First Day at POM General Maternity Ward... Part 2

(If you haven't already, please read Part 1 first!)

So, after about a minute of fumbling, panicking, finding the suction and starting to clear his nose and mouth, the registrar burst through the doors with the naloxone (to reverse the effect of the pethidine) and showed me where the bag and mask was. She started puffing air into him, and said "he'll be fine... they do this all the time" I said "Really? I like your confidence. He's not pinking up...  Is there a paediatrician? Should I call for a paediatrician?" "Yes, that's a good idea", so off I went, and one of the interns kindly paged the paed, then I went back and continued bagging the baby, who was pink by now, but still not breathing on his own, while the registrar went out to sew up the woman's episotomy. The consultant popped his head in and shouted cheerily "Everything ok?!" I wanted to say that everything was most definitely not ok, but instead  I nodded and smiled "yep, we're all good now", and right on cue the little baby let out a mewl that could have come from a kitten. That baby could not have been even close to 2kg. Of course, Mum had not had any antenatal care, and when she arrived in labour her blood pressure was extremely high, making a condition called pre-eclampsia quite likely. This often stunts a baby's growth because it means the placenta's a bit dodgy. Anyway, the paediatrician arrived, took over, and he's doing very well now.

After the inital excitement, it became apparent that it was (mercifully) a very quiet day on the ward. Averaging 30-40 deliveries per day, there were only about 5 or 6 while I was on shift. Our ward round was typical of any other that I've ever been on. Except the women did not seem like labouring women at all! Our first lady was curled up lying on her side under a blanket. I thought she must be there waiting to be induced, and was just having a little nap. We checked her and she was fully dilated! I can tell you, in Australia most women will let you know about it at that point. Anecdotally, a number of PNG women were telling me that the midwives at the hospital were "bitches" "they won't let you make any noise and if you do, they yell and scream at you to be quiet". That was certainly true. One woman (the one being delivered by vacuum extraction) dared to cry out, and was met by an angry barrage in tok pisin from a senior midwife. Later on the midwives were laughing and said to me "Oh yes, some of our mothers are very inconsiderate. They come in here shouting and yelling, so we tell them all to be quiet". Needless to say, there were no birthing balls or bathtubs.

My colleagues were lovely. Very friendly, helpful and extremely tolerant of my obstetric and tok pisin rustiness. The poor resident was nearing his 36th straight hour of work. In PNG they still run to the system of the bad old days, where the doctor works a full day, is "on call" (aka working bloody hard!) all night, and then works the next full day. Another doctor has just dropped off the roster, so now they are "on call" every 4th night. He was still extremely helpful, and even quizzed me in tok pisin history taking vocabulary during his lunch break.

What stood out to me (but was not greatly surprising) was how few women on our ward round had received any antenatal (pregnancy) care at all. Just before I'd arrived, an un-booked woman delivered twins - SURPRISE! But of course, it's not all sunshine and lollipops. A young woman, only 21, arrived late the night before in labour but had been bleeding since early evening. I'm not sure exactly how things went down, but they found she had a major placenta praevia, which means that the placenta implanted directly over the opening of the womb, and as her cervix started opening up, the placenta was bleeding. They took her off to c-section and got the baby out ok, but they couldn't stop her bleeding, and she died on the table. If they'd known about it in advance, it's quite likely her death would not have happened.

Part way into the ward round, they brought her body into one of the cubicles (zero privacy) and soon after her family came in and began wailing very loudly and crying out for her. It was really awful. While we were listening to the young girl's family cry, we continued the ward round, and met with a 20 year old mother who had just delivered her second child stillborn overnight. She had attended antenatal care only twice during the pregnancy, during which it was discovered she had a haemoglobin (oxygen carrying component of blood) level of 50. That is less than half what it should be, and well below the level at which we would do a blood transfusion in Australia. However, she did not take her medication or attend follow up appointments, and when she arrived at the hospital in labour, the baby had no heartbeat. Very very sad, and again, possibly preventable.

I'm not 100% certain, but I believe the general hospital and some other clinics offer antenatal care for a nominal fee of 1K (about 40cents) per visit. I'm not sure if the problem is transport, finance, or lack of knowledge of the benefits of pregnancy care. In any case, the consequences are tragic.

Lunch time was fun. I had lunch with the midwives in their tea room, as most of the doctors went home for lunch. After some inital shyness they soon peppered me with questions about what it was like in Australia - from what the hospitals were like to the price of groceries. Then, one of them asked me (after briefly conferring with the other three ladies) "We were wondering, are you fully Australian, or are you of mixed heritage?" "Mixed?" "Yes, you know, half PNG?". I laughed a little too hard. Not because of the question, but because this is now the FOURTH time I have been asked it since we arrived. "No...." I mean, I can't even offer an excuse. I am completely baffled as to why I am continually asked this question. I can't even say "Oh my grandfather was Greek and that's why I'm a bit dark" because he wasn't and I'm not! I have blue eyes people!!! I think it would be awesome to be of "mixed heritage", generally more attractive, to have a culture to be connected with, and be able to get a killer sun tan. But I'm not and I don't and WHY DO PEOPLE KEEP ASKING ME???

Ahem, moving right along.

Things stayed quiet after lunch. We mostly chatted, the registrar and the resident were both amazed to hear that in Australia women get their own room and their own dedicated midwife - in the public hospitals! Their jaws dropped when I told  them we have portable ultrasounds on the wards, every room has a CTG machine, most rooms have a bath for pain relief, and there is a computer in every room for us to complete patient notes on, check blood results etc. They could not believe that all these services were offered at no cost at all to the woman. And the fact that most fathers attended the birth of their baby - No! Really??


Just before it was time for me  to leave, the resident and I went around and checked the women who were still lying in their beds, silently in labour. A woman having her eighth baby lay in bed, grunting and pushing quietly, fully dilated. After watching for a while, the registrar came and said "she's not going anywhere fast, baby seems a bit stuck. We'll wait half an hour and if the baby's not out we'll do a ventouse" I didn't realise that when we walked away, the midwife also walked away. About 15 minutes later, I walked past and (thanks to the lack of appropriate curtainage) could see that she was pushing away completely alone. I threw on a pair of gloves, grabbed some gauze pads, stood next to her just as the baby's head came into view. Then I got to assist in something you rarely get a chance to as a junior doctor in Australia - a normal delivery! And because there was no-one else there to do it - unheard of!

Anyway, I really loved the experience of yesterday, and I'm looking forward to going back tomorrow! I'm interested to see what it's like on a busy day, and what we do then.

Of course, Nini was very happy yesterday with our fantastic neighbour Lou, who took her early in the morning, and Lou's little boy Lachy. Nini and Lachy are best mates, and they run around chasing and kissing each other whenever they meet up. Then Mary came and picked Nini up from Lou's, and the fun continued. They read stories, cooked some brownies, went to the playground with all Nini's friends and then drew some more chalk pictures in the car park. Last night as I was putting Nini to bed, she removed the dummy from her mouth and said "Nini Yockie fun playgrount" "You and Lachy had fun at the playground today?"
"Yeeeeess! Wooooooow! Fun Nini Yockie!"

I'm so lucky to have such wonderful people that I know will look after Biscuit so well while I'm away!

Thanks everyone for all their support and kind words on facebook and in emails. Thanks to Sarah and Rachel who sent me helpful guidelines and protocols - very much appreciated - as well as everyone who's offered to find some supplies. I'll keep my eyes peeled and ask the other docs what they reckon they need most, and then I'll see if we can sort something out, but again thank you.

Obviously I don't think I'm here saving the world or anything, I'm just helping out at a busy hospital a couple of days a week. And it's not like I'm living in a tent in Somalia while I'm doing it. Compared to my friends who are doing it tough in Haiti, this is a total picnic, so don't think too highly of me, please!

Anyway, thanks to everyone for reading! I'll try and keep up the posting semi-regularly this year, it's one of my resolutions.

Have a good one! :)