Double trouble

Photo of the week

Highlight of the week: We have recruited 200 people into our stroke prevention programme so far this year.

Lowlight of the week: Our hectic schedule stops us from having an early morning game drive this week.

Maximum temperature: 36 degrees Celsius

Rainfall: One drop rain - literally

Spoiler alert: If you are of a squeamish disposition please sit down before you read on.

I am full of admiration for Obstetricians and Midwives. Caring for 2 lives at the same time. What may be good for one life can be bad for the other. A juggling act. Finely balanced. Emotions run high. Minutes count. Decisions last a lifetime. As a paediatrician, I can only work with the baby delivered to me. I stopped doing neonates in 2004. Opted out. Of having to stand by empathetically pushing with the mother. Sweating with the midwife. Heart racing. But my adrenaline was helping no one.

I would urge the baby to appear. The cord to be cut. Then my adrenaline would serve a purpose. A well drilled sequence of events would unfold. Resulting in a baby that could breathe and thrive. Neonates was never my thing. I prefer my babies dry and clean. And more than a few hours old.

Thankfully, having babies out here is usually run of the mill. But when the sh*t hits the fan there are protocols in place. Skilled staff. Good equipment. We are thankful for this, as babies keep being popped out. Thick and fast. Mothers often too young. Too many pregnancies for some. Four children seem to be the accepted number at present. But many families continue to plough the historical furrows. Hungry mouths to feed. Clothes. Education. The usual demands of parenthood. Multiplied.

A lack of contraception at present is leading to consternation. A population explosion in the making? Women are the losers in all of this. Contraception is unavailable for young girls. The morning after pill absent in our clinic. And beyond the budget of many schoolgirls from the local pharmacy.

Pre-marital sex is the expected thing for boys. But frowned upon for girls. A social inequity.

14% of our population are HIV positive. Negativity is our holy grail. We preach the options to the unconverted: One partner; condoms; circumcision. Each worthy and proven. The former seems impossible for some. Condoms, free but not selling like hot cakes. Male circumcision, wise, but often too late.

Hormones cause our young people to mix a little too closely. Despite the lack of appropriate precautions. So, they come to our clinic in their droves. With drippy willies. Unpleasant discharges. Pain. Ectopic pregnancies. Pregnancies. Infertility. Chronic ill health. All consequences of an unplanned rumble in a darkened place. A sexual health catastrophe. Borne from lack of education or bad planning.

Our maternity staff are pretty self-reliant. They don’t trouble us much. Our indemnity doesn’t cover us to work in this litigious, double jeopardy, specialty. Of course, as good Samaritans we can pitch in. But horses for courses. We have other fish to fry. Maternity clinics are always busy. Lots to be done. All women get HIV and syphilis tested. Dated. Weighed. Blood pressured. Educated. 8 prenatal visits as standard. On Fridays they get up and dance. Their clinic area is never quiet.

Last year we had a heart-breaking experience. Too raw to write about when it happened. Still devastating to us now. So, I will not be too graphic:

We are at Nyamununga. A beautiful tree clinic. We sit beside a baobab tree, that lies at 45 degrees. A thousand years old, but not destined to outlive us. Keith is told of a lady delivering a baby unexpectedly. Nearby. But the baby is stuck. Keith runs off to investigate. And finds her in a long-drop toilet area. Sita is indeed trying to push her baby out. But the baby is breech and trapped. The head wedged in an oh-so-small space. Sita and Keith also wedged in an oh-so-small space. The midday sun searing down and lighting the impossible dance. The image is still etched on Keith’s retina. To this day. The baby’s head unwilling to show itself. Keith tries a couple of manoeuvres. But without stirrups or an episiotomy kit, his options are limited. Please bear in mind that this is the first birth that Keith has attended in 30 years. This is not his day job. So, he phones a friend. Kaseba, our lead midwife. She talks Keith through his next play. But the play book is missing some vital pages. And the stalemate stays stale.

Keith mobilises the flying squad. Oh, that’s us. He realises. We have the only vehicle in town that can serve as an ambulance, supported by medical personnel. Somehow, we load Sita, her half-born baby, and an entourage of family and friends, into the back of our Blue Beast. A cloth chitenge to shield Sita and the babe from the unforgiving sun. The Beast negotiates the rough and circuitous alleyways that head vaguely back to our clinic. Doubtless the swinging of the Blue Beast’s axles also shifts Sita’s pelvic bones to nudge her babe towards the light. We hope.

Ten, too-long, minutes elapse. We arrive at the clinic and carry Sita into the delivery suite. Stirrups. Kaseba’s knowing gaze. Sita finally lets go of the babe.

Within 5 minutes Kaseba expertly delivers the baby. The baby is blue and floppy. Airway opened. Inflation breaths to the lungs. To my surprise, within 3 minutes we have a good heart rate. But the baby remains floppy and unresponsive. After 10 minutes with no breathing effort, we stop. We have no neonatal intensive care facilities here. This baby might have survived in the UK. Full on intensive care. Drugs. Ventilation. Cooling. But the baby’s brain function would likely fare poorly on any continent.

We wrestle with the aftermath. A grieving mother. A devastated family. A maternity service reeling from the avoidable loss. Sita knew of the breech presentation. She was 39 weeks pregnant and in tiger country (sic – we have no tigers here). Her labour started the previous night, yet she still declined to head to Kamoto, or even to Kakumbi. What might have been the reason for her bad choice? Perhaps she had lions on her doorstep? More likely elephants. But there is an elephant in the room, as we sink into our own states of despair. No one can talk to Sita about her bad decision.

Sita at least survives. But she buries her babe.

So, we let maternity do what they do. And we remain thankful that the majority of expectant mothers follow the advice that they are given. Home delivery is not on the menu. Breech babies are catered for at Kamoto. When the stakes are high, expectant mothers need to be in the right sort of mess. And even plain labours need to be supervised under the watchful eye of a maternity guru.

Update on stroke prevention programme.

We continue to devote most of our afternoons and weekends to the stroke prevention programme. We have now recruited 350 local people to the programme. That makes it over 200 newcomers since we returned here in June. We have screened staff at local NGOs as well as camps and lodges. Project Luangwa, Tribal Textiles and Chipembele for example. We have also started up a blood pressure and diabetes clinic at the Kakumbi Health Centre. Keith is currently training the staff. They use a protocol. Low dose medication and lifestyle changes are de rigueur. Your money has gone towards training costs, medication, and the Nyanja website. Any further donations will be gratefully received.

Donating to “Reduce Stroke”

Dear supporter,

Thank you very much for considering donating to reducing the chance of heart attacks and strokes in South Luangwa. Project Luangwa has agreed to receive donations for this programme, and this can be done by bank transfer to UK bank (details below). If you are making a donation to this project, please add the notation Reduce Stroke to the payment, in order to help us track it. If you would also like to send an email to ian.macallan@projectluangwa.org then this will also be very helpful.

Thanks again for your kind support.

Metro UK Bank Account Details

Metro Bank PLC

 Account number: 21201928

 Account Name: Project Luangwa

 Sort code:  23-05-80

Swift code:  MYMBGB2L

IBAN: GB88MYMB23058021201928

Bank Address:

Metro Bank Plc,

One Southampton Row,

London

WC1B 5HA

Recipient Address in UK:

Project Luangwa

 George Fentham Meeting Room

 Marsh Lane

 Solihull

 United Kingdom

 B92 0AH

Glad we did not get between these 2 males

Necking giraffes - teaching a young male how to fight

The gardener came early today