Response

There's been a terrific response to my plea for fetal dopplers, which means the world. Being from Minnesota, it shouldn't come as a surprise that if you have a need that helps others, you just need to ask directly. People want to help. They give generously. 

In fact, between the four people who offered to buy a doppler straight up, and the other folk that offered to contribute money toward one, and the other person who got me in touch with a medical supplier with two old ones to donate (and the other person who put me in touch with the director of a nonprofit who might also be able to help with some other medical equipment) - between all of them and the company who agreed to give us a discount on the cost of the new ones - we're going to be able to import six fetal dopplers. Woot! I'll find homes for them no problem. As long as we can use some of the money to cover the extra baggage fee when Sarah, my sister-in-law, carries them here in July. 

This week's work drove home to me their importance yet again. (Possible trigger warning.) 

First thing on Monday I walked in the exam room to find the midwife concerned about his patient's baby showing distress. The emergency c-section didn't end up being exactly STAT for various reasons, however, and when I saw the midwife come back a few hours later, he looked stunned. There'd been thick meconium which the baby had aspirated. The child was technically born alive, but with an Apgar score of 1. He'd tried to resuscitate her for 30 minutes, but it failed and the baby died. He stood there quietly explaining it all to us, shaking his head, looking defeated. A lot of things went wrong in that scenario, not least that the woman's membranes had been ruptured for two days. But closer monitoring could have helped for sure.

Then yesterday I had two patients in a row that highlighted to me why Malawi has such poor perinatal mortality statistics. The first patient was 24-years-old, and this was her fourth pregnancy. That alone was a bit atypical to my American mind, but in peering more closely at her health passport (a small yellow book for recording prenatal clinic visits), I suddenly realized that she had no living children at all. Her first baby had been stillborn at 9 months gestation. Then the second and third babies had also been stillborn at 8 months. Here she was, waddling up with her big belly to lay down on my table, without saying a word, just peering up at me expectantly. And me hearing that fetal heartbeat, and knowing what that must signify for her.*

She then walked out the door, and my very next patient was a 20-year-old in early labor who had had no prenatal care at all (likely living very far from a health centre). She also had a history of two prior stillbirths at term. Two healthy twentysome-year-olds (as far as we know), and five term stillbirths between them. No living children. That is not a normal statistic. 

(Then I had a thirteen-year-old orphan in labor who was by herself and sobbing the entire time, she was so scared.)

A lot of things need to change in order to improve such situations. No one thing is a magic fix. 

But rest assured that anything which offers more accurate monitoring of these babies in labor is going to be helpful. It's a start. 

So thank you. 

Hospital laundry looks more cheery here.

This is how you make gauze: you wrap the spool around a notebook many times, cut it with a scalpel blade, then carefully fold each one to the right size. Voila!

And when the water is out all day long at the hospital, with nothing left in buckets, you wash your hands before lunch with fluids from an IV bag. Lactated ringers, if you're curious. But I don't have a picture of that.

 

* I'm a midwife, I'm all for vaginal birth. But this particular patient was dilated 4 cm and wasn't having contractions anymore. Given the whole context, where she was, what her history was, I didn't feel great about trying to kickstart her labor with inexact augmentation and a potentially long delivery. "Could we not just get her a c-section?," I asked the midwife I was transferring her to. She agreed and planned to ask the clinician - but I left for the day before I heard what happened.