First team:- midwives – Helena White
photographer – Ryan Moore
It takes a while to prepare for a trip like this. Vaccinations with certificates, passports, visas, address of accommodation, letters of invitation etc,etc… plus all the supplies that we wanted to take with us – in total 180 kg of baby clothes and supplies for the hospital including sphygs, urinalysis stix and clean surplus items from opened sterile packs.
We had a lot we wanted to achieve in a short time frame so we hit the ground running determined to get it all done.
We landed at Lunghi airport in the dark which is always disorientating but added to the African mystery and excitement of a fairly chaotic airport – at least it wasn’t raining! The water-taxi was new so the 45 minute ride to the mainland was much less worrying than on my previous trip – no RNLI if things go wrong! Our friend Julie Tomes had arranged transport for us, with armed guards, to our accommodation – the guards main duty was to stop the mountain of suitcases falling off the back of the truck onto the road but it was our first reminder that this beautiful country was not long out of a savage civil war.
The accommodation was cool and spacious, exactly what we needed to come back to after the busy days we were going to have.
First visit to the hospital. It was smaller than I had expected but busy with beds full and ladies waiting patiently for clinics – some pregnant, some with small children. The main entrance goes straight into a ward so of course the first thing we noticed was the lack of privacy but as we came to realise that is actually a luxury. We were greeted warmly by Dr Virginia George and the obstetric team and had a meeting where we were introduced to everyone and discussed our plans both for the trip and for the Health Link and listened to all their ideas and hopes too. The first case of baby clothes was given and the first bundle given to a lady who had delivered that morning, she was delighted.
First ‘workshop’ at Lumley hospital on neo-natal resuscitaion. We used a doll borrowed from Aberdeen Women’s Centre, a birthing unit run by a Scottish midwife – Jude Holden – and an example that we aspire to for Lumley. The doll came from a teaching aid called Mama Natalie that can replicate APH/PPH and was brown rather than pink which was noted and appreciated by the staff at Lumley!! The teaching session went very well and by the end all the staff were participating and learning with the bag and mask kindly donated from the NNU at the Alexandra. They appeared to have no resus equipment for neonates save for the suction devices we used to used when the head was just delivered. It is very difficult not to start saying ‘we don’t do that anymore beacause…………’ We need to work with these midwives and build a trusting relationship where we can suggest changes in practice that we have adopted due to results shown by research. Sensitivity is paramount and we must also remeber that we have a lot to learn from them too.
We were cordially invited to the College of Medical and Applied Health Sciences in Freetown to participate in a ceremony awarding scholarships, donated by Cardiff University, to school children so they can continue their secondary education. We didn’t realise that we would be asked to actually present the awards and have photographs taken with each child! It was a privilege to do it and make a difference to those children’s lives with such a small donation. The speeches were inspiring and we hope to put one of them on here soon.
We travelled through bush country today to a place called Tokeh Beach. An amazing place. Beautiful white sandy beaches with a backdrop of partially destroyed, burnt out buildings from the war. You can see how fantastic they were – beach side resorts, the beginnings of a tourist industry. But there are people working on new resorts now, big plans for beautiful hotels and leisure complexes, looking to the future to rebuild the country through tourism.
Very interesting day today. Ante natal clinic at Lumley hospital. It was very much back to basic midwifery skills of measuring the uterus to determine the due date, palpation for ? multiple pregnancies, weighing, observing for signs of pre-eclampsia and thanks to our few urinalysis stix a more definite diagnosis. This session highlighted for us the many needs of the hospital and the women. Basic equipment for ante natal care, trying to implement the use of ready made emergency boxes for the delivery room, shelving for easy access to supplies needed on a daily basis etc etc. Talking to Winnie, the matron, in her office we were able to develop the ideas for the Link and assure her that we intend this to be a long term project and relationship of friendship and professional support.
Went into central Freetown today to meet with Dr Kargbo – Director, Reproductive and Child Health Programme, Ministry of Health and Sanitation, mainly to discuss our Memorandum of Understanding for the Health Link and to ask him to approve and sign it on behalf of Lumley Government Hospital. He was a very interesting man. During the war he travelled behind rebel lines to treat and vaccinate young children. He was often questioned by rebels with a gun at his head making his missions incredibly dangerous and as a result is now determined to implement a health system protecting children and safeguarding the future. Foreign aid currently supporting the health system in Sierra Leone will be phased out over the next 5-10 years putting increasing pressure on the Government to have systems in place to continue the services currently being offered and developed. The problem comes when the poorest of the poor are unable to make any contribution to the ‘village health fund’ – what happens then? Are they told that if they don’t contribute then health care is unavailable? Does the first world continue to support the third world ad infinitum? Or do we just stop because enough is enough – we have our own financial crisis to worry about?? These are the dilemmas we are faced with but adequate solutions will be hard to find.
We visited a small local market today and meeting the locals was very interesting. The crafts and batiks they were selling were beautiful. We got chatting and once they knew we were midwives one of the girls took Karen to one side and asked if she could feel her tummy and see if she was pregnant (!), Karen couldn’t really tell but Kathy had a pregnancy test with her (what an efficient midwife!) The test was positive but the reaction was sobering. In Sierra Leone women have a 1:8 chance of dying as a direct result of childbearing – not really a cause for celebration. We wished her luck and will go back to see her on our next visit.
We then went back to Lumley Hospital and delivered another teaching session. PPH – an emergency that the midwives there deal with on a regular basis. Their knowledge of the physiological processess and the emergency proceedure to follow was impressive but they enjoyed the session as we were all in agreement as to the most effective ways of doing things. But again this highlighted huge gaps in the supplies available to them – often no basic IV fluids, no colloids and blood needs to be found from a willing relative or stranger. All this takes time while the woman is haemorrhaging this is why we would like the ladies to be grouped at booking and a possible match to be found and on standby when she delivers – or better still to have a small blood bank at the hospital. Looking at the laboratory equipment was heartbreaking, they had a fair amount there but much of it was incomplete and not working properly so this will also need to be addressed.
We then said our goodbyes and promised to return.