First Day Clinical Practise
It was a big day today. I had felt quite apprehensive about what I was going to witness today and so spent quite a bit of time in prayer and reflection beforehand. I woke up and my quiet time comment was the words of William Booth, the founder of the Salvation Army in response to his daughters anxiety on the battlefield. He told her not to focus on the waves but to look at the tide. Don’t get tossed around with the waves, but look to the bigger picture. I then checked my emails and there was a beautiful and encouraging email from a friend of mine at church. She just reminded me that The Lord was with me and went before me. I then opened the hotel curtains to see a beautiful pink sky as the sun was rising. To me it was God saying, Fear not, I have gone before you and am with you. Tears sprung to my eyes. As He always does, God had encouraged me in three ways. I felt that the day was going to be ok.
First stop was meeting up with the Ministry of Health acting chief nurse. They were not available when we visited the week before, so we made the trip this time. The meeting was interesting, enlightening. We came away feeling that we had settled the dust and had been welcomed.
Next we stopped at Amana Hospital, a very large public referral hospital in Dar. They have 24 000 births a year. Last month they had over 3000 births and this month, June, they had 2500! Mary had 4 midwives and decided to stay in the labour and delivery wards. I took 3 midwives and went to the antenatal ward where women with antenatal problems are admitted and Sally had 3 midwives and went to the antenatal and family planning clinic.
The ward was neat and clean with not too many women in it. We met the sister in charge and introduced ourselves. I arranged for the 3 midwives to each choose a patient who was happy to be interviewed and have a full assessment. We had a woman who was 34 weeks pregnant with twins and had had 2 previous Caesarean sections. Her complaint was preterm labour pains and anaemia. The next woman was 37 weeks pregnant with her second baby and had severe pre eclampsia – a big cause of death here in Tanzania. She was very swollen, was on anti hypertensives and had 4+ of protein in her urine. She wanted to go home and was ready to sign herself out of hospital, so the midwife had to use lots of good education skills to explain the danger of pre eclampsia and convince her to stay while a decision for delivery was made.
The third woman was a girl. 15 years old and pregnant. She was thrown out of her fathers house and was now living with her mother who was struggling to provide for her and her sister. They lived in a one room apartment and were being evicted. While she was admitted to hospital, the mother and sister slept on the streets under a tree near the hospital because they couldn’t afford the transport fares to and from their house. I was really impressed with the kindness and compassion shown by the midwife who did her assessment. She recognised the social problems and how this could affect the outcome for the mother and baby. She arranged for a social work review before discharge and also told me she took down her telephone number and was going to arrange for some baby equipment and clothes to be donated to the girl. She spent a lot of time educating the girl about what to expect in labour and what danger signs to watch out for. She also began some teaching about family planning and protection against STIs.
Afterwards we had a discussion about how there are so many issues that seem impossible to address and so it seems hopeless to do anything , but if as midwives we can help plant seeds of hope and enable women to change one thing for themselves, that helps them move in a positive direction. One step at a time. Puli puli. Slowly slowly.
For Mary and I it was a day of more change as we moved into the new GHAWA apartment. I felt unsettled again, but was quickly able to settle myself down. Deep breaths, thankful for small things, it changed my perspective and altered my thinking to that of gratitude again. A drink at the waterfront watching the sunset was a good end to a challenging day.