Reality check

Last week I was very busy on the delivery suite and at the weekend I travelled to Liwonde safari park which was a very welcome break!

The labour ward is very different to what we have in the UK. The ward is divided up into 6 cubicles that are large enough for a small bed and a little walking space either side! There is no such thing as privacy on the ward, which I found quite shocking. You are able to stand in one bay and look over to see what is happening in the others… However I soon discovered that quite often there are only two midwives on duty and the ward could be full and therefore they need to be able to easily see what is happening with everyone. I found quite quickly that I had to stop trying to compare things to what I am used to and just go with what they have. The midwives here work very hard in a very poor resourced area and they really do try their best. I think as an outsider its easy to come in and see where things can be improved but its important to first understand why things are being done the way they are. I had a very interesting week that involved lots of births including two breeches and twins! 

They do not have an obstetrician where I am working so the midwives do everything… its great!! I managed to do lots of promoting of delayed cord clamping and skin to skin which made me feel like I was achieving something even if it was just with my women… for now.

Friday afternoon one of my worst fears I had coming here came true. Sadly we lost a mum. I knew it would happen at some point and with such a high maternal death rate it was inevitable. However that does not make you any more prepared. It was horrible. We did everything we could for her but it wasn’t enough. She left behind a 10 day old baby who will now be cared for by her husband and extended family.

It really reiterated to me the highs and lows you experience on a maternity unit. I was so happy that I’d had very positive outcomes with all my births. I was actually having the best week ever. But in an instance that all changed. The most frustrating thing is if the right resources had been available the outcome could have been very different. But that’s a very big if. It brought me back down to earth. I am in Africa and the situation here is not good. The focus is on maternal and infant mortality for a reason. Volunteers are really needed here. I just hope I can make a difference! 

I was very glad to get away at the weekend to somewhere so tranquil. It gave me some much needed time out to reflect. We saw lots of hippos, which are supposed to be one of the most dangerous animals in Africa… but I think they are quite cute! We also saw lots of elephants, baboons, waterbuck and wart hogs or as our guide referred to them, Pumbas! On our way home we stopped off at a market where people selling their fresh produce surrounded our van. It was great I did all my shopping through the minibus window! I arrived home Sunday evening recharged and ready to face the week ahead!!

 

A whole new world

Soooo much has happened since my last post and I am only two weeks in…. I have been all over the place and I am still sticking to the plan of just taking it as it comes!! The highs and lows really do go from one extreme to the other… I wasn’t really prepared for that. In all of my preparation to come away I knew how important it would be to make connections with the volunteers already in country… now I am here I realize not only is it important it is a lifeline! I really don’t know what I would do without them! Arriving not only into a new country but a whole new culture alone is SCARY!!! Nothing-here works as it does in the UK people’s attitudes to everything are so different. I am so used to having an order to doing things that allow me to be most efficient. Those of you that know me know I am not always the most organized person…. Compared to here I’m a control freak!!! Its fine and I can go with it until I need to try and get something done, then it’s frustrating. Its funny though because everything works out just fine… people just don’t seem to get too stressed maybe I will learn a thing or two!!

One top tip that I have learned the hard way, do not bring travellers cheques to Malawi. No where will cash them!! I eventually managed to talk to someone (after being sent from piller to post) that allowed me to pay them into my account… but it will take 3 weeks to clear..grr. However my UK bank card works perfectly well here so I actually would have been better to leave the money where it was and withdraw it, rather then making a last minute dash to the bureau de change at the airport and being stuck for cash week one… That was probably my moment of feeling most vulnerable. New country, no access to money…shit! But an angel in the shape of another volunteer came to my rescue… like I said a lifeline!! Lesson – never travel without your debit card and never rely on traveller’s cheque!!

My meeting with the Malawi Nurses and Midwives council was very interesting… the lady I spoke with didn’t really understand A. that I am “just” a midwife and B. That I could be a qualified midwife without ever doing a ventouse….. Midwives here are expected to carry out ventouse births, breech births (yay) and there is no such thing as a forceps birth!! After a very interesting conversation I managed to convince her that I am indeed a qualified midwife!! She then informed me that I would be able to complete my orientation at Nkhoma district hospital. I will spend 4 weeks working on the maternity unit to obtain my MNMC registration.

My new home

Arriving at my new home in Nkhoma was definitely a high. It was above any expectation that I could have had. It’s a beautiful old colonial house set up on a hill with beautiful views. I am sharing with two other VSO volunteers who have been amazing in helping me to settle in. We have a massive garden with an impressive vegetable patch that some previous volunteers put a lot of hard work into, very grateful to them!! We are lucky as we can get all of our fruit and vegetables from the garden, which makes a huge difference when living on a volunteers allowance.

The college is also very picturesque! There are 3 classrooms, a relatively well-stocked library and an amazing skills lab that I cannot wait to get my hands on. Very exciting!  

The college

This week I spent some time getting to grips with the curriculum at the college. We currently have 75 first year students and 49 third years. We don’t have any second years due to financial problems. The students here train in both nursing and midwifery. The students that I will be teaching train for 3 years to become Nurse midwife technicians. They do two modules of midwifery theory and practice in their third year. I have learned that these students obtain a certificate upon passing that is only recognized within Malawi and which doesn’t recognize the students as “professionals”. This is because Malawi as with a lot of African countries face the problem of training nurses and midwives that will go on to leave the country and work abroad. The nurse midwife technicians are then deployed to areas where it is felt they are needed. 

A classroom

A key focus here at the moment is on maternal and child health. The maternal mortality rate is still very high at 675 per 100,000 births. There is currently a debate around converting the qualification so that the students can be recognized as registered nurses/midwives, which is a Bsc qualification. It is all very difficult to get to grips with. It seems bizarre to me that the students train for so little time in midwifery when it is one of the areas where the skills are most needed. I am definitely going to have my work cut out!

The library

 On Wednesday we travelled back to Lilongwe for a conference aimed at “valuing nurses and midwives and the role of international and local volunteers in improving health service delivery in Malawi” It was a very positive conference that brought together leading organisations and volunteers to discuss all manner of issues surrounding Maternal and child health and what is being done in order to combat such issues. It was really good to see that the problems that are being faced in Malawi are being recognized and that people are working very hard together in order to try and bring about positive changes.

The conference

It was at this conference that I got to meet the other VSO health volunteers from across the country. All of who were very welcoming. I was particularly excited the meet the only other midwife volunteer currently in country with VSO we had a lot to discuss!! Unfortunately though my time at the conference was cut short as the next day I was taken sick with a very horrible bug that resulted in me being admitted to the hospital and missing the second day of the conference… I had rather hoped my first hospital experience would be as a health care provider rather then a patient but hey! It was very interesting to observe the different ways things are done. I’m sure the private clinic that I was in is not much of a comparison to where I will be working. But it was a gentle introduction to how basic health care facilities here are. Now I am well on the mend and preparing to start work at Nkhoma hospital tomorrow. Where I am sure my eyes will be opened even wider!!

From London to Malawi

Landing in Lilongwe

So I arrived early afternoon yesterday after a very long journey which was relatively uneventful – I think that’s a good thing! I met a lovely Lady from Somalia on my flight from London to Nairobi. She was 74 and has had 9 children!!  We had 3 seats between the two of us so had a very comfortable flight! She insisted on immediately teaching me some Swahili, here in Malawi they speak Chichewa but learning wasn’t optional so I politely participated. I’ve learned already that it is much easier to go along with things then to try and justify why they are not necessary. She quickly took it upon herself to look after me and make sure I was comfortable. She had a very sweet nature and for the duration of the flight we became firm friends and parted ways with well wishes and hugs! I will always be grateful to her, boarding the flight I felt so sad to be travelling alone for the first time and leaving home, but she quickly had me laughing and back to my normal self!! After parting ways I went on to board my flight from Nairobi to Lilongwe.

When we were descending into Lilongwe I eagerly looked out of the window for my first view of the big capital….. it never came instead we landed in what I can only describe as a baron field with a runway. My first thought was OMG this must be some kind of cruel joke, but then for the first time it actually hit me, I am in Africa…Shit!

The airport was the smallest I’ve ever seen but as I later was informed the largest in Malawi!! I was soooo happy when I exited the airport and quickly spotted the VSO sign and Daniel one of the VSO employees. I have never felt so relieved. We had only had brief email contact prior to my departure but honestly you would think I had known him my whole life I was that happy to see him! Its funny how even the smallest amount of familiarity becomes so important when you are outside of your comfort zone!! 

So as we drove back to the VSO country office I was given some lessons on life in Malawi. I discovered that Lilongwe is divided into numbered areas and that I would be staying in area 10. This seemed important to learn for navigation purposes but when I learned area 10 is next to area 43 and there is no system to the numbering so I gave up. I have learned to just go with it very quickly. Nothing makes sense yet, but I’m sure in time I will begin to understand a little more.

The garden at VSO Malawi

After a short (hot) drive and a quick stop off to collect some keys we arrived at VSO Malawi, quite different to the VSO offices I have visited in London! Big iron gates, high walls, an electric fence and a guard…the words prison sprang to mind however I think its more to keep people out then people in… I hope!!

By the time I arrived I was completely desperate for a shower so jumped at the opportunity to do this straight away while lunch was prepared. Showering was an interesting experience. At first the water ran brown… but after a while turned clear. Then I noticed a huge daddy long legs (or African equivalent) in residence directly above my head and he kept moving threatening to come down on me. It also looked like it had some kind or large stinger, but this could have been my imagination running away with me! My shower was brief and not as refreshing as I had hoped with frequent threats to the spider to leave me alone and strong instincts to run away. When I was done I made a sharp exit and realized I had actually flooded the entire bathroom oppps, but a small victory for me the girl who is petrified of 8 legged beasts! Maybe this won’t be so bad.

Terrifying

Queue lunch. I felt a naïve momentary sense of excitement when I learned we were having fish and chips. Then I looked down at my plate and saw a dead fish eyes and everything. I had to withhold what would have been a very loud OMG and quite possibly tears. Instead I went with it, got over it and through fear of not wanting to appear rude ate it. And it was very tasty! I was told what type of fish it was but I think I was still in shock so wasn’t paying much attention, apparently its quite popular in Malawi so I’m sure I will encounter it again… yay! I was a little apprehensive after the cook asked what I wanted for dinner and I asked for chicken and could just imagine a dead bird on my plate! However dinner was served minus the feathers much to my delight!!!

My room for now

I decided to get a very early night as I knew today would be very packed. Which it has. I have had meetings with various members of the VSO team all of whom are lovely and very welcoming. I have also managed to get a sim card so will have my phone up and running very soon!!

I will be staying at the VSO office again tonight and then tomorrow I will meet my employers from Nkhoma college. I’m not sure what the plan is as it has changed numerous times through out the day… so I’m going with it!! I think I will be back here on Thursday and Friday. Here WIFI doesn’t seem to be too much of a problem which has been a relief! And I’m making the most of it!! Its nice to adjust slowly. I have realized that all I can do is take it one step at a time, one day at a time. I’m excited to start my placement but it may not be for a little while yet as I need to gain registration with the Nursing and Midwives Council Malawi (NMCM) first. However I feel really positive about it all. I’ve also learned I need to be patient I’m used to having everything now, but I know it will come in time.