrician in as it was a public holiday and that they didn't have any NG tubes on the maternity unit. We asked if we could bring the mother through to see her baby (we were convinced the child wouldn't survive) but were told this can't happen while there are 2 women labouring-as soon as they were delivered we could bring her through. The midwife rang the obstetrician for us who came and agreed the baby was hypothermic and needed transferring to the neo-natal care unit. He went and made a care plan of warming the baby, NG feeding of EBM every 2 hourly and IV antibiotics. We took the infant over to NCU on the pediatric ward and the mother soon followed. the NCU was behind a tinted glass door, we had to put hair nets on and change our shoes as part of their infection control. Once through this door there was 2 rooms, to the left was a room where the mother's nursed their poorly infants and things like hair nets, shoe covers were stored. The room to the right was where the infants stayed, this room was maintained around 30•C by two heaters mounted on the wall; it had a large bed that had been converted into 4 small cots and a resuscitaire - where our infant was placed.  I was quietly glad to see a piece of equipment I recognised! However although the resuscitaire appeared familiar I soon realised that it was really only a matress with an overhead heater. But this couldn't be used, nor the electronic thermometer probe attached, as the machine didn't have mains socket. The air, oxygen, suction, heat etc were all controlled by separate pieces of equipment in the most basic of forms.
The nurse had taken some time to gather the equipment to site a cannula but did appear to have a sense of urgency, the first I'd seen that day. The poor woman even apologised to us for not being able to find the equipment sooner. It took her a few attempts but she soon got a cannula sited and administered the first dose of antibiotics. She also periodically used foot controlled suction to clear the mouth of mucous, this reminded me of a camping bed foot pump in reverse - it had to be controlled slowly and steadily by foot-no suction rate/pressure on a dial like we would set on the resuscitaires at home. This was also much more complicated than expected as it took at least 20 minutes for her to find tubes that fitted together, then they needed sterilising as they have very limited single use equipment. In the end I had to hold two mismatching tubes together to ensure an airtight seal and she used an NG tube with the end cut off as there were no other tubes small enough to use in the mouth of this infant or a yankauer. During this time the baby began to feel warmer by touch and the skin colour was improving but the nurse didn't have a thermometer available to check.
It was now 1pm and Valerie and Beverley were leaving, I was due to finish with them but I couldn't leave that baby so arranged for Tom to come and collect me a few hours later. 

After they left, Marley's song was stuck in my head, hoping he was right-hoping this little thing would be alright, I started humming the chorus to myself repeatedly, almost as a prayer...and my sight became blurry as my eyes filled up. I was so upset, angry, scared, frustrated. This poorly baby had been in the hospital since about 7am and a formal plan hadn't been made until nearly lunch time. Midwives were so overwhelmed with caring for labouring women and new admissions that they hadn't had chance to do any checks on this baby. There were less staff available due to it being a public holiday. The baby had had breathing difficulties for so long what if it was too late already? This was my first encounter with an infant where I thought it may not survive and I felt absolutely helpless!
I went to find the nurse to see if there was anything else I could be doing. I couldn't find her and when I asked a parent of another patient if they'd seen her, they said she was searching for equipment. I asked if another nurse was around and was told no, she was on her own. My heart sank as I realised this nurse who'd dedicated so much time to the baby we had brought over was responsible for all the other patients too - at least 3 other neonates, 5 children in the diarrhea unit and minimum of 3 other inpatients.
I went to the mother of the infant I was with and with the help of another 'NCU Mother' who knew a little English and a lot of gestures, she finally understood my request of her to express some fresh colostrum. As I thanked her and turned she reached for me and started speaking to the other woman who'd managed some translation. They both looked at me and seemed to be asking something, I told them 'Sielewi. Pole' - 'I don't understand, sorry'. The second woman then asked 'girl? boy?' It was now that I realised the woman didn't know if she had a son or a daughter, she hadn't seen her child since they were transferred in immediately after delivery at 6am this morning! My heart dropped for her. Without saying anything I took her hand and led her after me, gave her a hair net and pair of shoes and ventured into the warm room where the babies were all asleep. I introduced her to her baby while she whispered 'asante' 'thank-you', I carefully unwrapped part of the kanga and showed this woman that she had a daughter. She kept her distance while continuing to whisper 'asante'. I pulled out my hand gel, squirted a bit onto my hand then motioned to put some on her hands, we rubbed our hands dry then I took her hand again and placed her finger in the palm of her daughter's hand. After a couple of minutes the woman stood up straight, said something to me I didn't understand (again) but from her gestures I gathered she was going to the other room to express milk for her baby girl. 

The nurse returned with equipment for siting a naso-gastric tube. As I'd already seen that they have very little single use equipment, I was intrigued as to how this would be done. She had a tube as we would have in the UK and some cooled boiled water in a sterilised cup. As she was preparing she asked me how we site an NG tube in the UK, I felt relieved that this was something I'd learnt to do on placement a couple of weeks before going to Tanzania. I told her how we measure the tube for the infant, how it's inserted and how the pH of the aspirate is checked before each feed to ensure it hasn't been inserted into the lung. She was very interested in what I told her and again apologised for not having such advanced equipment. I told her not to apologise, she's doing a wonderful thing and us mzungu are just lucky.
She dipped one end of the tube in water to lubricate it then asked me to hold the other end of the tube in the water, keep it there and tell her if I see any bubbles. She began inserting the tube in the right nostril and told me that if the tube is sited in the lung then as the baby breathes out bubbles would form in the cup. This was how she checked it's location. While I did think this was an interesting way, I did think that this technique must also carry the risk of an infant inhaling water via the tube. The tube was sited, there had been no bubbles and the water level in the tube had not moved either. The mother had brought some colostrum and I drew it up into a fresh syringe. The nurse gave the feed. Finally! Her chest sounded clearer, heartrate had improved, skin colour was better and there was no longer any nasal flaring! The nurse had got hold of a thermometer and while I can't remember it, it had improved, thankfully!
Time had flown and Tom was waiting to take me home. It had been a long, tough day. Now I was hoping the little thing was gonna be alright overnight and kept on humming the tune which soon became the theme-song to my time in Tanzania.

One of the incubators on labour ward

The cots in the neonatal unit warm room

The resuscitaire with foot pump suction and the oxygen pump to the left

Birth-Tanzania styley!

While I know the title comes across as a bit of a generalisation, I must remind readers what I write only reflects my experiences, at a specific place and a specific time, with specific people.

So, yet another landmark date arrived. My first day on placement here in Tanzania.

I was very quiet that morning as we had breakfast and on the drive to the hospital. From the experiences the other girls had already shared with me I was really nervous; and I was so glad I wasn't starting the placement on my own-Valerie and Beverly were working today too. 

It was a public holiday so I was told that the matron of the hospital who oversees all elective students and volunteers wouldn't be in. So instead of meeting her, I was taken straight to the maternity unit. I had an idea of what the unit looked like from photos I'd seen online so ina weird  way things looked kind of familiar. We got changed and I had a very brief tour of the unit. There were 3 main rooms - the antenatal room which had about 12 beds for anyone who had been admitted in early labour or with PIH etc. this led onto the labour room. First there was an alcove with a bed, closed off with a curtain, this was often used as a triage area for antenatal admissions. Past this moving clockwise was a counter top with weighing scales and a wipe-clean, cushioned mat which was the neonatal resuscitation area. Above this counter there was an emergency cupboard with some resus equipment and a selection of drugs. Then there was a trolley which had 3 large metal tins which looked a bit like pressure cookers! These stored sterile equipment such as scissors, clamps, needle holders, etc. Then there was 3 incubators which resembled wooden cupboards where infants were kept warm with small electric blankets or hot water bottles (with covers of corse). Then there was 2 labour beds with heavy duty plastic sheets, side by side with plastic curtains to offer some privacy, however these weren't always a good fit, so there was often gaps. Past the second bed was a large, 50s style cot that could easily fit 5 babies in! This was mostly used as an extra counter top. Then there was the drugs cupboard and some storage cupboards. Along the fourth wall of the room was the desk where new admissions were seen, all midwives and doctors paperwork was completed then 3 doors to the clinic room; the staff room (which had 1 table, 2 chairs and was also a storage room and at times also used for clinics; and the sluice - 3 bins for different waste products and a huge 'trough' with a cold tap at one end and a drain at the other. When it came to cleaning there was only cold water, and detergent when available (which was most of the time). The labour ward then led onto the postnatal room where again there was approximately 12 beds but at times extra beds were squeezed in when necessary (leaving no leg room between beds) and no cots. All women co-slept with their newborn and on one very busy day, there were 2 women to some beds.

So in a labour ward with such limited place it may be unnecessary to point out that these women birth alone-the only birth partner is the woman in the adjacent bed! Family brought flasks of chai and pans of stew for women-if they had family close enough to visit. One thing I really admired, although I didn't figure it out until further on in the placement, was the solidarity of the women supporting each other in these wards; either sharing food, calling the midwife for someone in the opposite bed, encouraging each other during the first stage of labour and looking after each others newborn while washing etc. Especially for the primigravida women, this must have been such a relief when no family were available.

While Beverley went to observe a caesarean, Valerie and I stayed to watch a birth. The women stay on the antenatal ward until they feel things are progressing, then they bring themselves through to the labour ward, lay their kanga (gorgeous pieces of fabric used as clothing, headscarves, swaddling and sheets) on a bed, strip off and climb up onto the bed waiting for a midwife to come and assess them. If she's not yet fully dilated, she's asked to return to the antenatal ward. If she is fully dilated then she remains on the labour ward and progresses alone, even when second stage commences. The women are phenomenal! They remain active and mobile until second stage, they are fairly quiet throughout their labour, completely focused on their body and birthing their baby, with no pain relief. Once pushing commences they are on the bed, mostly supine, either holding behind their knees or on their ankles. I only heard one midwife 'manage' second stage, telling the woman to push, all other births I saw were physiologically led by the woman's body and own involuntary pushing. I did observe several midwives almost provide an assisted delivery-as soon as the head was delivered, they didn't wait for restitution or the next contraction, they pulled the body out of the birth canal. When I enquired why, I wasn't really given an explanation. On one occasion I was told it was because she needed to get that baby out quickly to make sure it was OK but when they don't regularly listen to the fetal heart during labour, and the liquor draining had been clear for this birth I couldn't see any evidence as to why the fetus would need a prompt delivery. There may have been a valid reason, just not one that I could identify.

Once the baby was born, oxytocin was administered IM, cord cut, the sex of the baby shown to the mother and it was wrapped in a kanga and weighed. The baby then remained either by the scales or in an incubator while third stage was completed, the perineum checked and sutured if required, then the mother was wiped down and made her way to the postnatal ward. Quite often the woman had walked herself and carried her belongings to the postnatal ward within 15 minutes of giving birth! On one hand I was in absolute awe of the ability and attitude of these women to just crack on. On the other, I was very conscious of the lack of care during the immediate postnatal period for these women and was more surprised by the lack of care for neonates, but that's another story.

Overall my first day felt like a baptism of fire! I knew resources were limited and demands on staff were high but experiencing it was completely different to any expectations I had. I found it hard to observe women birthing with no support or regular checks-mostly due to the limited staff being needed elsewhere so they couldn't provided one-to-one care. And when something did require the attention of a senior midwife, I'm sure try got sick of us mzungu shouting 'Sister! Please come.' And hearing about the caesarean was v.interesting and again, will make another interesting jackanory!

What a start!

So much has happened and its been so unbelievable, there have been several occasions I've had to remind myself it's all real and I am really here-and i mean that in both good and bad ways! I'm not going to be writing totally   contemporaneously (bad student midwife) but it will be in chronological order.

So after landing we left the plane and there were some staff welcoming us, this made me grin like a cheshire cat! Then we walked across the tarmac to the arrivals gate in pitch black. On this little journey my heart gave a little leap, I'm really here, after all the dreaming, planning, organising and traveling, I've actually made it to Africa on my own! Got into the arrivals area and filled in an arrivals card, then proceeded to the visa desk. The woman was clearly a tough cookie and a bit intimidating. I handed my form then she demanded "$50!" I'd forgot about that bit so started rooting through my bag for cash. She was clearly getting peeved off. She stamped everything and shooed me away. I was trying to collect the forms, passport and close my bag with all my belongings back in and she barked at me "desk 2!" I was fully aware of where I needed to go, just wasn't quick enough, and this telling off made me all the more flustered. Finally escaped and got my visa entry stamped then through to the luggage carousel where I had a battle with a luggage trolly. I must've looked such an inept, clueless mzungu! A woman insisted on helping me, I vaguely remember reading that flycatchers will do something nice then demand money. She kept saying she wanted to help me, told her thanks but I don't need help and I've someone meeting me.

Got my bags and off through customs-nothing to declare. Through the doors and a mini sea of people and while I'd put my WaCT hoody visibly on front of my trolly I didn't have my glasses on, and with the dim lighting too I struggled to see the sign to indicate who was collecting me! He started waving it and came over. Introduced himself as Tom, said 'Karibu' and told me Fred (the Tanzania WaCT manager) sends his apologies but he's at Maasai with some of the other students. It was late so just driving to the house, sleep and he'd pick me up about 11am for orientation. Sounded good! I nodded off to sleep during the drive to my new home. Then we went kinda 'off road' these bumps resembled the turbulence I'd just recovered from but at least I knew I was on solid ground-just very uneven! We arrived at the house and I was welcomed by Beatie, my Mama for the next few weeks. She made some tea and showed me around the house quietly, and another girl appeared in the hall-Valerie. We shared our drink and compared some notes on our courses then turned in at 5am! 

It was nice to finally climb into a bed after all the traveling! Woke up about 9:30 and went to the kitchen where I found another woman. Said good morning and with her limited English and my even more limited Swahili I finally got across that I'd like a shower. To my confusion she boiled the kettle! She then poured the hot water into a plastic basin and took it to the shower room! That's when I realised there was no hot running water and I was stood there trying to figure out how to wash my hair and shower with 1 basin of water on the floor. It was tricky at first but I've become a bit of a pro at bucket showers now :) 

(The bucket/bath/shower)

Tom came to collect me and we went to the hospital to collect Valerie then we headed into Arusha. Along the way Tom pointed out amenities I may need, corner shop, supermarket, where to get a dala-dala from/to which is the public transport - it's basically a small minibus that can usually seat 12 passengers tightly but we often saw dala-dala with perhaps 20 passengers-not for those who suffer claustrophobia or the faint hearted! The driving (as expected) is manic. Lots of over taking just in the nick of time; parked cars or dala-dala that are moving off don't wait for a gap in traffic really, just pull away and whichever vehicle is already travelling has to get out of the way! But considering I'm a bit of a nervous passenger in the UK I didn't flinch once, felt completely at ease with Tom at the wheel. 

When we arrived at Arusha it was a typical city centre, a lot of hustle and bustle and more crazy driving along with people pushing huge carts of produce, people draped in trainers and belts as lots of roadside traders. We went to a place called the Policemans Mess where we had lunch; rice, beans, veg and barbecued chicken-it was a food mountain and it was delicious but I couldn't fit it all in, Tom seemed quite surprised I was unable to finish the food. We then went to the beureau de change and to go get a local SIM card, that turned complicated but that's a long and unnecessary story! 

Then Tom took us to the Maasai market where crafts and gifts can be found. He warned us that the stall holders will try and charm us and will say they're giving a discount but really it'll be a mzungu price, so always barter and start at 50%. It was actually quite intimidating for a first day experience and even though I bartered I still got conned, which I didn't realise til much later in the day when it clicked that I'd confused the exchange rate! Well lesson learnt! 

Then back to the house where Valerie and I aat on the porch in the evening sun  and talked; she told me about her experience of the hospital so far and we got a glimpse of Mount Meru-Kilimanjaro's little sister which sits behind Arusha at 4566m high. Much later in the evening the other 4 students arrived back from Maasai along with Fred. These were the girls I'd been getting to know through Facebook and it was lovely to finally meet them properly. Dinner was served (more huge portions) and they shared some of their experiences with the Maasai. It sounded amazing and I couldn't wait to go. 

So much happened and I couldn't believe I'd not even been in Tanzania 24 hours! The next 4 weeks seemed like an eternity-in a good way :)

(One of the thousands of dala-dala)

(Mt Meru, although this wasn't taken from the house)

Days 1-3

MAMBO!

I made it to Arusha in 1 piece early hours of this morning, it already feels like I've been here ages so much has happened but this post is about my time in transit and a little bit beyond! 

So I left my house Monday 11:00, that was a longer drive to Manchester airport than expected due to road works and horrific weather conditions, but made it, I got a little teary eyed when my Dad wished me Bon Voyage. Got onto the plane and felt v.nervous. The seat next to me was empty which made it a little easier to stretch out and relax-saying that I was impressed with the available leg space-much better than expected! That flight was straight forward enough, a little bumpy at times but nothing more than driving down one of the roads at home! 

2103 miles later I landed in Istanbul at 20:30 and although I'd slept on the flight I was really tired. I went through the transit door at the arrival gate and went and found a bench as it got dark. It soon got busy as the gate I was next to had a departure but that was only 23:30 so a reasonable enough time. And then I lay down! I had my headphones in which helped me doze but there was a group nearby and they were really noisy up until 03:00 Tuesday! And I decided I could never cope sleeping on a park bench, this 'cushioned' bench was making my bones numb! I rolled over so many time-right side, back, curled up, stretched out, left side, front, legs up, legs down... properly woke up about 06:00 and went to the bathroom to freshen up and go find something to drink. I then decided to find my way to the transit desk to find out about the tour, I'd read this airport can be a bit tricky so thought it best to allow plenty of time. Well I got told off for not going to the desk as soon as I arrived-how was I supposed to know?! Plus I already had my boarding pass so it didn't make much difference. Anyway then it got a whole lot confusing-she told me I had to go through passport control and go to the hotel desk. Straight forward enough, right? Queued up and got to passport control-he had no English and I had no Turkish, he asked if I was transit, I said yes and he waved me away! Didn't give any clue what or where to go just flapped to the left. So I went and joined another queue in the general direction he was waving. Got to the front and he asked where my visa was-told him I don't have one as I'm in transit-he laughed and told me I should be going through transit security not passport control. So I told him I'm going into the city, and was told to come here. So I finally got told I need a visa to do that and he pointed in the direction of the visa desk that I'd not spotted. Went there, paid $20 and got a stamp. Went back to passport control and finally got through! Went and registered for the tour at the desk and was distraught to see that right next to it was a Starbucks with big comfy armchairs that people were sleeping in-I so wished I had gone to the transit desk the night before! So I curled up in one and had another doze for about 40minutes until we were called for the tour. Onto an open top bus and away we went, the warmth outside was lovely but the air was fresh and cool and smelt sweet and spicy...well except for when we went past the sewage works! We were taken to a restaurant for breakfast-plate full of ham, feta cheese, cucumber, tomatoes, olives, bread, honey, an egg (which I don't eat) and lots of sweet tea. This gave us a chance to chat and compare journeys and adventures-I was sat with a Brazilian guy heading to London to study medicine, a New Yorker heading home after a trip to Tel Aviv, an older man who was a traveller in every sense and considered himself a citizen of the world with no fixed address, Manuel from Sweden, Mia heading home to Hong Kong and a family from South Africa who's children were fluent in 3 and 4 languages at the ages of 5 and 9 respectfully, thanks to a multi-lingual marriage!

Driving along the coast I have never seen so many ships and liners all queuing to get in and out of port! They just went on and on. We then went to the touristy centre-visited the Basilica Cistern which is an immense underground cistern built to store/provide water to one of the palaces above. Truly was an immense space with thousands of columns holding it up. Then moved onto the Hagia Sophia, which was a cathedral and the biggest structure in the country for some time, adorned with gold mosaics and fantastic chandeliers. It was the turned into a mosque and the artwork was plastered over. Since becoming a museum they've exposed some of the Christian artwork but left some Muslim details in place to show the contrast.

Across the square was the Blue Mosque, unfortunately I didn't get to see inside-really wish I had! 

Then onto lunch-lentil soup (possibly the blandest thing I've tasted), salad, grilled chicken with rice and creamed potatoes. Then something very sticky and sweet for pudding. 

After that it was 15:00 and some of us went back to the airport-I was still knackered and was feeling a bit run down-a little bit of me does wish I'd stayed out and visited the spice bazaar but with the heat too and another flight to endure I wanted to make the most of stretching out. So I had another freshen up and got changed then had a wander the full length of the airport and a nosey in some of the shops. I began to feel like a zombie  so searched for another quiet bench. And that time I really did fall to sleep properly. Woke up about 18:30 and felt like a new person. After a bit I headed to my gate for the 20:35 departure, this plane was at full capacity-the airline merged 2 flights together so half the passengers were continuing onto Mombasa. I was sat next to April and Clark, a retired couple from Los Angeles, they'd been in Istanbul for 5 days, were heading for a 12 day safari followed by a 5 day Gorilla trek in Uganda! April said she had to look after me properly as I look after so many women at such an important time-that was heartwarming! 

We took off and my heart was pounding again! As we were still climbing the plane swerved left, then right, then there was a couple of small screams and gasps as I grabbed onto the chair in front certain we were about to do a barrel roll, then there was a lot of bobbing of turbulence followed by a dip...then it just became bumpy like the flight the day before, but that was my nerves shot! I'd even started praying even though I'm an atheist! That was when I felt very lonely and wished one of my nearest and dearest were with me-someone familiar to grab their hand. There was a lot of turbulence during that flight, bobbing away. I kept trying to persuade myself that some roads at home have potholes that make journeys bumpier than this one but I wasn't fooling myself...although the attempt provided a good distraction at times. After lots of turbulence we finally touched down (a bit unexpectedly) and that was a very bumpy landing too-but there was a cheer we'd made it! Not sure whether it was a cheer just at the excitement of arriving in Tanzania, or relief of surviving...dare say it was a bit of both!

Today's the day 5,113 miles to go!

Say in the departure lounge with a pint...there's a couple sitting a few tables away eating a full English breakfast and it smells amazing! I may have to follow their example of my last English grub for the next 4 weeks! 

I am enjoying a pint though!

 My heart is racing, I'm a bit nervous with take offs and I've no-ones hand to squeeze (hope whoever sits next to me on the plane doesn't take my unprompted hand squeezing as a proposition lol). And actually I'm not nervous-that's a huge understatement! I'm absolutely papping my kegs!!!!! But now I'm not so nervous of what I'll see whilst on placement, it's the journey I've already began-travelling so far on my todd! Why did I think this was a good idea??? Lol 

Well 103 miles done and the next leg is about 2,000 miles to Istanbul where I have a 23 and a half hour stop over! So I'll probably have time to write up that mini solo adventure! 

9 sleeps left...

I've started packing!
I've got 3 shifts left on delivery suite placement, 1 meeting with my link tutor, 1 carboot sale and a trillion piddly little tasks to sort out.
I've got masses of stuff to take with me as donations for the hospital and orphanage as well as cash that's been donated by some very generous people too (details here).

Now as excited as I am, I'm also very nervous. I read this book just before starting my midwifery degree and the true story made me want to experience midwifery in a developing country. The book is an account of a teenagers life from a middle class family as the Taliban take over power. It inspired me because her mother was a doctor, and under the new ruling, women couldn't work, nor could they be seen by other men...so imaging the complications that arise during childbirth?! Afghanistan is still THE unsafest place to be pregnant with 1 in 11 women not surviving childbirth (Atlas of Birth, 2012), compared to 1 in 23 in Tanzania, and 1 in 4,700 here in the UK. Yet things are improving, and women are starting to regain some of the care facilities they should be entitled to. Here is another inspiring story of a young midwife who is making a difference. And, along with the adventure I'm about to embark on, much to my mothers concern, midwifery in Afghanistan is another venture that blows my mind and I'd love to persue some day...So far everyone I've told thinks I'm crazy...and yea, I know I am!

To Do:
change GBP to USD
finish packing
dye hair
find camera charger and memory cards
wax legs
decide on a cabin bag

14 days to go...

So in exactly 2 weeks time I will be flying over Europe somewhere having started my adventure of a lifetime! I think I'm almost sorted, my to-do list is finally beginning to shrink - YIPPEEEEE although my stack of things to pack is realllly growing, praying I don't go over the luggage allowance!

My placement goodie pack arrived from Women and Children Tanzania (the elective placement organisation I am travelling with), so excited when I opened that package...

As you can see, it contained a lovely cozy hoodie, a drawstring bag, a sphygmomanometer, stethoscope, pinard, fob watch, tape measure, a selection of gloves and alcohol hand gel! What a good goodie bag that is!

And I've set up a donation page too, for anyone who wants to donate follow this link! As the page explains, I want to give a cash donation directly to the people I am working with, rather than a global organisation. This way, I'll be able to see first hand how the money will help, how it might be used, and more importantly, the people who'll benefit from it! The only deduction will be the commission for exchanging the money, other than that, it goes straight to the people who need it!

Thank you! x

21 days to go...EEEEKKKKKKK!!!!!

So I finished my last post commenting how interesting the comparison between care for poorly babies would be, well after completing my placement on a small special care baby unit (SCBU) I must admit my perspective on care here has changed already...well actually I suppose that's not quite an accurate way to put. Really it's more a case of I had views about care before starting this course, then as I've learnt things and worked with different people I've kind of adopted some of their views and thinking - as happens. Now after my time on SCBU, I've been exposed to another view which really has reminding me of what my opinion originally was. I'm sorry, that's a bit of a spaghetti junction on an explanation there! Hope you're still with me lol

As student midwives, and registered midwives too, the message about woman centred care is at the core of everything we do and learn; organisations such as the RCM, White Ribbon Alliance and WHO tell us woman centred care should be pivotal in all that we do while providing safe care...but I'm actually starting to think that's too narrow! 

One SCBU nurse told me about a situation many moons ago, where she was trying to facilitate a premature (but stable) neonate to have some time with his mother who was recovering a traumatic labour followed by a crash section and PPH. However her endeavours were in vain as this nurse was told by a midwife that she is too busy caring for the mother and doesn't have the time to think about cuddles. As the nurse was not given permission to bring the infant onto the postnatal ward, it was over 12 hours before this mother and infant got the opportunity to bond. Now it can't be denied that high risk postnatal care is demanding for any midwife but surely the priority of any woman after giving birth is to see and spent time with her child. So while I accept there may be much more complex elements to this situation than I know, in my opinion, facilitating time for mother and child to bond in those significant early hours, addressing what is the woman's priority (seeing her child) is more woman centred than just focusing on her physical well-being, and the duration of separation may also affect her physical well-being (stress causing raised BP, resulting in a higher EWS score perhaps).

Now that is one very rare occurrence, but just an example of how this placement has got me thinking about the perspectives from both sides perspectives and it has made me consider experiences I've had where perhaps care should have been family-centred on a holistic level rather than woman-centred on a medical level.

I've found this experience on SCBU eye opening and invaluable, it has really made me think about the importance of infant development and environmental factors. Consider more flexibility with care, can jobs be consolidated to reduce interfering with bonding time, things that can be done to encourage bonding, being family centred in postnatal care-not just woman centred and think about what I can do in the future to make transitional care smoother for the two teams involved. It's also made me think about how I can support women when their babies are taken straight to SCBU - I now believe I'll be able to support women better, be able to explain what the neonatal team will be doing, preparing women for what to expect when they see their child on SCBU and

So after those thoughts/impressions being consolidated, I'm wondering what care of the new family will look like in Tanzania? More-so where there is a premature or ill infant. How much of what I've learnt in the last 2 weeks will I be able to share with the midwives there, and similarly, how much more will I learn from them?

In other news - I had my birthday, I got spoilt, I smashed my money jar and banked the pennies.

 I gave blood for the first time, something I've wanted to do for a long time and decided I had to do before the big 3-0 next year so figured I best do it a) before my yellow fever jab and anti-malaria drugs and b) while I'm feeling brave!

I've paid for my placement, paid for my R&R trip to Zanzibar, got a selection of donations together for both the hospital and the orphanage which I'll be visiting. I still need to sort my travel insurance (job for later today) and have my yellow fever jab tomorrow...not looking forward to that :/ I'm currently putting together an info pack for my parents with my whole itinerary and important details that may be of use to them. My to-do list is looking interesting - as soon as I cross something off, there's usually 2 or 3 more things to add lol typical! I've got all the important things bought, and completed my toiletries shopping today...so think I'm almost ready!!! 

3 weeks today I depart...beginning to wonder whatever possessed me to fly alone?!?!

35 days to go...

So now it's getting to the point where I'm getting nervous about the placement itself. It's crazy to think so much energy, planning and organising has gone into a single 2 week placement. I'm nervous about things I'll observe and won't agree with; I'm nervous about not having to speak up and question/challenge practices; I'm very nervous about seeing a situation where a poor outcome was simply a result of lack of resources. I'm terrified about feeling out of my depth and not having my usual pillars of support available - friends, family, my cohort; all the people I don't hesitate to routinely turn to when I need to share amazing news of a delivery just as often as I need a hug, rant and/or cry.
I tell myself these are undoubtedly normal worries and concerns for someone about to embark on such a massive change of culture alone. But then again I won't be completely alone, I'll have the other 4 lovely student midwives to turn to at times.
My professional cool-headed angel sat on my shoulder tells me it'll all be good, these worries are normal and I shouldn't waste energy worrying...but then there's the little devil on my other shoulder screaming panic in my ear as there's plenty to be worrying about, including all the things I still need to buy/do! Well right at this moment in time the angel is drowning out the devil.
So along with my fun bedtime fiction reading (Harry Potter and the Chamber of Secrets at present...and I've somehow managed to read them out of order so far), and my constant perusing of Tanzania and Zanzibar guidebooks and a Swahili phrasebook, I'm also trying to fill my brain with information about obstetric emergencies. I've kinda figured that Tanzania will test my knowledge of these and it's knowledge that will always be of massive value throughout my career. It'll also be really interesting to compare the differences in norms of practice so I kinda want to do some reading up on WHO guidance.
Soon I'm starting a placement on a SCBU ward, another thing I'm a little nervous about but it will certainly be interesting and yet another point where the comparison of care for poorly babies, or infants at greater risk of becoming ill will be particularly interesting between the 2 countries.

Done:
anti-malarial tablets ordered
paperwork and admin bits
a stack of travel toiletries received as a gift from a wonderful friend xxx
got scrubs and found shoes

To Do:
buy shoes
sort insurance
book Zanzibar trip (just waiting for some details to be confirmed then I'll be booking away!)
break open my savings jar (mixed feelings about this - it's so pretty, but it's full of cash lol)