I haven’t been doing much blogging over the last couple of weeks as I have been in Kamakwie with limited electricity and internet access. I did my first blog for the Royal College of Midwives website last week though, which you can see here. Two weeks ago was my first week teaching at the midwifery school. The students are community health nurses and the first ones in Sierra Leone to be trained as midwives, they are committed and motivated and I am enjoying my work with them. However, teaching a class of 73 students, making the session interactive, ensuring everyone can hear and not losing my voice is quite a challenge. I also learn a lot from the students who have an extensive knowledge and understanding of the challenges of health work in Sierra Leone.
Last week was spent on the maternity ward at Kamakwie Wesleyan Hospital. This first week was for me to get to know the staff, see how the ward works and talk to the midwives about what works well and what is problematic or needs further development. Health Unlimited has been working with the hospital since 2005, initially rehabilitating the hospital, which was damaged in the war. More recently HU is providing drugs for maternity cases and fuel for the ambulance. Over the last 5 years the number of women attending the hospital has increased and the maternal mortality rates within the hospital are going down. This is a good sign that the work that Health Unlimited has been doing so far to enable women to reach the hospital quickly by a four wheel drive ambulance, removing the financial barrier to healthcare through community loan fund schemes and keeping hospital costs down through provision of essential drugs is having an impact.
A new mother and grandmother
There is still a lot of work to do to reduce the numbers of women dying though, especially at community level. One woman on the ward had suffered a ruptured uterus, this is a serious and life threatening complication of obstructed labour. This had sadly meant her baby had died before she reached the hospital. Obstructed labour is one of the main causes of women dying during childbirth. This can be because women are unable or unwilling to go to a health facility or because of lack of appropriate referral and treatment by health staff. My work starting next month with health workers and community members in the villages will focus on addressing these issues.
- The midwife in charge of the maternity
Thursday was a busy day with two women having emergency Caesarean Sections and giving birth to healthy babies that morning. One was a woman of about 30 weeks pregnant woman who had come in with bleeding. She had a tiny boy weighing 2lb 3oz. With a bit of encouragement he was able to breastfeed beautifully which is incredibly important as there is no special care unit for premature or sick babies here. A little bit of time spent supporting a woman to breastfeed successfully costs little but can save babies lives. The other birth was a woman who had previously suffered an obstetric fistula which is a severely disabling complication of obstructed labour. More this in another blog.
Sadly after our two success stories of these healthy babies we had the tragedy of a young pregnant woman, who was already a mother to two children, passing away later that day. She came to the hospital with severe pneumonia and sadly despite having all the treatment that we could offer did not survive. I have worked in Sierra Leone previously and I know that this is a reality here, but the death of a woman is incredibly upsetting. Being with a woman as she passes away is something as a midwife in the UK I would be thankfully unlikely to encounter. It is hard knowing she would have been unlikely to die at home. I am grateful to have the opportunity to be able to spend this year with working with HU to support their work to reduce these unnecessary deaths.
In the evening I had plenty of smiling faces to cheer me up. I am a source of endless fascination for the many children in the houses across the street from me. My house has no kitchen yet, I cook on my front step on a small gas stove. I normally have anywhere between 2 and 10 children and the occasional adult coming to greet me or sit on the steps and watch me cook, people walking past call out that it is ‘chop time’ (food time) as they walk past. I wondered if I would get lonely in Kamakwie, not a chance!
I am in Freetown but we are having real problems with power and internet. I tried unsuccessfully to post this yesterday. I am going to try and include some photos but apologies if they are not in the post.
