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Obstetric care at Barbara Bay Maternity Hospital, Ethiopia

Dr Margaret McDougald shares her experiences at Barbara May Maternity Hospital in Mille, Ethiopia, from March 2012.

Twins born at Barbara May Maternity Hospital in Mille, EthiopiaThese are our miracle twins! Mother arrived at 13.00 hours having delivered the little girl weighing 1.6 kg three hours previously! The baby’s temperature was only 32 deg C and we did not think she was going to survive. Her 15-year-old mother was unable to deliver her brother vaginally and, after failed instrumental and 1.5 hours debate as to whether we could or could not do a Caesarean section, during which time every man and his dog was consulted, we finally got into theatre and delivered the second baby who weighed in at 2.4 kg. The family were discharged a week later with both babies breastfeeding well.

Since the end of January, things have been going apace. We continue to run twice-weekly clinics and are seeing a mixture of gynae and obstetric patients. By using the end of the ward for antenatal patients and seeing gynae patients in the clinic room, we are able to finish at a reasonable time. The staff are gradually becoming more at ease with theatre work, although today was a little more challenging due to sickness and holidays. But operating time is decreasing as they become more familiar with procedures and the instruments.

This month Jane and Daphne have run some really good training sessions. Moving and handling have improved greatly as a result and, although they managed to drop me while transferring me from bed to chair, the patients have fared much better. Neonatal resuscitation is being taught to everyone with a very strict exam at the end. We are using the doll from the doll and pelvis kit and unfortunately it is not quite in proportion for a newborn. It would be good if we could get a proper baby resuss, so that they could learn jaw thrusts as well.

The weather is definitely warming up now – scarcely any need for light covering at 03.00. The morning shower continues to be bracing after an early morning run, but leaving it until later is not advisable as the water is then too hot and there is no way of turning it down.

We have a group of young local volunteers working on the garden and an area is now looking quite green. Our regular gardener has planted more things and we now have flourishing tomato plants, and a water melon was found recently hiding under a broad leaf! The soil here is very good – clay not sand and, when irrigated, plants do well.

The highlight of the week is to go into town after church and take refreshment in a local hotel – coffee without sugar for me, Coke for Daphne and Miranda for Jane. However, a few weeks ago the staff cooked for us and we had a real feast with meat, biscuits and popcorn.

Our staff house now has a completed roof, and ceilings too. After carefully showing them how to put a first priming layer of paint on the ceiling tiles while they were still on the ground, the plan was scotched by failure of the paint to arrive. So, instead of a nice easy job with a roller and improved penetration, the paint is being brushed on from a homemade pair of steps.

We had a little surprise on Saturday: a cat was seen going into the wardrobe – the doors are tied together with string as the locks do not work – this is Ethiopia! Closer inspection revealed three small kittens. Sentiment prevailed and they are continuing to enjoy their luxury accommodation!

The staff house is coming on well. Some glitches with the supply of materials means it will not be finished when I return to the UK, but the ‘English contract’ means that there is every incentive to complete rapidly and there is no payment for re-working. Half of the laboratory equipment has been delivered and we are waiting for the promised training. However, the microscope is now in use.

Our next challenge will be to access the target population more effectively. We have seen a couple of sad cases recently – an 18-year-old came to the gynae clinic last week, complaining of urinary incontinence. She delivered a stillborn baby 3 months ago and now has a fistula. The tragedy is we were here working 3 months ago and, while we perhaps could not have saved the baby, given that we were not doing caesareans then, we could have prevented the damage to the mother. A 20-year-old came in with a history of postpartum haemorrhage. We sent the ambulance as requested. When she arrived we found out that the baby had been stillborn 6 days previously after a 4-day labour. She had bled intermittently for the last 2 months of pregnancy and again before and during delivery. She had stopped bleeding before she arrived. She came with her traditional birth attendant and we used the opportunity to explain that referral earlier could have made a big difference. Fortunately, the mother survived.

We have now delivered 60 babies and all the mothers are alive and well.

It has been great having Jane and Daphne here. They are now extending their considerable obstetric skills and helping with estate management. Yesterday we used mosquito nets to prevent the little wretches exiting from the septic and grey water tanks, where they are breeding. En route to UK from the USA are ‘mosquito dunks’ – these are tablets containing Bacillus thurigiensis israelensis which attack the larvae. All-out war has been declared and hopefully we shall win the battle. Mosquitoes are reputed to bite at dawn and dusk but these bite from dawn till dusk. Despite best endeavours they sneak into my mozzy tent and feast all night, gleefully buzzing triumphantly to their friends on the outside. They exhibit a marked preference for fresh European meat.

In April I will be joined by Ruth and Valerie, two Australian midwives. It would be great to have another obstetrician, as the service is reduced when I am away and we do need to get out into the bush and train traditional midwives and the local community about the service and how to make timely and appropriate referrals.

Margaret McDougald, 5 March 2012

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