Prepared

I am coming to the end of my second month here in Arusha. So many thoughts, feelings, emotions and much to reflect on. The setting of Selian hospital is so lovely. Wards are all set around a large open square of grass and beautiful big trees are scattered around bringing shade. So for me even driving to work feels like a blessing compared to the dramatic drive I took each day in Freetown to PCMH. I must admit at the moment it is actually quite cool, so the open hospital is pretty chilly, but I am sure in the heat of summer it will be a real blessing.

Like any old cowboy, it I so good to be back in the saddle. After 4 months at home with no mummies or babies to care for, it is so wonderful to be back on the ward. I feel again just the privilege of being able to care for these women. I know many woman in the world work hard and are ill-treated but I have a sense the burden on the Massai woman is very great indeed. You get the feeling that there is not a lot of joy in their lives. So be able to just sit there and rub their back, hold their hand , offer them care, is such a privilege for me. You can see  their hard work in their hands and feet. They work hard, they walk far, and life is hard!

Dorah, the head Midwife at Selian was very welcoming. It is always that tentative thing in the beginning about forming the friendships. Trying to make the staff realise you are there to help and be on their side rather than swooping in and changing all.

So many times in my life I have been amazed how God always prepares you for what he asks you to do. I am so mindful as I arrive here that what has happened in the preceding years both in South Africa and Sierra Leone has all been preparation for this next part of the journey.

On my second day in the hospital there was a lady who very sadly lost her baby at 18 weeks. It was a challenge to get the placenta out as it was so small and friable but also the extra challenge was that her Female Genital Mutilation (FGM) really was quite extensive. As I was working away, I realised how great God is, that I had worked in Sierra Leone where this too was common practice and therefore I felt more confident dealing with it here. If this had been my first experience of caring for a woman with FGM I think I would have been totally freaked out. I thanked Him for his graciousness to me at that moment.

A few weeks ago we had a woman who had had a C/S with her first baby and now was in labour with the second. The midwife who was on duty with me was very doubtful that she would be able to have a vaginal birth. The midwife gave the Mum about a 5% chance of succeeding. Well, after a day of careful monitoring, and lots of questions along the way, the Mum finally had a fully dilated cervix. Andrew needed to help us with an assisted birth at the end, but the midwife was so surprised and delighted that the labour process had actually worked. She arrived at work 2 days later, still bubbling over with reflections of that day and the way the woman had laboured.

As with everything in Africa it is small small. No great giant steps taken in a hurry. Rather little by little, working alongside, supporting, teaching and mentoring we hope to make Selian the very best place in all of Tanzania to birth a baby!

Arusha Luthern Medical Centre (ALMC)Nursing School

A little while ago I went with Lillian and Juliana 2 tutors from the ALMC nursing school to see the site of the proposed school which is due to open in September. The school is going to be held in a secondary school for the time being until a site is located and building is completed. It is very interesting in Tanzania, the Tanzania Nursing and Midwifery council are not only interested in the curriculum and teaching of the school, but the school has to provide accommodation for all the students as well.

The school hopes to open in September with 30 students. I am involved with them as we are hoping that their students will come to Selian to do their midwifery practical. That will be great for us to have more hands on deck but also I will do clinical supervision with them, while they are doing their midwifery block.

We also had the great privilege of having Euni Siminson coming to see the sight with us. She is a very gracious more mature lady that has been a missionary in Tanzania for the last 57 years. She and her husband came here from the USA and she was really the person who got Selian Hospital up and running all those many years ago, in collaboration with the Lutheran Church. Anyway, she was so excited to come and see the site, as she is having some students from the Masai Girls school being sponsored to train as Nurses through the Eunice Simonson Scholarship.

Juliana , Euni and Lillian in the dormatory corridor 

In the Nursing students kitchen

 She heads back to the US shortly to a ceremony to announce this programme, so it was so lovely including her in the future plans. 

A Tale of 2 Theatres

Friday was a routine day in theatre for Andrew and his team. They had a few 4^th degree tears to repair and then had a hysterectomy planned. After his first 2 cases in theatre, Dr Winnie informed him of a lady who was in labour that had now got obstructed.

So we ended up going to theatre for a Caesearean Section with this lady. I was interested to watch the end of the hysterectomy once I knew our baby was safely out.

 Prayers before Surgery starts

Dr Mruma teaching a junior Dr C/S

Our baby is nearly here

The end result of the operation in ourtheatre

So we had the safe arrival of the sweetest little boy in our theatre. I then went over to Andrew’s theatre to find them in then midst of removing a few fibroids. Fortunately, they did not have to do a hysterectomy. The first one was about fist size and 2 smaller ones. Great for me to watch some surgery that was not obstetrics.

But I had to admit we had a much cuter specimen at the end of our procedure, this precious little boy compared with the fibroid s that Andrew and Team had!

Andrew and Dr Winnie busy at the TableThe end result of their surgery! Fibroids removed

My Masai Ambulance

I arrived at work this morning and the night midwife called me to see this baby. It had been born 3 weeks ago at home and had been admitted over the weekend with these massive necrotising lesions all over its little body.

The mum was a masai woman sitting there on the bed with her red tartan wrapped round her and her decorative earrings hanging from her overstretched lobes.
This poor little thing was so ill looking. Had a roaring temperature and was so wasted. Immediately after assessing the baby we got the mum to express some milk so that we could top the baby up. Despite being on the breast all the time the baby was not actually sucking effectively.
The Mum was a champion expresser. In no time at all she had 30mls and again was a dab hand at cup feeding her baby.
I just love it when you think you are really going to need to teach a mum how to do something, and then you ask her to do it, via an interpreter of course and she is a total pro!
So off the mum went diligently expressing and feeding her baby every 2 hours.

They needed to be transferred to Mount Meru Hospital , which is the regional hospital as we could not offer the care they needed.
So there I am cruising along in my little Rav 4, with Dorah my midwife colleague heading off to Mount Meru hospital with these 2 beautifully clad masai ladies in the back. And a little masai baby bundled and snuggled right up with its Mum.
 The Granny was telling Dorah how she had never been to Arusha despite only living about 40km away. She felt very apprehensive about travelling into town.
I was chuckling to myself because between Dorah, a Tanzanian midwife, these 2 masai ladies and myself, a South African we managed to all get the giggles about Granny being overwhelmed by the sights of Arusha.

At the hospital we left the mum in casualty to be seen by the Dr. Dorah and I then went to see the neonatal unit and labour ward. Amazing what I find interesting . It is a very busy unit. Up to 30 births a night with 4 midwives on duty. The place was light and clean, first impression really not to bad.
The delivery room had 10 beds together. Have to admit I don't think I have ever seen so many labouring woman in one room in my life.
The neonatal unit seemed organised and the nurses were in attendance. I will surely go back to follow up on this little one, but really wonderful to know that  there is somewhere we can transfer babies to that the care looks like it will benefit the babies.

So this is the life here it seems. Always new experiences and trying to savour them along the way.