Today was my last day in the prenatal clinic and my take home thought was . . . I want to start a clinic here.
For this week I have been in the same room doing belly checks and listening to fetal heart tones. The women when they walk in the room supposedly have had their histories taken, their blood pressures taken, and have been weighed. In reality, many of the women who came to me did not have any medical history recorded in their books and some didn't even have their names written on their books. I was also a little suspicious of the blood pressures, namely because they were always nicely rounded numbers and were often the same numbers. So then, I peeked out the door and, to my horror, saw that the nurse who was taking BPs was not using a stethoscope. When I asked the nurse with me if that was their normal procedure she said that was due to short supplies, but later I found two unused stethoscopes sitting in a box in the lunch room?! Another frustrating piece is that, as far as I can tell, the nurses have tea and lunch for three to five hours each day. True, some work gets done during this period but I haven't observed much. Today for example, we saw 100 patients between 9 and 10:30 (that means each woman was in the room for about 3 minutes and 30 seconds - which includes time spent dressing and undressing). What would happen if those hours were spent providing care?
I just don't understand. In Malawi childbirth is still very dangerous, maternal mortality (per 100,000 births) is among the highest in the world, and yet the few resources that are available are not being utilized to improve care (at least not in this hospital). Leaving today I had the impression that unless the woman herself vocalizes a problem, the only thing that happens during prenatal care is that something is scribbled in her book (and often it is scribble), when it is deciferable it may not even be accurate. Therefore, when she arrives in labor, she can show that she has attended routine prenatal care, she might have 4 to 6 visits documented, but in truth she received NO care. Twins, preeclampsia, bleeding - who knows, and certainly she doesn't know what to do if she begins bleeding or seizing because no one told her about pregnancy risks.
One more story. A 41 year old woman with 7 previous pregnancies came in today saying she was pregnant because she had not had a period for three months. This early on in a pregnancy you can't necessarily palpate the uterus abdominally, and in the US, in addition to doing a pregnancy test, a midwife would size her uterus, one hand internally the other hand on her abdomen. What happened here is that the midwife told her she was going through menopause and sent her home, and then she told me "these women from the village just don't know, they can't even remember all the times they've been pregnant." What?!
Back at the College I mentioned my observation about the BPs to two Malawians who were sitting at my table in the cafeteria and one made a good suggestion. He suggested that I tell the charge nurse what I saw and simple ask (rather than accuse) "Is that the correct way to take BPs?" I think I'll try that next time I'm in that clinic, I was a little too shell-shocked to figure out how to do something diplomatically. Yesterday and today I did bring in my measuring tape and my fetoscope, I didn't say anything but I could tell the nurses were watching me measure bellies.
I am going to study hard and learn Chichewa, the faster I am able to learn the sooner I can begin talking, listening, asking, and educating.