International Day of the Midwife

 The International Day of the Midwife was celebrated in Style at Selian Hospital. We started off by having some Primary School kids from Christ Church International School come and  see around the hospital and learn more about what Midwives do.

They were very sweet asking good questions and getting very excited when they saw a baby that was less than an hour old.

We then had 45 pupils from the local secondary Schools come and learn about the role of the Midwife. They seemed very interested and I think could have stayed for the whole day asking questions.

 Sarah our head midwife explained to them all that happens in the Maternity Unit. Talking about labour and birth, Caesearean operations and Normal birth. Again they had so many questions.

 Sr Flora explained the importance of Antenatal care and why babies come back after birth for Immunisation and for weighing

Sr Editha explained what an Obstetric Fistula is and the fact that there is help for the devastating condition woman can suffer from when they have no access to good maternity care.

Because we were  celebrating we had to have a cake.

 Jonny and Paul looking very smart in their Maternity Africa T shirts

The afternoon we had planned a gathering in the chapel. Again with the Midwives from the different departments explaining what their roles are . Making sure that all staff new the various functions of a Midwife.

All staff parade in the hospital grounds as they came to the chapel. 

We had the great honour of having Euni Simonson  come to be a guest speaker. Here and her husband came to Tanzania 60 years ago as missionaries and the build Selian hospital up fro a small dispensary to the hospital it is today. In her beautiful Swahili she shared stories of birth and what the heart of a Midwife should be. What a privilege it was for us to hear from this wise Godly woman.

The day finished with Happy, a patient who had her baby at Selian in Feb, telling everyone what the care and compassion of the Midwives the had meant to her and to encourage everyone to keep giving good care to all.

It was a fun day , with some serious issues discussed but hopefully everyone is a little wiser about what the true role of a Midwife is in Tanzania.

Moving on!

It has been a while since I last wrote. Many things have happened and as always in this dynamic world some good and encouraging things as well as some sad and challenging things.
One of the really exciting developments has been the arrival of Dr Jonny Rust and family from the UK. Jonny is an obstetrician who will be with us for 5 months in the Maternity unit. He comes with a passion for teaching and such a willing heart to help, that it is such a blessing to have him with us for this time.

Using our new model

How a baby moves through a pelvis

Jonny explaining so well!

Kiwi delivery

Dr Freddy Mbise teaching us about professionalism

 This was a teaching day we had recently for all the Maternity/Gynae and Reproductive health staff to be refreshed on some of their clinical skills.
It is always a challenge to get everyone to teaching, the ward is busy and the staff shortage is a challenge at times.This way the staff get paid for coming in to do an extra shift bit that is a teaching shift - but this seems to work well.

Last month we had our busiest month yet with 167 births in the unit. This month looks like we are on track to being even busier so that is wonderful to know that more woman are feeling the freedom and confidence to access the service we re offering.

Some of the lovely midwives at handover

This week we seemed to have had a higher number than normal of HIV positive woman. 2 of them were just diagnosed when they came into labour and the other 2 were known. I am reminded again about the complexities of the disease. The longing to deny that they really have it, knowing the life sentence it brings with us. Sarah our senior midwife is very up to date on the care these woman and their babies should receive so has taken a wonderful lead in counseling these ladies. Another woman was needing a blood transfusion at the beginning of the week and her husband came to donate. He was found to be HIV positive. Mum however is HIV negative. Hence now the challenge to inform the husband and educating the couple to help the Mum remain HIV negative!

The final story of this week was a Masaai man who had 2 wives. One had undiagnosed triplets, sadly one of which died, but then wife number 2 is admitted with a 2 week old baby who is septic! One can only imagine the family dynamics with 2 wives both just post partum and all sick babies, a real challenge.

Southern Tanzania

After 2 days in Dar es Salaam having some training I headed to Mtwara in Southern Tanzania. I was to look at 2 Maternity units and 2 Nursing and Midwifery schools and do a Gap Analysis of what skills are needing developing.

I was met by my Rafiki nimpia ( new friend) Tecla.

A donated ambulance actually being used for the purpose for which it was intended! Encouraging.

Beautiful hospital veranda

Filling in the Gap Analysis

She is principal of one of the schools. What a humble beautiful lady. We then set off in the Ministry of Health car along the bumpy roads to Newala.

Newala is based on the edge of an escarpment overlooking the river ,so one can peer into Mozambique. It is green and lush and beautiful.

I was so warmly welcomed at the Nursing School in Newala. We then strolled over to the Hospital which is just next door. There is a lovely relationship between the school and hospital.

Everyone seemed so focused on my visit, that bless the poor lady who was in labour delivered her baby by herself despite there being 15 students and midwives within 3 meters of her. Was trying to emphasize patient care always comes first, even if you have a visitor!

We then overnighted in Masasi. The country side is so beautiful. I was amazed at all the bicycles on the road. And so many women riding them. Also what was being carried on the back was quite entertaining. At times it looked like a whole shop was on the back.

There were so many schools along the road. More so than what I have seen in South Africa in the rural areas. Education exposure, something it looks like they are doing quite well down here in the South.

Teaching staff at Nchingwea Nursing and Midwifery School

All the Male Midwifery Students

The next day I was at Nchingwea School and hospital. Again such a warm welcome. I found the care in this hospital quite encouraging.

I think the thing that really rattled me on this trip was seeing the conditions under which the students need to study and live. They are all crammed into dormitories, lack of funds see them staying at the school for their holidays. I felt overwhelmed with compassion for them, and how despite the hardships they persevere. When I think about my student days, the total privilege of small classes, great resources and not to mention friends, parties and good times!

I felt embarrassed about how I have demanded a higher standard of care from the Midwives I work with and now I see where they come from I am humbled by how they have overcome to all be where they are now!

So I return to Arusha with a deeper sense of the challenges to Maternity Care in Tanzania. But also excited about relationships that have been established and the many opportunities we have for the future.

I realised while visiting these hospitals, the love I have for the rural African hospital. Large verandas, covered walk ways, open doors everywhere, patients and family lounging on the grass, no hurry anywhere. Much of it is a sight that makes my heart so glad! Despite the challenges I think a lot more healing can come from an environment like this than the type of hospitals many of us will find ourselves in.

A beautiful Day

We had yet another really exciting day when a long term patient of our gave birth to a healthy little girl.

Regina was pregnant for the 5^th time and as yet had not had a live baby. She has been an inpatient for about 2 months. It had been a very anxious time for her and for us too as health professionals as we so desperately wanted her to have a happy ending this time.

After a failed Induction  - she really wanted a vaginal birth, she went to theatre for a C/S. A beautiful little girl called Ebeneezer was born.

It was a great day of celebration all round.

Mum and Daughter having their first cuddle

The other patients were so so lovely. Jennifer Maria her neighbour in the ward prepared her bed for her to come back to post C/S. Also she acted as Fairy Godmother cuddling the little girl while her Mum was still in theatre.

Fairy Godmother Jennifer Maria so deligted with her new role!

Fatuma, another long term patient who has become the Matron of the ward went out to buy soda’s for all the patients to celebrate. Fatuma made me laugh the other day when I went into the ward to give medication and she was giving me strict instructions on who needed what and who was where! Also as us Midwives are chatting about things at the nurses station she is often there to make her contribution.

I just love the Sisterhood in the ward. The way they all get to know each other and seem to share so many of their joys and sorrows. As you escort a lady back to the ward after she has delivered, there are so often many “Hongera’s “around, celebrating the wonderful achievement.

Regina has again been such a reminder to me of the pain for woman who are childless in Tanzania. She speaks about how the community stigmatise and judge you.

When I checked with her if she needed some pain relief the day after her C/S . She was very firm in telling me she was too happy to feel any pain.

Wishing her and Ebeneezer many years of great joy.

Baby Katie

Some of you may remember the patient I wrote about last year who was 43 with no live baby and 3 failed pregnancies. I met her early on when I got to Arusha. Some how her story just so struck a cord in my heart and I prayed fervently for her that her hope would not be disappointed again.

Well the day I left to go home to see my Dad who was unwell, Maria delivered a beautiful little girl.

Mummy and Midwife gazing on the little treasure

Little Katie looking startled! 

I have been wondering since I got back how they were doing and then on Monday they arrived. Maria and baby Katie.
She is chubby and gorgeous! A joy and delight to her Mum and Dad. And not to mention this midwife. I have thanked God many many times for allowing the joy of this baby.

A reminder for me again that "Hope deferred makes the heart sick but a longing fulfilled is the tree of life!"

Zanzibar

Who would ever have thought I would go to Zanzibar on a work trip?I am just back from 3 days there visiting the Midwifery School and the main maternity Hospital.

Students in their classroom

It was wonderful to be near the sea again and have time to swim in the ocean. My day at the College was certainly interesting. One realised how in Tanzania and Zanzibar that there is just so much a better infrastructure and basic foundation than what I saw in Sierra Leone.
The principal of the school was a wonderful older midwife who had a passion for teaching ethics. I spent time with the 3rd year students getting them to fill in a skills questionnaire. There are 68 students in this class. Almost impossible to teach a clinical profession like midwifery with so many.
It was very interesting that of all of them only 1 wanted to work as a midwife when she was qualified. This set alarm bells going for me. We have to find a way to train students in a way that they will want to practice the profession once they are qualified.Also the question really is should we not begin to focus more on quality than quantity? I know not an easy question to ask in an African context.

I was hosted by UNFPA as I was going some consulting work for their mainland office.

The maternity hospital was the main referral hospital on the island. Here too the midwives did the Gap Analysis Assessment. Despite being overworked as they kept telling me, they still seemed to have time to sit and chill.

Midwives doing the Gap Analysis Tool

It is a very busy hospital. The midwife in charge was brilliant. Motivated and enthusiastic. She is committed to doing a great job. In the time I was there I saw her teaching, training, reprimanding, doing clinical work and organising - she is someone to treasure and work with.

A Zanzabari's midwife hands

In the evening as I sat by the beach sipping my G and T , I felt so blessed that here I have the chance to travel around Africa looking at Maternity Hospital, meeting midwives. Just what I love!

Refresher week

I am not doing very well at keeping up to date with the blog.
Really sorry, things been a bit crazy.
A few weeks ago we had a refresher week for the midwives. Now that we have hired new midwives we decided to have some intense teaching time to make sure we were all on the same page.
We had a lot of fun, all learnt or were reminded of many things and launched our new protocols for the Maternity Unit.

 Dr Stephen, fresh from Sheffield teaching Jacob suturing

Paul and Lucas being our technical support team

Dr Elena doing Neonatal resus

Dr Andrew , teaching about Suturing, not preaching even though it may look like it.

Reviving our baby

Some of our wonderful midwives