an unexpected birth

One of my patients today had an interesting birth. She had not attended for any antenatal care so we weren't expecting her, she didn't know her dates so she wasn't really expecting anything at any particular time either.
This was her first pregnancy and when she arrived we could already see the top of the baby's head so we expected to see a baby soon at this point at least! We had very little time for doing a thorough check, just enough to know the mother and baby were both doing fine. She was very calm, she came in alone having been contracting a few hours.
She delivered her baby boy easily and the cord was so short I couldn't actually do anything except to hold the baby in mid air so I called for some help. Wanjiru came to help me, the first thing she said to me as she walked in when I said the cord was short was 'is there another baby?'. I moved from 'what?' to 'oh, my word, there is another baby' in a split second after looking up from the baby to the mothers abdomen! It wasn't the right shape! So we informed the mother, confirmed that the next twin was coming feet first and waited. And waited. And then helped it along with some drugs to get some contractions back. And it finally came a couple of hours after its brother, a footling breech delivery! 
Thank God for such a great outcome considering all the factors! And thank goodness for such a great midwife in charge today who supported me through the surprise breech birth. Although not my first breech delivery it being an undiagnosed twin pregnancy, with an undiagnosed breech presentation, needing augmentation and with some fetal distress in a small unit in Sierra Leone was certainly a first for me and one to remember, although I fear (and am kind of excited about too if I'm honest) that it won't be the last!

A visit to the Chimp Sanctuary

Only an hours drive from the Ship is the Tacugama Chimpanzee Sanctuary, so we thought we'd pay them a visit. Admittedly this was a few weeks ago, but there has not been much time to blog recently. They do tours twice a day, have a quarantine area, nursery enclosure and then a couple of large enclosures for the older chimps (the largest is 8 acres so we couldn't even see any chimps in that one - they are still fed, but they partially fend for themselves too). We saw some of the chimps being fed, some stealing food from anothers mouth, chimps playing, grooming each other, one threw a stone at us and one had a baby on her stomach. There are currently 96 chimps living there, all rescued, mostly from people keeping them as pets. They do have an opening for one named Samuel, but Sam wasn't able to come so no danger of getting him confused with the chimps :-)

 The nursery enclosure where young chimps can stay for a year or so before they move to one of the larger enclosures

 not quite sure if they are cute or ugly!

 helpful instructions about how to talk chimp!

 Our little chimps had a lovely visit. It is quite suprising to find this kind of place in Africa.

Accreditation update

The accreditation team representing ACSI (Association of Christian Schools International) and MSA (Middle States Association) arrived on Monday night, this week. They were in school through until Friday looking at lessons, examining paperwork and meeting with administrators, teachers, parents and students to see whether we have met the standards necessary to become an accredited school.

On Friday afternoon (after the President's visit - more on that another time) they presented their initial findings to the school. We have been recommended for full accreditation by both ACSI and MSA. This recommendation will go to the boards of both organisations within the next few months to be ratified.

It has been the culmination of years of work by the teachers and leaders of the school. I have been privileged to be part of the team that has put together the school improvement program that gained us accreditation while also physically moving the school twice in the last 9 months. This team was clearly brought together for such a time as this. Well done everybody!

Tommy.

Angella's birth (and pics of the birthing room)

Angella's baby was the first that I have had the privilege of delivering here. It was her first baby, she came in alone and laboured extremely well. There are no pain relief options beyond paracetamol and so she was completely in control and open to ideas about changing positions to make the birth easier. She prayed throughout most of the labour, for strength to get through it and for a good birth. She had a lovely calm birth of a baby girl who at 3.88kg was pretty big compared to the average baby here. She was kneeling for the birth, and although this is my favourite position too, she had decided for herself after we'd tried a few positions that this was most comfortable. What struck me most was her reaction afterwards though. She wanted to know how much the baby weighed, she wanted us to take pictures and for her to have the baby nearby and we had the baby feeding pretty quickly. The mother's here do generally seem a bit more distant from their babies somehow and not as interested as Angella was about her little girl. She called her husband, but told me he wouldn't be coming in to visit, but I did meet Grandma who was full of thanks and praise. And rightly so for another little baby made it!
To give you an idea of where this all took place, I took some photos at various times when the birthing room was empty:

 So on one side of the room there are two delivery beds which can be separated by a curtain

 and on the other side there is a mattress on the floor, either used if the other beds are full or for more active births if the woman/midwife don't want to use the bed. This is where Angella had her baby :-)

 this is the room from one doorway to the other. You can still see the mattress on the floor in the back left corner of the picture and the curtains on the right where the beds are. Through the doorway is clinic - you can just see blue curtains where the antenatal women come and we check them. The corner of the room nearest to the baby scales in the picture is storage and drug cupboards etc.

And through the doorway the other side is the ward. You can see 4 beds on the right and there are 4 on the left of the ward that you can't see in the picture too. This can be antenatal or postnatal women. I took it when they were mostly outside eating dinner, it was actually full it just doesn't look it! It is pretty much always busy.

So you can see that it is pretty small, but actually pretty nice considering where we are. They could do with some more equipment (just more of the basic things like BP machines, tape measures, fetal heart dopplers that work, thermometers etc) but it is set up pretty well.

Tom got his yellow belt!

After a few months of Tom learning Karate we finally got to see a performance and then presentation of belts.

 The presentation of the yellow belt

 Once they all had their belts

 All the karate boys. Tom is the only yellow belt in the front - the other's have all been learning for a while longer than him and so got a mixture of other belts, blue, green and brown I think. Well done boys! And thanks to Montez and Peter for instructing them.

the wait is over...

The accreditation team arrived last night and the school accreditation will take place this week. The feedback will be given on Friday so watch this space! Thanks for all your support during the accreditation preparation phase. It has been a LOT of work over the last two years, everyone will be glad to have it 'done' and to move on to other projects in the school. Keep us in your prayers this week. Thanks.

our lovely boys and their friends AKA school photo time

 Here you have the whole school on the dock, Tom then Toms class (L-R = Libby, Anna, Miss Estelle, Megan, Tom, Daniel, Andre)

then you have Josh, Josh's class (Top-bottom, L-R = Miss Elizabeth, Josh, Luke, Max, Elisha, Nathanael, Janice) and then Tommy's staff shot, all alone as the kids in his mentor class (same as a tutor group) have left :-(

best and worse places to be a mother

The 2011 list has come out of the best and worse places to be a mother. So the best:
1. Norway
2. Australia
3. Iceland
4. Sweden
5. Denmark
6. New Zealand
7. Finland
8. Belgium
9. Netherlands
10. France

and the worst:

153. Sierra Leone

154. Equatorial Guinea

155. Central African Republic
156. Sudan
157. Mali
158. Eritrea
159. DR Congo
160. Chad
161. Yemen
162. Guinea-Bissau
163. Niger
164. Afghanistan

It is good to see that Sierra Leone is not right at the bottom!
For more info and to be able to view the complete list:
http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6748295/k.BE47/State_of_the_Worlds_Mothers_2011_Statistics_and_Facts.htm

more thoughts about midwifery in SL

I had hoped to write a really insightful blog about work each week, help you 'experience' a little of the world of West African midwifery, but I am finding words to explain my long days off the ship hard to find.

I am trying not to continually talk about the taxi frustrations, which I desperately hope are over now, this weeks driver actually turned up and on time. Thank God for that. I am also trying not to be critical of the ways things are done here, as the midwives on the whole are doing their best in a tough environment.

There are many challenges for the midwives, some of which would even be the same in the NHS, but some unique to low resource settings. I realise how much I took for granted in the NHS - I really miss all the ready made sterile equipment packs containing everything you might need for a birth or to suture and the maternity care assistants always around to help you find things!

There is not enough equipment here so we are constantly moving blood pressure machines, fetal heart dopplers and other things between clinic, the birthing room and the ward. There are not enough beds, so some of the women end up in an overflow area in one of the VVF wards.

There are not enough midwives, yet the midwives here are responsible for everything, whether low risk or high risk (there is actually an Obstetrician here temporarily, and usually one who is on-call for caesarean sections, but this is not a permanent position so the midwives can't learn to rely on her too much).

Yesterday the midwives on the ward were looking after a one day old baby who was very unwell. They helped him breathe for 30 minutes, at which point a line needed to be drawn and the decision made to stop. We were joining the Mother's prayers for a miracle, but really a miracle would have been the baby's only hope. There is no paediatrician, there are no neonatal units, no ventilators. We just get to do our best.

Some days it doesn't feel like it is enough.

everyday life through the car window

 Anyone wanting a white t'shirt? It amazes me that anyone would choose to wear white living here, it is so dusty everywhere.

 Lots of the 'shops' are little huts like this where you can buy drinks, bread, phone top up, have a haircut or get clothes tailored.

 Most people here would do their shopping in markets like this one. There are a few supermarkets on the other side of town to where we are, but we've not ventured to them yet. My friends tell me you can buy everything in the markets that you would want, the tricky thing is finding it!

Tom enjoyed seeing poda podas (minibus taxis) and huts like these with the UK flag or Premiership football teams emblems painted on them. They seem to all like the same big teams though - Man United, Arsenal, Barcelona etc

patriotism through the car window

 A few weeks ago before the anniversary of Sierra Leone's independance tree trunks got painted

 and walls

 and stones by the road

and anything and everything really. All in the green, white and blue of the Sierra Leone flag.

work experience

Recently the high school students got to try out a job on the ship for a weeks work experience. We were going to write a blog to show how varied and cool some of their experiences were but it seems Estelle has done that for us :-)

For lots of photos of Tommy's students at work around the ship see:
http://estellesmiles.blogspot.com/2011/05/work-experience.html

Happy (American) Mothers Day!

Tom has learnt to email, he went to the internet cafe by himself this week and sent me this:

Happy mother day I know it is amarcon but we can still selbrat.

I Love you

Love From Tom Farrell

So lovely! I'm all for celebrating all Mother's Days, I only wish my Mum was a bit closer to celebrate with her too. So Happy Mother's Day Mum. Again :-)

boys making fire

One of the fun things the boys got to do at the beach was help make a fire and watch Raul gut and cook some fish for our lunch. I can't say I understand it, but there is something about boys finding playing with fire fun! I enjoyed eating the fish so it was good all round! Thanks Raul!

 They collected sticks

 then lighted the fire

 and poked it a bit while the fish cooked

and then we ate it with rice and mango :-)

a day off school

Unfortunately the teachers still had to work, but the rest of us enjoyed a day at the beach with some lovely friends. It is such a contrast driving through the busy, dusty streets and then arriving at a deserted, beautiful beach. Here are some random pics from our day:

 The view of a banana islands

 completely empty :-)

 I took some pics of these grasshoppers for Tommy as he wasn't there to take them himself!

 The place to come for relaxation!

Josh covered in sand

 Photo of a random lump of wood, knowing Tommy would have tried something like this if he'd have been there!

 In case you think this is some kind of perfect holiday destination - the toilet was just a mounted seat sitting directly on the sand and there were only 'walls' on two sides. Still it was clean and I could only see one person while I was sitting and he looked pretty busy doing something else. Haha

So it was a fun day relaxing and playing with our friends (thought it best not to put pics of other peoples children in their swim wear on here, so take my word for it they were there and we had a lovely time playing together!).

another dress up day

Life has been quiet lately, not much blog worthy happening. Most of us have been sick and really not doing very much. Tommy is working all the time in preparation for the accreditation, which is now this month! Sarah is still having major taxi troubles getting to and from work, but the problem has changed from taxi's being late to not coming at all. So nothing exciting really, but the boys did get to dress up as a character from a book:

Tommy: Mr Sneeze from the Mr Men
Tom: Obi Wan Kenobi from Star Wars (his fav book in the school library!)
Josh: a generic Knight, just because he wanted to dress up and take his new sword to school, made kindly for him by one of the other Dads to protect his princesses :-)