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AMA

I used to work as a midwife/nurse in a rural East African hospital. AMA

69 replies

NicoAndTheNiners · 10/07/2018 17:24

That’s it really, only spent a few months there but it was an eye opening experience.

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AlwaysFuckingTired · 11/07/2018 01:27

How did antenatal/birth/postnatal care differ from the UK?

NicoAndTheNiners · 11/07/2018 07:41

All care had to be paid for. I didn’t get involved in the finance side of things at all so unsure of how much stuff cost. I know many local women didn’t access any healthcare at all and birthed at home as they couldn’t afford it.

Nobody had appts for antenatal care, they’d be told roughly when to come back and just rock up to the hospital on whatever day they felt like and wait to be seen. We’d do a BP check, urine check, measure fundal height, listen in to FH. Nobody had notes so nothing documented! Give tetanus vaccination.

If women were giving birth at the hospital they’d often arrive a long time before they were in labour. Hospital was very rural, 2 hours from the nearest proper road and a lot of women walked for a couple of days to get there. So they’d come and then not walk home. The antenatal ward was full of women waiting to go into labour, often top and tailing sharing beds!

They’d spend 90% of their labour in that room with other women and only move over to the labour room for second stage. They had to pay for a special thick disposable sheet to be put on the bed there and weren’t allowed in until they’d handed the money over! No pain relief at all. My first day a local midwife warned me not to get to close to the woman as I might get bitten! Pretty much everyone had routine episiotomies, the local midwives thought I was strange for disagreeing with this practice. No resus equipment. I saw quite a high rate of stillbirths. No guidelines for doing any checks in labour, not for listening into FH, checking the woman’s BP, etc or checking progress. All done as and when.

No real postnatal care. The women might stay for a few days if they wanted to before leaving. But no routine postnatal examinations.

Women had to provide their own food and drink while in hospital. Often they had relatives who would camp in the hospital grounds and cook for them.

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AlwaysFuckingTired · 11/07/2018 16:28

Poor women. How did you find they coped with no pain relief at all? I would have been hysterical.

Is stillbirth not viewed as horrifically as it is here in the UK, due to being so much more common?

Do the women know about/have access to contraception?

Earthmoon · 11/07/2018 17:12

Was FGM practiced a lot in the country you worked in? If yes, did your hospital stitch the ladies back up? Or open them up before labour started?

NicoAndTheNiners · 11/07/2018 19:23

I didn't see any FGM. Don't think it's common where I was.

Women coped very well with no pain relief....or appeared to. No screaming or crying.

I think stillbirth was considered quite normal. First one I saw was the woman's 4th stillbirth. As I was trying to resus the baby the lab guy wandered in to talk to the local midwife about a party. She said to him oh it's sad this baby has just died (I'd admitted defeat) and he put on a sad face for five seconds and went back to asking the midwife out!

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NicoAndTheNiners · 11/07/2018 19:25

No access to contraception that I was aware of. The local headmaster asked me to go and talk to the girls at the secondary school about health issues and they looked at me gone out when I mentioned condoms!

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SheepyFun · 11/07/2018 19:33

What facilities did you have at the hospital? I was in a sub-saharan African country a decade ago, and was shown round a rural clinic, which included a delivery suite for women in labour. There was no running water or electricity, and I didn't even see anything as advanced as a drip running (I saw plenty of patients).

In said country, a c-section at a government hospital cost about £5 (in the city where I lived - the hospital would have had power and water, at least some of the time), which would have been a week's wage for a low-skilled worker, but very few people had jobs; most were subsistence farmers.

SheepyFun · 11/07/2018 19:35

FGM wasn't practiced locally, and some contraception was available - most women preferred the pill, but would only use it once they'd had as many children as they wanted; there were worried that it would render them infertile if they used it to space pregnancies - at least that's what my local colleagues told me!

NicoAndTheNiners · 11/07/2018 19:40

No running water.
No glass in the windows so mozzies everywhere.
There was electricity but I'm 99% sure it was from a generator.
Operating theatre so we could do sections.
An amazing lab. Could get a HIV result the same day which is better than here! The govt had invested in labs and HIV treatment so that was first rate. HIV meds provided free of charge.

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NicoAndTheNiners · 11/07/2018 19:42

Oh and someone had donated an x-ray machine but nobody knew how to put it together, operate it or read xrays so it stayed in its box.

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NicoAndTheNiners · 11/07/2018 19:43

We had IV fluids and drips. Everything like that had to be paid for upfront.

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NicoAndTheNiners · 11/07/2018 19:44

Not much in the way of drugs. Apart from HIV meds.

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Ummmmgogo · 11/07/2018 19:45

were you a volunteer or an employee? was bf or ff more popular? did the babies leave hospital in a pram or sling?

SheepyFun · 11/07/2018 19:50

Where I was, you could buy anything over the counter in a city (including elephant sedative!) - good range of antibiotics, no prescription necessary.

I never saw a pram or a bottle. One lady I knew had twins, and others who were lactating would wet nurse them as she struggled a bit with supply. It was a much much better option than formula - most couldn't afford it, and were cooking over open fires, which would have made sterilising bottles challenging.

I'm not a medic at all, but was aware of some of what was normal locally. Every family I asked had lost a child, many more than one. I'm very grateful for the healthcare we have here.

Ummmmgogo · 11/07/2018 19:55

was the elephant sedative used on humans or elephants? did the babies have their own bed or cosleep?

halfwitpicker · 11/07/2018 19:55

Were you a volunteer? I guess you weren't paid?

NicoAndTheNiners · 11/07/2018 19:55

Volunteer.
Never saw any bottles. Breastfeeding only and they never needed help to get baby feeding!
Slings only. No prams. They'd have been useless as no pavements or roads.

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Ummmmgogo · 11/07/2018 20:00

thanks for answering this is very interesting. did anyone ever name their baby after you?

MissCherryCakeyBun · 11/07/2018 20:05

What can we do to directly help these women and their children? I've worked for various charities in the past and I'm wary donating to them as I know how much money gets wasted, what do you recommend we do to offer assistance/help/support so that it actually does to the place it's needed?

BischBaschBosch · 11/07/2018 20:06

Please tell me you put the X-ray machine together....

Ummmmgogo · 11/07/2018 20:09

can nurses normally xray and build xray machines @bisch? I thought it was only radiographers who could do that kind of thing.

NicoAndTheNiners · 11/07/2018 20:10

Never had a baby named after me.

No I didnt put the x-ray machine together! Anyone with suspected fractures had to go 2-3 hour drive away.

But we could treat most other stuff. Well try to....

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NicoAndTheNiners · 11/07/2018 20:11

Yeah I wouldn't have had a clue with the machine...even the doctors didn't try!

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NicoAndTheNiners · 11/07/2018 20:13

As for donating money I guess if you can find a small, independent outfit the money isn't wasted on admin, etc. But the problem for most people is not knowing if such set ups are genuine.

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tenbob · 11/07/2018 20:18

What was the background of the other midwives?
Did they have a formal university education, or was it a more vocational route?
What role did men have in the birth and post natal care?