Vaccine Production Lines

This morning all our purchased bedsheets and gloves, plus surgical instruments (thanks to Anika’s aunt) arrived at the clinic and we received the sweetest handclap in gratitude. We also discovered 2 more volunteers from Projects Abroad were starting at the clinic, a grand total of 6 altogether in our tiny labour ward. To the postnatal clinic! Anyone who knows me will most likely have heard of my dream to vaccinate a production line of small African children from preventable diseases. Today dear friends, my dream came true.

Again, I’m so incredibly impressed at the efficiency and documentation of postnatal care. Women come equipped with health records of their baby’s birth weight and one by one each baby is weighed on a communal set of scales. The midwives then council mothers on their baby’s growth; either congratulating weight gain or reinforcing feeding techniques. Family planning services are recommended to women after their 4th baby I think, and this service is free of charge!

Then there’s the immunization schedule:

·      Polio and BCG (tuberculosis) at birth

·      Pentavalent, a combination of diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenza type b prevention at 2 months

·      Vitamin A and Measles at 9 months

One midwife observed each of us perform an intramuscular injection and from then on we were left to draw up and vaccinate baby after baby. Watching bubs cry has never been more satisfying! My heart also leaps at the thought of herd immunity, by which babies who are unable to receive a vaccine are somewhat protected from disease transmission by healthy bubs who have the privilege. Also witnessed a neonatal screening test and HIV test performed on 4 year old twins Brenda and Belinda; still wrapping my head around the comprehensive screening! HIV neg by the way.

Heading back to labour ward, we heard the suction machine first. Through the wide open door to the delivery room we could see a huddle of midwives bent over the resus table. I had been expecting it, but seeing a flat baby always brings a lump to my throat. With no idea of the circumstance, I navigated my way in and tried to feel a fetal heartbeat at the umbi, but all pulses were absent. Looking around at the midwife 'bagging' the floppy body, I asked if anyone had attempted chest compressions. The midwives looked at me blankly – “what’s that?” Immediately I began chest compressions, instructing the head midwife when to ‘breathe.’ It felt pretty useless, but I really wanted to try as the mama was watching the whole thing unfold. After several rounds and no response, I asked how long since delivery. I was not expecting 15 MINUTES.

Not a word had been spoken to the mother in those excruciating moments. No doctor was present when the head midwife declared “eh, no life!” and flopped the wrap over his porcelain face. “Pole Mama.” “Sorry Mum.” That was the explanation. The baby boy was left on the table whilst clean up took place.

When the doctor arrived, he took one look at the offensive smelling and horribly discoloured placenta and declared Chorioamnionitis, an infection of the fetal membranes. Thankfully this was communicated to the mama soon after. With no words even in English to give to this mother, I stroked her arm before leaving the room. When her husband entered, I heard her wails echo through the clinic. These poor babies, whilst taken home by the family to be buried, are not cradled or even viewed by their parents. All the while the baby lay fully visable to the ward through the open door.

Trying to piece together all the unknowns, I later asked Dr Japhet whether the baby suffered Intrauterine Fetal Death (IUFD) from the infection. No fetal heart had been monitored throughout labour. The doctor assured me that the midwives were aware of the death, but could not explain to me why they proceeded to attempt resus for 15 minutes. This alone breaks my heart. Chorioamnionitis is a treatable condition.

I’m learning to distance myself from the shock, otherwise it hurts too much.