see one, do one, teach one.

The interns here run the show- so they are newly qualified doctors at Fy1 level equivalent in the uk- they are a lot more hands on as medical students but still don't have much experience.  They will look after labour ward, do c-sections and see new patients all with little or no senior input.  The senior interns ( 3 months into the job) will often teach the new interns how to manage patients and also often how to operate, so i have been trying to teach while on labour ward and help them with c- sections as well as just generally supervising them a little more so that bad habits aren't passed from one intern to the next.  They also have no organised/ planned teaching sessions. 

So i've been thinking of organising intern teaching sessions and had one today which went well :) Iam basing my teaching sessions on the Life saving skills- essential obstetric and newborn care course run by the liverpool school of hygiene and the RCOG.  We started today with Basic life support/ resuscitation- basic but hopefully these skills and future sessions will help save lives :) It would also  be good to get the midwives involved too- if we learn together we may work better together as this is a real problem.   Here's hoping they find it useful and that future sessions go well! 

pre-eclampsia

Pre- eclampsia and eclampsia account for 10% of maternal deaths in Malawi.  The prevalence in the hospital i'm working in is very high and i see the worst cases as its a referral center so on several occasions they come after they have already had a fit- my old consultant who is a pre-eclampsia expert would love it here! 

For the non medics amongst you - pre eclampsia is a condition in pregnant women ( thought to be related to the placenta) which presents with high blood pressure, protein in the urine ( caused by problems in the kidney) and oedema.  It affects both mum and baby and at its worst can cause fits/ seizures in the mother and even death.   It also affects baby, sometimes they stop growing, and the fluid around them is reduced.  when and how severe preeclasia strikes varies- sometime it can be very early and very difficult to control so the only cure is delivery and this can lead to very premature babies being delivered.  There is also a condition called abruption which can be linked with pre-eclampsia- this is when the placenta detaches and the mother can bleed very heavily and the baby can die inside.

I have seen all the complications of pre-eclampsia here,  fetal growth restriction and still birth, abruption and eclampsia which is very rare in the uk.

Although you cant predict who will get it there are certain risk factors which put you at greater risk like older mums, first time mums and those with multiple pregnancies.  Pe-eclapsia often doesnt have symptoms until it is severe so we have to depend on screening tests to detect this condition.  During every antenatal visit we are meant to  measure the blood pressure and dip the urine so that we can detect it early and start treatment before it becomes severe.   I noticed that this wasn't really being done, so decided to have a closer look.  I went through all the antenatal notes of the mothers on postnatal ward all 50 of them and looked to see if their bp had been checked.  Only 3 women had their bp checked at every antenatal visit, 5 had their bp checked once and the rest didn't have any despite the average no of antenatal visits being 3-4.  of these mothers 5 presented with severe  pre- eclampsia on admission and 3 with eclampsia. 

A simple thing such as checking bp could have detected problems earlier which would have resulted in much better outcomes for mother and baby!.  However im told that some of the health centers don't have bp machines or they are broken and even in this big hospital we  are always running out of urine dipstick and there isn't a bp machine for the postnatal ward and they have to keep borrowing the one on labour ward so the bp's are not checked as often as needed and so some people have a seizure after transfer to the ward.  Its often simple things that can make the biggest difference!



simple life saving equipment.

Happy new year!

A Belated Happy New Year to all my readers.  May 2013 see mothers everywhere have a safe happy pregnancy and delivery.  May maternal mortality be a thing of the past!