FROM SARAH...

Sorry I haven’t posted since that first one a couple weeks ago – when you are keeping track of the cuts, scrapes, aches, and pains of 16 other people you don’t find yourself with much time to spare at the computer! As I type, (8:10am Ghana time) the rest of the team is out on the worksite for their last day of “hard labour”. This morning I am teaching a workshop down at the clinic, and so have a few minutes to spare for the computer before I go! This is a long one so put your feet up…..

I believe I told you all about the time Hope & I spent at the clinic helping with infant immunizations. When I left off, the plan was for me to take part in some home visits with the Community Health Nurses (CHN) the following week. This being Africa and all though, plans changed!


On Saturday the 22nd I popped down to the clinic for a few minutes to drop off a book for them “A Book For Midwives” by the Hesparian Foundation. As we pulled out of the clinic driveway a woman was walking in. She gave birth to twins later that day. One was 2.8 and the other was 3.2…not pounds but KILOGRAMS!


On Monday the 24th I went down to the clinic to meet Evelyn the head midwife, and find out if there was anything I could do for them/with them etc. She had been called away, so I assisted the CHN’s with their month end reports for the Government. I also learned more about how they assist with Family Planning. I’d spent a bit of time with them, when the other two midwives (Esther and Rebecca) called for me, as they wanted me to “consult” with them on a patient. Eek! This could be anything! A young woman 22 weeks pregnant was having a lot of back pain. The midwives having already ruled out the medical possibilities, concluded it was muscle-related and wanted to know what I would tell her to do, as they did not know. I talked (with the midwives interpreting) to her about some postural issues while working around home, while sleeping, etc. The midwives were absolutely delighted that I was able to give some simple suggestions “We would have just said ‘We are sorry. There is nothing we can do’ and sent her home.”

[…..pause in the typing… somebody just came in with a scraped up wrist from a tumble out on the roof…. It is cleaned, has antibiotic cream, sterile gauze pad and tape….. they’re back to work and I’m back to typing!.......]

I was just finishing talking with the young woman and the midwives when the CHN’s came to the door and said they needed me for a moment. I went back to their little office, where they had lunch spread out for us. Thick grey porridge type something, and a fried brown something. Oh my. They wanted me to try traditional food that the average person down in the village would eat, so had brought millet porridge (apparently it is highly nutritious) and akala (a fried bean dumpling). The millet porridge was unlike anything I had had before, and I drank a lot of it (about 2 cups worth because that is what they brought for me!) I was a bit concerned about the safety of the food, but decided that since they were CHN’s they were unlikely to stear me wrong. By the time lunch was done there were only a few minutes left until I was going to be picked up so I headed in to let the midwives know I was leaving. They said “Why have you spent all morning with the CHN’s? We wanted you to spend time with us too!”. Oops. I made arrangements to come back the next afternoon.

I spent Tuesday afternoon talking with the midwives about non-medical methods for easing labour pain and helping labour progress. Even things as simple as hot or cold compresses were new to them. The schooling they receive is very medical-focused, but they do not have the material resources which they are taught they need. For instance, they have been taught to use a Fetal Heart Rate Monitor during labour, but they don’t have a monitor (or the paper, or the ultrasound jelly, or even reliable electricity) to use, so they feel like they have nothing. They’ve been taught that the ONLY position acceptable for giving birth in is lithotomy (ie flat on your back with your legs in the air), even though they could see that for women who were tired especially, that position was very difficult. They were so excited when I told them that if the mother was comfortable being in a position, and they the midwives were comfortable ‘catching’ in that position, then whatever position the mother naturally assumed was probably fine. Yes, there are times when a particular posture is more or less advantageous. But the look of relief on their faces when they realized the women did not have to lie flat was wonderful! We then spent some time in the birthing room looking at what they had and seeing how things could be arranged to be more ‘user-friendly’ for both the midwives and the birthing women. Did you ever imagine a walker for an elderly person would get wedged into a bed and become a squat bar?

Kokrobite Community Clinic serves 6 area villages, and has 3 midwives (I senior, one middle, and one student). In each of the villages there are also Traditional Birth Attendants (TBA’s) who assist the women in their homes. I’m not entirely clear on all this, as I was told earlier that many women birth without support.

[…pause in the typing again… banged knuckle of someone on the worksite….. cleaned, antibiotic cream, bandaid and tape…. That ought to keep it reasonably safe until they are done on the worksite for the day. The CHN’s said it was very important for us to keep all wounds covered when outdoors, as there are many ‘unfriendly’ organisms in the dirt, and a lot of that dust is in the air. We are more cautious here than we would be with blisters and such at home]

Back to the TBA’s…. Once a month the midwives hold a workshop for the TBA’s, to help them develop their skills and to build bridges. Often a woman will not come to the clinic until she is absolutely exhausted and the TBA can do no more. The TBA then goes home and sends the woman with her husband or a neighbour to the village. Today the midwives have asked me to teach the workshop, and be available to answer any questions the TBA’s have. I am excited that I can help build the bridge between the TBA’s and the clinic midwives. Well, the computer just gave me a low battery signal so I’m done for now.

Sarah(thedoula)