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!!

1 comment:

  1. Michelle, it is great to read about your adventure'. glad everything is OK and that your enjoying things if rather hectic. Love the clothes descriptions , must keep an eye out for any old Fujifilm shirts ;-)