Small Steps, Giant Leaps

Small Steps

I’m lounging on a comfortable beach chair with the sounds of the gentle waves rolling up the beach, only metres away. Every now and again a dhow sails past with the brilliant white sail spread across the bow of the boat making a stunning picture against the backdrop of a blue blue ocean. Men paddle past in dugout canoes. Coconuts crash to the ground nearby as the hotel curators clear the palms of the dangerous missiles. Muffled Swahili voices are carried away by the gentle winds. Heaven. Bliss. I’m glued to my lounger, unable to move. Unable to think beyond the moment. My brain is tired, my head sore, my senses have been overloaded the last 2 weeks. It feels good to breathe in some fresh sea air and do nothing.

We are in Zanzibar. Beth, a midwife from Perth, has joined Mary and I. It is lovely to have her with us. We picked her up from the airport and have whisked her away to Zanzibar with us. We arrived after 7pm last night with fingers crossed that the hotel matches he pictures on the website. After our experience last weekend we were hesitant to expect anything. As soon as we came to the front entrance, my heart started to sing. All the lights of the front gate were working and the flags announcing the name of the hotel looked new. It looked clean and freshly painted. The hotel lobby was beautifully decorated and welcoming. I was starting to relax. Our family suite is a little small, but it overlooks the beach and stunning tropical gardens. Mary and I kept looking at each other with grins from ear to ear. We knew that after the week we’d had we needed a retreat like this to recharge, ready to face the next fortnight.

So why do I feel so tired? In need of some rest and quiet?

My senses have been assaulted. Dust, noise, blood, meconium, crowds, traffic, faeces, licquor, screaming, sobbing, wailing, mosquitoes, sickness, death, sorrow, joy, fear, laughter, smiles, gridlock, jammed, relief, delight…

So many feelings and emotions.

Yesterday was our last day with the group of 11 midwives that we have been teaching. I felt quite emotional. They were the first group to receive the course I had spent months writing. It was a joy to read through their completed journals and case studies. I had seen them all grow and develop as midwives. When A representative from the Tanzanian Ministry of Health asked them what they thought of the content of the course there was a resounding chorus of affirmation. It stirred me to the core. They said they felt inspired and more confident with their clinical skills and Mary and I have certainly seen that happen over the duration of the course.

From their feedback they seemed to feel empowered as midwives. I think we were able to encourage, support and assist them along a journey of quality midwifery care and continuing professional development. I feel excited because that was exactly what I’d put in the curriculum framework as objectives for this course.

One of the participating midwives, a very experienced clinical instructor, gave a speech of thanks at the end of the proceedings. She said she felt like a new excited midwife again, inspired to do simple things to prevent the deaths of mothers and babies. She shared her experience of a birth that I supervised her in. The woman was having her second baby but it had been a long difficult labour. She was now ready to push but it was taking a long time. She was flat on her back, exhausted and trying to push as best she could. There was little progress, the head kept rocking back inside again. I suggested to the midwife that we change the mothers position to be more upright and help the head move down with the assistance of gravity (I said this at the time when a few other local midwives were yelling at the woman to push harder). She was exhausted. So after another ineffective push, we managed to get the mother to move from her back onto her hands and knees. Her head dropped down onto the bed so she was head down, bottom up. She pushed again and this time the head progressed and next push it was out. The midwives were all amazed at how quickly the change of position had managed to assist the descent and birth of the head.

The midwife said that this experience had really inspired her that changes in position can make a big difference to outcomes for mothers and babies. I felt so pleased to hear this. In fact, understanding more about the mechanics of the pelvis and position changes had a huge impact – they all mentioned it as something new they had learned. Both Mary and I witnessed our midwives at different times getting all the labouring women up off the beds and benches and getting them to rock their pelvises during a contraction, shimmying and shaking their hips to help with the descent of the head and getting it into a good position for birth.

Another part of the course the midwives said had made a big difference to their practise was essential newborn care and resuscitation. And I could see there were major improvements over the 2 week period. From being a little slow to respond and unsure of what to do next, I was now seeing the midwives respond quicker, getting resuscitation equipment (what was available anyway!) ready prior to birth and not waiting too long before commencing ventilation of the newborn who was not breathing. There was plenty of practise on real life babies unfortunately. At one stage Mary did 3 full resuscitations on newborns with thick meconium, within 40 minutes! That includes cardiac compressions. I have never seen so many floppy, pale or blue babies covered in green meconium before.

We used the Mama Natalie simulator to reinforce the emergency responses we taught. It worked really well and the midwives commented that being able to practise the steps with the doll helped them retain the information.

Small steps…

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