6/20/11 - 6/24/11

Connor has already written a lot about some of his first impressions of the hospital. I think that I've been lucky to have Maria, a really excellent nursing student, teaching me this past week. She will be leaving this week, though, so I'm on the lookout for a new guru. I've also been very lucky to have the maternity ward to work in. There are usually anywhere from ten to fifteen women in active labor, and a baby comes along about every couple of hours. I've already learned so much by participating in these births. This incredibly high volume of laboring women is managed out of a very small room. Women labor outside or in the hallways until they are ready to deliver, and then they occupy one of three delivery beds, which are right next to each other, separated by only hanging sheets and about two feet. Each mother brings in any gloves, medications and blankets that she wants the nurses to use. She also brings a black plastic sheet to lie on while she delivers. The labor suite has one blood pressure cuff, a fetoscope, a handful of suction bulbs to clear the babies' airways and antibiotic eye ointment for all the babies. They also have a very limited supply of oxytocin, pitocin, syringes, and sutures which they reserve for the very, very poorest of patients. Other than the specific c-section which ended very badly with a baby who probably had brain damage and ultimately didn't make it, there are a few other events that really stood out this week.
A baby was found in the town. She had been born just a few hours earlier and abandoned in the street, and she was perfectly healthy and really cute once she'd been bathed. Connor, Jennie and I bought some formula for her and she is being cared for by one of the head pediatric nurses. She named the baby Gift. It was startling that there was no system in place to handle abandoned or orphaned children. If they are not claimed by other family members, the children will be looked after until an orphanage accepts them or a family steps up to take care of them. This lack of protocol pervades all aspects of the hospital's operations, sometimes with devastating consequences. On Friday, a mother came in to the birtng suite (the aforementioned small room with three beds crammed in side by side) to be examined. She said she'd come in a couple of days ago with some fluid leaking and that she had been laboring since then, but that she had vomited a few minutes earlier so she thought she should get it checked out. My friend Maria examined her, but couldn't find her chart anywhere. The charts are all kept in a pile on the table in this room, but they frequently wander off and have to be searched for in other parts of the maternity ward. Maria noted that the mom was two centimeters dilated and was still leaking some fluid, so she ordered the woman to be given a test for malaria and to be observed. Maria was really concerned that this mom had been laboring so long while she was losing fluid- this boded badly for the health of both the mom and the baby. The mom climbed down from the bed, then walked a few feet and then collapsed, convulsing. When the nurses managed to get the mom back onto a bed and check for her pulse and blood pressure, there were none. The mom was gone. No attempt was made to save the baby, whose heartbeat Maria had heard only moments earlier. On fact, the blame for this mother's death landed largely on Maria, even though the nurse who had admitted this mother earlier had failed to register her in the admission book and even though no one had followed up with this mom, in the midst of a complicated labor, for two days. This lack of oversight and management, the complete absence of a system for monitoring mothers at regular intervals, is at least partly responsible for the common deaths of mothers and babies. The babies who die are often kept in a cabinet in the birthing suite until the families come to claim their bodies. I saw four babies either being placed in there or taken from this cupboard. I've only been in the maternity ward for one week.