As the GHAWA car pulled up near the teaching class at Kisarawe, the two traditional birth attendants (TBAs) who have joined the class, came running out to warmly greet us. They smiled widely and grasped our hands to welcome us. It was very special and a lovely start to the day.
We had finally worked out why the data projector was not working, so with e few adjustments to the setting on the laptop we were able to set up the PowerPoint, using butchers paper as the backdrop. This was important for today because we had two short videos to show about quality care to women in labour and then how to check the placenta. It worked really well and obviously had a big impact because there was plenty of chatter and discussion about what they saw. A couple of times the power went out, but not for long.
This time Beth and Mary had everyone up and moving to show how important it is for women to be active and remain upright to assist with the progress of labour. Again, lots of laughter as hips were swinging.
Yesterday during a discussion about problems in pregnancy, a nurse had mentioned they do fundal pressure (apply pressure to the top of the uterus during labour) to assist the delivery of the baby ie. make it happen quicker. Today I spent time educating the class about the anatomy and physiology of the uterus and why it is so important not to apply pressure to the fundus during labour. I think we managed to get the message across and they understood the significance of the uterus and the danger of that action (over stimulation of the uterus can cause uterine rupture and fetal distress).
By lunchtime we were all three feeling rather tired. Last night we were kept awake by a very rowdy group of World Cup soccer spectators. At 1.30 am I was woken suddenly by loud shouting, whistling and the sound of the plastic chairs being thrown around the pub area. I felt a bit fearful at first but then remembered that the soccer was on so it was probably related to that. I tried to doze off again, but the revellers got louder. At about 2.30 I noticed that they were finally moving on, but I was so awake that it was difficult to fall asleep again. Then I noticed a buzzing mosquito and desperately tried to make sure it was outside my bed net! I think I finally managed to fall asleep after 3.
At the end of today we went for a short walk around the maternity unit. Currently there is a new labour room being built, so all the mothers are kept together , antenatal, labouring and postnatal all together in one ward. I think the saddest thing for all of us to see is a woman labouring on her own: no support, no encouragement, no touch or massage. Just lying on the bed, often on her side with a Kanga covering her. There is no sound, but you know she is in labour because her feet and toes are tense and move in circles as she deals with the pain of another contraction.
One of the things we’ve been teaching the nurses and midwives is the importance of quality care in labour and what that looks like: kindness, touch, water, regular toileting to empty the bladder, regular vital sins and observing the labour: strength of contractions and how often they are coming, descent of the baby’s head into the pelvis, cervical dilation, monitoring progress of labour and intervening if it is not progressing as expected. Although we know many times this does not happen in reality in the hospitals I do believe strongly that it is necessary to teach. If we sow seeds of kind quality care, eventually someone will act and influence the others. That reminds me, during one of the ice breaker moments today, a nurse midwife got everyone to sing a song which they later interpreted as, “we like our teachers and we want to be like them”. I found that quite significant. It is important to stick to the right path, teach the right way to do things, over and over again because eventually the seed will take root in fertile soil and grow into a plant that will produce good fruit, again and again. That’s how change for the better occurs. Through perseverance and sticking to the right way even when the right way is not always followed.
There is always good fruit from a plant which has been sewn in good fertile soil.