Below and Beyond Expectation

Below and beyond expectation

I’m coming to the end of a rather interesting weekend away. A time of refreshment and relaxation. There was a moment where I didn’t think it was going to be relaxing though.

Friday was the final day of theory, teaching the midwives about essential newborn care, resuscitation and responding to maternal obstetric emergencies. A day jammed packed to the full. To be honest, by the end of the day I felt a bit ambivalent because I was starting to see that the ‘we know this stuff’ was actually, ‘we have heard it before but we don’t put it into practise’. It was the end of a full week for the midwives and I was feeling hot and tired too, but I really felt sad because I had a sense that a few of them really didn’t care about the quality of the care they gave. They were in the minority, but I felt it that day. There were definitely some midwives who were motivated and keen and really wanted to make a difference for women in their care, but there were also others who were not. It’s the same all over the world though and so I had to remind myself that if one midwife changes one thing about the way she practices as a midwife and that improves the outcome for one woman, then I have done my job.

This feeling was compounded when at the end of the day our amazing GHAWA in country team leader, took Mary and I to a very nice club for a cocktail to celebrate the end of the week. So far we had only seen dusty, dirty, busy, crazy Dar and the inside of our hotel room or the classroom. She took us to the beautiful Cape Town Fish Market, a rather ritzy place set alongside the ocean with magnificent views over the bay, yacht club and towards masasani peninsula where we had a clear view of the new GHAWA apartments (we should be in them by tomorrow). With jazzy sounds in the background we sipped cocktails and reflected on the week that was. She had shared with us the traumatic premature birth of her baby daughter, at 29 weeks gestation, and how staff had treated her badly. She told of hearing a midwife not showing kindness to a woman whose baby had died, but no one bothered to tell her or explain what had happened. She said that many times she has witnessed unkind care from midwives and nurses and it made her angry. There still seemed such a long way to go in terms of educating midwives about the important role they had to play in providing quality kind care to women in the most vulnerable time of their lives.

As the cocktail took effect I felt myself begin to relax. Looking out over the water my shoulders softened and my mind shifted from all the obstacles, to all the possibilities again. Stick to your plan Sara, keep promoting kind care until the cows come home. We can all do with some reminders about the need to care for women better…

Soon a man looking like the duty manager came our way. He said, “welcome to Tanzania Global Health Alliance. You are very welcome here. Same name different faces. You are doing lots of good here in my country and to thank you for this, the next round of drinks is on me!” So we had another drink and some delicious fresh calamari before heading back to our hotel with lighter heads and hearts.

Saturday morning we actually had a sleepin. What a pleasure to not race off anywhere. After a leisurely breakfast we excitedly headed off to the Jangwani Beach Resort for some R&R where we were expecting a rather nice beach , comfy beach loungers and great hotel service. After a hairy 40 min drive we arrived. Our faces dropped – it looked so old and rundown and the rooms were not facing the beach as expected, but rather on one side of a busy road. As we were led to our room I was starting to feel very disappointed. The glistening pool in the brochure was green. The place looked tired and empty. Thumping music played in the background. We were led up some steps where we had a view of a guy doing the laundry and an area of land that looked a bit like a rubbish tip. The woman opened the door to the rooms and let us in. Our faces dropped. The room was tiny, dark and had nothing in it. One old terry towelling freeing gown, one pair of beach thongs. No kettle, no water or cups, no nothing. we tried to settle in by sorting out the safe, but it was soon apparent that it did not work. All our valuables were locked in the safe but we couldn’t get them out! I found the manager. I also asked if there were any better rooms. There were, but they only had a large double bed in them. Mary & I decided it was worth sharing a big bed for the sake of our sanity!!

After unpacking and again having trouble with the safe, we were taken on a tour of the resort. Across the road was the Xanadu Club, a water park that had obviously had it’s hey day in the 70s. It all looked awful. We then wandered to the beach front. Tired old beach loungers were scattered around the area with the sound of music thumping in the background. It was a windy day, so as we moved closer to the ocean, the music faded away into the distance. There were a few groups of young local people playing beach volleyball and swimming. We decided to have a drink and try to relax. It was hot and very bright. The soda drinks were very welcoming and even came with ice. Starting to relax.

We then ordered lunch and had a lovely grilled fish with mashed potato. It was delicious. Time for a walk along the beach … The sand was covered with litter. Plastic, bottles, shoes, syringes, empty packets of tablets, balls, a soft teddy bear, condom packets, bags. It really was horrible. The rubbish was so thick that we had to wear shoes for safety. We walked for about 2 km. it was great to feel the wind in our hair and breathe in the fresh sea air. On returning to the hotel we even dared have a swim in the green pool!

Later that evening, while Mary had a Skype call, I went for a wander to the Xanadu club again to see the sunset. Well, the place was heaving. It was obviously the place to be seen. The music was incredibly loud and very sexy. There were wet bodies everywhere gyrating to the music – just like from a scene from the music videos on “rave” on Saturday mornings in Perth. There was a wet dancing platform where people were dancing under sprays of overhead water. Alcohol was flowing fast. I started to feel a bit uncomfortable, so took a few shots of the sunset and then hightailed it back to the room!

We had a rather hot and spicy curry for dinner and then crashed for the night.

This morning we woke up deciding to be adventurous and get a boat out to mbudya island, about 20 minutes away. Things started looking up when we were given complimentary towels and were led to the right boat. Up until now the customer service had been terrible. We had asked for a bottle of water which never came. We asked for a cup of tea, but ended up making it ourselves.

Anyway, off to the Island we went. It was magnificent. When we arrived there were a handful of people. We decided to go for a walk along the beach, this time there was very little rubbish. The tide was out and so there were small pools in the coral reef that were full of interesting creatures, tiny spindly star fish, bright red thick starfish, sea cucumbers. It was delightful exploring the coast.

A swim followed by lounging around under the Banda for shade. After a long wait some lunch appeared, freshly caught fish cooked on an open fire, with salt, lime and hand cut chips. Absolutely delicious . Another unexpected surprise for the day.

At 2pm, just as requested, our boat skipper came to pick us up. It was a wet ride back to the mainland but we felt exhilarated and refreshed after such a relaxing time on the island. Plenty of fresh air and sea water…

And so now were back in the Holiday Inn in the city. Washed, relaxed and ready for sleep. Tomorrow is a big day. I wonder if it will be below or beyond my expectations..


Birthing in the Classroom

I have given birth once today and died due to unkind and neglectful midwifery care. I then assisted a beautiful baby into the world and there were no complications despite it being the mother’s sixth baby. But then I helped a woman give birth who had a massive 1.5 litre postpartum haemorrhage and I struggled to find her urethra to insert an in dwelling catheter, although I did manage to demonstrate a very good bimanual compression of the uterus to stop the bleeding. I couldn’t stop the red fluid from staining Mary’s lovely white pants though and so we ended up in fits of laughter as we tried to mop up the “blood” inconspicuously!

There were quite a few times today where we all ended up laughing, the local midwives too. We had them shimmying to demonstrate how the baby can be rocked down through the pelvis. They loved slow dancing together and trying out different positions, supporting one another. They also really enjoyed feeling the bones in their pelvis and learning what happens to the opening when standing, squatting, lunging. Lots of laughs all round.

It was a great day, full of energy and learning new things. Mary and I have been very impressed with their level of knowledge which they can roll off their tongue, but our aim is to try and get them to translate that knowledge into practise, really understanding the information and applying it to their clinical areas. Another aim is to get the midwives to be able to educate the women in their care, explaining information in simple terms so that the women understand, especially the many illiterate women who come to their hospitals .

Yesterday we spent time going over the importance of antenatal care in reducing poor outcomes for mothers and babies. We had some great discussions about education, clinical assessment and early referral of women who present with problems in pregnancy. We got the midwives to engage in a role play with each other where one was a midwife, one a pregnant woman and the third person either a difficult husband or a controlling mother in law. They really got into their roles! At one point an irate ‘husband’ was pointing a finger at the midwife and telling her off about something in Swahili. The midwife calmly told him the facts about the issue she wanted to discuss and eventually won him over. This was a great exercise in getting the midwives to gain confidence in dealing with difficult relatives who have strong and misguided ideas about things. They loved it and could see the benefit in practising this so that they didn’t get caught up in the argument, but remained calm and focused on objective facts. It was hilarious.

We also had a very serious discussion about caring for women who have lost a baby. It was very moving to hear Mary share about how attitudes to the death of a baby have changed over the years in Australia, where we now acknowledge that it’s important for mothers to be able to hold their dead baby, grieve the loss in a caring environment. Unfortunately death of neonates is very common here in Tanzania, but it was reassuring to hear that they are working towards providing more mother friendly care for grieving mothers.

Where the knowledge of the midwives has been very good, we’ve made them think more laterally about issues and problem-solve more complex situations. I think so far the midwives have enjoyed the course. Every now and then someone will fall asleep, but then we call upon the ice breaker person who gets us all up, dancing and singing! It’s fun. And tiring… But I feel good.


The Course has begun

I keep forgetting to take photos with my phone so that I can post them in this blog! My camera is not linked to my iPad so they remain in the camera..

It has been a very busy 48 hrs. Yesterday Mary and I accompanied Sally, the in country logistical support person for GHAWA, and met with senior nursing and midwifery leaders and educators in the country and dares salaam. It was very interesting. The protocol, different personalities, expectations, customs… It was tiring but interesting. A few of the people voiced concern that the course I have written was too basic for their staff because they have already studied foundational skills. They seemed happy with my explanation about the rationale for writing the course as it is and were very supportive from then onwards.

We had a quick tour around the major public maternity hospital in dar. They have 24000 births a year, 100 per day!! When we visited, there were 10 women in the final stages of labour waiting to push. That is the labour room was full. There were 3 midwives looking after them. 2 women were sitting on benches outside feeding their babies that they had just delivered. The mothers looked exhausted. Relieved that they were alive and that their babies were too.

Then in the adjacent room there was a woman sitting in a wheelchair waiting to have a Caesarean section for fetal distress. There was another woman in theatre already and so she had to wait. Also waiting for a Caesarean section was a woman who had had an antepartum haemorrhage. Her placenta had come away from the wall of the uterus (abruption) and she had lost about 500 most of blood (we saw the blood all over the antenatal clinic floor). Her baby had died. She was now being induced while waiting for the c section. She was conscious and appeared to be a good colour, but she could deteriorate very quickly and was at very high risk of dying if she bled anymore. I felt so sad for her.

Next we went to the neonatal unit. It was full of babies, most looking very sick. They all shared long cots. There were tiny preterm babies struggling for breath, septic babies that just lay very still, and babies suffering from birth asphyxia. I saw a plump full term baby take its final few breaths before dying. It was very very sad.

When I walked out of the nursery I really did wonder what on earth we could do. The problems seemed so great, I was thinking, that I was struggling to see where we could make a difference. But then I remembered the quote from mother Teresa : “if I look at the masses, I will do nothing, but if I look at the one, I will begin”. As I went to bed that night I was starting to think about ways to encourage the midwives that they can make a difference and it begins with changing one thing that they do to improve the quality of care they give to women and babies.

Today we started the first module of the course. What a special moment. All the work that has gone into writing the course and wondering whether it was suitable was now going to be realised and tested. There are 10 midwives who are participating this time round. They are all so lovely. I’m learning their names quickly and it’s wonderful to see them smile.

Mary has some great ideas from her years of facilitating courses in developing nations. She set some ground rules with the women and wrote them on the board. She also got them to choose a person to review the learning at the end of the day, someone to be the time keeper making sure people arrived on time and were penalised (in a fun way) if they were late, and finally a ice breaker person to wake the class up if they were falling asleep! The ice breaker got everyone up singing songs, moving their bodies and making actions to simple tunes. It was great fun.

Today’s session was all about family planning and sexual health. The focus was on how to engage the community so that they took on family planning and practised safe sex. It went well. Let’s see what tomorrow brings…

Tanzania here I come…

I have not written my blog for months. Time has flown by and so much has happened. I’m currently on a flight to Dares Salaam with a midwifery colleague to spend 4 weeks teaching midwives. The length of time away from my family goes against every grain of my body and saying goodbye to my husband and 2 sons was very difficult. In fact, just prior to getting in the car to travel to the airport, I suddenly did not want to go at all. I felt dreadful anxiety about leaving the kids. But, my husband and I had discussed this many times before coming to the conclusion that it was the right thing to do on this occasion. Again, he reminded me that it was ok, the boys will be with him. They are going to South Africa to spend 2 weeks of the school holidays with Richards dad which I know will be very special for them. After lots of hugs and a few brave tears all round, I was off.

I’m travelling with Mary Richards, a very experienced midwife who has spent the last 6 years working all over the world teaching midwives and health workers. I came to know of Mary through a friend of mine who linked me to her Facebook page: Global Maternal and newborn network, a forum for people working in developing nations to share resources and support one another. I have learned so much from Mary and her site and it is such a privilege now to be spending time with her in person. Already we’ve had conversations about dealing with people in authority who are obstructing good maternal health program’s from growing or being supported, burnout as a midwife, we’ve even shared our birth stories – that’s what midwives do.

I’m travelling to Tanzania, dares salaam representing global health alliance, Western Australia or Ghawa. I’ve been working for them over the past 6 months writing an education course for midwives in developing nations. The course is a very simple program to provide professional development for midwives or upskilling so that they achieve competency in basic midwifery skills according to the International Confederation of Midwives. There are 6 modules in the course and I’m delivering it for the first time to see how it is received. There may be quite a few things that need changing, who knows. We’ll see what happens.

I should be in dar at 1.30 pm and we’ll be picked up by the driver Semmy, who will take us to the Holiday Inn where we’ll stay for the first week. This while the new Ghawa accommodation is sorted out. To be honest I’m rather pleased that we’ll be in the hotel for a few days; it gives me a chance to acclimatise at my own pace!! Tomorrow the plan is to be taken on a tour of the first hospital where we’ll be training , Amana hospital. It is one of the larger public hospitals in dar. We’ll meet significant health leaders and managers and finalise plans for the course to begin on Tuesday.

To finish today’s blog I want to share the amazing story of how came to be involved with GHAWA and am now on a plane to Tanzania . In May last year, with the sudden downturn in the mining boom in Western Australia , my husband was retrenched from his job. This was a very difficult time for our family. He managed to get 6 months contract work flying in and out of Queensland which was handy, but we knew I had to find paid work. Up until the I had devoted myself to volunteering in the charity, Living Child, which I had founded in March 2013.

I really did not want to work in the local Perth hospitals as I truly felt called to issues in global maternal health after my experiences in PNG. I was rapidly developing a passion for training midwives in resource poor countries and setting.

Soon after my first trip to PNG I wanted to write a very simple curriculum for midwives and village birth attendants vbas. I had written a basic teaching plan which we used on a trip to the village of Bunam in July 2013, which was very successful. But I never had the time or chance to sit down and tease it out, step by step, so that any midwife could pick it up and teach it.

I decided to pray. I felt that if God had introduced me to global midwifery, then He could find me a paid job in the field too. I told God I was going to wait and see what job opportunities there were before jumping into just anything, and I was going to trust him that he had the right job for me.

A few weeks went by and then one day I saw an email from a midwifery colleague which was highlighting an expression of interest in a 3 month contract for a midwifery educator to write a midwifery education curriculum for midwives in developing nations! I couldn’t believe my eyes. This job had my name written all over it!

It took me a long time to actually sum up the courage to put in an application. All sorts of fears and feelings of inadequacy plagued me. With the support of my husband and dear friends, I finally got the application in. And got the job…

My first few weeks in the nursing and midwifery office were spent pinching myself that I had the job! I have a lovely desk, with 2 computer screens and access to all the resources I need to research and gather information to write the curriculum. I have now completed the first foundation unit and have started the intermediate and advanced skills units. The trip to Tanzania will certainly give me a whole new perspective and inspire some new thoughts and ideas for the course.