meeting local midwives

Health care for pregnant women and children under 5 has been free for almost a year now. I have just spent three days with about 30 local midwives at a local conference and have really enjoyed learning from them about the challenges and fustrations of working here. Some of the challenges they face must make working very difficult - it seemed that doctors will often not attend a woman when called, drugs might run out or be locked away somewhere, they are lacking good, knowledgeable role models who are prepared to challenge existing poor practices. It would appear that small changes have been made - the partogram (chart used for a visual summary of clinical information in labour) has recently been introduced and the midwives have some understanding of how to use it. Since the introduction of the free healthcare initiative pregnant women are attending an average of four antenatal appointments, I think this is a big improvement from what was usual previously, although the midwives find this a challenge as it has significantly increased their workload.

I think one of the biggest challenges to improving the midwifery care here is getting the midwives to believe that they can make a difference, that maternal and infant mortality can be reduced, not just by better equipment and fancy resources, but by being more diligent in the basic care of women. Much of the care described to me was based on the idea of 'this is what we have always done and what we all do', rather than what is actually the best care practice. They laughed at ideas of women kneeling to give birth and looked skeptical about the idea of reducing their episiotomy rate on primips. I am excited to be working as a midwife this year, but anticipate that this is the start of a steep learning curve, not only about the practice of midwifery here but how practice is influenced by the wider culture and beliefs.

One for Roger...

I really love our location here in Sierra Leone. Sarah has done a good job of showing you what our berth is like. We have a great view of the Lion Mountains from which Sierra Leone derives its name. We also have some good local wildlife - particularly a number of kites(?) that spend a lot of time near to the dock. I am keen to get some good pictures of them - these are from my first few attempts. Hopefully over the next 9 months I'll get better ones.

Tommy.

Screening update

This is the press release on the Mercy Ships blog about the patient screening that took place yesterday. The crew involved are shaken up, especially those outside seeing what was going on. Tommy and Sam were involved in the security in front and behind the gate and are still processing it all.

"Posted by Mercy Ships staff on Mar 07, 2011 at 12:11 pm

Mercy Ships is deeply saddened by the tragic events that occurred today during medical screening at the Freetown National Stadium when a crowd stormed the gate resulting in several injuries and one life lost.

Mercy Ships personnel working at the site attended the injured and accompanied them to local hospitals.

"Our hearts and prayers are with the individuals and families of those affected by today's events. The occurrence of this incident in the course of activities intended to restore lives is tragic. We move forward with tremendous sadness, but great determination, to assist as many people as possible in the next ten months," stated Mercy Ships Founder, Don Stephens.

Mercy Ships exists to serve the forgotten poor and has served Sierra Leone five times over the past two decades, also helping establish two land-based health care facilities. For the next ten months, Mercy Ships will be providing surgeries for qualified patients while working alongside the Sierra Leonean Government to support its five-year healthcare plan and strengthen the functions of the national health system.

Please keep the people of Sierra Leone and the Mercy Ships crew in your prayers, not just today but in the months to come"

There is an intensly personal account of the day from one of the nurses at the screening on her blog here.

Screening day

Today is screening day - please remember our crew today as they see the many people who will come in the hope they will be scheduled for surgery in the coming weeks and months. The screening is at the stadium in Freetown a little distance away from the ship.  Tommy was assigned to the security team and so was *lucky* enough to be up before 3.30am to arrive first to facilitate some kind of queueing. The high school students and almost all the teachers have the opportunity to go again to help with entertaining the children with bubbles, balloons, balls and colouring. The little ones are in school on board as usual, I am helping with pre-school today as their teacher is at screening so it should be a fun day. We'll let you know what happened at screening soon, but be praying for the crew today, they will need much endurance for the long day and the intense heat and wisdom to know who to schedule for surgery. Thanks.

slideshow of our arrival in SL

check it out here:
http://www.mercyships.org/blog/entry/the-africa-mercy-arrives-in-sierra-leone