Friday, 31 May 2013

Baptism of Fire

I’ve been hanging out with Vicki Chan. She is here until Tuesday so I am having a fairly thorough orientation into FreMo, Nairobi, Kenya, the staff, the markets…. Everything she can think of she is sharing. For that I am grateful.

On Saturday we started the day with a meeting. It wasn’t long before the meeting turned into an active birth workshop with Vicki and the other staff. There are two midwives here – Magadalene and Penina. Mercy is the midwifery assistant. Fred is our doctor and he lives not far away. The other staff are clinical officers. Their role is that of junior doctor for all the non maternity cases that walk in the door, and a cross between PHO/Registrar for maternity. I say that but I have never, ever, ever seen a doctor care for a woman in such a midwifery way as these clinical officers do. It is beautiful to behold.
Rocking it!
Shaking it!!

Vicki is a totally complete and accurate encyclopedia of active childbirth. In the couple of hours we spent together I think I’ve learnt more about active birth than I ever had. If you ever get a chance to have a two day workshop with Vicki, then do NOT hesitate.
Rolling it!

And yes, next door in the other birthroom was a woman in labour. She struggled. It was a difficult birth. She put everything and more into having that child. Everything we learnt that morning about active birth and promoting decent and encouraging strong labour we put into practice that afternoon. We wanted to transfer, but mum and husband said no.  She needed medical intervention, but they couldn’t pay for the care WE were providing… in a different hospital, she would be held prisoner until the family came up with the money.
Exhaustion or Relief... you choose!

It costs 4800 Kenyan shillings to have a baby at FreMo. Currently that is about $57.60. For that they get birth, a room, food and postnatal visits. And not surprisingly, many women can’t afford it, some work on a payment plan so they start paying it off when they know they are pregnant. Some can’t pay, and Moffat works with them. Sometimes they continue to pay little by little in the postnatal period. Sometimes they don’t. Moffat is working on a system where instead of insisting they pay what they can’t give, he gives them a plot of land in a block he is renting, gives them a startup fund and they can grow vegetables there. They can use them to feed their families and they can sell them to finance their family and to repay debt. He gives this to the women.

So, 26 hours after this woman went into labour, Neil Obama was safely brought into this world to join his three sisters and older brother.  We all breathed a collective sigh of relief, shed our emotional tears quietly and whispered our gratefulness to whichever higher being was watching for her that night.

Welcome to the world

My turn for a cuddle while awaiting the placenta

But wait, there’s more.

There is only one staff member on overnight.  We are living on site so it doesn’t seem right to simply walk away when there is business about. We continued that night…. Another multi with a K36 delivered through what looked like infected liquor…. Baby took a couple of breaths and decided it was too hard. After about 5 minutes of active resuscitation (the best you can do with only a neonatal ambu bag) she decided that she would breathe by herself. There was another collective sigh of relief.
Mum and Ivy at their home visit

Ivy looking sweet as!!

 Meanwhile next door, an 18yo primip was going slowly. In the wee hours of the morning we detected fetal distress at around 6cms, high head, slow progress. The decels were deep, long lasting and variable. There was no need to rupture the membranes to know there was also meconium liqor… the thickest, greenest I have ever seen. Again, she refused transfer. We talked with her about her baby dying… she knew more about life and death than we did…. She would rather die here than go to a major hospital. We slowed down with the fetal monitoring, listening in around every 5-10 mins. We only needed to know how active to be with the resuscitation when the time came. The Mamma asked us to pray for her. Vicki did – out loud and with passion. There were more tears. The young mamma was so brave, she worked so very hard and pushed that baby out in under an hour.  The beautiful little one came out crying God Bless Her and yet again, we are grateful for a miracle
Vicki helping mum to bond with her baby 

This is Vicki and I doing a selfie with that euphoria when everything turns out ok, at 5am at that silly time all night duty people will recognize  after we have been awake since 6am the previous morning.

Looking fab after being awake for 23 hrs..... but wait, we
didn't get to bed for another 4 hours!!

FreMo in the quiet and still of early morning. Three mammas and babies resting quietly, two midwives and a clinical officer taking a cup of well earned Australian style tea.  We have definitely earned it. 

And so, off to bed…. But only for a couple of hours. More adventures to come!!

Tuesday, 28 May 2013

It Begins....

Welcome to Kenya … Have a nice day.

And that was it, a little flourish and the visa was stuck in my passport. I didn't wait to examine it, I was in and off to collect my luggage and find Vicki Chan and Moffat Osoro. Welcome to Kenya indeed.

This may sound crazy… but it looks like Africa. The trip from the airport was exactly what I was expecting, road works, all types of transportation you can possibly imagine, animals and a sea of humanity on the move. The trees were distinctively different and the smell, yes the smells.

I was made to feel very welcome at FreMo and was greeted politely and kindly by everyone. I’m still working on the names but I know I will get there.  If any of you have taken the time to look at the FreMo website or Vicki’s blog it is exactly as it looks.

 The view from the street....

Inside the main corridor...

This is the corridor that takes me to my room. I have to walk down it at an angle or my clothes get caught… it is cement at this end, but rocks at the other end. If I have my backpack on it is difficult.  I call it my room but I have two, and they are separate to FreMo and behind their complex. There are other rooms here, one is for Vicki, another is a FreMo storage… and yet others house whole families in them.  Therefore I feel privileged to have some privacy, as I know I will be retreating here simply to take time out, or for my complete and total sanity’s sake!! After dark, the security man, Eric, walks me here and waits to make sure I am in. He carries a big stick!

My front room....

My bed room...

My LifeStraw Family for filtering the water….. it works really well and tastes good. I do have to carry jugs of water from FreMo’s kitchen to here, but that is OK.

So. Here I am. It feels comfortable; the people of FreMo make it feel familiar. They are good, friendly people doing a hard job in difficult circumstances.  

Thursday, 9 May 2013


Well I’m officially on leave. I’m in my first week of having four months away from my paid work. I don’t know what that feels like as I’ve never done it before, and I guess I’m still settling into the idea of not seeing my work colleagues (or the women I care for) until August. That seems like an age away! In my last couple of weeks at work I spent some time with the midwife taking over my role while I’m away, working together, talking together and introducing her to people who can help her so that I know she will be ok.

During the course of this activity many people gave me their best wishes and asked me if I was excited about my upcoming adventure.  The answer is – I’m not quite sure. It’s hard to describe how I feel. I remember being excited when I planned the big European adventures of 1988 when I left Australia for a period of time which ended up being 5 years.  I don’t feel like that. I remember planning the move back home. It doesn’t feel like that. It feels a mix of nervous anxiety with a tinge of heightened expectation at the unknown. I’m heading into an adventure that has been five years in the planning and it could simply be that it’s a long time coming and I’ve used all my nervous excitement.

It might simply be a case of I know what I don’t know as a practicing midwife. For the last ten years or so I have been working in the antenatal arena and am considered an expert in my field. What does that mean? It means that I know the systems within our hospital inside out. It means that when a problem arises we refer quickly and easily (via medical opinion/referral) for blood tests, scans or medical opinion.  AKA ‘We have the technology’. For some time past I have been asking myself what would I do in certain situations if I didn’t have the technology at my fingertips??

I have spent the last eight months or so “upskilling” in the birth suites. I spent all of my time there asking myself what I was learning that would help me care for women in Africa. The answers were mixed… I now am proficient caring for women with an induction of labour, an epidural, active management of 3rd stage and can ‘catch’ a baby at LSCS. I’m fairly sure there will be none of the medicalization of birth where I am heading. Will I be able to support a woman in natural labour, with non medical pain relief options and natural 2nd and 3rd stage?

I know that I will be well supported by the staff who live this as an everyday experience. I know that I will be challenged in many ways, least of all mentally, emotionally, physically and spiritually. I will see things I’ve never seen before, and things that I’m hoping I will never see.  I know I will learn many things that will help me continue to grow as a person and as a midwife. And if I achieve that I will be happy.

Am I excited? I guess the answer is Yes. Twelve days left before I leave. Talk to you all again then.