Looking past the inequities

Hi everyone! I (Alana) was able to spend more time on the Labour & Delivery ward at Lewanika General Hospital this past week. This week I was joined on various days by McKinnley, Ali, and Kristen. It was wonderful to be able to teach the girls a bit of what I learned about the unit, the processes and protocols, the staff and their roles, and the intended care during the antenatal period.

This week I was able to engage more with some of the mothers and their family members, as the unit itself was a lot busier than it was last week! On Friday there was not even enough beds for all of the mothers being admitted - and there's already 19 beds and 3 delivery beds! Regardless, the staff seemed to deal with the flow of patients quite nicely, as there was a balance of new admissions and labouring mothers throughout the day. It still continues to amaze me how strong some of these women are. Due to a lack of resources, there really is no option for pain control during the active phase of labour, and the mothers may receive Panadol (equivalent to Tylenol) after they've given birth if they are expressing continued pain. As well, these mothers are having to endure labour basically alone. The staff are there as medical professionals to ensure the safety of the mom and babe(s), but no family members or support persons are allowed on the ward or in the labouring room. This is a great role for us to fill and demonstrate to the staff the comfort measures we like to implement, such as cool cloths and back rubs. It is evident that the mothers appreciate it and the reassuring words that everything will be okay, the baby is coming, etc. I think it's really important for us to recognize that each mother is still a unique individual and will need care and support in her own way. It has been nice to speak with some of the mothers before they are actively labouring, and then connect with them again once they're in bed cuddling their babies. Having these conversations really reveals the inequities in the population in Mongu. You start to see the variations in education (some only up to grade 2, some university degrees), living circumstances (close by, very far away, support persons), and access to food and water. But it seems no matter the differences between these women, they all connect with one another, offer each other their food or extra clothes, and help translate from English to Lozi if they hear us makuwa struggling which helps us with our assessment pieces and helps the mothers receive the care they need.

Many of the supplies we have brought have been put to great use already! I have seen many mothers come in without necessities - baby blankets, hats, and clothes, so being able to provide them with these items has been wonderful. The staff have also been utilizing the penguin suctions for every delivery, and there are enough to properly clean and sterilize each suction between uses which helps promote infection control greatly. I was able to assist in the delivery of twins this week (two beautiful, healthy girls brought into this world by a strong and caring mother). For extra precaution we had the babies assessed by the doctor who has been working in SCUB this past week. He questioned us about their vital signs, APGAR scores, reflexes, etc., and decided to send them to SCUB temporarily just to help warm them up. In this instance, we were also able to utilize the feeding cups we donated to the unit and get the mother to express some colostrum to finger feed to the babies. The head nurse had asked me to make some posters for the unit as well, so this week they received one on the stages of labour and how to care for the mother during each stage, as well as a one on breastfeeding. In a developing country, formula feeding is not really an option as it is costly and not readily available. It also involves adding water, and sometimes heating the formula in a specific way, which can pose risks to the infants health. It was great to see eye to eye with the nurses that breastfeeding should be encouraged and supported in every mother that is able to. This weekend I will also work on a newborn assessment and vital signs poster to put in the primary delivery room to encourage an assessment to be completed asap and have the "normal" vital signs readily  available for the nurses and midwives.

I've really enjoyed these past two weeks in labour and delivery, I've learned a lot and developed trusting relationships  with many of the staff. Next week I will be at Save a Life which will be an entirely different, but I'm sure equally rewarding experience!

Best wishes to everyone reading this - see you soon! - Alana