A group came to Lilongwe from Scotland this week to teach a 2-day course on Advanced Life Saving Skills in Obstetrics (ALSO) to a group of nurses, midwives, physicians, and clinical officers here. Of the nine instructors, 7 were midwives. It was a great course for multiple reasons (1) the information was great, very complete, evidence-based, and supporting interventions only when absolutely necessary; (2) there was a lot of practice with dummies and hands-on activities; (3) all levels of providers participated, it was a nice leveling experience; (4) the instructors were all volunteering their time and are still here for another week just cleaning and painting the labor ward. They're trying to recruit people here to teach the course elsewhere in Malawi and they said they would like me to be an instructor after I have a bit more experience (maybe only 6 months). So that is an exciting possibility.
This morning when I walked in, I was told that a mom was about to have a vacuum delivery so I went to watch. When I got there the baby was out, gasping and the clinical officer was calmly standing over it just waiting for a suction. He asked me how I was and I said, "fine, how's the baby?" and he said "not so good." He had just completed the same ALSO course with me where we were taught not to suction, because it does more harm than good (it can damage the baby's throat and mouth in addition to causing a vasovagal response which will drop the BP and heart rate further) and just to start resuscitation and yet there he was standing over this baby who was looking back at him wide-eyed and shocked. I gently reminded him about what we learned but then an OB who had not taken the course came and instructed him to take the baby to the nursery for suctioning and so he started off, picking up the baby by the ankles (another no-no since it can damage the baby's spinal cord and injure the neck). The Scottish midwives saw the scene from across the room where they were cleaning and one came over and gave me a hug, bringing tears to the surface I didn't even know were there. Coming to the hospital is like plunging into ice cold water first thing in the morning, painful at first, but once you're in, you adjust, smile, and begin.
I want to add another thought here about Dr. Meguid. I have been seeing him more and more around the hospital and he also took the course this week. I am so glad he's here. He's constantly reminding me to smile, checking in to see if I'm okay, and reassuring me that change is happening and that it will happen. He makes me believe that it is possible to turn this place around. He told me that he's been working in different places in Africa and that the reason he has chosen clinical as opposed to policy work is because, "At least you can make a difference to one person, even if they forget you the minute they leave, you still made a difference." I agree.
On that note, I checked-in with the 21-year-old today and she was smiling. She motioned from her waist up, showed me her wounds and said, "bwino bwino" (very good). Talk about looking on the bright side.