Wednesday, 31 August 2011

baby Sarah

Yesterday was a busy day at work. My first lady in the birthing room had a lovely normal birth of a little girl her Husband said they would call Sarah after the midwife :-)

The next lady was an HIV positive mother having her 8th baby! She complained more than most mothers having their first baby, didn't want to try any of my suggestions as to how we could make things easier for her, vomited all over the baby towels and blankets I had just prepared, kept grabbing my scrubs and my arm in quite a painful manner and finally popped the baby out when I had popped out for a sandwich!! She had been pretty hard work and when I came back she was just sitting smiling, amazing what giving birth can do to transform your behaviour!

I had a couple of antenatal ladies to see, both in their first pregnancy. One probably felt neglected as she was our lowest risk woman and it took time for us to get to her. I confirmed that her waters had broken and admitted her to the ward. She was walking around looking like she was in labour, moaning and bending over, but it sounded more like she had symphysis pubis pain than labour pain. Once the waters have broken we admit women and start an induction of labour after 24 hours if labour has not started. The other lady said she had been feeling some fluid coming out for a few hours. She didn't have a pad (lovely), just a soggy colourful lappa tied around her which made it somewhat difficult to really tell what kind of fluid we were dealing with! A short while later we could see that she was bleeding and that her waters hadn't broken. With no obstetrician Katie, the lead midwife, and I took her to see if we could work out where the placenta was on an ultrasound. So she was an interesting case, working through the APH (bleeding in pregancy) protocol to assess and monitor her given the limitations we have.

Another lady came in looking like she was established in labour. Unfortunately we didn't really want her to be labouring as she was for an elective caesarean section because of a previous VVF (fistula) so we 'rushed' her to theatre - meaning we called the theatre staff from home, sent drivers to get them and then took her. The baby caused us a little trouble, he was a poor colour and seemed a little cold so we warmed him with kangaroo care and gave him oxygen, but later he needed a full resuscitation after stopping his own respiratory effort. We had to wake the mother to warn her that he was doing very poorly and we were nearing the 30 minute cut off, where we have to make the decision to stop resuscitating. There are no ventilators here and so there has to be a cut off as we can not indefinately continue breathing for a baby who is making no effort for themselves. I left at the end of the resuscitation time to go with another lady to theatre, but found out when I returned that the baby had just completely turned around and was back with the mother breathing for itself. Hopefully that is still the case today and the antibiotics have time to work. We pray over the babies as we resuscitate them and we do literally see miracles happen here.

This next lady going to theatre had come in having no fetal movements all day. She was given an initial due date of July 1st and then it was amended to August 11th sometime in the pregnancy. It is so difficult establishing when babies are due here as women don't know their dates and don't come to see us until late in the pregnancy. Often we have to make a clinical guess, which for her was probably inaccurate as she was a 'bigger' lady to start with. Her first baby had died, the second was alive having been delivered by caeasarean section for being very big and 'overdue'. The previous caesarean meant she couldn't be induced using the drugs they have here, there are no CTG's (fetal monitoring) so all factors together - no movements, overdue (maybe), big baby, previous caesarean - meant she went for another one. And it didn't look one day overdue judging by the vernix liberally covering it but we are thankful that she has a live healthy baby.

Monday, 29 August 2011

the climbing frame returns

The childrens climbing frame was taken down at the end of 2009 (!!) so that there was space for the pool to be installed. It had to be redesigned to fit into a different shaped space before it could be put back to play on, finally it is finished and we can play again (we being only people under 13, so not really 'we' given that some of us are 'old', but the boys and their friends are enjoying playing and getting covered in black dirt from the matting :-))

 you can climb up and then cross the bridge to the slide or the monkey bars to the firemans pole
 The slightly bigger kids still enjoy it as it makes games of tag more interesting!
The pool is just behind it behind the green netting on top of the white wall

Friday, 26 August 2011

craft shopping

 when you go to the beach you have the opportunity to purchase bead necklaces...
...pyjama bottoms/trousers, fabric bags and the odd wooden figure

Much as I love shopping, the crafts here have generally been quite few and far between, and the ones that do seem to exist are very poorly made compared with Benin and Togo. If anyone fancies a necklace or two there are plenty of them though...

Thursday, 25 August 2011

Abdul Kanneh (patient story)

 Fatmata, a fourth-grade student, faced some monumental problems that no thirteen-year-old should have to face. She left school to give birth to a beautiful baby boy she named Abdul. The baby was born with a cleft lip and palate. In her native culture, this type of deformity was considered to be a sign that Abdul was a demon child. So, Fatmata’s mother threw them both out of the house.
 Fatmata had no way to earn a living to care for her child, so she moved in with Mbalu, her wise and loving grandmother. Mbalu offered to help raise the child so Fatmata could continue her education.

Because the clefts made it difficult for Abdul to get all the nourishment he needed, he was not growing as he should. Worried and anxious, Fatmata brought her two-month-old son to a Mercy Ships screening, hoping that the volunteer surgeons could repair his clefts. Little Abdul was accepted for surgery, but since he was underweight, he was placed on the Infant Feeding Program to help him gain enough weight to undergo surgery.
 Under the awning of the Infant Feeding Station, Nurse Jessica King, clinical dietician, explained the techniques to properly feed Abdul. He was weighed and measured each week, and he did very well on the program. In a few weeks, he weighed enough for surgery, but Fatmata was not old enough to be onboard as his caretaker. Mbalu was very happy to take on that role for her great-grandson, and Fatmata came also to nurse her son. 

The volunteer surgeons repaired Abdul’s clefts, and the difference was obvious on the faces of both the baby and his mother. Finally, they could both smile. Fatmata and Mbalu were delighted. Now little Abdul would have a life free of physical disfigurement and verbal abuse. “Thank you, thank you, we are very happy,” they both repeated.
Fatmata hopes to save enough money to go back to school in the fall. “I want to train to be a bank accountant someday,” she confided. In the meantime, she is learning how to be a good mother to Abdul.

Story by Elaine B. Winn

Wednesday, 24 August 2011

A visit to the waterfall

The boys visited Charlotte Falls as part of Summer programme. Freetown has some areas which are very green and beautiful as well as poverty and overcrowding that are much closer to where we are docked.
 'the gang'
 Lovely boys, good friends. Josh and Max.
 And some of the waterfalls.

Saturday, 20 August 2011

Tom's summer

 Here are some random pics of Toms summer programme group:
Toms summer programme group spent time visiting the HOPE centre. This was taken just outside the Port gate, between the Ship and the HOPE centre.
 Red noses.
 They had a lot of fun and played a lot of games. Here is Matts new hair style.
Tom was Elliot's dog 'Bull' in the dog show. The dogs had to manoever around an obstacle course and then perform tricks.

Josh's summer

There were just four children in Josh's summer programme group, his friends Max, Janice and Elisha were also here for the summer.
 The terrible four looking pleased with themselves after turning Miss Jamie (?) into a mummy
 Not sure what this photo was about - but I do love some of the facial expressions
 Josh in the photo booth. Nice glasses
 Josh loved our beach outings, even the rainy ones
 Josh and Max had a lot of fun playing in the sea jumping the waves. They both learnt to swim over the summer without their floatie jackets (in the pool not the sea)

Friday, 19 August 2011

Summer holidays

We have finished our summer holidays now, but here are some pictures of what we got up to...
 We did lots of crafts and baking inside as it was raining a lot
 We made up games like an obstacle course, cowboy hats compulsory
 and we made Mummy try it. She got stuck under the chair and we laughed a lot
 We played a LOT of football, sometimes with each other, sometimes with Mummy and Daddy, sometimes with the bigger boys and a couple of times with Maggie and Alan which was really fun :-)
 We played a LOT of lego too
 and had some lego wars

 We watched movies, played games, read stories and spent a lot of time chilling out together. It was a GREAT summer :-)

Wednesday, 17 August 2011

this is no sunny holiday...

I took this today - it is the dental team walking to work. Rainy season is well and truly here.

back to blogging...

Finally back to blogging after some internet trouble in our cabin which we finally managed to sort out - just about anyway :-)

So what have the last couple of weeks held?? Constant rain, the start of school, new families arriving, a very exciting parcel (thanks Jen and Michael), constant talk about football as the boys prepared their teams for the fantasy football league prior to the season starting, Sarahs Mum and sister booking flights to visit next month, us booking our flights to return to the UK in December...

School started again last week and so far seems to be going well. Tom is now in Grade 2, his new teacher is (another) Miss Amy who we love already and is going to be a lot of fun. He has been so positive about school, he is just a little sad that there are no other boys in the class now that he can talk Star Wars with! Maybe it will help him be a little more focussed though. 

Josh is still in pre-school, it is beginning to feel like he's been there forever now, as he was in the same room with the same teacher, Miss Elizabeth last year, and in the same room for some of nursery before that too. He is in a class of 7 children and the older 6 have an extra hour now each day where they start to learn a little and do some group activities.

We have quite a few new teachers who are settling in. Tommy is mentor teacher for the Grade 11 girls and is still teaching Maths and Computers.

I am still working at the birthing centre. Just when I feel like I have got the hang of things I have something that I don't know much about and have something new to read about on my days on the Ship. Yesterday I had my first lady with typhoid so that will be the theme for this week! We also had an HIV positive lady give birth so I got to learn a little about their infection control practices for that. And just when I feel like I have seen it all and significantly less things shock me than might have done a few months ago, a lady showed me her mouldy toes at clinic and said she lives in a swamp. Yep, that might not be the best place to be living in rainy season, but I'm guessing moving might not be an option. I can't stop thinking about it though - I really never thought I would hear the words 'I live in a swamp' outside of the movie Shrek and it all just seems so wrong.

During a quiet part of the day I got to visit and tour Lumley Hospital, a nearby Government Hospital. It was quite small, but the lady giving us the tour made sure that we saw every cupboard, office and room possible! We got to see the wards, delivery rooms, theatre, recovery and sterilising room and pharmacy, along with the sluice and goodness knows what else! We're not sure if the power was off as everywhere was dark, the corridors so dark it was a challenge to walk down them without walking into a bench or something! While it wasn't as nice as the Women's centre where I am based it was better than I was expecting to be honest. All the beds had sheets and the mattresses on empty beds looked clean, they all had mosquito nets and rooms had curtains on the windows. It did need a bit of a paint job and someone to find a store room to put all the random bits of equipment and bits of beds that seemed to be abandoned in various places. The community health officer showed us their immunisation schedules - now that healthcare is free to under 5's the uptake is pretty good. The hospital send people out into the community to offer immunisations as part of their outreach work too. We looked at their birth register - it's funny how these things are very similar between different units and different countries. They have had 25 births this month so far, 3 of which were caesarean sections. The birthing room had recently been done up with the help of some external funding, it was just a little sad that there was nothing besides two brand new narrow delivery beds (complete with stirrups) for helping women labouring and birthing there. I'll take one guess about what position their women give birth in - and I'm guessing it might not be the best one for the women!