Tiny, little babies

This week I was working on the antenatal/postanatal ward along with a student midwife so I thought I would share a little about some of our tiny babies.

One of the reasons Mums have to stay on the ward for some time is when they have a very early or small baby who needs some TLC. I am not claiming that all early or small babies do well but I think many people would be very suprised at some of the things that are achieved here. While there are no neonatal units, paediatricians or neonatal equipment such as incubators there are some little miracle babies on the ward every week, making it through another day with us. Yesterday we had a couple which I thought I would share about.

The first was a baby weighing 1.28kg at birth, now almost returned to it's birthweight after losing a little weight, and the second 1.08kg at birth, now just 900g. They were 8 days and 6 days old. .These little ones always make me smile as they wear a nappy almost as big as them (as you can't get pre-term ones here) and are either tucked down their Mum's clothes or wrapped in so many blankets that you can hardly seee them. Both had needed some resuscitation at birth, but actually not very much and had adjusted to life outside the womb within a couple of minutes despite their small size. This is testimony in itself to the staff where I am working - when I attended a midwifery conference here in SL a few months ago with midwives from other hospitals and taught some of the neonatal resuscitation as groupwork I was shocked by their complete inability to even initiate basic newborn resucitation (opening an airway, giving initial breaths, maintaining breaths and cardiac compressions). I am sure our midwives are saving many babies through just being competent with basic newborn resuscitation skills - no they can't do everything, drugs wise we are limited and there is not any further support for babies in terms of ventilation or anything, but what they can do they do well.

Once they are born and in the days ahead our priorities are simple - keep them warm and keep them fed, prevent infection and observe them closely. We encourage kangaroo care, where babies are put next to their mother's skin and then both of them covered. This helps keep the babies nice and warm. When the Mum's need a break then we just wrap them well. The feeding is a little more complicated with these small babies, especially the early ones who are not able to breastfeed. We get the Mum's expressing milk and feed this to the babies either by nasal tube or by syringe and gradually increase the amount they take at each feed. The little ones usually need some IV fluids too initially (it is always a big challenge trying to get cannulas into babies that weigh less then 1kg and I was very happy that one of the other midwives bravely took this challenge and got it in first time with the little one yesterday!). There are no pumps here to help with giving fluids so it's back to what we learnt in nursing school many years ago - calculating how much fluid they need for their bodyweight per day, minus the milk they are having, making up the bag with a mixture of dextrose and saline, eventually working out how many drops per minute the drip needs to drip at. This bit becomes quite time consuming - partly because the drip rate often changes when the baby moves and partly probably because of my paranoia that we will overload one of these tiny babies with fluid if it drips too fast and we fail to notice.

Tiny babies don't always make it, but many, many do, and it really is just these simple things and some midwives who know what they are doing who are making it happen. It might not sound like much, but each time I go to work and see these tiny babies tucked down their Mum's gowns it is like seeing a miracle before my eyes and I love it.

life and death

Work this week saw more new lives arrive and also reminders that life is fragile here. It was a long day supporting a young mother through her first labour - a real typical stroppy teenage mother for all those midwives who know what I mean! Her bump was tiny and her dates not really known so we were estimating a baby between 33 and 35 weeks gestation. We prepared for a premature birth - which really doesn't mean much here as there are no neonatal services, but I had a second midwife and plenty of things to keep this baby warm once it arrived. It actually was a pretty average size (for here, it would have barely stayed away from SCBU if in the UK!) once it arrived and we just dried it well and kept it with the mother, later we checked and it weighed just over 2.5kg. So all was well.

During an earlier part of this Mum's labour I offered to do the 6 week postnatal check on another lady, not realising that this was going to be someone I know. Only being at the unit once a week I don't really expect a lot in terms of continuity with the women but I had seen this lady for a couple of her antenatals and then had spent time with her again the day after her birth, the day her baby had died. This wasn't the easiest postnatal check I have ever done, 6 weeks is still so early after such a great loss, and it can't have been easy for her to have come back to the unit to see us. But I was glad to see her and chat with her and I'll certainly be praying for a better outcome next time.

Later in the day a family came to collect a baby which had died (prior to labour even starting) which had delivered in the night. It was one of twins, the other healthy and doing fine as far as I know. The poor family, presumably the husband and one of the sets of grandparents came to collect the baby. It was taken away in a cardboard box, which seemed a little harsh somehow. But maybe wrapping it nicely in a blanket would have been culturally inappropriate, especially given that most people don't have their own transport and may have been refused the taxi if anyone had known about the box's contents. I'm not really sure of the rights and wrongs of the way things like this are done. I would say though that the midwives are very nice and fairly sensitive, giving their condolances to the poor families who have to make the walk through the ward full of mums and babies to collect their cardboard box.

It is all in a days work here, seeing new lives born and sadly sharing a small part of the grief for the babies that are lost.

a quieter life

We're now just over a week into the children's eight week break. The first day saw a bunch of families leave for their holidays and since then there has been a constant stream of goodbyes as we have seen many friends leave the ship. Last week we said goodbye to Uncle Sam and Auntie Amy along with other close friends and many of the teachers. The goodbyes continue this week (and next) with some of the other families leaving and a couple of other friends to say farewell too. There is a lot of change to cope with as we adjust to this new season of not having our ship 'family' here any more, friends who started their Mercy Ships journey with us three years ago in Texas and have been our biggest support on the ship since then. Tom's teacher of the last two years left and some of his classmates will be leaving soon so there will be some adjustment for him too.

 Having the boys home is a challenge - their energy and need to get outside frequently doesn't match particularly well with it being rainy season, living on a ship with only a small amount of space, being limited how often we can get out off the ship and with the rather green looking pool which is closed for the time being. That said we had a great first week overall, we have been working our way through craft kits and things that the boys have been given, played lots of board games, played with their friends a lot and got outside to play each day. This week the load is shared as Tommy has taken some leave and the boys are having fun playing with him and taking him to the cafe for crepes! I'm off to work tomorrow for a break!

what does the last day of school look like here?

 The day starts with the 'End of year celebration'. Each child graduates to the next grade and is given a character trait which their teacher feels sums them up. Here is Josh with Miss Elizabeth.

 Mixed up in between the presentations to each grade of students are a couple of musical numbers, one of which was the song 'hop little bunnies' by the Nursery and Preschool classes.

 Tom with Miss Estelle, his teacher for the past two years who we will sadly have to say goodbye to next week.

The afternoon was a pool party and then gathering in the cafe for crepes, then a little football on deck 7 before dinner :-)

So that was the last day of school, the boys are now home for a couple of weeks before Summer Programme starts. We have a few days off together over the summer, otherwise work sort of continues as normal, minus the students! There is still plenty that needs to be done post the accreditation and babies that plan on being born to keep us busy.

Many families have left for their summer holidays today so it is quieter already. A few more families are leaving in the next couple of weeks, along with most of our teacher friends and some of the people closest to us. One week today until we have to say goodbye to Uncle Sam and Auntie Amy. It feels like the next few weeks will be constant goodbyes :-(

Happy survival

While working on the antenatal/postnatal ward today I looked after a woman who had a greetings card on her bed. It was from her Aunty. I copied down some of the words:

Happy Survival.

You have made it.

"to God be the glory..."

Congratulations on your survival.

I kid you not, this is actually what it said. It makes you think about the reality of life and death here. I'm pretty sure none of my Aunts would have ever considered the possibility that I wouldn't have survived childbirth and would never have seen a card like this in the shops. Let's hope one day there is no need for cards like this here in Sierra Leone either, that Aunties can stick to the 'congratulations on the birth of your baby' message instead.

I'm pleased to say everyone present at the start of the shift was still alive at the end, plus a few extra little ones who arrived fit and well somewhere during the very busy day. First thing, I looked after a lovely lady called Mabel who had her baby in the antenatal clinic room as the beds were all full. Her first baby died following a difficult birth about 18 months ago and it was a joy seeing Mabel and her proud husband take their healthy baby home.

'our' container came

It is fun what you can see out of your window!

our big boy just got a bit bigger

Tom is now 7 and the memories of nappies and pureed food seem a little more distant. Our little boy now seems pretty grown up.

In case you haven't seen him lately he is crazy about two things - football (soccer) and Star Wars. The love for football maybe comes from his Dad and Uncle Sam and the constant chatter about football through out the season. He loves playing football, watching games on TV and talking about league tables and things that boys seem to do. His love for Star Wars probably comes from the bigger boys on the Ship and their collective love of Star Wars Lego. He has a slowly growing collection of themed Lego and seems to have a fairly good grasp on the Star Wars story considering he hasn't watched most of the films!

We had a vaguely Star Wars themed party yesterday, the idea being that the kids would complete various games presented as Jedi training exercises. The reality of course, was a little more chaotic than I had planned but a lot of fun. Tom was quite sure that they all needed to practice fighting with lightsabers, so we compromised and said the last game in the training could be using the lightsabers to keep balloons in the air.

Today he has started the day with chocolate shreddies, a treat sent from the UK and then opening his presents. Josh was just as excited as Tom while he was opening the presents, they squealed with excitement at star wars keyrings, t'shirt and lego, talking about who all the characters were (I'm still none the wiser but feel like the day is getting closer when I will have to educate myself and actually watch the films to know what they are talking about)! He is a very lucky boy with some very kind family - thank you!! I took some pictures, but I should have taken a video, he was just so happy and overwhelmed and full of thanks, it was lovely to watch him.

The rest of the day will apparantly be full of building lego, wii football, games and football. Oh and a little bit of eating chocolate cake with our friends, Uncle Sam and Auntie Amy :-) Sounds fun.

walking out of the port

Walking out of the port there is always lots going on. People who want to tell you about their health problems, container trucks lining the street to get into the Port, people hanging around the small stalls chatting. Anyway, only a little way up the road there is a painting of the previous mercy ship, the Anastasis from a previous visit to SL! It always makes me smile, thinking back to when I lived on the Anastasis in 1997 for a few months.

rubbish, garbage, trash

Sierra Leone lacks decent waste disposal services and so much of the rubbish ends up on the streets. And quite a lot ends up in the water, even more when it has been raining. This causes big problems for the ships intake valves and they are frequently becoming blocked. Divers were going down a couple of times a week to clear the rubbish and more recently a couple of times a day. This is not the most pleasant of jobs as you can see, and we are incredibly grateful to all of the divers for helping to keep our generators working and our A/C on.

 Can you spot Olly and Dan?