I'm finishing up my last few shifts, spending these last few days enjoying the amazing people, the wonderful mothers and their babies, my new midwife and doctor friends.
One of the miracles of my time here: the mother who seized for hours with cerebral malaria delivered a SGA baby on the medical ward two days later while she was comatose. His APGAR's respectable he seems healthy. He was breastfed by relatives when available, then lovingly bottlefed by visiting clucky medical students who couldn't keep him out of their arms. 8 days later, visibly neurologically altered by her malaria and probably the prolonged seizures, his mother walked slowly into the nursery to breastfeed her little man. He opened wide and latched like he'd never been fed any other way. Both of them were discharged home the next day.
The rhythm here doesn't change, the women come in waves, they push their babies out and a day or so later they pile into cars and drive home. I watched the twins speed by in their mother's arms squeezed into the front seat of one of the ubiquitous Vila buses, somehow she managed to wave to me, lovely smile on her face. Occasionally a high risk case, or an induction that goes south (still don't like misoprostol inductions) winding up in the OR, or the intensity of a big bleed. And then the lull comes again, and we sit and laugh and cut and fold gauze and roll cotton wool balls and wonder when the women will come again.
As if to remind me that not all ends well for all footling babes. That next night a woman presented in second stage with a small foot dangling between her legs. Her large (3.8+kilo) boy's body delivered to the neck, then stalled for close to 13 minutes, despite all efforts to resolve the emergency. Hypoxic/anoxic for at least a lot of that time, when his head was eventually freed he required prolonged resuscitation and predictably he began to seize within hours of birth. 4 days later he is no longer seizing, and while he will latch and breastfeed when offered, he has yet to 'wake up', or show us he's hungry, or behave as a normal healthy baby should. We continue to watch him and hope.
And this morning a phone call today from the morgue, where the body of an infant was deposited after being 'found' at the rubbish dump. Clearly born at or close to term, with a significant abdominal wall defect (gastroschesis), baby's life appeared to have been ended deliberately, before his body was discarded. We don't know who he is, or where he came from. He wasn't born at the hospital. I assume there was a death certificate issued, though he won't be counted as one of 'our' babies. Another tiny life begun and ended smartly. We all wondered out loud today about the health of his mother, who and where she was. None of which we're ever likely to know.
In happier news, the very first cervical cancer screening program here is about to be started, funded in large part by the WHO (I think). As well a vaccine manufacturer has donated 1000 doses of the HPV vaccine which offers at least 1000 little girls here hope of significantly reducing their risk of cervical cancer. I'm thrilled, as are the staff here.
It's cooler tonight, after some late afternoon rain. Sunday will see me leave here and return home. I'm keen to see my boys and husband again, after so long (5 weeks) but I'll miss it here.
NiVans are stunningly lovely people. Strong, proud, generous and cheerful. They work harder than anyone I've ever met, and have taught me valuable life lessons in gratefulness and happiness as well as my beloved midwifery.