I had another frustrating day at work on Thursday. It started off fairly quietly, with one postnatal mother and a lady with a late miscarriage who is having possibly the worlds longest induction of labour (3 days, and not a single contraction). There are 12 beds on the ward, and I find it particularly insensitive that she is in the only one with a breastfeeding poster above it. Two other ladies came in during the day, and this is where things unravelled.
Both of these ladies were multips (civvies: they've had babies before) and they came in within an hour of each other. Neither were obviously in labour, but as expressing pain verbally during childbirth is discouraged in Ghana, and they had had babies before, Ellyn, Amy (a WtW student nurse) and I kept a close eye on them. Ellyn took one lady (who was slightly pre-term), I took the other (who had thick meconium in her liquor), and Amy helped both of us out. We were confident that they were both in established labour, and interrupted the staff's mid-morning kip to let them know this. Ellyn's lady still had intact membranes (civvies: her waters hadn't broken), so she was taken to the delivery room to have these broken for her. In the UK we use an amnihook to do this (a sort of knitting needle with a tiny plastic hook at the end) and it's not a very pleasant procedure, but in Ghana they use a snapped needle. Before they did this they thought she was fully dilated, then they thought she was 8cm, then 9cm, then 6cm, then 28 weeks, and finally back to 9cm - all the while moving her, naked, from ward to delivery room as they continuously changed their minds.
Whilst this was happening, I was confident my lady was cracking on. I decided to examine; an hour before she had been 4cm but I thought she was involuntary pushing, so it made sense to see what was going on. I got my gloves on, she opened her legs, and I could see they baby's head. I decided that examination might not be needed after all. I let staff know this, and let Amy know so she could deliver her first baby. My hand was on the baby's head to slow it down a bit, and then a midwife shoved me out of the way. It was the same midwife who did an awful job of delivering a shoulder dystocia baby on my first day, and it's scary to see her skills don't improve in a non-emergency situation. She put her hands into the vagina, and starting pulling on this baby. I was repeating the words "why are you pulling the baby? Stop pulling the baby." over and over again, but she only stopped when I asked her if the woman had been having a contraction during her pulling (she definitely didn't). The midwife asked the woman, who confirmed this. This didn't change the midwife's management, and she kept on tugging. With the next contraction the shoulders were born, as anyone who knows the rudimentary mechanisms of labour guessed they probably would do. The midwife kept on tugging, and the baby was born.
Once again, it was a botched delivery with a baby needing resuscitation. Because Ellyn's lady was in the delivery room at this point, my lady gave birth on the ward. I'm so glad I had the forethought to anticipate this would probably happen, considered the meconium risk factor, and took the bag/valve mask out of the delivery room and into the ward. Once again I was the only person with a stethoscope which I gave to Amy who was telling me what they baby's heartbeat was doing. Amy is great at resuscitating adults but has no training in resuscitating babies, so I was having to tell her exactly what to do. We needed to use the mask to help bubba with breathing, and once again were the only people who noticed/cared about the condition of the baby. Neonatal deaths are seen as so normal here that often babies born in this condition are left for dead. We got the baby breathing, Amy started wrapping her up and giving her to her mummy, and I took the mask back to the delivery room - conscious that Ellyn could deliver a preterm baby with no resus equipment available. I gave her the mask, and heard a scream from the ward.
It came from my lady: the lady who laboured to fully dilated silently, and made minimal noise during birth. She dealt with pain well. I legged it back to the ward and saw the delivering midwife doing a bi-manual compression. At this point I stopped being tactfully ignorant and asked the midwife to stop, and to explain why she was doing what she was doing. She said she felt the woman was bleeding excessively... she really wasn't. I asked her what she hoped to achieve by stuffing her fist into a vagina without consent, and she said she wanted "to expel clots". In the UK I would feel I had to report her actions to managers, but in Ghana there's no system for that. You can sleep on the ward, and if there's an adverse outcome it's just 'one of those things'; there's no infrastructure for patients to complain through, therefore staff know they can do/not do whatever they like because they are completely unaccountable.
After this I was very ready to leave Kwesimintsim and not return. Ellyn and I went to Circle Market to pick up some more fabric, and were taken there by a sleazeball taxi driver. He asked us if we were married. Ellyn truthfully said yes, and I decided I could prevent another proposal by doing the same. It's amazing how difficult it is to think of a convincing back story on the spot but I think he brought it... just. We returned to the house, and got ready for the Thursday night BBQ.
This turned out to be messy occasion with lots of vodka and Ghanaian dancing. Some of us decided to go 'out out' afterwards, and had to battle with the house security guard to get out of the house. We managed it, got to the bottom of the rubble hill with no twisted ankles, and flagged down 2 taxis to take us to the only club we knew of. I was in the first taxi which sped off and left the other one behind, so we got the the club and saw it was shut. We cut our losses and went to one on the other side of the road. We weren't quite sure what had happened to the other car with our friends in it, but we were too tipsy to be worried and danced instead (when we got in we found out they'd found out the first club was shut, and were driven to a series of other bars which also turned out to be shut, cut their losses and went home).
If you've see the first Inbetweeners film then you've probably got a good mental image of this club. There were about 10 people there, including the 4 of us, and we were the only ones willing to dance. We hit the floor, 'We No Speak Americano' came on, and we did some Inbetweeners dancing towards the only 2 men in the place. They were a bit leery, and we remembered about the others, so we left and went back to the house where we found them tucked up in bed. I've been told something about a table cloth and bra being stolen/worn/thrown, but memories are hazy and I'm sure there'll be photos on Facebook in due course. We woke the others up and convinced one to come back out with us. Being a group of thinkers we took a can of mosquito repellant with us to use as pepper spray of we bumped into any more creepy men, staggered to the bottom of the hill again (being chased by our poor security guard win a torch), waited for a vehicle to take us to Takoradi's best bar at 2am on a Friday morning, got bored after 10 minutes, and then walked back up the hill. On the way up I launched a one woman mission to rid Ghana of all bugs by liberally spraying insecticide over the road, and I'd love to say something else interesting happened, but it didn't.
Love Emily x
P.s. I've since learned the club we went to is a notorious pick up place for prostitutes (which explains the 4 girls sitting on their own in hotpants), and white girls fetch almost double the price, but the black prostitutes tend to attack them because they don't like their clients being 'stolen'. It's amazing what you don't pick up on when you're drunk!
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