I was so nervous about today. After months of planning, finding a nanny, finding a volunteer position, getting everything organised, all of a sudden today was here!
I'd only found the article (previous post) a day or two ago, and it was the first vivid description I'd found of what I might expect. Based on that, I was fairly anxious to see what it was going to be like! I certainly learned a lot today, and I know that I have a vast amount more to learn. It was a quiet day by typical standards (usually about 30- 40 births per day, there were only about 5 today), but unfortunately today's stats included a stillbirth and a maternal death....
When I arrived this morning at postnatal ward as directed (relieved to have found the right ward), I was hit by a smell of lots of people living in close proximity. I passed two rooms full of metal framed beds jammed in close together and women and babies spilling over them with blankets instead of any kind of bed linen, and relatives milling around them. There were no curtains or privacy, some women washed newborns in a small hand basin.
I found a few doctors in a small room, and started chatting. They were all very friendly, and we went off to the morning handover meeting together, where I'd agreed to meet the consultant with whom I'd organised the whole thing.
The meeting was a recent case presentation by a resident, and once the consultants arrived, they took great pleasure in grilling him about things he clearly had not asked the patient. In a very PNG way, his colleagues rubbed salt into his wounds afterwards, saying things like "Doctor, I think you could have improved that presentation by taking a better history...". In Australia, doctors do it in a somewhat more subtle way. They try and ask extremely detailed questions of the presenter, thus indicating that they know all of the "basics" of the topic, and really only need to know the specialist level questions. Here they seem to tell it straight.
More telling it straight followed the presentation, when the Australian consultant was talking about a senior nurse who recently died due to complications of diabetes. He stated that diabetes was a problem affecting all of us, and that we should not put ourselves at risk by being fat and unfiit at a young age, then said "I'm talking about you, especially, Tuma. You are too big for a young man, and you don't want to get sick and die". WOW!
Despite being the only other caucasian in the room on the day and at the time and place we had agreed to meet, the consultant seemed to have forgotten all about me until I introduced myself after the meeting. After that, he swiftly escorted me down a maze of coridoors inside and outside connecting buildings in various states of completion and disrepair.
We eventually found the labour ward, and the registrar that I'd be working under, Joy. The labour ward looks very much like we'd imagine an emergency department to look. Cubicles (same size as standard ED cubicles) lined up along a long wall, with partition walls that just come to the end of the bed. Then about a metre in front of the partition walls, a straight curtain rail that runs the length of the long wall. If the length of the curtain rail is x, then the total length of curtains on the curtain rail is x/3. Even if you tried to pull the curtains for privacy, at best you covered a third of the labouring woman. At one stage a random nurse walked past and with a casual glance said "Oh I see the head a little. Baby not far away now". True true. (How PNG is that?!)
As described in the article, the beds are in a state. Foam gaping out under the plastic, ancient bed frames that are difficult to move and dismantle, no linen (only blankets women bring from home, and black garbage bags to catch the mess). All the equipment which we use disposable, pre-sealed versions of in Australia (ventouse cups, amnihooks, clamps..) are reused again and again, soaked in a questionable fluid in between patients. There are no paper towels, so after washing hands all the staff dry them on a communal towel hung off the trolley, which I suspect reinfects them with whatever bugs they washed off the first time! There are sharps containers, but they live at the nurses station and are not in patient bays. The HIV rate is very high. Infection control nurses eat your heart out!
Things that I found encouraging... There were plenty of gloves. Syringes were clean, needles were used and then disposed. Most basic drugs were available, although they had run out of magnesium sulphate (anticonvulsant used for a specific pregnancy related condition common in PNG due to the lack of antenatal care... this is one you probably don't want to run out of!). It was airconditioned - bonus! They at least have pethidine available for pain relief, and do use it on request. Even though I found pethidine to do NOTHING except make me groggy/stoned and in pain, and less able to cope with the pain, I suppose some people think it works and good for them. Maybe it's also a case of any port in a storm.....There is a CTG (monitoring) machine, but this is strictly used for women with meconium stained liquor 3+ (a possible sign of a distressed baby).
So, the very first thing I did was assist at a vacuum extraction (ventouse), where a baby affected by pethidine came out blue and not breathing, not responding to stimulation. I was handed the baby and told to take him to the resus room. When I found the resus room, it was empty except for another extremely small baby lying quietly under the heat lamps on the examination trolley. He was unceremoniously dumped into a plastic baby tub by the midwife, and our still blue still not breathing baby boy placed on the trolley, his head lolling a little as we did so. His eyes were open, staring. He still hadn't made a sound.
Full disclosure. I have never resuscitated a neonate. Truth be told, I have never ever been the sole person involved in any resuscitation full stop. Especially not 5 minutes after arriving on a ward, no idea where the suction was, or the oxygen, or that neopuff bag and mask thingo...
Anyway, this seems like a good enough place to end part 1. I'm exhausted and off to bed! I'll try and finish the rest off tomorrow while Biscuit's asleep.
Nighty night!
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