Monday, March 31, 2014

A Wonderful Week on Maternity and Post-Natal!

      When I was asked to list my top three preferences for clinical placements at the beginning of this trip, maternity was not one of them.  I’ve never found the whole labour and delivery process to be very magical, and I saw newborn babies as screaming bundles of poop and involuntary reflexes rather than bundles of joy.  I preferred pediatrics, where I can enjoy the transformation of these little bundles into real live human beings.  

Lo and behold, as my second clinical rotation of this practicum, I found myself being assigned a split mat-peds week.  But to my surprise, Aryn and I ended up spending the entire week on the maternity ward!  The learning there was so rich that it just didn’t make sense to limit it to only a few days.

There have been many posts about Zambia being a low-resource country; where supplies and resources are replaced by necessity and creativity.  However, my week on the Lewanika maternity ward showed me that you don’t always need supplies to deliver quality care, wherever you are in the world.  As an experienced “baby nurse” once said: “for the most part, these are well women coming into the hospital to do something they’ve been doing for thousands of years.”  In high-resource countries like Canada, laboring mothers are often surrounded by a team of specialized health care professionals, who are monitoring mom and fetus constantly and are ready to intervene at the first sign of trouble or delay.  Based on my experiences in Zambia, I think that some of this close monitoring could improve the maternity care here, but I also think that high-resource countries could also learn something from low-resource areas...     

This week, Aryn and I participated in a C-section of twins!   After the surgery, the mother was returned to the ward with her babies.  They were placed in the “acute bay,” where the sickest patients are usually placed.   Aryn and I returned to the floor about an hour after they had been transfered.  When we arrived, we assessed the mother, and we found her drowsy, weak, and difficult to rouse.  Our nursing-gut alarms went off immediately.  Her blood pressure was less than half of what it should be.  This was a big deal.  Using our best “you need to come NOW”-voices, we rounded up the doctors and anesthesiologists who had been involved in her surgery.  In a flurry of adrenaline and sheets of paper, the patient was somewhat stabilized.  But the situation made me think - how long had she been in that state?  How long until someone would have noticed?  Even without a single supply, an experienced pair of eyes can detect when someone is going downhill.  It’s just a matter of looking.  There’s certainly no shortage of experience on the post-natal/maternity wards, so I think using that experience as a resource to assess patients early and often could be a cost-efficient, sustainable way to improve patient outcomes at Lewanika.

On the other hand, being on a Zambian maternity ward has highlighted how intervention-crazy we are on Canadian L&D wards.  Besides a tool to cut the cord, healthy births really don’t need any medical supplies or interventions at all.  Hormones and muscle power tend to take care of the rest.  One night at Lewanika, there were 10 births between 2 midwives.  It might be out of necessity, but maybe it’s cultural; either way it seems as if the perception is that healthy human mothers are fully capable of delivering babies.  The calm, cool, and collected midwives of Lewanika assist the mothers through the process.  Giving birth is a painful, exhausting process for the mother and I think that health professionals in high-resource countries often take too much credit for it.  Health professionals don’t deliver babies, mothers do.  

- Darien 

This week was my first week in the hospital. Last week I had the privilege of starting my Africa practicum at the Save a Life Center. Transitioning to the hospital was nothing short of terrifying for me. After hearing the experiences of the girls last week, I felt completely unprepared as a nurse. I have never had to resuscitate a neonate and the thought of potentially doing so scared the daylights out of me. Anyone who has worked with babies can understand how fragile and sensitive these little buggers are. This week I realized on the ward how ‘resilient’ they are - or how resilient the professionals on the ward think they are at least...

  I’m not disregarding the care that the physicians show on the ward, but I do think there is room for improvement. During rounds on the ward I found the largest focus of the assessment on the mothers, with minimal focus (in my eyes) on the newborn baby. I guess when I think back to the care that we give in Canada, physicians are doing more of an ‘observation’ assessment than us nurses. Maybe there was some piece that I was missing throughout the day that the babies were receiving more attention than in the morning rounds. Something I have noticed while working in the hospital is that the families of the patients do all of the personal care, bring in all of the food/water/tea and are expected to be there for their family members. Maybe it is expected that your family is supposed to guide you and your newborn baby in the right direction. Maybe I was being paranoid and all of the babies on the ward were actually perfectly fine. Like I said before... to me, babies are fragile, sensitive little buggers! 

One specific story that stood out to me was with a patient who had an incomplete c-section incision. The incision had resulted in two different fistulas for the mother and in turn an infection had festered. The first day I met this woman she was having a cleaning and a dressing change on her wound. They took her into the ‘treatment room’ and put her on the table. They proceeded to pour hydrogen peroxide and iodine into her open, quite deep, wound. I sat there at first and watched her cringe in pain. Without saying a word, or moving her hands from squeezing the bed above her head. I couldn’t take it any more. I went up to the head of the bed, grabbed her hand, and told her to squeeze as hard as she could for as long as she needed. I proceeded to comfort her and tell her how strong she was being for the amount of pain she was pushing through, analgesic free. As I was leaving later that day she waved me over to her and she asked, “Will you be here tomorrow for my treatment?” I assured her that I would be. This moment was the highlight of my week. All of our ‘feelings’ classes that we had gone through in the past four years finally came to use! This is one area that I believe the nurses and health care workers that I met with this week could be stronger at. We have been told over and over that ‘being tough’ and ‘not crying’ is a sign of strength in Mongu - but what strength is anyone gaining from a stone cold nurse or doctor at a patient’s most vulnerable moment. Nobody had expressed to this patient the current procedure or the projected plan. She had expressed to Darien and I her fears in which we then made a point of answering her questions with the best of our knowledge.

This week wasn’t all doom and gloom. For goodness sake, we were a part of a delivery of twins! Darien even caught the second baby! We watched an SVD and were able to experience a smile on a mother’s face that is only had at the sight of a first born child. Rounds with the doctors was a wonderful learning experience. They tested our knowledge and challenged our answers when we were second guessing our confidence. 

I’m grateful for my week on the Maternity and Post Natal ward! And once again, just when you start getting comfortable, change occurs! Looking forward to the Sefula clinic next week with Robyn!

- Aryn 

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