First day Working in Ghana

Today has been my first day working as a midwife in Ghana. I expected it to be under-resourced. I expected there to be education limitations. I knew mortality rates are far higher for both mothers and babies. What I wasn't expecting, though, was a complete "so what?" mindset.

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.

(This is the delivery room - I stood as far back in the corner of the room as I could to take this photo, which highlights the cramped conditions here)

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.

 

(This is Sharon. Before this photo was taken she said "I can't believe I'm sitting in between two white people"!)

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

Ghana day 1

So. I have arrived in Africa. At the time of writing this I'd been here for an hour, and it's already been a huge culture shock. Getting here was relatively trouble free - getting out of Heathrow was the tricky bit! Firstly I checked in, received my boarding pass, and said emotional (for Megan...) goodbyes at the security gate. I was re-united with my parents approximately 93 seconds later because my boarding pass wouldn't scan. I marched straight back to the check-in desk to replace it with a functional one (earning lots of dirty looks from other passengers), re-said the emotional goodbyes, scanned it at the gate again, and it worked. I gave my parents a wave - confident the drama had resolved - and headed through to security. Now, I don't know if any of you have used a TENS machine. I've been trying it recently to help with transverse myelitis pain, and it's worked wonders. I now have a thorough appreciation of how it appears through a body scanner: fairly similar to an explosive vest, really. This meant I qualified for a suitcase search (it's amazing how quickly they're able to find your luggage when they want to!), and at that point 32 matching underwear sets, 2 skipping ropes and a shitload of nipple cream becomes extremely difficult to explain. I eventually managed to, and it was agreed I'd done nothing illegal, but I still felt like a terrorist whore.

Since landing, I have witnessed 10 people inside a Mini (father and 1 child on the drivers seat, mother and 2 children on the passenger seat, and 4 others squished into the back) which then had to be jump started, and after getting it moving the guy pushing it jumped into the boot. Traffic lights are seen as an optional guide. Roundabouts operate on a give way to the bigger vehicle system. I've seen a goat roaming a dual carriageway. If you want to overtake you just accelerate in whichever lane has least traffic. The Work the World rep said a prayer for us before we set off. I've seen a family drive truck laden with piles of clothes, a fridge, and three children. It's definitely a country where you just roll with whatever happens, and I can completely get on board with that!

Arriving at the Work the World house was another eye opener. Everying is clean and comfortable, but is a stark contrast to the dusty road, roaming goats and huts we see from our windows. Everyone is so friendly, and it's been really interesting hearing other students stories. I start working tomorrow, and I'm excited and nervous in equal measures.

I did a stock take of what I brought out with me for the orphanage - you guys are awesome!

Thank you all for all of your support and encouragement which made this amazing adventure possible.

Love Emily x

Sunny Hunny

Last weekend my dad organised a scooter ride to Hunstanton (aka Run to the Hun): a great weekend with great weather.

Now academic work is a thing of the past I've been filling my spare time with HCA shifts. I recently worked on an intensive care unit and was amazed at the closure this brought. I booked the shift because I thought it'd be an interesting place to work, and it didn't occur to me that it would affect me on a personal level.

Whilst there, I came across a leaflet which is given to patients when they step down from intensive care, and when they finally go home. It outlined PTSD, but also went into detail about why this can occur. Perhaps the most helpful part was it didn't once mention the phrase "at least you made it out of here", or anything similar.

It explained that your mind makes links with things when you're ill, which you're often too ill to be aware of. It used the example of feeling unwell, in pain and frightened whilst being in hospital, and then associating these feelings with the beeping sound of machinery surrounding you. This is something so simple which I hadn't considered before. Understanding this made me realise why - in December, January and February - I was terrified by most aspects of daily life. I'd associated bleeping with pain, despair and fear and these emotions were re-triggered every time I heard a beep - from a phone, a doorbell, a microwave, an oven, or even an e-mail. It explained why I found it impossible to sleep in a normal bed without some fairly hefty sedation, because I was used to being semi-recumbent on a hospital air mattress with opiates being pumped directly into a central vein. It also described how the relative silence of 'home' becomes an unfamiliar, and therefore unsettling, sound.

Who knew one shift could achieve so much?

Love Emily x

Everything looks like it's all coming together

I'm in very real danger of becoming a proper adult!

I applied for a job back in the Midlands on Wednesday, they asked me to go for an interview on Thursday, I was interviewed on Friday afternoon, and got a job offer on the train home. I've applied for quite a few jobs more because I felt I should, rather than because I wanted to work at that particular hospital. I went to this interview though, and knew straight away it was the place for me. 

There's also talk of me having spinal surgery to try to get a bit more feeling back. It would involve fitting a sort of pacemaker below the level of the lesion to see if the affected nerves can be tricked into working again. It's a pretty big op, so my neurologist wants to give me until April 2016 (18 months post transverse myelitis onset) to see if I make any further spontaneous improvement, and we can see what the most appropriate choice is at that point. 

I'm very happy, and life is great at the moment. I've got 16 shifts left as a student, dissertation results are coming out this week, I'll soon know my degree class, and in 35 days I'm setting off for Africa. It finally looks like it's all coming together!

Love Emily x

Time flies when you're having fun!

I can't believe how close to the end of midwifery training I am! Last week I did my final bit of academic work, and now I'm waiting for results and working flat out as a HCA to fund my elective.

Unfortunately, after the earthquakes in Nepal, I've had to change the destination. Initially I was still set on going - perhaps even more so, given the increased use I would have been. The university got quite anxious about my decision to still go, and eventually flat out forbade me to go on their time. I looked into going on alternative dates so I wouldn't be bound by their decisions, but no insurance company would touch me. I like a challenge, but this was a push - even for me. So, after a couple of strops, I've made plans to go to Ghana instead.

Whilst in Ghana I'd also like to do some teaching at an orphanage in Takoradi. I've built up a stash of pens, pencils, felt tips, colouring books and educational posters to take, but if any of you lovely people wanted to donate something small and light for me to give to some local children it would be very much appreciated.

After I've finished working at the hospital I'm going to explore Africa a bit more... much to Megan's panic. From Accra I'm going to Johannesburg (via Kenya) for a few days to explore the Sterkfontein caves. From there, I'm going to Zambia to be amazed by Victoria Falls (+/-a cheeky microlight flight...) and pick up a safari travelling through Zimbabwe and Botswana - finally ending up back in Johannesburg, and then fly back to the UK.

Not bad, considering 8 months ago I couldn't walk.

Love Emily x

Made A Difference

On Friday I had a fantastic night with some of the girls on my course, and a few of our tutors. It was a black tie dinner for the Made A Difference awards ceremony, which was put on by ARU. Earlier in the year students were given the opportunity to nominate any staff member who had made a positive difference. I nominated Fran, my personal tutor, for the constant unwavering support she's given me for the past 2.5 years.

In September 2012 I had no idea of what was to come, but I was aware I was in very precarious remission from Crohn's disease and dealing with the final weeks of a terminally ill close family friend's life. In 2013 an epilepsy diagnosis came out of nowhere, and the battle against Occupational Health began. Throughout all of this Fran fought my corner and came up with some great solutions to problems which I thought were insurmountable. In 2014 when life threw me another curve-ball and I lost the use of my legs, Fran communicated with my mum when I was too ill to do so myself. Her calmness and confidence that at some point, somehow, we could find a way round things to make me a midwife took the stress of my training away, and let me give my complete focus to learning to walk again. Even after my mobility had near enough returned to normal Fran realised I was too depressed to be back at work before I could admit that to myself, and made that difficult decision for me.

My nomination was read out at the ceremony, and Fran very deservedly won. We rounded the evening off nicely by taking full advantage of the free bar :)

Love Emily x

I've had a pretty good few days!

On Sunday I ran my first 5km since my illness. I did it in an embarrassingly slow time, but 6 months ago I struggled to walk for 50m.

On Monday I was still infected by the running bug, so I entered the London Marathon ballot for the 3rd time. Paralysed to marathon in 18 months would be amazing!

Today, I delivered the prized 'baby number 40'. It's a great feeling knowing I can now go to where I need experience, and that's not necessarily where there's a pushing multip.

Tomorrow I'm going to the Indian embassy to get a visa. It also happens to be my birthday; I'm denying the 25% of a century thing by preparing for the travelling I should have been healthy enough to do earlier in my life.

All in all I'm very happy :)

Love Emily x