Busy Week at Vila Central Hospital!

Week 3

Miliaria is gone! Once I started using the air conditioning at night it cleared up.

This was a very busy week for the Maternity Ward at Vila Central Hospital. To follow is a few of the highlights of the week. I hope you are enjoying this and let me know if you have any questions or are curious about anything that I have not mentioned.

There were 2 vacuum extractions performed by the Doctor that I observed. One was to assist a mom during 2^nd stage of labor (pushing) because she had severe heart disease. Before the vacuum assist she had an episiotomy. This woman had a severe heart murmur you could easily see by looking at her chest wall. It was very unforgettable to hear and palpate. Her baby was thought to be somewhere between 36 and 39 weeks gestation and she delivered a 2.26 kg girl. The second vacuum extraction was performed on a woman who needed a little extra help and she had a big (3.92 kg) baby boy who had a cleft lip and hard palate. By the way, he did great with breastfeeding despite this anatomical deformity!

I continue to practice my suturing and observing the midwives suture. This week I have had lots of opportunities to strengthen this skill and I am feeling much more confidant suturing.

There were a couple resuscitations this week. One was on a 3kg boy who had AROM (artificial rupture of membranes). AROM is where the bag of waters are broken with a device called an amnihook. There was thick meconium in the bag of waters. His 1-minute, 5-minute and 10-minute Apgar’s were 5/5/9. He received suctioning and blow-by oxygen. Another was a 3.9 kg girl with 1-minute, 5-minute, and 10-minute Apgar’s of 3/6/10 and who was SROM (spontaneous rupture of membranes – bag of waters broke on their own naturally) with thick meconium. She received suctioning and blow-by oxygen. The mommy of this big girl had placental membranes that were slow to deliver and cervical prolapse.

A 24 year old G3P2 (3 pregnancies, 2 viable births) VBAC (vaginal birth after C-section) gave birth to a 3.14 kg girl with Apgar’s 9/10!

I observed another footling breech with a nuchal cord who had an emergency C-section. She had a 2.62 kg boy with Apgar’s 9/10. It was interesting to feel the little toes of this boy during the vaginal exam. I am very familiar feeling the heads of these little babies not little toes!

We had a baby girl who was BBA (baby born on arrival), which means that she had her baby at home. This woman had had her baby at home and her mother brought her in with the placenta still inside the mom and cord attached to baby. We clamped and cut the cord on the truck and wheeled the mom into the delivery suite where we tried to deliver the placenta. Unfortunately after a couple hours the placenta was not coming out. So we arranged for Dr. Robert to manually remove the placenta in the surgical ward. This is a very painful and invasive procedure that I witnessed and that I hope does not happen all that too often. She had been given the strongest analgesics and sedatives the anesthesiologist had. The placenta was completely manually removed and mom and baby are doing great!

Lastly, I had to help a mother a little with the delivery of her 3.4 kg baby girl who had been a little stuck and required me pulling her. It was not a true shoulder dystocia by the way.

For fun, I have been continuing my daily swims. The New Zealand midwife, Elizabeth, and her midwifery student, Angela, arrived. Angela and I went to go swim the swim course and dove into a group of jelly fish. I could not see any jelly fish but they were there. We both had this strange nerve tingling feeling all over our bodies. The sensation went away for both of us after a few hours. I have been scuba diving in the waters around Efate and the ocean environment is beautiful. I have been eating out a couple times to get a sense for the restaurants in the area. I had a wonderful fish dinner with mango chutney at a restaurant called Chill, which is located on the waterfront. It was during sunset and I saw a most magnificent sky. The cruise ship was leaving the port and oh my, this ship is huge! It had a big television screen, which I could clearly see the screen as it sailed away. I continue to enjoy my walks to the hospital whereby all the little children so happily greet me as I walk by.

Week 2

Well, I seemed to have gotten miliaria. No, not malaria! And for those who don’t know what miliaria is, it is a heat rash. For me, it developed on the backs of my hands and has spread to my lower arms, legs and feet. At first, I thought it might be an allergy to the latex gloves, latex is what is exclusively used in the hospital here. No latex free option for those who have developed an allergy to latex, which is a common allergy in those working in the health profession. It has been suggested to me to give it some time and my body will adjust to the heat. And to give myself a break from the heat, I have succumbed to using the air conditioner at night when I sleep. I have slept better since doing this.

Recently, I have been thinking a lot about life and death. A fellow peer at Bastyr was on a Nicaraguan study abroad trip this Spring break and drowned while swimming in a lake. Her name is Michelle Eustache and I knew her as a very enthusiastic and curious person and it is sad that she is no longer part of this physical realm. Please keep her parents and those closest to her in your thoughts and prayers.

There have been several deaths at Vila Central Hospital in the Maternity Ward…

Sadly, the 960-gram, 25 week old baby boy I told you about in the last post died.

And the baby in the nursery with the omphalocele that I also shared in my last post has passed away as well. It is very sad. The baby was healing well and the omphalocele was receding and seemed to be improving.

When someone dies in the hospital many people gather around and wail. It can go on for an hour or so. The echoes of this last loss still permeate in the memories of my ears. It is hauntingly eerie sounds that some women make. From my observation, it seems very healthy for the family and friends to be together and to discharge this energy.

So some birth highlights of week two here in Vanuatu…

Getting lots of practice in the artificial rupture of membranes. The midwives like to use this technique to speed labor progression.

So far, the youngest birthing mom is 18 years of age and the oldest is 37 years of age.

I manually replaced a prolapsed cervix of a 37-year-old G4/P4 woman. After that, I had educated her about Kegel exercises, which don’t seem to be something well shared here. These exercises bring tone the pelvic floor muscles, which get super stretchy and lax after childbirth. They are exercises we all can benefit from doing.

I observed an elective C-section of a footling breech presenting baby who had a nuchal cord times two (the umbilical cord was wrapped twice around the neck)!

And the largest weighted baby was a 3.92-kilogram girl (that’s 8.64 pounds) which is big for NiVans!

And for a little rest and relaxation, I have managed to go for a swim everyday since I have been here. The ocean is nice and warm and the pool where I am staying is a nice cool off from a hot day.

I went to church with one of the nursing students on Sunday. We took the “bus”. Which is a man who drives a van and will take you wherever you need to go for 150 vatus. We were taken to a rural area, which was well taken care of by the inhabitants. The gardens were lovely and well tended. As we walked up to the church, I quickly discovered that the NiVans have very strong and beautiful singing voices and I love the lyrics to some of their songs. They sing about the value of life and being thankful. It is interesting to hear them sing so loudly and strong because most NiVans are soft spoken, men and women alike. I have heard on a couple occasions a NiVan shout but mostly they talk softly. On this particularly Sunday there was a group of men soccer players from Mele village (a village that has the famous waterfalls on Efate island) who sang a song for us. It was interesting to me to see these men become quite shy and humble before us. They sang wonderfully!

More to come wait patiently…