I made it back to Atlanta safe and sound last night, and fell asleep on the couch before 9 pm.  This has been the hardest trip for me in terms of time-change.  It took me a few days in Dar es Salaam to actually sleep through the night, and here I am on the other end struggling to stay up past 7.  On the flip side, getting up early this morning gave me time to make breakfast for the family.  I haven’t downloaded photos yet, and can’t really spend too much time on the blog this week because I need to make up all theRead More →

I broke one if my rules by agreeing to do births in Tanzania- I agreed to work in an environment where I couldn’t really communicate with the women. If I cannot communicate, I am very little help. Actually I can be worse than little help because asking questions takes too long, I cannot get good information from the women and if I am in a situation with an immediate need I can’t let those around me know. It us very American to assume the entire universe speaks English. While I don’t doubt there are English speakers in every country, they will tend to be yourRead More →

One of the cool things I get to learn about here is post parting IUDs. In the US, you would wait for the checkup to insert at six weeks or later – the US had a fairly high postpartum follow up rate and the expulsion rate for IUDs is higher when done postpartum. In Tanzania, the postpartum IUD makes sense, and the mother only needs to return to trim the strings.  I had seen one in Honduras, and I could have seen two today if I hadn’t been helping a primpip push (trying to avoid an episiotomy and fundal pressure). I still have a fewRead More →

One of my learning goals while in Tanzania is the partograph. It is a visual representation of the labor that allows you to identify problems quickly. The biggest struggle to learning to use this tool is the reality of Tanzsnisn hospital birth. There are too many women and not enough staff, so the partographs don’t always get filled out. Women don’t enter the labor ward until they are 7 cm or more dilated, which doesn’t leave much time for completing a partograph, and nearly impossible without the information that was never written down from previously in the labor. Despite the real life problems, I amRead More →

I was asked by several people to get lots of photos. I can’t feel good about doing that. My first problem is that when I work with a woman, I can’t really communicate well with her. This means she can’t really give me permission to take her photo to share in this way. My second problem is that it is almost impossible to take a photo in the hospital without getting patients in the picture. The women in the maternity wear only kongas, which ate tied loosely and lowered to breastfeed, or used as a bed cloth leaving the woman fully exposed. Either way, notRead More →

I’ve spent four days at the hospital. It is a busy place, and seems understaffed and as if the maternity has been squeezed into too small a space. I’m learning their routines, and getting faster at my planning and doing. It felt good to be in control of a birth today – and for a little two kilo boy. He wad the second baby I’ve had with tachypnia without nasal flaring, grunting, retractions or off color. The first I blame on too vigerous suctioning from the nurse. But this little guy stumped me. I was using all my good patho study to figure it out.Read More →

I’m at the airport with a bording pass, which has been no small feat given recent weather events. I will arrive in Tanzania a day later than expected, but the delay gave me a wonderful night with an old friend and a much needed chace to sleep and destress. I don’t think I realized how crazy my schedule had been over the past few weeks, or how exhausted I was. Starting the journey yesterday would have been a disaster, and honestly I dreaded the trip so much more than I desired it. Truth is, I shouldn’t be a good traveler. I get car sick. IRead More →

I have been watching the unfolding of tension in central Africa since before my visit in 2008.  Reports of rebels attacking villages.  Allegations of government corruption. Growing tensions between neighboring countries. This morning I found this article in my inbox: http://www.reuters.com/article/2012/09/03/us-burundi-rebellion-idUSBRE8820HP20120903 A group has officially declared war on Burundi. You may be accustomed to thinking about war in terms of the risk to soldiers, but my heart and fears immediately turn to the women and children who are caught in the midst of struggles for power.  Some migrate to “safer” parts of the country or to neighboring countries in an attempt to keep their families aliveRead More →

I wanted to share a photo of the maternity in one of the public hospitals in Honduras. As you can see, the layout is a bit different from any hospital in the United States.     In this hospital, the women labor together in one room. When the head is on the perineum they are moved to the expulsivo (through the door) where the baby will be born. There are some curtains for privacy, but they are not used in this hospital. Your first thought may be that this is terrible.  That poor quality care is the result to expect in a less wealthy country.  I want toRead More →

I know planning for the next trip has started, but I wanted to share a few things from the Honduras trip. One of my jobs in Honduras was the training of traditional birth attendants in neonatal resuscitation.  An interesting and useful fact about fresh babies is that 9 out of 10 times when a baby doesn’t initiate breathing on its own, breathing can be stimulated with positive pressure ventilation.  What is that?  Forcing a little air in the babies lungs. In the hospital this is done with ambu-bags – those masks with the big bulb someone squeezes. I took some special ambu-bags with me on thisRead More →