Time is flying

Tailspin

Two more working days!!

I am in a tizz trying my utmost to get things done.  I used to tell my son we can only do our best and that if everthing didn't get done the world would not stop spinning.  I know this but I still carry that Anglo-Saxon guilt on my shoulder.  

My students have just completed classes and start clinical practice next week, so I think I have that in hand.  The colleague who will be doing my job 2 days a week until December was looked rather bemused after our handover. She has some leave to recover from that though. Her biggest job is to relocate my things to our new department in October/November.  She groaned when she heard that as that same chore fell to her in 2008 when I attended the ICM conference in 2008 in Glasgow. 

I am not very organised and I keep everything.  However the new offices will not have the ability to archive files in the manner we have in the past. So this time I'm trying to go paperless.  Each day I scan the essentials of half to one file to load onto our database. You wouldn't really know it to look at the office!!

A taste of things to come.

Two colleagues have now had 2 weeks in Tanzania and things seem to be going relatively smoothly at the moment.  They have had an orientation to four of the hospitals we will be working with.  I believe they have gained a new appreciation of our Australia working conditions. One of smaller hospitals with only 15 labouring beds has 80-120 births per day with very few modern facilities or resources to assist either the women or the staff.  Compare this to the hospital we work in, the main tertiary referral centre in Western Australia, which only averges around 20 births a day.

The neonatal intensive care unit in at one of the hospitals only had had one nurse to 24 unwell infants. No oxygen, or ventilatory support, and only one cardiac monitor.  Things that we take for granted.

It seems there is opportunity for fun though.  They went to a village about 200km from the city to paint a primary school and deliver a donated ambulance. Sleeping on the floor, eating cassava and dry rice crackers, no electricity and running water were new experiences for them.  While there they were called to help a woman in preterm labour which fortunately went well for everyone concerned.  The mother and baby were sent home several hours later and were expected to return to the clinic for the first 3 days. A walk of 30km each time for the woman.  Imagine western women contemplating this daunting task.

I have so much to live up to.

Practise run

Accumulated resources

I have over 20kg of stuff waiting to be packed. None of which is personal effects.  I hope I wont need an awful lot of clothes.  The obstetric training pants are not a good social look, although could be quite a point of discussion.

The weather here is quite glorious at the moment 25^oC and only 46% humidity.  It is hard to visualise what I will feel like in a week's time. Saturday is reported to be 26^oC but the humidity is more likely to be at least 20 points higher.

Definitely not a seamstress!

I got my 20 year old sewing machine back from my son's girlfriend today.

Sewing has never been my forte. My mother didn't sew, and I never learned at school. However as a new mother myself I was enthusiastic to add this to my list of accomplishments - albeit short lived........ 

My sewing repertoire never extended beyond child size t-shirts and tracksuits.  Children are amazingly uncomplaining until they can talk!!  Then there was a craft phase where my long suffering family and friends received dreadful tissue box holders and photo albums. We still have a rather inebriated Christmas tree fairy that I actually find quite charming!!  But I digress. 

What has this to do with Tanzania?

I am leaving in just over 3 weeks for a developing country that has significant rates of maternal and child mortality and morbidity.  The task of the GHAWA volunteers will be to provide midwives, nurses, doctors, medical students and skilled birth attendants with appropriate education and skills, in a resource poor environment, to help turn this statistic around. We are very aware that this won't be achieved overnight and neither will it be easy. However it is hoped that we sow the seeds and with time they will flourish.  


The World Health Organization (WHO) defines the maternal mortality rate as the number of direct and indirect maternal deaths during a given time period per 100,000 livebirths. Approximately 500,000 women die each year due to complications of pregnancy and childbirth. Of these women 99% are from African, Asian and Latin American countries. In Western Australia there have been 35 maternal deaths in the period 1981 - 2008. Only 18 of these were directly related to the pregnancy, - a Maternal Mortality Ratio of 6.8 per 100,000 live births^1.  Compare this to the Tanzanian Maternal Mortality Ratio of 578 per 100,000 live births.  This is approximatley 18% of all deaths of females between the ages of 15 and 49 years (WHO).  An enormous task awaits us.

There are a number of illnesses and disorders of pregnancy that can threaten the well-being of both mother and baby. Obstetrical emergencies may also occur during active labour, and after birth (postpartum). In an ideal world world all pregnant women would see their chosen health care professional on a regular basis and are more likely to have a problem diagnosed and managed quickly and effectively. We are charged with providing education and clinical support that will assist  in the effective anticipation of problems and the ability to perform a variety of emergency procedures and manage complications. 

Training pants!!  
Adults are very often visual and kinetic learners, so didactic lessons may not be very effective.  We will require some resources to aid us.  In developed countries we have expensive high fidelity equipment to use in learning situations.  We know this is not going to be the case in most instances in Tanzania. So over to the trusty needle and thread.  

As previously stated, my needlework is not of the best standard.   However my rather meagre offering might just do the job.  I have been reliably informed that gelatine and  cochineal makes great blood. This remains to be seen. When my fingers have stopped bleeding we may be able to deal with our first "postpartum haemorrhage".

                 
^1.  Ref:Gee V. (2010). Perinatal, Infant and Maternal Mortality in Western Australia, 2004-2008. Department of Health, Perth, Western Australia.
              

Countdown

The packing list is daunting and I haven't even started to consider personal effects. You wouldn't believe how much "stuff" a person accumulates to go on a volunteer trip as an educator / clinician.

Negotiating the Jungle

Image by Gary M. Stolz

Weight may definitely be an issue.  4 of the books I am taking with weigh nearly 5kg, then there are 2 female pelvises and a rather ugly fetus with cord and placenta (a manikin - phew!), old fashioned pinards stethoscopes and other medical paraphenalia.  Then I have to pack enough toiletries, medicines and clothes for 3 months!  I think I may attract some interest clearing Customs! 

I'm beginning to panic. There seems to be so much to do and I'm not even thinking about my day job!

I have to extend a very warm thank you to Emirates for allowing me an extra 10kg to take some of this equipment over with me.