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!