Aside

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…

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