Happy 50 Years Sierra Leone!

Today marks the 50th anniversary of Sierra Leone becoming independant. The people in Freetown have been painting everything green, white and blue, holding marching band parades for weeks, celebrating for days and will hold a lantern parade tonight. For us it is a normal workday, but for the locals a national holiday. I did ask one of my taxi driver friends to take some pictures of the parade, but he said it is too dangerous to take a camera, all the bad men are out! Hopefully someone will take some pictures.

Happy 50th birthday Sierra Leone!

Simple things

When I worked in admissions in our on board hospital a couple of years ago I remember that asking patients when they last had malaria was routine, not if they had ever had it but when, it is a given here that everyone has malaria from time to time. Before I came here the issue of how malaria affects pregnancy had not really entered my radar, it is just not something I ever needed to worry about. Every day at work here malaria is mentioned - women are given preventative treatment, sleep under nets and we are there to diagnose and treat active cases as part of the much wider antenatal care we give. But why is it such a big deal?

Malaria in pregnancy increases the likelihood of the woman becoming anaemic (or more anaemic), there is a large increase in low birthweight infants (which is the greatest single risk factor for neonatal and early infant mortality and also a risk factor for developmental delay, so you can see why we prefer bigger babies), it accounts for about 5% of infant deaths (in this part of the world), it also increases the likelihood of the mother dying, of sponatneous abortion (miscarriage), stillbirth, growth restricted babies and pre-term births.

I know that all sounds very depressing - the good news is it can largely be prevented with just a couple of simple measures. The WHO approach which we follow is to recommend all pregnant women sleep under Insecticide Treated Nets and be given Intermittent Preventative Treatment. Women who present with symptoms should be treated aggressively, although often malaria during pregnancy has no symptoms (besides possibly anaemia) because of the woman's acquired immunity so the other two measures are vital. So the next time you get one of those alternative gift charity forms where you can buy a mosquito net for someone in Africa just remember it might actually save some lives. It is the simple things that can make a difference, but here not everyone can afford something so simple.

The Resurrection

Yesterday billions of Christians around the world celebrated a man rising from the dead. In this they did not celebrate the resuscitation of a man, as happens in hospitals every day, but that a man who was dead is no longer dead and never will be again.

Tim Keller expresses why Easter is absolutely central to the Christian faith:

Sometimes people approach me and say, “I really struggle with this aspect of Christian teaching. I like this part of Christian belief, but I don’t think I can accept that part.”

I usually respond: “If Jesus rose from the dead, then you have to accept all he said; if he didn’t rise from the dead, then why worry about any of what he said?

The issue on which everything hangs is not whether or not you like his teaching but whether or not he rose from the dead.”

[...] we can’t live our lives any way we want. It also meant we don’t have to be afraid of anything, not Roman swords, not cancer, nothing.

If Jesus rose from the dead, it changes everything.

[(emphasis mine) Tim Keller, The reason for God]

"If Jesus rose from the dead, it changes everything," that was my conclusion a little over 13 years ago - what's your?

Happy Easter - He is Risen!

Happy Easter

I don't really know where to start or what to tell you about Easter on board. Reflecting on our Easter this year, it has been a mixture of sickness, our plans cancelled and some of our family missing out on the activities on board.

Yet it has also been a time of quiet relaxing, easter egg hunts, movies and sharing time with people. We have celebrated together and remembered the day that changed the world. Happy Easter! Christ is risen!

colouring eggs

 The kids gathered in the dining room to dye some eggs

 Josh and Max dunked nearly all of theirs in the green

 Then you check when they are ready

And admire the variety of colours. Tomorrow we get to eat them as part of our Easter brunch :-)

big and small babies

Another day of midwifery. A few of the women hadn't gained any weight, and the odd one had managed to actually lose weight (this idea of weighing the women is a whole new one to me I must admit - beyond a body mass index calculation at the first visit we don't weigh women during their pregnancy back home. Here though I can see that it might be a more useful indicator of how things are going). A few babies growth was not what I would have expected either, given the gestation or just considering growth since the last visit. One woman fit both of these scenarios so I talked to her about the importance of eating well and how we would really like the baby to grow bigger. Lots of the women say they have no appetite or are reluctant to eat because of acid reflux and helping them to understand the importance of eating well can help. But this lady told me if she gets money during the day (presumably from selling some kind of produce or something) then she can eat, and if she doesn't then she can't. It's hard to know what to say to that really. I checked if there was anything else we should do given the lack of growth, but the other midwife said we just give diet advice and check it again in a few weeks. Still it's something to think about and to check out what the policy is or should be for such women (I couldn't find it at the time but am pretty sure they do have one already). 

After clinic I worked on our overflow ward, we have an 8 bedded antenatal/postnatal ward but had managed to have 10 extra mums and babies on one of the VVF wards as it had been so busy. When I arrived on the ward the Mums were all outside eating dinner. The babies were all wrapped in their multiple blankets lying in the middle of the Mum's beds. I wished I had a camera. One of the babies I was checking was 3.6kg, the same birthweight as Josh. He looked quite out of place amongst all the tiny little scraps on the other beds, it reminded me of when Josh was in NICU and had looked like a giant compared with all the prem babies around him. The Mum was so proud, and rightly so, that is quite an achievement here where the average birthweight is about 2.5kg.

I could write on and on about yesterday's taxi saga's, but I'll just say I have had the true African experience now and please pray I find a new, reliable one!

a trip to the beach

Yesterday some friends came and took us to Bureh Town Beach about an hour away from the Ship (on a good journey). We had a lovely time getting to know a couple of families who have lived in SL for a year or two and hear about their experiences. The boys had fun playing, Tommy had fun taking pictures too.

It was really quiet until a bunch of people came in the last hour or so that we were there. They brought the biggest speakers you have ever seen and were all dancing. Tommy said it reminded him of Southend Seafront :-)

A real live man in the maternity unit and other stories

Some observations and thoughts from this week...

Another day in Antenatal Clinic, now not so unfamiliar or strange. Sixty five women came, many of them were already sitting outside waiting before I arrived at 06:30. It was a long day, clinic went on until almost 17:30 and then there was 65 sets of notes waiting to be put into the computer.

While the other midwife was engaging the women in some lively antenatal education I was able to watch and wonder about them all. It seems to me that pregnancy is a great leveller, everyone at the clinic in the same boat - a shared, common experience. The women chat and laugh together as they respond to the midwife and then between themselves while they wait for their turn to see one of us. Some come in their Sunday best or their business attire (no mistaking the lady who is a banker!), others in holey, slightly grubby t shirts and a lappa tied around their waist, but I wonder how much that matters to them while they wait? They all want a live healthy baby at the end of the pregnancy and they wait their turn to be seen, some for hours on end (I might add unlike the women of the antenatal clinic I used to work in when I trained who used to moan to the receptionists if the midwife was running 15 minutes behind!). The outfit that made me smile the most was on a lady who looked like she was covered in hairdryers and somehow it didn't look that strange, although I did wonder if anyone here actually has a hairdryer.

We split the patients up for their checks between Ami, the other midwife and myself on the basis of whether they spoke English, (figuring I was going to be up a creek without a paddle otherwise). This worked pretty well and meant I could largely just get on with my own cases. I can do the antenatal checks no problem. I've got the hang of the worm meds, antimalarials and tetanus vaccines, giving out iron and folic acid but today I learnt some new things (as I am sure I will every week!). We also give HIV positive women nutritional build up milkshake powder, multivitamins and prophylactic treatment against opportunistic infection. These poor women must rattle from all the pills (they get HIV treatment from somewhere else too) but it is a blessing that we can improve their health and that of their baby through providing this aspect of care- free of charge.

Another noteworthy moment was when a man came into the labour ward - "belly woman" business is truly a woman's realm here. I did see one other Dad visit two weeks ago when his wife and newborn were on the ward. He was very sweet and very proud of them. But the 65 women came to clinic all alone today, will probably give birth alone (except for the midwives - most don't seem to even have a female relative with them from what I have seen) and stay on the ward without seeing their husband until they can return home! Somehow I must have accepted it as I was quite suprised to see him and was almost suspicious as to why he was there. But he held his wifes hand and they walked around together as she quietly laboured, and then he left again.

So these are a few thoughts - so much happens in 12 hours that it would be too long winded to mention it all and there are some things I don't feel I can blog about yet. One of the biggest challenges in clinic is trying to solve the puzzle of when women are actually due to have the baby, but that will have to be a post all of its own sometime and just amuse me in the meantime :-)

millionaires

I withdrew a million from the bank this week :-)

A million Sierra Leonean Leones. Actually only about £143. It should keep us going for a while though - you can't actually fit this much in your wallet to spend it all at once anyway!

water everywhere, but not in the fresh water tanks

Yes we live floating in the ocean. Yes we have a lovely view of plenty of water everywhere, but we are having some trouble on board having enough fresh water. Please pray that we would resolve this, that we would be able to load more water soon and more importantly find out why our water useage has been so high - particularly if there are any leaks or problems in the system that are affecting this. We haven't been able to do laundry since Thursday (which was when we were due to do ours) and now we are not able to use the showers either. We still have some water at the moment for drinking and hand washing but even when water is loaded it takes a couple of days for it to be treated so it is safe to use so it will take some time before things are back to normal (and normal for us is still restricted laundry slots and strict 2 minute showers, not really normal in most peoples definitions). Think of us all getting stinky and enjoy your shower tonight :-)

Hobbies

People ask me if I think our kids miss out on things by living here. Most of the time despite living on a Ship in Africa it doesn't feel like our kids are really missing out on much, the only thing that really comes to mind is the people they love in England that they don't get to see often. But one of the challenges is that there is not the usual array of hobbies, clubs and after school activities to choose from that really suit different kids. Tom has now stopped learning the recorder, much to the relief of our ears and taken up karate. I'm not sure how long that will last either, but he's giving it a try! He would really like a football (soccer) coach or swimming teacher if anyone fancies it?

Tom in his borrowed Karate outfit!

 This week running club started again, something both our boys LOVE! They just run up and down the dock with their friends for about 45 mins getting filthy in the process. Some pictures here:

http://tvedtfamily.blogspot.com/2011/04/running-club.html

Antenatal clinic

This comes with a warning that more of our blogs are going to be about midwifery but I'll try and keep them in English so that you don't need a midwifery dictionary to read them. Yesterday we saw 52 women in clinic which made for a busy day! I have been writing down my thoughts when I get back, so here are just some short random thoughts from what I wrote to give you some glimpses into what it is like...

My first day in AN clinic, it was sort of like AN clinics I remember - urine checks, BP checks, palpations (assessing the position of the baby), giving advice, and yet somehow it was quite alien. This new world includes routinely giving worm medicine, antimalarials, tetanus vaccines and iron tablets/folic acid to every woman....the day started with the women attending clinic singing and praying and the midwife reminding the women about the danger signs in pregnancy, which included more singing and clapping and laughing as she dramatically acted out each one...
...Its a world where a large proportion of the patients have suffered loss of a newborn, some have lost one baby after another...they take it all very matter of factly, it seems a bit harsh at times but I guess it is a part of life they are more familiar with than I am...
...I learnt my first maternity Krio today: "de pikin du shake?", "fine, fine shake?" (is the baby moving? moving well?)...I managed to amuse quite a few women by my poor attempt at one sentence along with some interesting body wiggling...
...There seems to be different thresholds here for referring to a doctor, admitting patients for observation or acting on the findings of the antenatal check. It was hard to decide whether this was because there are less options here, less that can be done, or whether the midwives didn't really understand or acknowledge the warning signs at times...
...my first assessment by myself (having done a couple with another midwife there) and I think the baby is breech. It has been years since I palpated a breech and so I reluctantly asked for a second opinion - waiting for someone to tell me that I had my very first palpation wrong, but alas it was truly breech! Sort of to my relief and sort of disappointing given that the lady was near term and would have been happier with a well behaved cephalic (head down) positioned baby...
...the other lady that I'll remember was 26 weeks pregnant and the midwife seeing her couldn't find the fetal heart beat. Once I had the same trouble as did a third midwife we were trying to decide a plan. I must admit I have never had this trouble before, but knew that back home we would just scan to check if we had any doubts. I asked whether this was possible, otherwise suggested we get her to walk around for a bit to see if the baby moved position and try again. It turned out that the doctor was already at the ultrasound scanner with someone else from clinic so we took here there. That was quite a horrible moment for a minute, wondering if we would find it ok. It was like a flashback to when I was scanned at work and they didn't find the baby's heart beat, it is not a nice way to find out something is wrong. It was such a relief that the heart beat was fine, just apparantly hiding from three different midwives....

So there was another day at work, and another week ahead trying to make sense of it all and read up on some of the things that came up before more midwifery fun next week! 

Goat soup to watch football?

Forget all the usual foods you might associate with watching sports and try something new ....goat soup....available near the Freetown National Stadium! I thought this was quite random and liked the bright colours :-)
 

missing midwives

Save the Children have just put out a new report on the 'missing midwives' and the implications that result from a lack of midwives. A quote from it:

The global shortage of 350,000 midwives means that many women and babies die from complications that could easily be prevented by a health worker with the right skills, the right equipment and the right support. There are 358,000 maternal deaths annually, and more than 800,000 babies die during childbirth each year. Millions more newborn lives are lost in the first month of life. If births were routinely attended by midwives and skilled birth attendants with the right training and support, the lives of 1.3 million newborn babies a year could be saved.

Good to know someone values midwives :-)

Link: http://www.savethechildren.org.uk/en/docs/Missing_Midwives.pdf

riding African style

Toms first ever ride in the back of a pickup. Another half dozen people climbed on after I took this so Tom was pretty well wedged in!