A CHALLENGING DAY…

I had to include this picture – This was a particularly challenging day, Breech delivery ( Bottom First) stillborn baby, Successful Resuscitations X 4 – One unsuccessful, one baby died about and hour later after resus, obstructed labour and 6 caesarean sections for various reasons, eclampsiai ( fitting in pregnancy) and after a normal delivery

Washing day at Amana Hospital

I look down at my feet – they are swilling in water…my first thought was – oh great burst water main….but no its cleaning day!

On day four – they usually just mop but today is water and scrubber day, electrical cords lying in the water….broom, meanwhile we still have no soap at the sinks to wash our hands – I bought Sapoderm soap at the Duka la Dawa (Pharmacy) and placed the at all the hand basins – amazingly there is this fantastic poster on how to wash your hands etc BUT no soap, no pump pack, but they provide one 100 ml Sanitizer gel per week!!!!

GLOVES, GLOVES, WHERE ARE THE GLOVES!?

It’s gone in the first 5 minutes. We wear gloves for everything – double glove for deliveries, and Chase and I bought 20 packets of gloves with 100 gloves per pack – but 10 am every day they are gone – we share with all the midwifes as well. The hospital does an amazing job providing what they can in such an under resourced environment.

Chase and I stuff our scrub pants pockets with gloves so we have enough for the day.

Chase favorite baby – he was a wee cutie pie.

Chase second favourite baby

This wee baby was quite flat at delivery – we gave him positive pressure ventilation via bag and mask and he picked up really well.

He actually had a lusty cry which is very rare here.

Check out the fabulous Osh Kosh Hat!! Best dressed baby that day!

This little man was being checked after a few resus

This little man was being checked after a few resus – some unsuccessful – it’s so frustrating because the mothers arrive after long labours – sometime we have no idea how long they have been in labour – foetal, distress is common place and it’s such a race to save so many babies – this little man was being checked cos we had so many tired babies – this is just me checking him after ten minutes – he was so exhausted as was his mum – see the poster in the background – fantastic posters from US AID and the Help Babies breath program http://www.helpingbabiesbreathe.org/

HELPING BABIES BREATHE

Helping Babies Breathe (HBB) is an evidence-based educational program to teach neonatal resuscitation techniques in resource-limited areas. It is an initiative of the American Academy of Pediatrics (AAP) in collaboration with the World Health Organization (WHO), US Agency for International Development (USAID), Save the Children’s Saving Newborn Lives program, the National Institute of Child Health and Development (NICHD), and a number of other global health stakeholders.

THE GOLDEN MINUTE

The Golden Minute: A key concept of HBB is The Golden Minute. Within one minute of birth, a baby should be breathing well or should be ventilated with a bag and mask. The Golden Minute identifies the steps that a birth attendant must take immediately after birth to evaluate the baby and stimulate breathing.

One part of newborn care: The HBB curriculum is designed for use as part of a coordinated educational approach to early neonatal care and can be effectively combined with other curricula. It is much more than a classroom-based educational program. Its system-based focus is designed to change clinical practice across systems of care.

Helping Babies Breathe

Challenge: An estimated 717,000 newborns die each year from intrapartum-related causes and the inability to breathe immediately after delivery.

Mission: To train birth attendants in developing countries the essential skills of newborn resuscitation, with the goal of having at least one person who is skilled in neonatal resuscitation at the birth of every baby.

These twins were born to mum who had polyhydramnios ( lots of fluid around the babies ) she was very big – the mum had a Caesarean section and they were big babies 4.2 kg and 4.6 kg –which is extraordinary.

Jeanette see your knitted beanies on the babies! Hey Kasey …Go BDO our accountants – this little guy was very snuggy ! Tiz & Kim’s head beanie – BDO bootees !!!

Jeanette see your knitted beanies on the babies!

HEART-BREAKING.

Chase comforting a young mum who lost her baby this morning – this was her second still born baby.

It was heart breaking – There is so little time for the comfort because in the other room mothers are pouring in the door delivering ….I hugged this mum and cried with her whilst I watched the midwifes manage to deliver another 4 babies in the 10 minutes I gave this mum…it was such a small time to say sorry (pole – pronounced Polay)

We gave this mum a beanie, booties and a little one-zy ( Barbara – they were your gifts and I said to the mum they will bring her luck for her next baby)

The midwife counselling consist of saying to the mum when they get home …and ask god to help you and at next pregnancy you must come every month and be at the hospital early…..there are no tissues to dry their eyes and so Chase and I bring in a small packet each day and they always get used.

Chase & I go into postnatal ward every day and give beanies to those mothers who birthed over night and touch base to those we looked after that morning to the day before – it’s always so rewarding to re connect and I love the continuity of care being part of their after care.

Me in the cleaning room

This is me in the cleaning room – we soak the baby resus bags and masks, nasal prongs ( there are only two sets) and the penguin suckers – soak for 10 minutes in chlorine solution, then wash in soapy water then rinse in clean water – then dry on an old no sterile sheet.

The nasal prongs are hung on an old hook by the open window – so I wrap the prongs in a sterile glove – at least its clean …ish.

In a busy day the babies can be sucked out by a bulb syringe used on several babies – I simple wash then in soapy water if we are out of time and believe I am making a difference – I have had at least 4 sisters have come to me and say I am very good  trying to stop cross contamination.

In front of me is a wee baby that had died that morning …this is where they are placed.

THE LUCKY ONES

I say a little prayer when I go into that room and often go in that room several times so the babies are not alone – and know I am watching over them at least while they are with us in labour ward – I say a prayer for these little babies …all the while pretending to clean equipment that I have already cleaned…..these wee angels I pray god will give wings…..

We have in Australia so many things we don’t realise.

We may complain about tax but we enjoy education for our kids, roads without pot holes the size of trucks, warm beds at night, good food, and healthcare should we choose to seek it – and for our babies ( and ourselves) we have the best chance and we can find no excuse not to give our babies the best start.

We think our lives are difficult at times – we complain and stress over minor things… One thing I take from this experience personally is there is still much to be done….it’s not enough to enjoy career, family, friends and life without giving back to someone, somewhere, and for me in every mothers eyes I see hope & dreams no different from yours or mine – except they were born into a nation crippled by poverty, poor health, failing infrastructure.

Aunty Glenny’s Hat

THE GENEROSITY

The generosity of you all in what you have donated, given and knitted may seem so small to many of you, maybe even trivial but it’s a truly honest gift of generosity and giving – these mothers love to know someone cared 1000’s of miles away –that someone cared enough to knit, purchase or donate – that they are not forgotten and invisible – they are cherished no matter how briefly, no matter how fleeting – the human touch, a smile, a look and your gifts gift are full of meaning, humanity and love.

For strangers we don’t know ….. but sisters in humanity. I leave you with this poem tonight

Love Chase & Jan XX

Go to www.midwifevision.org
To improve the health of mothers and babies through community support, education and getting involved
Dar es Salaam
Tanzania

Beanies are given out…

Thursday, 26 June 2014

I wanted you all to know we gave out the beanies today (some of them and the baby socks) it was such a moving and beautiful (mnzori in Swahili) privilege and the mothers were so grateful and so humble – they have so little it was received with tears, laughter ….lots of hugs and mostly of all the joy on their faces when they showed us the wee babies.

We have Swahili lessons three nights a week, which is hilarious, but a must to really immerse yourself in the language, which is to know a people, they are wonderfully generous of spirit and we have had some laughs.

Mothers all in labour waiting for a bed

Chase is with me on labour ward… It’s a room with 8 delivery beds plus two observational beds or high risk beds.
There is an antenatal pre-labour ward which is effectively a booking place and you assess the patient – start a partogram (special chart for labour and delivery) – it’s a very busy ward.

Post Resus…Good outcome…

There are 80-120 babies born every day, which I know defies belief but its true – the mothers travel far and wide.

The sisters on the ward – Midwifes – they are highly skilled and care for a great deal of women every day and see every imaginable pregnancy outcome, and they have full days. There is no tea room or break room , because they never have a break on shift – there are few lulls in the constant stream of mothers.

So day One – we arrive at the hospital – change into scrubs – get our ID badges – go to the ward – and the sister comes in to greet us and says please come we will show you orientation later….. We are busy – please bring your gloves. We  walked into the labour ward and I was immediately involved in a delivery.

There is no tea room or break room , because they never have a break on shift – there are few lulls in the constant stream of mothers.

Beanies and Baby Socks

The midwifes are incredible and they deal with many many difficult cases – there is a ward round twice a day during the morning shift and about 2.30 – 3.00 pm – decisions are made on progress.

Communications can be a challenge with broken English and Swahili all mixed in together – –  my Swahili is limited to words like Push = Sakuma….stop ( acha) , breath good  relax, darling, beautiful baby, sorry, slowly slowly – etc etc.

But let me tell you all the best part of today…

Mother and healthy new born baby

The popular beanies – these ones from Kayla and Granny Helen

So the baby’s beanies and baby sox’s…..I am not sure I can convey in words the generosity and love you all gave in your gifts of money, equipment – baby clothes, knitted beanies, it was a beautiful and very moving privilege today  – they soaked up today the love and Golden strands of love infused into every stitch knitted or crocheted for them….the mothers…. – given by you all as total strangers 1000’s of miles away – each stitch infused with love and these gifts for me were just a breath away from being one of the moments in one’s life when you are glad your own dreams came true – that I have a profession that allows me to connect to my fellow midwifes a world away from home – being a helicopter pilot – pure freedom and professional growth – and our business which is a sum of stunning people who work within its whole mechanism ….without the success of so many of our team in making the company what it is today – I would have been able to be here …

Bucks wife Lilly – and her baby socks  a big big hit ….they loved them so will have to get the pattern specs – with one of my mother’s whom I delivered her baby.

One thing I bought that Becker Helicopters donated was educational material in Swahili and resus babies for practise, booklets.

It was amazing as we went through the golden minute – the babies first minute of life – and it’s a helping baby’s breath program to assist health care workers ….the charge sister ( they still call them that here)  she ran a teaching session with all her staff during the lull we had that day – …the posters were placed on the walls, student were trained during the day by their tutors…I was very moved and proud to have provided this training material all from a USA sponsored initiative and was so involved in the teaching of these students because there are so many resus everyday. I got involved with the teaching and created such a buzz with the words

The Golden Minute -it is now a passion of mine to teach this Helping Babies Breath program (HBB) – I will be returning in October to do more teaching.

Chase with new born baby

Golden minute – the babies first minute of life –
and it’s a helping baby’s breath program to assist health care workers

Its back to our roots as midwives – when it matters what we have as core skills and core anchors in our profession…..to be able to pass that torch to the next generation of midwifes.

….anyway I must away….internet is woeful here – staying at a local hotel on weekend to catch up on work back home and hope to get this email out before then but they don’t have hotspot or free Wi-Fi here.

With Much love and heartfelt thanks,
Jan & Chase
(Dar es Salaam,Tanzania)

Tanzania, Dar es Salaam (Oyster Bay) – June 2014

Dearest Mikey, Micheala, Family, Friends, the team back at work, midwife colleagues in 1A and fellow midwives at Amana,

Its late and I’m tired, and jetlaged,  but I wanted you all to know we gave out some the beanies today (and the baby socks) it was such a moving and beautiful (mnzori in Swahili) privilege and the mothers were so grateful and so humble – they have so little it was received with tears, laughter ….lots of hugs and mostly of all the joy on their faces when they showed us the wee babies. But I am getting ahead of myself.

I’ll add pictures to let you experience the moments.

Where does one start with such an amazing experience both culturally and professionally and all the while with Chase in her first year of study and soaking up what is an intense experience. The trip took us a long time – we had 9 bags

Let’s start with Dar as Salaam, we are staying in any area called Oyster Bay – diplomatic and western area in a house with security, a cook and 36 other people…mostly 22 year olds, all women but one guy Jack! Layout – Shared bunks, bathrooms, cold showers, hand washing clothes in buckets, power outages, local food for dinner –the chef is sweet guy …eating a lot of rice and fruit.

Swahili lesson three nights a week which is hilarious but a must to really immerse yourself in the language is to know a people, they are wonderfully generous of spirit and very we had have some laughs.

First two days we took the dala dala which is the name for bus in Swahili  for bus – but really the bus resembles an overcrowded, standing room only, death-trap, crammed in with locals with babies, food, baskets and an intensity of heat, smells – true three day old sweat, flies, dust and roads that would make 4 WD safari look like a walk in the park…..two hours from the house to the hospital  and then two hours back…did that for two days and gave that away  – we now have taxi guy who takes us in 20 minutes in a car with windows and seat belts – and we can sit with our bags and enjoy the view. – all for $10 – the dala dala is only 80 cents !!!! but in balance $10 seems cheap!

Mothers all in labour waiting for a bed

Every day we have so much stuff to carry to the hospital it was almost impossible to carry it in the dala dala.

We take our own gloves, masks, alcohol wipes, hand sanitiser our scrubs to change into water, and of course all the baby beanies …

Chase is with me on labour ward…it’s not called birth suite here because one cannot in any shape for form call it as suite.

It’s a room with 8 delivery beds plus two  high risk beds – Eclampsia,(fitting due to pregnancy induced hypertension – high Blood Pressure) obstructed labour, APH, etc

There is an antenatal pre – labour ward which is effectively a booking place and you assess the patient – start a partogram (special chart for labour and delivery) – it’s a very busy ward.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

There is 80-120 babies born every day, which I know defies belief but its true- the mothers travel far and wide because they are encouraged to have  safe delivery – they have very little but are wonderfully happy and I have fallen in love with many of them.

The sisters on the ward – Midwives – they are highly skilled and care for a great deal of women every day and see every imaginable pregnancy outcome, and boy do they have full days.

There is no tea room or break room , because they never seem to have a break on shift – there are few lulls in the constant stream of mothers.

So day One – we arrive at the hospital – change into scrubs – get our ID badges – go to the ward – and the sister comes in to greet us and says please come we will show you orientation later….. We are busy – please bring your gloves.

We  walked into the labour ward and was immediately involved in a delivery of a women on the floor – managed to get her on the bed …she delivered quickly – lady next door pushing – delivered…within 20 minutes 7 babies had been born.. We were in the zone….by one o clock Chase & I lost count after number 26 deliveries, 2 full resuscitation’s…with great outcomes   80 % meconium liquor ……Sister Rose was fantastic and I worked with her all, day, she taught me so much and it was Sister Rose who gave such encouragement to me that I could be of help here.

One lost …..at 28 weeks…C section for APH – ( haemorrhage)  the baby died …wee angel…..the wee 28 week baby – I placed it next to lusty crying babies …I wanted him to have company in his passing…..

It was hot – 32 degrees, no fans, no fly screen so flies everywhere – the sweat is dripping down my back – no breaks, no time to eat – going to the toilet is like a major expedition.

There is no tea room or break room, because they never have a break on shift – there are few lulls in the constant stream of mothers.

After being supervised and trained, Chase is now giving injections of oxytocins, we need the help because there are so many deliveries going on – draws up the drug &  checks with another RM and gives it IM – sets up delivery packs, weighs and records the babies – helps at resus. In fact I have come to rely on Chase being beside me in a Neonatal Resuscitation.

Chase will tap out the heart rate of the baby, I usually give bag and mask if required (mostly it is required) – If I needed to start cardiac compression, Chase could take over the bag and mask. Its wonderful having Chase beside me and we work well together. Routine during the day is – Restock the limited supplies – constantly through the day run out of drug we use post delivery to actively manage the delivery of the placenta and also to prevent the mothers bleeding, its a drug called oxytocis – IV bottles are rigid plastic – IV running sets – having to count drips for – augmented labour it’s a whole new skill (we use pumps) in Australia – no soap at the basins – hand sanitizer you have to provide.

Lignocaine in large bottles – methylated spirits to swab tops.

A plastic sheet about 3 feet square – (which the hospital kindly provides)
they are soaked in vats of chlorine and hung out to dry.

The other kanga we place on their chest and deliver the baby to the chest – then upon clamping the cord (delayed clamping of the cord) the baby is placed into a clean dry kanga – taken to be weighed and antibiotic ointment in each eye – wrapped and placed under a two bar heater on the wall – a piece of tape in placed on the chest with name of mother, and sex and weight.

Meanwhile back at the mother – Oxytocins given at cord clamping – the third state ( delivery for placenta) very very quickly after that.

Beanies and Baby Socks

Check if she requires any repair – repair then with 5 mls local anaesthetic – suture using the same clamps you used to clamp the cord.

There are no scissors – only scalpel blades with no handles for all cutting of cords and suture material. Suture material is cat gut – dissolvable but it’s very stiff.

The sharps bins are thin card board  overflowing – all placentas go into the other bin, all equipment used in delivery is washed and re – sterilized immediately by an old man who runs this autoclave all day long.

The mother is asked to get up and we walk her to the sitting area – a wooden bench where she immediately breast feeds her baby – along with all the other mothers.

Delivery on the bare floor.  Where are all the other midwifes you may ask-?? Delivering babies as well – even student nurses delivering.

Mother and healthy new born baby

So the baby’s beanies and baby sox’s…..

I am not sure I can convey in words the generosity and love you all gave in your gifts of money, equipment – baby clothes, knitted beanies, it was a beautiful and very moving privilege today  – they soaked up today the love and Golden strands of love infused into every stitch knitted or crocheted for them….the mothers….  given by you all as total strangers 1000’s of miles away –

Each stitch infused with love and these gifts for me were just a breath away from being one of the moments in one’s life when you are glad your own dreams came true – that I have a profession that allows me to connect to my fellow midwifes a world away from home –

Being a helicopter pilot – pure freedom and professional growth – and our business which is a sum of stunning people who work within its whole mechanism ….without the success of so many of our team in making the company what it is today – I would have been able to be here …

It feel wonderful to be part of something that is bigger than yourself …..its refreshing to be embraced so generously by these midwives, the mothers and privileged to be make a small contribution to some of these little tackers first moments of live.

The girls in the postnatal ward are 4-5 to a bed – they share and sleep together.

With one of my mother’s whom I delivered her baby

The popular beanies – these ones from Kayla and Granny Helen

Chase and I to a tonne of medical equipment which they have lapped up and the single use equipment came into its own ad they run out all the time – so please my midwife colleagues back in 1A please save the single use equipment including single use resus bags – suture kits, delivery packs- they are just desperate here and I feel so very guilty about how much we use once and throw away….in fact at one point today I just wished I could have bought more – contributed more …..We are so very blessed in Australia, NZ, UK, Europe…..

Chase with new born baby

One thing I  bought that Becker Helicopters donated was educational material in Swahili and resus babies for practise, booklets.

It was amazing as we went through the golden minute – the babies first minute of life – and it’s a Helping Baby’s Breath program to assist health care workers ….the charge sister (they still call them that here)  she ran a teaching session with all her staff during the lull we had that day – then the teaching flip charts were put up on the resus machine  that no one uses and can’t work because of power cuts all the time and no wall suction and no oxygen cylinders) ….the posters were placed on the walls, student were trained during the day by their tutors…I was very moved and proud to have provided this training material all from a USA sponsored initiative and was so involved in the teaching of these students because there are so many resus everyday.

Golden Minute – the babies first minute of life – and it’s a helping baby’s breathe program to assist health care workers

Pass that torch to the next generation of midwives

With Much love and heartfelt thanks,

Jan & Chase

(Dar es Salaam, Tanzania)

Dearest Colleagues | Staff | Family | and Chase Tanzania trip update – only 9 days to go before we leave.

Chase sits her final semester University exam the day we leave so she is focused right now on study. Equipment update: I am trying to get as much single use disposable medical equipment from GP’s | Doctors surgeries | Hospitals as Tanzania Amana Hospital can use as much equipment as possible.

Coolum 7 day Medical Practice have been the first to come to the fore with manual BP machines – something that is almost a dying art. The Coolum 7 days Surgery has them store away so they might as well make a difference somewhere in the world. I have my pinnards which is manual device used to listen to babies heart rates – I used to use in PNG 100 years ago – have dusted it off !! I have also ordered from Coolum 7 day two Doppler’s small manual Fetal Heart rate monitors for the Hospital to keep.

Sunshine Coast Private Hospital Maternity Unit Health | Ward 1 A (Uniting Health) have also donated some little baby clothes and we are trying to gather as much single use equipment as we can.

Becker Helicopters have also donated some medical equipment, some of which is for teaching and training over there. One is a baby model for teaching neonatal resuscitation– they have a training program in the hospital but don’t have enough baby models to teach. So Becker Helicopters are donating the little models that are sold at a very reduced price to countries that are part of the

United Nations Millennium goals. It’s great to see large companies getting behind the lack of resources. http://www.laerdalglobalhealth.com/ Chase & I have to take our own gloves if we want to wear gloves for any procedures and deliveries.

Thanks to Peregian Springs Medical Practise and Coolum 7 day medical practise we have been immunized for Rabies, Cholera, Typhoid, Hep A & B, Tetanus, Yellow Fever, etc etc We are partially packed with all the extra equipment we are taking for the hospital. Beanies update: My mum has sent off her knitted beanies from NZ, Aunty Glenny is still knitting (Go Aunty Glenny) and Granny going well with Kayla lagging behind (Chase sister)

Will have photos of these wee babies wearing these gifts of love. What a fabulous response ……it’s overwhelming | Thankyou ….

Chase & I have been hand washing and drying all, the booties and hats and singlet to make sure they are all fresh and clean. Just gorgeous detail in some of the little wee hats….. I cannot thank you all enough. How privileged to be part of something that is so infused with love for these little babies.

I take my hat off to you all cos I can’t knit to save myself. See below Perry’s mum has some great photos of all these women knitting away …..it brings tears to your eyes such generosity of time, energy, wool and love

Just sent the courier parcel and this morning took a photo of Judith Chapman ( on the right in the red- she was the one who organised the knitters) and Mary Busch.

They were the only ones who could turn up for the photo at the RSA. Only a few of the beanies on the table the rest still in the box. The 62 were knitted in 4 days and the man in the wheelchair from Oxford had done 22 of them!!!!!!! NZ Couriers take the consignment to Auckland today.

We have done all the Custom forms and sent with the box. Fedex Auckland receive the consignment and send it on to Backers. Don’t have consignment number but could get if required. Love Dad and Mum.

Keep sending the babies beanies, email me to pick up any equipment etc and I’ll be right along. Post beanies to

Attention: Capt. Jan Becker

PO BOX 9165

Pacific Paradise

QLD 4564 AUSTRALIA

If you want to be removed from the email updates I won’t be offended- just put remove on the subject line Hospital in Tanzania The new maternity Block – perhaps I should take a pot of paint to brighten it up a bit!

Jan