First Baby!

Orientation day! A grand total of 18 of us were starting placement so we had a great group of Aussies, Canadians, Americans and Finnish to learn the happenings of Arusha with. Without trying to scare us, the directors shared stories of muggings, robberies, prostitution and bag snatching. Way to reinforce the safety vibe. After handing over our $500 work visa – carazy corruption in the government – we headed out for a walking tour of the city.

Despite enduring the scalding sun rays on my poor hat-deprived face, we trekked through the dirt road streets dodging vans, buses and motorbikes. I’m still getting lost every time I go there, every shop seems to sell the same selection of drinks, clothes modeled on exorbitantly wide hipped manequins and cell phones. Highlight of the day was discovering Shopright, equivalent to WalMart bearing the slogan Pay Less, Get More. Filled with delicious western foods, my chocolate cravings will be satisfied.

Also experienced our first taste of the Massai markets and 'overwhelming' does not do this place justice. The souvenirs seem mass produced, and matched with keen salesmen who corner you in their pokey shops. I’ve taken to walking down the aisles and streets avoiding eye contact and yelling POA! over and over in response to MAMBO! (how’re you doing? cool!) These guys all want to know your name, where you’re from (KANGAROOS they all cheer) and perform this interrogation whilst holding your hand. Again, no personal bubble here.

Had my first experience of a dala dala too, a form of transport for locals which involves cramming a van which seats 12 full of about 25 people plus goats and maybe some chickens. The ticket master per say hangs out of the van whistling at people to get their attention and mob you to receive the 30cents for the ride.

We left the group to hunt for an internet stick, and 3 of us ended up wandering blindly around town for an hour. It’s almost comforting to know that wherever you go, there will always be dozens of smooth talking men ready to assist you in a pinch!

PLACEMENT

Filled with anticipation and trepidation, Anika and I were escorted to our first day of placement at the local maternity clinic. The head doctor gave us the grand tour, and I have to say I’m super impressed with the variety of services available. Not only does the clinic contain a labour ward, delivery room and under 5 clinic, but a concrete square for postnatal checks and weighs and a family planning clinic. We were told proudly that out of the 213 babies born to HIV mothers, 99.8% of babies were not infected, so positive!

Stepping into the labour ward, I was again overwhelmed by the large room containing 18 beds, most supporting laboring, silent women. Not a relative to be seen, the women lie on their sides and shake their wrists and slap their thighs, yet not a moan escapes them.

Quick comparison outright.

Autralia – one on one care, Tanzania – 2 midwives to the entire ward.

Australia - single room, Tanzania -  crowded ward.

Australia – Labour support people, Tanzania – laboring solo.

Australia – Encouraged to keep active and walk, Tanzania – flat on back.

Australia – Sterilized equipment, Tanzania – cloth wiped will suffice.

And these were the blatantly obvious. I’ve quickly realized that the role of the midwife is to birth the baby and c’est tout. Women are left to labour without support, and any yelping is addressed quickly with a clap and stern shushs, “Shut up, you’re disturbing the other patients.” Forget breastfeeding support, mothers are expected to deal with any baby issues themselves – the lactation consultants back in Aus seem so very luxurious! We came across a woman who had suffered a postpartum haemorrhage, and we asked the midwife if she was being observed. “Of course she is,” we heard, “every four hours.” After a haemorrhage. Naturally.

Sorry to bombard you with gory details but you are reading the blog of a midwifery student here. Perineums are all often classed as intact regardless of grazes or even minor tears. VEs (Vaginal Examinations) are performed without lubrication and consent.  Anika and I witnessed a lady brought into the delivery room to be examined, roughly examined and told to return to bed. Unsure of my place and overstepping cultural boundaries, I simply held her hand through the procedure, helped her carry her belongings back to her bed and gave her a quick squeeze whispering to her “you’re doing so well.” I know she didn’t understand English, but got a smile out of her. Words of comfort go far here when the health culture is so rigid.  

On I go. I was shocked to find that women have to bring everything they’ll need to the clinic with them. Sure you think, baby wraps, maybe even food. Water and sheets for the labour bed? A little harsh. Baby cord clamp, oxytocic medication (used to assist the delivery of the placenta) and syringe to administer this medication? Astonishing. I was curious as to whether women could even afford this, and the consequences of not being equipped. As it turns out, the wrist portion of rubber gloves makes an excellent substitute for a cord clamp. Off the floor I kid you not.

Speaking about these gorgeous babies, I asked the midwife if I could do some postnatal observations on the new babies. She simply laughed at me and told me that it was now the job of the mothers to observe their babies, no baseline obs necessary. I should have known since I never saw a single Fetal Heart Rate performed at any point – not in labour or when pushing. How midwives have any indication of complication is beyond me.

THIS IS THE GOOD PART I PROMISE – DELIVERY OF AFRICAN BABY NUMBER 1!

Anika and I soon learned that to get involved, we had to be assertive and get into the action, therefore stationing ourselves in the delivery room. A lady was on the table (so narrow I was so scared she’d roll off) about to push whilst another lady in early labour was examined on the next table in full view.

Keen to assist, I donned my gloves and planted myself in the action so that the midwife allowed me to accoucher. Suddenly, a head was out and the midwife instructed me to pull, no contraction. Thankfully, bub arrived quickly and safely; a gorgeous little boy. The midwife insisted we weigh him right away (because who new what the weight would be in half an hour?) so poor mum was ignored whilst bub was found to be a healthy 3.53kg. Anika expertly wrapped him, and the midwife instructed her to draw up and administer the oxytocic, leaving the baby abandoned on the counter. Chilly in only 1 thin cloth, I proceeded to hold him for the remainder of third stage, in which Anika delivered the placenta by active management used routinely here.  What an experience, excited for what new bubs tomorrow will bring.