Maternal and Child Health

From the Field: Dominican Republic (PALS)
Sent in by: Achal Patel

From the Field: Dominican Republic (PALS)
Sent in by: Achal Patel

From the Field: Dominican Republic - Pediatric Advanced Life Support (PALS)
Sent by: Achal Patel

We awoke yet again to a warm, sunny, and vibrant day in Santiago: conditions that seemed to be a recurring theme in the city. Day 4 would mark the separation of the team with Dr. Karotkin presenting three lectures at the Children’s Hospital in Santiago with Dr. Lopez and Dr. Shaw making the trip to Moca to present the PALS course to local physicians. I joined the later group to learn about a different constituency of trainees. Today I shed my cell phone, my only indicator of time, and adopted a mindset of ‘Dominican time.’ Rather than obsessing over regularity and quenching my need for a constant time check as I would at home, I enjoyed the events of the day as they progressed and let them arrive with a more relaxed mindset. While I was trying to go through my day limiting my use of technology, Dr. Lopez seemed set on maximizing its use, skillfully answering calls on his two Blackberry’s at once and always having them both easily accessible. I soon learned how this mastery is part of the reason for our success thus far on the mission.

After breakfast we made the trip to Moca, a much smaller city than Santiago. We made the trip, which was anywhere between 20 and 30 minutes, and arrived at a private Catholic school, our headquarters for the day. Along the way we passed an interesting juxtaposition of man and jungle with buildings and roads surrounded by lush greenery in seemingly flawless harmony. Upon arrival we were greeted by friendly local physicians, many of who traveled from the mountains surrounding the valley to take part in the training.

When these physicians arrived from all around the city of Moca, it became clear that our in country contact Dr. Ramon Lopez had undertaken preparations before our arrival that were both extensive and time-consuming. Without exaggeration, he seemed to know practically everyone everywhere we went, and if he did not he was quick to make local contacts. If it were not for his help the reach of the program would surely not be as significant. In addition, the universal warmth of both the people and weather in the Dominican is clear and outwardly reverberating, welcoming the curiosity of travelers with great kindheartedness making the arrangement of training sessions easier for the entire team.

After setting up and awaiting the arrival of the remaining participants, Dr. Shaw gave an overview of the course to probe the knowledge already possessed by the physicians. Among the questions he asked was whether the physicians had defibrillators in their hospitals or any experience in using them. Thereafter, one of the participants remarked: “we have a defibrillator in our hospital, but we don’t know how to use it.” The lack of training on the use of defibrillators has become a persistent theme throughout this trip and is reason for concern, more alarmingly so when stated by an experienced physician. While the hospitals may have equipment that can be upwards of tens of thousands of U.S. dollars, they obviously will not do patients any good if the majority of the healthcare providers in the hospitals cannot use them. The prevalence of defibrillators in the United States is often taken for granted, with AED’s at hand in a multitude of public areas, such as airports where they are every few hundred feet. The lack of such equipment in hospitals would almost be unimaginable at this point in American healthcare. Yet, in countries such as the Dominican Republic physicians are making do working without such equipment.

The proper training required for the use of a defibrillator is relatively simple and if incorporated into the curriculum of medical schools within the nation it is evident that great progress can be made in the way of resuscitation techniques. We are hoping that the training provided by Dr. Shaw over the course of the two-day training will provide these physicians with enough information to allow them to properly use their equipment at hand. The enthusiasm shown by these doctors was quite evident through both their mannerisms and the questions that they asked throughout the session. Being experienced and having worked in hospitals, the physicians seem to realize the importance of the PALS course and I have confidence that they will pass on the training on to their colleagues as well as students. If Physicians for Peace and other similar organizations can continue their training programs until there are enough in-country physicians who can provide similar classes or until such material is incorporated into medical schools, there is great promise for the future of Dominican emergency care, both pediatric and general. As for the class itself, Dr. Shaw covered a very similar material set as he did on days 2 and 3 of the trip. He also demonstrated nasal intubation techniques and provided a review of the proper form of CPR and general intubation in addition to the more advanced topics in regards to PALS. Some of the physicians seemed to have never been taught the correct methods of performing CPR and have never needed to utilize CPR as general physicians; however, it was apparent that they were more than capable of performing it after being shown the correct approach. The interest level from the practicing physicians on such topics was noticeably higher than the medical students, with Dr. Shaw fielding many more questions than on days 2 and 3, once again indicating the real-world importance of the material covered in the training.

As we made our way back to the hotel after the day of classes, I left with my thoughts on the current medical situation in the Dominican Republic being confirmed. While there are ample enthusiastic and adept physicians present to provide care, many have never received the training necessary to perform proper pediatric advanced life support. However, as demonstrated by the classes, this issue can be easily solved. As I stated earlier, if physicians who currently have the proper training in the country spread the knowledge they have acquired and if there is a desire from local physicians to continue to improve their training, then pediatric as well as general emergency care can be significantly improved. Thus, an internal support and knowledge-sharing network will be vital for the future success of the Dominican Republic’s healthcare system.

From the field: Dominican Republic - Pediatric Advanced Life Support (PALS)
Sent by: Achal Patel 

We awoke to another picturesque day in Santiago anticipating the completion of the two-day classes in the Children’s Hospital. As we walked through the hospital today I noticed each ward had around ten beds in them each. While the wards were congested, I observed a significant number of doctors and nurses present to care for the patients, certainly a reason for optimism, as it was evident that there is not a lack of human capital in the hospital. Unfortunately but understandably so, due to hospital regulations I was unable to document any of my observations through photographs. But, it is clear that these doctors and nurses work everyday through improvisation and do an excellent job at it.

With the enthusiasm and hands-on skill possessed by these healthcare providers one can only imagine the strides they can make in the healthcare sector of the country with just a few more resources and proper training on the utilization of these resources. While I have been previously aware of the tremendous medical resources available to us in the United States, I am only beginning to realize that even this acknowledgement cannot lead to me accurately comprehend the advancement of medicine in the States compared to the majority of the world’s countries. If these countries possessed even a small fraction of the medical resources available to physicians in the United States the possibilities for medical advancement are tremendous and exponential.

While missions aimed at clinical work can provide short-term alleviations to medical issues and may perhaps even be glorified, I have come to the realization that it is further training that will provide the basis for medical advancement and self-sustainability in many countries, including the Dominican Republic. After setting up for the day the students trickled in after completing their morning hospital duties and training resumed shortly after 10:00 a.m.

Today I sat in on Dr. Karotkin’s Neonatal Resuscitation class with the second session being the more interactive and examination day of the class. Dr. Karotkin would use the second day to build upon the topics covered in the previous day, which consisted of the overview and principles of resuscitation, initial steps of resuscitation, use of resuscitation devices for positive-pressure ventilation, and chest compressions. He began the second day by covering the procedures of endotracheal intubation, the utilization of medications for neonatal resuscitation, and actions taken during special cases. Afterwards lessons on resuscitation of babies born preterm and ethics and care at the end of life were covered. Right before the lunch break I learned that the majority of the students in the class were on call the previous night and had not properly rested for upwards of 30 hours. Yet, impressively enough they continued to pay attention throughout the presentation with many students simultaneously studying the material covered the previous day and absorbing the new information provided. After the conclusion of the lessons and the lunch break, the students practiced intubating a ‘dummy’ baby; for many this was their first time.

Thereafter, an 89-question test evaluating them on the material covered was administered. With the aid of a couple medical students fluent in English the class was able to take the test printed in English smoothly. While the tests have not been graded yet, I have faith that all of the students will pass and receive their Neonatal Resuscitation Program certificate. Meanwhile, in the PALS class Dr. Shaw is finishing up giving the practical exams to the students after the written versions were taken this morning. All of the students who were administered this test passed and were given their certificates today. Afterwards, we bid farewell to the students who helped to make the two-day programs a success hoping that they will eventually be able to utilize the materials they learned over the past couple of days in a clinical setting. Departing the Children’s Hospital, we entered the Santiago rush hour traffic and made the short trip back to the hotel after what we considered another successful day in Santiago.

From the Field: Santiago/Moca Dominican Republic
Sent by: Achal Patel Mission Program: PALS

Day 2:

From the Field: Santiago/Moca Dominican Republic
Sent by: Achal Patel
Mission Program: PALS

Hi!, I'm Achal Patel and a rising 2nd-Year Undergraduate at the University of Virginia on a Pre-Medicine track pursuing a degree in Politics. I am on a trip with Physicians for Peace in Santiago, Dominican Republic providing Pediatric Advanced Life Support and Neonatal Resuscitation Program training to medical students in the country. The courses are taught by Doctors Eric Shaw and Edward Karotkin, respectively; the mission will last from August 8th, 2010-August 14th.

Day 1:

In a small, rural school in the outskirts of Santo Domingo in the Dominican Republic, a fellowship of twenty women brought together over eighty clients, all new mothers, to celebrate a holiday that now has a greater meaning for them: Mother's Day.

Five years ago, a selected team of ten women were chosen to play a meaningful role in many lives. While raising their own children, these women were selected as "Resource Mothers" who would take on the significant task of accompanying pregnant 14-20 year old ladies throughout their pregnancies to support them through the physical, emotional, psychological and spiritual transition that comes with bringing forth a new life.

On this last Sunday of May, the eighty mothers celebrated their pregnancy or their newly birthed child alongside the now twenty Resource Mothers who have visited, counseled, and grown to love them.

"You just don't know the situation surrounding the pregnancy" says one of the Resource Mothers. "One of my referrals was from a father who said his daughter stopped speaking to anyone after finding out that she was pregnant. It took a number of visits before she trusted me. Upon finding out that this twenty-year old had been molested since she was ten, I realized how much work I had to do to make sure that she was going to be ready to take care of her newborn."

As Anna, another Resource Mother, said, "We take on the mother role for those ladies whose own mothers and fathers estrange them. After five years, many of those who once were my clients will drop by my house at any point. Their children are now my grandchildren.


This program has enhanced my understanding of family." Thus, the family of Resource Mothers celebrated Mother's Day together, laughing, singing, and dancing in full Latin style. The Mother's Day party was a great way for both clients and Resource Mothers to celebrate new life. All in the room were connected as mothers, as sisters, and as friends.

A new mother can be as vulnerable and helpless as a newborn. The Resource Mothers Program, modeled on a Virginia-based initiative, was designed to improve the health of expectant and new mothers and their babies in under-served communities in the developing world. Our primary concern is their physical health, but, more importantly, we try to encourage them to understand the importance of their overall well-being. We train selected Resource Mothers to serve as mentors, helping these young women to have safe pregnancies and a healthy babies.
Support our Resource Mothers - Help Us Help Others.

Greetings from Nigeria -
Sent by Robin

I had a very productive week. I arrived in the village of Pampaida around 6 pm on Monday. I was waiting for the vehicle to take me out since 8 am. But… this is Nigeria! This is the dry season. Everything is brown with a thick layer of dust. It was the rainy season in Oct/Nov when I was here last. The fields were full of crops, flowers were blooming. I definitely prefer the rainy season.

The people have been so welcoming. A woman with her baby on her back ran through a field to greet me as I was walking to Saulawa. (I only made it halfway before the jeep picked me up-same on the way back).

Monday night we had a delivery. It was her 4th pregnancy. She came in with a bulging bag of waters at the opening of the birth canal. We knew it wouldn’t be long. We monitored mom and baby but decided not to do an exam. As we were preparing the instruments, I looked over and saw mother give a push - and out came a beautiful little girl on the bed just as the bag of waters broke. Baby started crying immediately.

Both mother and baby are well and went home the next morning.  One of the health workers said the mother was going to call the baby, Robin. I suggested they call her Joy (my middle name and appropriate for this baby) instead. Because the mother has two girls and two boys, she is ready and interested in Family Planning. Tuesday we did prenatal care at Pampaida and Wednesday at Saulawa.

The renovations at Saulawa are very nice and clean (as clean as can be with dust everywhere) There are even western-style bathrooms with real toilets (not a latrine or squatty potty!). They are just awaiting furniture before they start doing deliveries again.

Hadissa, the midwife, was injured in a car accident so she isn’t working yet. I hope to go visit her next week. Today, I taught newborn resuscitation to the doctor, nurse, village health workers and even a traditional birth attendant (16 in all). I cut the top off a water bottle and lined the cut end with cotton batting, (as I had seen in Ghana ) to use as a mask. We talked about the signs of respiratory distress in the newborn, the importance of keeping the baby warm and how to stimulate the baby by rubbing the back. Then I taught them how to give breaths to the baby, if needed. Each person practiced with the baby doll that always travels with me. There were a lot of very good questions.

We want to encourage the women to make a plan for their birth: Where do they want to deliver, who will attend them, how will they get to the clinic if a problem should develop, etc. The village health workers have been asked to invite all the TBAs (traditional birth attendants) to come for a meeting on Thursday. We would love to have the TBAs as part of the Birth Team – to accompany the women to the clinic and assist with the deliveries. They have learned by experience and have been providing their services for generations. We do not want to negate them, nor interfere with their livelihood. The family can continue to pay them for attending the birth of the woman at the clinic and the birth team will have an extra set of hands. There are no fees for medical care at the clinic. At the same time the TBAs will be able to see how things are kept sterile, how we can handle rapidly occurring complications and we can also learn from them. Hopefully, the best of both worlds.

Also, on Monday I want to talk with Maryam (the 2nd Pampaida Delivery, who had a postpartum hemorrhage and mother of Matthias-my African grandson). I am planning to ask her to speak with the women who come to the clinic for prenatal care on Tuesday. Her story may encourage more women to deliver at the clinic.

Since we began in October, only 8 babies have been delivered in the clinic. Also, another priority is to have 24/7 coverage for deliveries. Currently, Banke and Dr. Ojo are in the village from Monday until Thursday afternoon. That leaves Thursday night through Monday without delivery services at the clinic. I met with a retired midwife last Saturday who seems very interested in working in Pampaida.

We are also exploring a joint relationship with the local training hospital to have the midwife students spend time in the rural setting as part of their training. We want to provide full-time consistent care to the village women. Well, that is my first week. Oh… great news! There is now electricity in the clinic. It is sporadic but very welcome. It is only on for 10 - 12 hours a day. And they have a solar light for when the electricity is off. Progress is slow, but it is occurring!

Wishing you a wonderful weekend!

Women helping women: Physicians for Peace volunteers with patients at Segou Hospital.

Laura Gwathmey and Laura Fine-Morrison are traveling with our VVF surgery team on the ground now in Segou, Mali. Here is their latest report, which shares their observations of both the patients and the staff they have encountered at Segou Hospital: 


Our work here in Mali makes us realize how lucky we are to live in a country that allows women equal status. Here, women have little control over their lives. Most of the patients we've encountered have scarring from female genital mutilation. One member of our team, the only female doctor on staff at the hospital, told us the story of her own experience with FGM. As a child, she was subjected to the practice, and decided very quickly that she would not want her own child to suffer as she did. Unfortunately, the Malian custom is that the husband's family gets to decide the fate of a female child, not the parents. Despite our team member's best efforts, her husband's mother decided that the practice would be contined with her grandchild, our teammate's daughter, at the age of 2. In reality, our teammate told us, she could accept it only knowing that uncircumcised girls, as they are known in Mali, never get the opportunity to marry or have a family. The choice is stark: genital mutiliation or a solitary life. 

 

We're here hoping to change that through our actions. Many of the patients we've seen require hysterectomies because of their extensive and prolongued conditions. Those for whom we recommended treatment all told us that they must ask their husbands before they can consent, and their husbands must sign the consent form, not the women themselves. As I write, one man is traveling to Segou to give consent for his brother's wife to receive a hysterectomy. As you can imagine, many husbands do not give consent, and their wives must live with an incomplete solution to their conditions. Through the actions of our all-women surgical team, working with local Malians, we hope to show that women can still be desirable and feminine while actively serving as role models.

- Laura Gwathmey
 

My experience of the hospital staff is that they care very much about their patients. The nurses and doctors joke around with them when appropriate, to put them at ease. A nurse or anesthesiologist will talk gently with a patient, and may touch her on the shoulder or arm if they see that she is nervous during surgery (in most cases the patients are not under general anesthesia.) And they work hard to educate patients about their treatment options as well as how to care for themselves post-operatively. 

 

How hard it must be for the staff, then, to have to work under conditions that often don’t allow them to provide their patients with very good care. The patients come in malnourished and often lack funds for food and medications post-operatively, including pain meds and antibiotics. The staff are tired, as they get very little time off  (doctors, for example, work 7 days a week; nurses work 5 days per week but are on call every 3rd night, which they must spend at the hospital). And the staff are well aware that what is available medically in other parts of the world is far greater than what doctors can offer here.

 

One doctor came over to me in the hospital break room while I was writing. He sat down next to me and asked what I was writing. When I told him, he said that what I wrote was very true. 

And he said things are going to get better. How did he know, I asked him. His response was that one has to be optimistic in life. Things will get better, he repeated, before walking out to attend to his next patient.

 

- Laura Fine-Morrison
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In May 2009, Physicians for Peace sent a team to Segou, Mali (Read about the first mission to Mali.) to help with efforts to address the widespread problem of VVF. (Read more about VVF and our surgery program.) Last week, Physicians for Peace volunteers returned to Segou to help more women get the surgery they need to heal this devastating condition. 

You can help mothers in poverty by supporting our volunteer medical missions in Africa. Donate now or visit www.physiciansforpeace.org to find out how to make a medical donation to our gifts in kind program.

Today was another successful surgery day in Mali.  We saw 6 patients, each of whom required extensive surgery and reconstruction. We also encountered a patient from our May mission who had returned to accompany her friend for fistula repair! She was completely cured and had encouraged her friends to travel to Segou for the same care. What a treat to see how our mission had changed her life! She was outgoing and talkative, unlike many of our current patients, who are shy and say little. Since the surgery, she seems to have come out of her shell.  

 

There is so much more work to be done.  I've included a photo of the welcome sign that the hospital and the Millennium Villages Initiative made for us.  We will be here through November 17 and seek to complete the daunting task of reconstructive surgeries for 50 patients.  Wish us luck and please keep checking back for more updates!

 

Laura

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In May 2009, Physicians for Peace sent a team to Segou, Mali (Read about the first mission to Mali.) to help with efforts to address the widespread problem of VVF. (Read more about VVF and our surgery program.) This week, Physicians for Peace volunteers returned to Segou to help more women get the surgery they need to heal this devastating condition. Laura Gwathmey, student of International Studies at Old Dominion University, is traveling with our medical volunteers to report on the progress of this mission. Check the blog for regular updates.

You can help mothers in poverty by supporting our volunteer medical missions in Africa. Donate now or visitwww.physiciansforpeace.org to find out how to make a medical donation to our gifts in kind program.

 

An important focus of Physicians for Peace Maternal and Child Health Programs is treatment and prevention of VVF and RVF (vesicovaginal fistula and rectovaginal fistula.) These serious complications of childbirth occur during prolonged labor, resulting in serious tissue damage to the mother. The condition occurs more often in developing countries where women become pregnant at a very young age. Read more about our VVF Surgery program.

In May 2009, Physicians for Peace sent a team to Segou, Mali to help with efforts to address this widespread problem. (Read about the first mission to Mali.) This week, Physicians for Peace volunteers returned to Segou to help more women get the surgery they need to heal this devastating condition. 

Laura Gwathmey, student of International Studies at Old Dominion University, is traveling with our medical volunteers to report on the progress of this mission. She sends her first update:

 

Greetings from Mali!  We've arrived in Segou and begun setting up at the hospital today. The staff and the Millennium Development office had arranged for a welcome banner for our group! I'll be sure to send pictures soon. We also began pre-screening fistula patients today. We expected approximately 30 patients, but when we arrived, we found 57 waiting for us and many more on the way. Apparently, the patients from Physicians for Peace's May 2009 mission were so pleased with their care that they passed along the word, and we have more patients than we can handle! We're also seeing a greater variety of patients than previously - we've had many fistulas, but also many children, one with complications from genital mutilation, and several male prostates.  Several of the women have been living with fistula for years; we met one woman today who has been living with fistula for 20 years! They have traveled for days to reach us and sleep on hospital grounds awaiting treatment. 

We also met with the governor of the Segou region and several local health officials today, pleading our case for greater support and assistance for the people of Mali. All of the officials agreed that there is much work to be done to help prevent and treat cases of fistula.  

 

We begin surgery tomorrow morning at 7 am and will continue until dark. Each day seems to bring a new challenge and a new heart wrenching story.  

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You can help mothers in poverty by supporting our volunteer medical missions in Africa. Donate now or visit www.physiciansforpeace.org to find out how to make a medical donation to our gifts in kind program.

Thursday, Nov 5, 2009

 

Greetings from Nigeria!

 

This week wasn’t nearly as exciting as last week - No births at the clinic. We did see a woman who said she had been leaking fluid for two days. She wasn’t in labor so we referred her to the hospital, after we found her husband who was off working in a neighboring field. She went to the hospital on Tuesday for induction of labor. Today she returned to the village with her beautiful, healthy baby!

 

A woman we referred for an ultrasound last week found me and gave me the report. When we examined her we could only feel the baby below her belly button and we heard the baby’s heart beat on the left and right side. Not sure if the baby was lying horizontally or there might be twins.  The report came back that the baby is transverse (horizontal).  She is about 8 months pregnant. We will watch her closely - if the baby doesn’t turn head down we will refer her for a Cesarean delivery.

 

Our babies from last week came back for weight checks and vaccines. The little girl who weighed 2.3 kg at birth was down to 2 kg so we reviewed breastfeeding with Mom. This is her first baby. She came back the next day and the baby had gained. No signs of dehydration. Mom brought me a bag of ground nuts (peanuts) as thanks. My “grandson”  gained .25 kg. I gave his mom a bag with powdered milk (for her, not the baby), another protein based beverage powder and 4 cans of sardines. After all her blood loss, we want to build her back up. We are encouraging greens and liver also. Maryam #2 gave me another bag of ground nuts and 6 bars of soap. I was overwhelmed - they have so very little. 70% of the people in the village are living on less than $1/day, and they are giving me gifts!

 

I have been walking every day and said I wanted to walk from Pampaida to Saulawa. Everyone kept telling me it is too far, too hot, etc. Yesterday, Dr. Ojo left to go to another clinic to get vaccines for our new babies (we don’t have a refrigerator). I got bored waiting for him - and decided to trek to Saulawa to help with the prenatal clinic. Several people stopped on motorcycles and offered me a ride. Thank you, no! I did it. I walked 9 kilometers. I think I probably sweat 3 liters, but I did it! Dr. Ojo started teasing Banke (she is 25) that the elderly woman is more fit than she is! I could be their mother, but elderly? Though 48 is the typical life span here, and  I am 52.

 

This weekend, I am taking Dr. Ojo and Banke to dinner. There is a Chinese buffet, but they want to go to Chicken Republic. I will let you know if it is like our KFC! They also want to go to a photographer and get a formal picture of the three of us. “The Pampaida Birth Team." Also, Banke and I plan to go to the market this weekend to see if I can find something for Matt’s (my son-in-law) wall. He is a history/geography teacher. Also my “sister” Joy wants some Nigerian fabric for a quilt.  So we will go exploring. 

 

I am counting down the days until I go home - in 8 days I will be on the plane. It will be a bittersweet farewell. I have made some lifelong friends here. Mary, from Physicians for Peace, is already starting to talk about my next trip. Right now, I just want to spend some quality time with my family.

 

Not sure if I will write again before I return. I promise to post lots of pictures when I get back.

 

Blessings!

Robin

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria, Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

Greetings from Nigeria!

 

We couldn’t go to Saulawa for clinic today because the ambulance driver was no where to be found and no one knew where the keys to the vehicle were. I was resting from our first delivery, when Banke woke me around noon and said we had another woman in labor.

 

Her name was also Maryam.  She is 20 years old and this is her 5^th pregnancy. It seems she only has one living child, and we never did find out what the circumstances were of the deaths of the other 3.  She has a 4 year old daughter.

 

She was dilated 5 cm and Dr. Ojo said her bag of waters had ruptured 2 hours earlier. We started monitoring her contractions and the baby’s heartbeat every 30 minutes. We are committed to being more diligent with the partograph. It was decided that we will have Banke “catch” this baby. Maryam was on the bed. The contractions were only 2 in 10 minutes, so we decided to walk a bit. These women make very little noise during the labor. I would occasionally see a grimace, or more likely I would see her just bend over when she got a contraction. Around 4 we checked her progress - only 8 cm. She is going slower than we expected. Dr Ojo decided to go play some soccer.  We told him to be sure to be back before dark to start up the generator so we could have some light.

 

We just hung out walking with Maryam, setting up our equipment and patiently waiting. At around 8, we checked her again - only 9 cm. Hmm, time to consider a plan. Baby’s heartbeat was beautiful. We felt Mom might be anxious, so we would be patient. (And still no driver or vehicle keys) Around 10, I noticed Maryam had some vaginal bleeding - a little more than we normally see. Baby looked great, but she really wasn’t pushing effectively. As the head moved down, Banke assumed the  “Catcher’s” position. She did a beautiful job! At 10:35 pm, a beautiful baby boy was born. No lacerations, either. He was a nice 3.5 Kg (7 ½ pounds). I took him and did the ‘baby stuff’ while Dr. Ojo and Banke took care of Mom. The placenta delivered intact 10 minutes later. 

 

Around 11, Banke was cleaning instruments, Dr. Ojo was in the hall chatting with family, and I went to check the Mom. She was lying in a pool of blood. She was starting to go unconscious. We put in an IV, gave her 10 Units of Pitocin in 500 cc of IV fluid rapidly to contract the uterus and drained her bladder with a catheter. So glad the class this week was on Post Partum Hemorrhage. We responded quickly without wasting any time. Mom’s pulse and blood pressure stayed normal. We put the baby to breast, elevated Mom’s legs and continued to monitor closely. The uterus firmed up for a short time, but the bleeding continued. We decided to give another drug - Misoprostel to firm up the uterus. This worked very nicely.  We reexamined the cervix and birth canal for any tears that might have been missed. None.

 

By around 2:30 things had calmed down. Maryam’s pulse and blood pressure remained stable and the bleeding had become normal. In all, we estimated she lost a little over a liter of blood.  Everyone was exhausted. I told the others to go to bed for a couple of hours and I would stay up. The generator ran out of fuel at 4:17 am. So my checks were done by lantern light.  The baby nursed again.  Maryam was resting comfortably.

 

Dr. Ojo relieved me at 6. When I went back to check on them at 8, Maryam had gotten up to go to relieve herself and had eaten some food.  She is pale and will be on iron supplements for a while.  God was definitely with us. We have no doubt if she would have stayed home to deliver, she would not be alive today.  We are hoping that this will encourage more women to come to the clinic to deliver.

 

That is the story of Pampaida ‘s second delivery! The training prepared us for this emergency. We are reminded to always be alert and ready to respond in a systematic, calm manner.

 

I have claimed this little boy as my African grandson. I will post pictures when I get back home. 

 

That’s all for now.  I need sleep!

 

Blessings!

Robin

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

I am finally able to write of the first ever birth at Pampaida Health Clinic, New Millenium Village, Nigeria!

Maryam is a 17 year old mother with her first pregnancy. The team tonight consisted of Dr. Ojo, Banke, the nurse, a CHEW-community health worker, and me. Maryam had her mother-in-law, aunt, husband, a niece and nephew and about 5 other men in her entourage. The men and children quickly found a bench or position on the floor and went to sleep.

We timed her contractions. This was something I hadn’t done in about 8 years. I had really become dependent on the fetal monitors for telling me when contractions we occurring and how long they were lasting. She was having 2 contractions in 10 minutes. They were only lasting about 30 seconds. We started a partograph to frequently record information on the labor. The baby’s heart rate was wonderful and the head was well down in the pelvis. Maryam’s blood pressure was a little high at 142/90 and she had a little protein in her urine. We would have to watch her closely.

Around 1 am, we saw much more restlessness and quiet moaning. Maryam would grab her back during a contraction. I started apply pressure on her lower back or squeezing her hips to help relieve her discomfort. The two men were busy playing video games on their cell phones. I guess some things are just universal!!!

We let Maryam push as she felt the need. No coaching, yelling or bright lights! So nice. The baby’s head slowly came out. The rest of the baby followed quickly. Time of birth 2:12 am Oct 27, 2009! We dried off the baby girl. She had a  nice strong cry. Banke and I tended to the baby. Her Apgars were 8 and 9. This is a scale to determine how well the baby is adapting to life outside the womb. She was doing great! We  tied off the cord with a fine string that had been soaked in alcohol (Spirits). Dr Ojo checked to make sure there were no more babies and gave Maryam 3 tablets of Misoprostel. This is a drug to help contract the uterus, deliver the placenta and prevent excessive bleeding. 

For the next two hours we continued to monitor Maryam and the baby.  They were doing well, so after cleaning up we went to bed at 4 am. I woke up at 6, checked Mom and baby were doing well. 

We had breakfast, saw 28 women in prenatal clinic and then went to discharge the new family. We did a discharge physical on both mother and baby and taught Maryam, her husband and the mother-in-law what to expect, when to return if certain signs developed, how to monitor the baby for dehydration and how to take care of the umbilical cord. We will see the baby back in 1 week. We will check her weight. Her birth weight was 2.3 kg - just a smidge over 5 pounds. She will get her BCG vaccine (to prevent TB), a Hepatitis B vaccine and her oral polio vaccine. Ideally, she would have received these right after birth but we have no refrigerator to store the vaccines so we have to get them from the clinic in Ikara and carry them in a cooler. Maryam will return for a check in 2 weeks.

We were all exhausted. So after pictures with the family, we sent them home in the ambulance (Maryam wasn’t quite ready to travel on the back of a motor bike), we all went to take a much deserved nap.

____________________________________________________

Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

Here is the lastest news from Robin Jones, a Registered Nurse and Women's Health Care Nurse Practioner, who is currently leading a team of Physicians for Peace volunteers on a mission to Zaria, Nigeria, to assist with work being done there as part of the United Nations Millennium Village Project. The core mission of the project is to help underserved regions of sub-Saharan Africa reach the Millennium Development Goals for ending poverty and improving maternal and child health by 2015. Physicians for Peace volunteers are working with local clinics to assist in midwifery education. This is an exciting look at the work being done daily to improve health care for women and children in this region...

Thursday, Oct 15, 2009

Greetings from Pampaida!

Wow! What a week! Monday, a woman came to the office in Zairia. She was introduced to me as a Midwife/Lecturer at the local Training Hospital. Dr. Woje asked that we meet and have open discussions and perhaps I could lecture with the students one day. We traveled over to the teaching hospital, where I was introduced to the Director of Midwifery and the Principal (Dean of Nursing Education). A meeting with the Faculty has been arranged for Friday (tomorrow) morning. I have also requested to spend a day following a midwife. I have drafted a list of questions for discussion. Also, I will ask their help in developing a Safe Childbirth Checklist.

Monday afternoon, in the middle of a rain storm, we headed out to Pampaida Village. There were 17 of us crammed in a small van, plus supplies. I did wear my seatbelt (ALWAYS!) The driving is a bit crazy. They use the horn all the time.

I settled in my room. I have a bed net here. No mosquito buzz attacks in the middle of the night. Banke, one of the nurses, has the other room on the women’s side of the quarters. She also does the cooking. She is an excellent cook. I have had French fries, fried yams, fried plantain, beef stew, spaghetti, rice, beans, greens, and melon and custard. My stomach hasn’t adjusted to the greens just yet. A sauce is made from sun-dried tomatoes and red peppers. It is put on rice, meat, vegetables and spaghetti. I am really enjoying the food. This morning for breakfast I have spaghetti with sardines and hash brown plantain. I was finally able to convince Banke to let me wash dishes. I told her the cook should rest after the meal and allow the ones she served, to serve her.

In clinic at MV1, Maru-a village Health Worker, has learned to do tummy checks. She measures the uterine height and also assesses how the baby is positioned so we know where to listen for the heart beat. She learned very quickly. Next week, I will work with Banke.  The Doppler is a hit with Dr. Oje. He works with the Doppler and I follow with the fetoscope to perfect my newly learned skill.  We have discussed the need to maintain the fetoscope skill as it is not dependant on batteries, nor does it have components that can break. The problems with technology...

In the late afternoons, Banke and I have been strolling through the village. The small children- toddlers are still frightened of the white skinned woman! The rest of the children flock around as they love having pictures snapped. I have to be careful - sometimes there is shoving to get attention and the littler one are pushed to the ground. I took pictures of the settlement-cooking, bedrooms, shops,etc. I have finally learned what millet is. It is a grain that grows on a stalk that looks similar to bamboo.  The grain grows on the top, similar to the tops of the corn stalk. When it is harvested, they beat the stalk to remove and collect the grain.

Today, we had our first training session. We discussed the reproductive system, fertilization and fetal development and prenatal care before the computer died. I have 4 students, one of which is a male. Lots of great questions were asked. We will continue on Monday.

I have enjoyed sleeping with a mosquito net. When I arrived back in Zairia, I was told they are going to put one up here also.  Not sure if it was the open spaces of the village or the net,but I certainly slept well there.

_______________________________________________________________

Monday

Oct. 19, 2009

As another week begins, we will be heading out to Pampaida in the next hour. I will do another lecture today.  We will wrap up prenantal care-maybe even a quiz. Then we will go over the components of labor. Tomorrow, I will be working with Banke in the clinical setting-doing ‘tummy checks’.

This weekend was much better than last weekend. I spoke with Jeff on Friday via Skype, so the feelings of homesickness weren’t so bad.  Saturday, I did some laundry. Boy, did I take my washer and dryer for granted!  I used a bucket and a large bowl to wash the clothes.  I ran out of bottled water so I boiled the municipal water (when it was on). Even after 20 minutes of boiling there was still a dirty looking sediment. I only used it for cooking. I couldn’t bring myself to drink it.

I read 2 books this weekend and did some knitting.  My exercise routine is up to 20 laps around the compound, 30 toe touches, 50 sit-ups and 50 leg lifts a day.

Yesterday, Dr Woje and his family came by to take me to church.  The message was on willingly doing God’s work. Another timely message. The Sunday school lesson was on daily Bible reading and study.  Mrs. Woje (Hannah) was very disturbed that I only brought my little New Testament. She has lent me a Parallel Bible and also given me a Study Booklet.  She has invited me to go to a Revival Convocation in Kaduna the last weekend of the month. She is going to be the boost I need to become more disciplined in reading/studying the Bible!  After church, I was invited to have lunch with the family at their home.  I helped cut up cabbage for cole slaw.  The meal was wonderful-rice with the spicy red sauce, curry, fried plantain, cole slaw (not quite like ours) and paw-paw. It was my first time trying paw-paw.  It is almost like a cross between the mango fruit, papya and cantaloupe. Very good!  Dr Woje extended an invitation that I stay in their guest wing on the weekends. I thanked him, but declined.

His wife has a water filtering business next door to the house.  They take the municipal water and filter it through sand and ultraviolet filtration, then bag it in small bags. People bite a hole in the corner of the bag and can enjoy clean water. Quite impressive!  He dropped off about 50 bags last evening.  I will take about half out to the village with me.

I transferred another 180 pictures from my camera. Maybe Friday, the IT guys can show me how to attach/send them. Or I can figure out Flickr. 

Signing off until Thursday afternoon when I return to the city.

____________________________________________________________

Friday, Oct 23,2009

Greetings from Nigeria!

 

This was a very busy week. I taught Monday and Thursday. We covered labor and delivery and complications. They have grasped previous concepts well. I continually quiz them on things we have already covered. Prenatal clinic days  are Tuesday and Wednesday. The male student, Tajudeen, did  "tummy checks" with me on Tuesday. He did a very good job.  He also taught the  pregnant women about condom use. I know...too late to prevent pregnancy, but they are encouraging condom use to cut down on the HIV incidence. He always asks the most questions during class.

 

We had a little girl that the doctor thinks might have sickle cell disease. She was dehydrated, febrile and didn't make a sound when they put the IV in. By late afternoon, she had perked up and was eating without vomiting. They will send blood for Hgb electrophoresis.

  

On Wed, at the other clinic, we saw 52 pregnant women! The nurse was gone to a conference so the doctor and I were busy. We took Maru, another nurse, with us. One woman said she was 4 months pregnant, but we couldn't feel anything on palpation. Did a pregnancy test which was a very faint positive. So we will see her back in 4 weeks. Either she is newly pregnant or had a blighted ovum. Another thought she was 6 to 7 months but had no uterine enlargement above the umbilicus. There was a lot below-either twins- I heard heart tones in the right and left quadrants or the baby was transverse. We referred her for an ultrasound.

  

After clinic, I showed Maru and Tajudeen how to clean up - wash the exam table, doppler, tape measure and scale with alcohol. They are using hand sanitizer between each patient. I have enough to last a couple of months. We had an assistant clean cobwebs, wasp nests and mouse and lizard droppings from the exam room in Saulawa. I wanted to do it, but the doctor vetoed the idea. The clinic is scheduled for a renovation, but we need to have it as clean as we can for the sake of the patients.

   

I have been doing a lot of walking - through the village or just down the road. It feels good to move. I have watched the men play football a few times. (soccer) They sure are good at heading the ball and also lots of fancy footwork - even barefoot or in flip-flops. There is certainly that sense of competitiveness. I guess that is a universal trait among males!!!

  

Banke, my housemate in the village, is coming by to take me to the market today. I want to get some material and have an outfit or two made. It will be my first trip out. I need that. The weekends are the worst as far as homesickness goes. Today is the halfway mark. Part of me wants to leave today and the other part knows there is still much to do. 

    

We have 9 women at term at Saulawa clinic so I am hoping we are around for a couple so the nurses who haven't done deliveries get some experience before I leave. The goal is to have the women come to the clinics to deliver. I warned the doctor that change takes time. If the nurses can train the TBAs (Traditional birth attendants) in warning signs and when transfer to the clinic or hospital is appropriate, they may be more successful with their goals.

  

I showed my Breech delivery/Shoulder dystocia video yesterday. Dr Woje informed the staff that I would leave the video so they can review it whenever they want. Guess I will get another when I get home! I have been able to utilize my teaching powerpoints from school. Most of the time my computer battery lets me get through the lecture.

  

Banke has asked me to let her take notes from the powerpoints in the evening when we have generator power.  I will probably download my powerpoints on Dr Woje's computer or a flash drive if he has one. Also, he has asked me to download the soft copy of "A Book for Midwives." I told them we believe in See one, Do one, Teach one - so I expect everyone to pass on the knowledge they are obtaining.

  

I will talk with Bala today to see if he can arrange a visit with Biya Dogon before I leave. Dr Woje doesn't know the name.

 

That's about it for now. Have a great weekend!

 

Robin

_______________________________________________________________

We thank Robin for her excellent reports from the field, internet access permitting! If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site atwww.physiciansforpeace.org.

Day 5 -

Greetings from Nigeria!
 

   The internet was down when I came to the office so I thought I would write as soon as it was available..

The little girl I saw yesterday after having a febrile seizure from malaria is improved today. Praise God!

 

I have been able to cook the soup mixes I brought.  I cook on top of a gas canister that has a stove grate on top.  It is sufficient. I will take my soups and oatmeal packs to the village, just in case the local food doesn't agree with me. The one local meal this week didn't!

 

One of the secretaries went shopping for me yesterday. She was able to get me a sheet- I had been using my shawl from my shalwar kamiz (Afghani outfit) to cover up. There was more to be covered than the shawl could accomodate! When the electricity goes out, I have been using a little pen light to get around. Now I can even read! She also got me a case of water.  I drink one bottle during the day, then really load up in the evening. That way I have the western toilet  vs. the squat toilet.  I look forward to my daily splash bath. The cold water feels wonderful.

 

Today, Dr. Woje and I will choose teaching topics.  He has also asked me to come up with a Safe Childbirth Checklist to post in both delivery rooms. So any of my fellow midwives, please feel free to send me ideas, anything you have used . You,too, can impact birth in Nigeria!

 

Barbara, another secretary, will take my laundry back to her home in Kaduna and wash things this weekend for me. She has invited me to spend next weekend at her home. We will shop for cloth and have her neighbor, a tailor, make me some clothes. Yeah!  You know how much I love wearing ethnic clothing.

 

I have been invited to worship with the doctor at his church on Sunday. I am sure it will be very upbeat and exciting. Many of the people here in the office listen to Contemporary music. It is great and makes me feel  like I have a family here.

 

I am starting to acclimate. I think it is in the high 90s to low 100s each day. Evenings cool off nicely-so the sheet is great to have. I am getting to sleep between 1 and 2 am.  The internal clock has been hard to readjust.

 

The people have been friendly. The babies are starting to warm up to me a little. They aren't screaming as long when they see "the ghost."

 

Peace on Earth Begins with Birth,

Robin

Day 6-7

The weekend was rough. I had a major case of homesickness. Everyone cleared out of the office by 3. The office was locked so no internet access. I was alone in the Guest House and there are bars on the window . And everything is inside a guarded, locked compound. Great for safety, but talk about feeling like I was in prison.  I had plenty of opportunity to review the book and outline my lecture for the week. I will actually start on Thursday.

  

Plenty of time for reading. I read 3 books over the weekend and started knitting a prayer shawl.  I finall broke down Saturday and called my husband, Jeff.  It was so good to hear his voice. Sunday, Dr. Woje and his daughters arrived to take me to church with them.  It was a wonderful time of study, singing and worship. 

 

This morning, one of the Midwives from the Training Center came by at Dr. Woje's request.  We then went to the University Training Center where I was introduced to the Principal and the Director of  Midwifery Education.  We have arranged a meeting on Friday with all the Midwifery Instructors and myself for some Cultural Collaboration.  I am  hoping to "follow" a midwife for a day or two and actually witness a few births with them.  I have already mentioned that I would love their input on developing a Safe Childbirth Checklist for the delivery rooms at Pampaida.  We talked about all the midwives who are retiring. I suggested, perhaps they would be interested in apprenticing some of the CHEWS and TBA s in the village.  I think involvement of the Nigerian midwives would be a great way to go rather than me coming in and explaining the way I learned.  I am so excited to see what natural birth looks like - wasn't able to do much when working with the physicians!! They like to manage labor and childbirth.

 

Everyone has been very welcoming. I did give a copy of "The book for Midwives" to the Director and principal with an inscription. "Looking forward to collaboration with you for the health of mothers and babies" signed Physicians for Peace.  We will be tight on books. I have 7 left. I will make sure the nurses who will attend deliveries get one. I have asked Dr Woje to disperse the rest to the CHEWs as he sees fit.

Peace on Earth Begins with Birth,

Robin

 

Many thanks to Robin for taking the time to send such great field reports from our volunteer medical missions! If you would like to make a donation to help mothers in poverty and support our medical missions in Africa, please visit our web site at www.physiciansforpeace.org.

More news from Robin Jones on of our Maternal and Child Health medical mission trips on the ground now in the Millennium Village of Pampaidas in Zaria, Nigeria...

Day 3 - 

 

No water or electricity when I got up at 7 am.  Breakfast of bread and butter with tea.

I arrived at the clinic. Dr. Woje loves the “Book for Midwives.”  I will check e-mail and then we will leave for Pampaida. 

 

It was about an hour ride to MV1.  I was with Dr. Oje doing ANC (antenatal care) The woman gets her record, goes to the lab for urine dip and anything else required. Then she sees the doctor. She is asked how far along she is, and if there are any concerns.  She then goes to the exam table.  We did raise the head to prevent vena caval syndrome.  Fundal height is assessed. All moms today were close to the “month" they said they were in. If > 28 weeks the fetal heart tones are assessed with the fetoscope. I even heard them. I took the Doppler but forgot the gel .  They assess the conjunctiva for pallor and assess the ankles for edema. The weight is obtained in Kg.  Today the women ranged from 40-60 kg. They are told when to make their next appointments.

 

On the initial visit the mother is screened for Blood type and Rh, VDRL HIV and now they are starting to screen for Hep B.  After the 1^st trimester, they are treated for malaria and dewormed. Some mothers told us how many pregnancies/babies they have had but don’t know how long ago. Age isn’t that important.

 

Girls marry around 13 or 14 years old. They have problems with CPD so I will be teaching the Partograph to identify when labor is lasting too long, without progression. VVF is a big problem.  Early identification of problems will prevent these.
 

I will be teaching the nurses prenatal care and the importance of early identification of preeclampsia- hopefully preventing eclampsia.   If the urine dipstick is + for glucose, a random glucose or fasting is used as the screening tool for GDM.  This isn’t too common of a problem here.

 

I was given a tour of the staff quarters where I will be staying from Monday- Thursday every week.  Nice sleeping area, small kitchen and a squatty potty!  There is running water and a shower.  My room has a lot of bees right on the window screen. I have been told they will spray.  No internet and very limited electricity so I doubt I will be e-mailing throughout the week.

 

After finishing clinic we went to the other clinic – MV2.  They had a delivery about an hour before we arrived.  The placenta hadn’t separated yet.  We had the baby nurse and promised to return after going to a community health survey of a village outside Pampaidas Millennium Village.  Ht/wt, Hgb, blood smear and urine and stool cultures are being done.  These people are the control group to see if the MV has shown improvement over the outlying communities.  They will gather the data and do teaching with these people.

 

When we returned to MV2, the placenta was out and intact! We rode back to the Zaria office.  Barbara, the secretary , is spending the night here with me.  Dr. Woje stopped at a restaurant so I could get a meal.  I got greens (spicy), pounded yams (bland), beef and liver.  I also  got two  bottles of water and some fruit juice. Going all day in the heat without water is tough. I downed them in no time.  I shared my meal with Barbara. Then she suggested we walk down to the Chinese restaurant to get bread for the morning.  I bought a loaf of bread and 2 more bottles of water.  It was good to go for a walk, but I won’t venture out on my own.

 

The electricity just went out so I will bathe by penlight.  This consists of splashing water, soaping up and rinsing off with a small bowl dipped into a bucket of water.  It will get rid of the dirt and sweat and cool me off.  I feel privileged to have these amenities.  My computer is  on battery and getting low so I will close for tonight. 

 

Great Day!

 

Day 4 - 

 

Today I was in Pampaida village to meet with the village chief.  He welcomed me as his guest and assured me of my safety. He asked what Nigerian food I will eat. Food is spicy here, so I am preparing for that. I told him I am willing to try anything. I met with the nurses (females) and the CHEWS (Community Health Extension Workers) (males) that I will be teaching. It looks like teaching days will be Mon and Thur, Prenatal clinic days are Tues, Wed and births will be OJT.  I will actually stay in the village Mon-Thur, then back to the guest house at the office in Zaria (1  hr drive) Fri-Sun.  There I will have electricity and Internet access (though sporadic).  So after this Sunday, Communication will only happen on the weekends.  Dr. Woje has invited me to worship at his church this Sunday.

 

From my work e-mail, I can attach pictures.Yeah!  Here are just a few.

 

Thanks!

Many thanks to Robin for taking the time to send such great field reports from our volunteer medical missions! If you would like to make a donation to help mothers in poverty and support our medical missions in Africa, please visit our web site at www.physiciansforpeace.org.

Robin Jones, a Registered Nurse and Women's Health Care Nurse Practioner, is currently on a mission to Zaria, Nigeria, to assist with work being done there as part of the United Nations Millennium Village Project. The core mission of the project is to help underserved regions of sub-Saharan Africa reach the Millennium Development Goals for ending poverty and improving maternal and child health by 2015. 

Robin will be working with local clinics to provide education so that those who are assisting during labor will have the knowledge they need to help prevent trauma to the mother and protect the health of the baby. She will also lay the groundwork for future missions in midwifery training to increase the number of qualified midwives available to expectant mothers. 

Robin sends us her first impressions of Pampaidas and the progress being made there: 

Day 1 -

Hi!

  I finally arrived in Nigeria yesterday at 11 am. We had a 3 1/2 hr drive to Zaria, where the Pampaidas Millenium Project offices are located. I checked into a hotel for 2 nights.  The accomodations are meager but sufficient. Water was off until this morning and electricity is sporadic. The 24 hr internet cafe was locked up. But the office has wireless, so I will be able to keep in touch with those in the States!

I was given an overview of the Millenium Village project this morning, watched a documentary of the project and met with the various directors.

 

There are roughly 5,000 people in Pampaidas village. Seventy percent of the village are below the poverty level (live on < $1 US/day) The areas being addressed over this 5 year project are
 

    1. Education- the children are educated from grades 1-6. They are working at ensuring the girls, as well as boys, attend school. Each child is given a backpack with books, paper and pencils. School furniture was obtained and they are completing the building of a school kitchen. Each child is guaranteed one meal a day at school.

      Goal: to sensitize parents on the need of school enrollments

 

    2.  Health- they now have 2 operating clinics.  Last week the clinics saw 221/158 patients.  Total antenatal care was 15/24 with 4/8 new OB patients.   .

       a. Outpatient consultations- provide basic PHC (Public Health Care ) services to all villagers; treatment of common diseases; provide short-term in-patient care.

       b.  Antenatal care - to provide routine prenatal monitoring including interventions such as deworming, IPT  Iron/folate and vitamin A supplementations.

        c.  Child welfare clinic where basic immunizations, growth monitoring, Vit. A supplements are provided. Deworming and treatment of  common nutrition/infection related illnesses are treated. 

       d.  Outreach activities- provision of proximity interventions that target families in their homes, build trust and ownership throughout the communities, and address cultural beliefs and socio-economic and behavioral barriers to care.

     I will tour the village and clinics tomorrow and meet with the clinic staff to formulate the needs/teaching plan.  I am excited to get started.

 

    3..  Gender and Community Mobilization- to mobilize the community (men and women) for farmer field day and to mobilize community clusters for training in agriculture and business development.

 

    4.  Water and Sanitation- 23 wells have been dug and capped to provide clean water with easy access, Latrines are being built.

   

    5.  Agricultural Business development and environment- on-going improvement and training on agriculture and business; develop receipts for repayments of loans; Improve on grains banking; increase fish farming activity and business; encourage home gardening to improve nutrition; start stocking agro input supply centerwithin cluster.

 

    6.  Infrastructure- receive materials for completion of work on poultry houses and agro processing centers.

 

   As you can see, a lot is happening here in the Millenium Village Project. I am excited to be a part of helping this village to become healthier, more educated and sustainable. I will try to send frequent updates

 

 

Peace on Earth Begins with Birth!

Blessings!

Robin

Day 2 - 
 

My body is still on US time so sleep is quite elusive.  When the electricity is up, I read. Currently I am reading Three Cups of Tea by Greg Mortenson.  It is about an American who decided to build a school in the mountains of Pakistan.  It is amazing what people can do when they put others before their own comfort. When the electricity is down, I have been listening to my IPod- music or audiobooks.

 

Last night I had my first full “splash bath”. You fill a bucket with water (cold), use a bowl to splash water on yourself, soap up, and then splash to rinse. It felt good to cool off. Much better than the Baby wipe bath the day before!  When finished, you mop the bathroom floor of all the water you splashed!

 

For breakfast, I had bread with peanut butter. I remembered to take my weekly Malaria Prophylaxis today. Several mosquitoes have already dined on me, so I don’t want to take any chances!

 

Last night I plugged my phone in at the office to recharge. When I walked in this morning, they turned the generator on. I heard a POP! And saw flames shooting out of my adapter/converter. That is now fried. The phone is OK but didn’t charge. I brought 2 adapters so I was able to get the phone charged. Glad I brought two.  I may have to get another locally!

 

Today we were at MV2 doing prenatal care. I worked with Hadassah, the midwife. Unfortunately, she said the BP cuff didn’t work. Dr. Oje had the Doppler at the other clinic, so while we waited for him, I did the weights, tummy checks, and improved my skills with the fetoscope.  Dating is difficult as women do not use calendars as we know them and most today had no idea how far along they were. Babies come when they come.  So the pregnancy wheels I made will be of little use.  We just measure the belly and see if there are appropriate changes in size and weight between visits.

 

I taught Dr. Oje how to use the Doppler. It is just an $80 model off E-Bay but it works well.  He was amazed when we found heart tones on a 14 week fetus.. Yesterday he wore and changed gloves between each woman. I have just used hand sanitizer between patients as we only do external exams.  I will bring extra for the clinics next time. Gloves seem to be a bit much just for measurements!

 

We had one girl, about 15 or 16 years old here with her first pregnancy.  They explained that she is of Low IQ, as is her husband.  She was very anxious, but we were able to get her calmed down and check the baby.

 

There is a lot of anemia due to the poor nutritious quality of the diets.  The primary stable is maize (corn) They grind it up and make a cereal or paste.  All the women are given iron supplements and also folate (B vitamin).  I saw several women with Vit B deficiency.  They develop cracks in the corners of their lips.
 

They admitted a young child to the ward who was having a seizure.  They gave her IV medications to stop the seizure.  The doctor felt it was a febrile seizure as a result of malaria. I said a short prayer for her.  

 

The staff are teaching me short phrases “senu de zwa” means Welcome; “Na Gode” is Thank you,” "Ina quana” is good morning and “Sa hanjuma” means See you later.  I hope to add a phrase or two each day. At my age, I can only retain small amounts with lots of repetition.  I am learning so much from them. I hope when we formally start classes, they will learn from me.

 

We will have a meeting with the health workers tomorrow to set up a class schedule that won’t interfere with the clinic work. Today, the doctor, midwife and I were a very efficient team. Between 11 and 1:30, we saw around 30 women. The midwife documented while the doctor and I did the exam.  Team work is great.  I will also poll them to see how they want to proceed with the classes. I think we will start with prenatal and move on from there. If a delivery comes in, we will immediately do “on-the-job training.”

 

Time to go to my room and relax a bit. I hope all is well back in the States.

 

From Nigeria,

Robin

We look forward to hearing more from Robin as we receive her reports from the field! If you would like to make a donation to help mothers in poverty and support our medical missions in Africa, visit our web site at www.physiciansforpeace.org.

 

Above: Kissairis Rodriguez (left) proudly wears her "Madre Tutelar" vest as she pays a visit to

one of the young girls she mentors as a Resource Mother.

In light of today's New York Times article, "Saving the World's Women" I thought I would share with you a first hand account of how Physicians for Peace maternal and child health programs are healing and empowering women around the world. It is the story of Kissairis Rodriguez, a young woman in the Dominican Republic who evolved from a scared teenage mother, trying to make a life for herself and her child in the barrios of Santo Domingo, into a mentor for other young mothers living in poverty...

 

"When I was 15 years old I got pregnant and had my baby at the age of 16. When I find out I was pregnant, I felt that the world was coming apart. I experienced all the difficulties and dilemmas of being a pregnant teenager. Four years ago, when leaders of my community talked to me about a program for pregnant adolescents, and invited me to attend a meeting, I went to the maternity hospital and received all the information about the Resources Mothers Program. I got very excited thinking about the possibility of being a part of it, because I knew there were other pregnant teens out there, and I wanted to be sure they could receive the help they needed. I was selected and trained by the Physicians for Peace staff, who offered me employment as a "Resource Mother."

 

As Resources Mothers, we are part of our barrios - we live there and  share our clients’ needs. Thanks to our training we can help young women keep away from drugs, alcohol, and tobacco - things so common in our community. We help them take care of themselves during their pregnancy, accompany them to prenatal check ups, and visit their homes, advising them and their families on how to have a healthy pregnancy.  We also advise them how to eat well, even when there is so little to eat.  We teach them how to nourish not just their bodies, but also their souls, so they can deal with all their worries and fears. 

 

My experience as a Resource Mother has inspired me to go to the School of Medicine, and in a few years I will become a doctor. I am grateful to God and to Physicians for Peace for the opportunity to believe that there is light at the end of the tunnel, but most of all for the opportunity to become a better human being."

Kissairis' story shows how women around the world are making a difference in their own communities. Global health organizations are realizing that supporting maternal and child health programs is the most effective use of their resources. Physicians for Peace is part of this movement. Please help us to empower mothers in poverty with our Resource Mothers Program, Midwifery Training Program, VVF Surgery Program, and Prenatal Lifesaving Program. 

Donate Here or visit our web site to learn more. 

Thank you for your support!