Best night shift I've had, way to end my final week! :) so pleased.
Me and one other volunteer on last night, Niamh (pronounced Neeve) from Ireland and already completed one year of undergrad medicine, with two nurses. Was so hands on last night, admitting patients, checking saline drips and administering IV/IM injections when needed, changing catheters and emptying their bags when full. I tried to be as helpful as I could even with the language barrier and the mums were really patient with us as well.
Such an epic night. Ok first off, many deliveries. I even got to help with a lot of them from holding the head and making sure the cord wasn't around the neck to tying the umbilical cord to cut it, to learning how to deliver the placenta...all with supervision ofcourse. There were three complicated births.
ONE: young mum, having trouble pushing the baby out to a point where she was just quitting trying to and the baby's head was half out. The poor thing had to have been stuck in the vaginal canal for over 10 minutes and green/brown liquid was leaking out from where the baby was excreting...the sad thing was that it was also the same liquid that the baby was probably starting to inhale. The nurses were getting so angry, telling the mum in swahili that if she doesn't keep pushing she is going to kill her baby! But the mum didn't seem to care all that much, the baby finally came out lifeless and the mother stayed as long as she needed to and then wrapped herself in her kanga and went to her bed, she didn't really even bring enough kangas to wrap the baby to keep it warm. Such a shame. So the nurses were trying to resuscitate the baby using the only oxygen machine they had, and a hand held pump that hardly worked right. Often the nurse or Niamh would squeeze the air bag and nothing would come out as if there was a leak somewhere, meanwhile the baby is still not hardly if at all breathing. It was so worrying to watch and super frustrating too because of the tools or lack there of--Niamh and I were getting so involved that if this baby had died because of technical failure, we'd have been so angry! Eventually he did finally breath on his own consistently after about 20+ minutes of working with the stupid machine and chest presses...pump 1-2-3 squeeze.... ended up putting a nasal cannula in after a while. Who knows though how much damage he had :( Named him James!
TWO: The next troubled case occurred during the resuscitation of James, where a premature baby was delivered at five months. The nurses swaddled him with blankets and left him on the table with the other baby but didn't do anything for it. It was so so teeny and wasn't breathing but I felt so bad that they were just leaving it there and not trying to get it to breath. Their explanation is that it is too early and there isn't a chance it will live anyways. But there is a chance! If it can be stabilized and then sent to a larger hospital there is always a hope! So I decided to rub his side just to see what he would do, and then I got a gasp!! I wasn't sure at first but then he did it again after I kept rubbing and my partner Niamh saw it too, we got so excited. She put the oxygen pump on him, sharing it between the new baby and James. I kept rubbing the new baby's sides and started chest compressions and then the gasps, all that they were, came more regularly. The little guy was trying!! We named him Seamus (yes I know it means James too, that was the idea) after about an hour of this, we tried to plead with the nurses to allow him to be taken to the bigger hospital in Arusha town where there is a NICU that deals with premature births. We said that we'd pay for the transport, we just want to give this baby a chance! and the mum and grandma was so worried too, they seemed to actually care. After a bit of convincing the nurses finally agreed and we woke up the night supervising nurse to fill in a transfer form to go. Riding in the ambulance was exciting, going who knows how fast in the middle of the night (about 5 am at this point) and arriving at Meru Hospital in Arusha, took us bloody ages to find the right place once we got there but we did and handed little Seamus over in hopes that the NICU would be able to provide much better care. They intubated him straight away so we just hoped for the best. At least he has the best chance he's gonna get in this part of Tanzania by us delivering him to Arusha, the nurses would have just left him to die at our hospital in Tengeru.
To be fair they do what they can. If they don't think a baby will live, why waste LIMITED resources on those cases? I mean throughout the whole night, we have been using sterile surgical gloves for the smallest things just because the maternity ward ran out of disposable gloves. Just makes you realise that hospitals here really DON'T have a lot, but they do what they can.
THREE: The final complication was when a women came in with twins, one she delivered at home and the other she delivered in the hospital, but the second had come out all white and not breathing...it wasn't going to live, it just looked dead. But the nurses tried their best to resuscitate this one since it was full term, and it just didn't work. Meanwhile another birth happened, so on the table with the heat lamp made for two babies, there were five. It was crazy!!
By 6:30am it was about time to clean up for the day staff, meanwhile another women was starting to give birth. She had been on the birthing bed for a bit of time and I had gotten the supplies ready for the birth: 10mL Oxytocin, pair of scissors, hemostats, cord clip and the kanga. Went to clean and then came back to check on the mum and the baby was crowning! I called to Niamh to come help me cause I was delivering the baby, it was coming now and the nurses were either sleeping or busy. So Niamh had the head and shoulders, it was her turn, and I tied/cut the cord and delivered the placenta. We did it all ourselves!! The nurse came to watch briefly to see that we were OK and then went back to cleaning. Hehehe it was AMAZING!! Such a good finale :D
By 8:30 we finally went home, we were knackered but so so happy that we did the night shift last night. I think I'm going to remember this forever. I learned/witnessed so much!
Me and one other volunteer on last night, Niamh (pronounced Neeve) from Ireland and already completed one year of undergrad medicine, with two nurses. Was so hands on last night, admitting patients, checking saline drips and administering IV/IM injections when needed, changing catheters and emptying their bags when full. I tried to be as helpful as I could even with the language barrier and the mums were really patient with us as well.
Such an epic night. Ok first off, many deliveries. I even got to help with a lot of them from holding the head and making sure the cord wasn't around the neck to tying the umbilical cord to cut it, to learning how to deliver the placenta...all with supervision ofcourse. There were three complicated births.
ONE: young mum, having trouble pushing the baby out to a point where she was just quitting trying to and the baby's head was half out. The poor thing had to have been stuck in the vaginal canal for over 10 minutes and green/brown liquid was leaking out from where the baby was excreting...the sad thing was that it was also the same liquid that the baby was probably starting to inhale. The nurses were getting so angry, telling the mum in swahili that if she doesn't keep pushing she is going to kill her baby! But the mum didn't seem to care all that much, the baby finally came out lifeless and the mother stayed as long as she needed to and then wrapped herself in her kanga and went to her bed, she didn't really even bring enough kangas to wrap the baby to keep it warm. Such a shame. So the nurses were trying to resuscitate the baby using the only oxygen machine they had, and a hand held pump that hardly worked right. Often the nurse or Niamh would squeeze the air bag and nothing would come out as if there was a leak somewhere, meanwhile the baby is still not hardly if at all breathing. It was so worrying to watch and super frustrating too because of the tools or lack there of--Niamh and I were getting so involved that if this baby had died because of technical failure, we'd have been so angry! Eventually he did finally breath on his own consistently after about 20+ minutes of working with the stupid machine and chest presses...pump 1-2-3 squeeze.... ended up putting a nasal cannula in after a while. Who knows though how much damage he had :( Named him James!
TWO: The next troubled case occurred during the resuscitation of James, where a premature baby was delivered at five months. The nurses swaddled him with blankets and left him on the table with the other baby but didn't do anything for it. It was so so teeny and wasn't breathing but I felt so bad that they were just leaving it there and not trying to get it to breath. Their explanation is that it is too early and there isn't a chance it will live anyways. But there is a chance! If it can be stabilized and then sent to a larger hospital there is always a hope! So I decided to rub his side just to see what he would do, and then I got a gasp!! I wasn't sure at first but then he did it again after I kept rubbing and my partner Niamh saw it too, we got so excited. She put the oxygen pump on him, sharing it between the new baby and James. I kept rubbing the new baby's sides and started chest compressions and then the gasps, all that they were, came more regularly. The little guy was trying!! We named him Seamus (yes I know it means James too, that was the idea) after about an hour of this, we tried to plead with the nurses to allow him to be taken to the bigger hospital in Arusha town where there is a NICU that deals with premature births. We said that we'd pay for the transport, we just want to give this baby a chance! and the mum and grandma was so worried too, they seemed to actually care. After a bit of convincing the nurses finally agreed and we woke up the night supervising nurse to fill in a transfer form to go. Riding in the ambulance was exciting, going who knows how fast in the middle of the night (about 5 am at this point) and arriving at Meru Hospital in Arusha, took us bloody ages to find the right place once we got there but we did and handed little Seamus over in hopes that the NICU would be able to provide much better care. They intubated him straight away so we just hoped for the best. At least he has the best chance he's gonna get in this part of Tanzania by us delivering him to Arusha, the nurses would have just left him to die at our hospital in Tengeru.
To be fair they do what they can. If they don't think a baby will live, why waste LIMITED resources on those cases? I mean throughout the whole night, we have been using sterile surgical gloves for the smallest things just because the maternity ward ran out of disposable gloves. Just makes you realise that hospitals here really DON'T have a lot, but they do what they can.
THREE: The final complication was when a women came in with twins, one she delivered at home and the other she delivered in the hospital, but the second had come out all white and not breathing...it wasn't going to live, it just looked dead. But the nurses tried their best to resuscitate this one since it was full term, and it just didn't work. Meanwhile another birth happened, so on the table with the heat lamp made for two babies, there were five. It was crazy!!
By 6:30am it was about time to clean up for the day staff, meanwhile another women was starting to give birth. She had been on the birthing bed for a bit of time and I had gotten the supplies ready for the birth: 10mL Oxytocin, pair of scissors, hemostats, cord clip and the kanga. Went to clean and then came back to check on the mum and the baby was crowning! I called to Niamh to come help me cause I was delivering the baby, it was coming now and the nurses were either sleeping or busy. So Niamh had the head and shoulders, it was her turn, and I tied/cut the cord and delivered the placenta. We did it all ourselves!! The nurse came to watch briefly to see that we were OK and then went back to cleaning. Hehehe it was AMAZING!! Such a good finale :D
By 8:30 we finally went home, we were knackered but so so happy that we did the night shift last night. I think I'm going to remember this forever. I learned/witnessed so much!
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