I'm working with another final year student (can I say newly qualified yet...?) called Ellyn, from Manchester. I'm so glad I had her there for support, and I don't think I'd be able to do it alone. Our first day was extremely surreal... we spent the morning observing staff doing their tasks: vaginal examinations with no consent or warning, listening to fetal heartbeats when they could be bothered and when the Sonicaid had battery and ignoring women in pain. I'm not sure what I expected the hospital to be like, but whatever vision I had was very far from the reality. There is one 12 bedded ward; 8 beds for labouring women and 4 postnatal. There are curtains around the labouring beds, but hey are only occasionally used to give these women some privacy. Males are not allowed. There is a bucket by each bed - this is used for vomit and urine. Once women are fully dilated (or, usually, at staff's discretion) they are moved to a delivery room. This is where our day took a turn for the worse.
It says a lot about Ghanaian midwifery that I don't know the name of this woman. Ellyn and I only planned to observe the delivery, but felt we had to intervene. Initially the delivering midwife was using her hands as forceps to bring the baby down, and didn't ease off as the head was crowning. She continued after the head was born, but there was no further progress. At this point alarm bells were ringing for Ellyn and I, as we both shouted "shoulders!". The delivering midwife was still tugging on the baby's neck and hadn't even considered McRoberts (for the civilians: a manoeuvre where the woman lays on her back and brings her knees as far as she can to her chest, to maximise the space in her pelvis), so we stepped in to do it. The midwife was still tugging on the head, and telling the woman to "chim, chim" (push, push). We tried to stop he woman from pushing (in a shoulder dystocia the baby's shoulder is stuck against their mother's symphysis pubis, so pushing it futile and may increase injury to mum and baby), and started supra-public pressure (trying to push the shoulders downwards through the mother's abdomen), and that didn't work either. The midwife was twisting the baby's head to try to get it out, but that didn't work either. I moved to the bottom of the bed to enter the vagina, and at this point the baby was born.
No two ways about it, this little lad wasn't born in good condition at all. He was as pale as me (which is extremely bad news if you're Ghanaian), not breathing, and the only good thing about him was he had a heartbeat... just. Ellyn and I took him over to a flat surface and did what we could with no equipment. None of the hospital staff seemed willing to do anything beyond stimulating this baby with a towel, and I was the only person in the room with a stethoscope to confirm this baby was still alive. Finding this out didn't seem to alter anyone's perspective of the situation, so Ellyn asked for a bag/valve mask. One was found (after the staff had debated whether or not they had one), and the 'lead midwife' gave the crappest inflation breaths I've ever seen whilst I performed a double jaw thrust. Ellyn tried to persuade her to slow down the maximise the benefit of the puffs she was giving, and I told her I was feeling air on my thumbs so the seal around the baby's nose and mouth wasn't working. Eventually this baby started breathing for himself, but I'm convinced that was spontaneous effort and not a result of the half arsed ventilation he'd been having. After this, I turned around to face the woman again, just in time to see the placenta be delivered. Her blood loss was fine, but the midwife performed a bi-manual compression (inserting a fist into the uterus via the vagina, and using the other hand to abdominally compress the uterus onto the internal hand), did no perineal inspection whatsoever, and then inserted an entire sanitary pad (complete with the paper strip which covers the adhesive side) into her vagina.
After the baby had developed some muscle tone I noticed his right arm remained completely limp. I mentioned to the midwife that I was concerned about a clavicle fracture or brachial plexus injury. She picked up his arm and dropped it 3 times, and agreed with me. And then she did... nothing. At this point I had definitely seen enough, but the final straw came when we saw a bottle of surgical spirit and a pair of scissors making their way to the baby. Ellyn and I left the room to digest the situation we'd found ourselves in, and heard the little boy's first cry as his foreskin was cut off.
Ellyn - being a far nicer person than I am - was worried we might have offended the hospital staff by intervening and taking charge of the situation. I, however, am happy to take resentment of people I will only know for two weeks over the long-term guilt of not doing all I could to save a life. After we took a breather we went back to the unit and had a chat with the staff. They seemed grateful for our help, and one even tried to persuade me to marry her brother! Ellyn and I got a photo of the baby we helped to save, and also of some of the staff.
Our afternoon was far better. Our Work the World manager took us on a tour of Takoradi. Unfortunately it was bad weather, but we were shown some beautiful beaches - and bars which back onto them! We stopped at one for a drink, and then headed to a supermarket. The prices of things here are baffling. 70cl of 40% gin costs ~10 cedi (around £2) but a box of Coco Pops (a staple food in my diet) costs 48 cedi!!
I'm starting to get my head around this no hot water business now, and the general Ghanaean culture. Everyone is so friendly, and they've even taught me the word for redhead (ohse). I'm learning to roll with whatever hospital staff is the best option, and starting to let go of my germophobia.
Love Emily x
No comments:
Post a Comment