They say a picture is worth a thousand words......

one of my many deliveries

new born

me with a great aneathetist

operating

waiting for post natal checks

neonatal unit

there are still lots of very sick babies being admitted

prematurity is one of the biggest problems

kangeroo mum- born at 29 weeks because of severe pre eclampsia- weighing only 900g at birth but doing well

labour ward bed

on the job training- neonatal resus with baby natalie

records room...hmm

my leaving present- now i am really malawian

with my postnatal nurses

health centre training day

I mentioned i my older posts that i was often surprised by the referals tat we got from the health centers, patients with pre-eclampsia sent without blood pressures ever being taken, eclamptics being sent without receiving magnesium sulphate which helps stop the fitting, patients never getting basic antenatal testing like heamoglobins or HIV tests and  patients in labour being referred far too late. 

So we decided on having a training day for the local health centers and 3 midwives attended from each center.  We taught them the importance of basic antenatal care, refreshed their knowledge on pre-eclampsia and eclampsia, the use of the partogram and neonatal resuscitation.  But more importantly we listened to their problems and what difficulties they face, lack of equipment including bp machines, lack of hb testing equipment, transport taking far too long to arrive in an emergency and being too short staffed to accompany the patients as it would leave no staff at the health centre. 

Early in the year Ammalife fundraised for BP cuffs and other essential equipment and these BP cuffs were given to each health centers so that they could carry out their work.  They were ever so grateful and when i did a follow up visit at the health centres several weeks later i saw them in again :)

 Discussing examples of partograms in groups

 Practicing taking of blood pressure in groups with the donated cuffs

 Neonatal resuscitation with our friend baby annie.

 Follow up visit to the health centers with on the job training- very basic conditions

The donated Bp cuff and emergency book with a midwive/ husband in a health center

post natal sepsis

Firstly sorry for the very long period of no blogging, a combination of being busy and rubbish internet got the better of me!

So this post is dedicated to one of my patient who i looked after for a month before she lost her life to sepsis.

She had a normal delivery, slightly prolonged labour but not too bad, a few days after she started complaining of abdominal pain, distension and vomiting- she was seen by another doctor and diagnosed with bowel obstruction, i saw her 2 days after that and thought she had endometritis- for the non medics that an infection of the uterus- i started her on strong IV antibiotics and observed 2 days later she was no better.  I have learnt by being here that you have to be quite aggressive in the management of these patients if they are to survive so i booked her for theater.  During her operation she had thin pus in her abdomen and a very infected, uterus that was starting to undergo necrosis- so we had to remove her uterus.  she has a few babies and this baby also survived but i have has some really young first time mums with very lengthy obstructed labour who end up having a c-section, after which their baby dies and then they get severe sepsis followed by a hysterectomy- it breaks my heart! But as my consultant says better alive without a uterus then dead with one.  Anyway back to my patient after her hysterectomy she was a little better but a few days later her abdomen was starting to become distended again despite being on antibiotics.  5 days from the hysterectomy she was still getting worse so it was time for another operation... this time she had accumulated an abdomen full of pus again, a washout and 2 large drains later she was back on the ward.  we sent some pus for microbiology and it grew klebsiella and group a strep resistant to pretty much everything except ciprofloxacin - we weren't winning here!  The drains became blocked and stopped draining and she started having high temperatures again, and a week later we were back in theatre with an abdomen full of pus again!  After this operation she started having intermittent seizure, we looked at all the common causes and she had none of these- so we fought for an MRI which showed a clot in the brain- thats a bit of a life sentence in malawi coupled with her still being very septic we werent going to win :(.  She was so lovely may she rest in peace, my thoughts are with her family, her three young kids and new born baby.

Purpural sepsis is still one of the leading causes of maternal mortality world wide, a combination of non sterile conditions, lack of antibiotics, long labours all play a part.

We don't always loose though- another of my patients finally went home after 2 months following a ruptured uterus,  c-section and hysterectomy, neonatal death, sepsis, laparotomy and wash out X2, Vesico Vaginal Fistula from the obstruction which caused the rupture,   VVf repair and now shes gone home in great condition :)