Tuesday, 15 May 2012


Standing at the ward desk, I wondered why my bleep kept making sounds.  Noone had bleeped me that day....ahh but the emergency bleep did go off in handover this morning...hang on, wait a second....I check my bleep.  Drat, I'm on call.  Rubbish, I'll have to phone my husband and tell him he can't go to badminton tonight as I need him to look after Little Miss whilst I work.

'medical alert, medical alert, A&E resus, ETA 5 minutes'.  Are you being serious?  I've now also got to inform the team that a) I'm on call, and b) I need to be on route to resus for an emergency.

The usual hubbub occurs when the patient comes in, secure the airway, check the vitals, gain access, take bloods.  Nothing unusual about this patient.  I get stuck in, I'm given the blood and start spliting the sample between bottles.  I plunge the needle into the blood cultures bottle and pull it out gently.  Ouch, that scratched me....oh dear lord, I think...I peel back my gloves...I've got a needle stick injury.  I pull my gloves off, run the tap with my hand under it and try to squeeze blood out of the most miniscule cut.  I grab the attention of someone else, I hiss 'I've got a needlestick, can you finish the bloods for me please'.  5 minutes later I don a fresh set of gloves, and help back with the patient.

Once it's all settled, a lovely colleague contacts occupational health.  They tell him what bloods to take from the patient, he counsels the patient and gains consent for his blood to be tested for blood bourne viruses.  He agrees.

Occupational health are nice enough.  Until they need to take blood.  'Make a fist with your hand'.  Umm no, sorry I can't do that.  The only other time someone asked me to do that, the act of taking blood hurt so much I promised myself I'd never make a fist again.  The reasoning is simple.  A nice relaxed muscle is easy to part fibres and hurts less than a contracted muscle.  She takes the blood eventually.  One week later my arm is still bruised, a good 5cm area.  My veins are clear and obvious and easy to take blood from.  It shouldn't have been that hard.

'Ahh, you had your Hep B more than 2 years ago, you'll need another one of those'.  No problem, I go through the consent form.  I'm breastfeeding, I tell them.  I'm told I can't have it, but it shouldn't matter.  Later that day I think about it.  I check the BNF (book of medications).  Why if a newborn can have a half dose of the hepatitis B vaccine, can't I have it?  It's not like half of the vaccine is going to come out through my milk.  Back I go to occupational health the next day.  I explain my reasoning, and that I want the Hep B. 'No problem, I just didn't think you'd want it' comes the reply.  That one sentence, which destroys everything that we are taught at university.  Medicine is no longer a paternalistic society, so why is occupational health?!

Thursday, 10 May 2012

My African Experiences: After Birth

In the UK an ideal birth usually ends with baby being placed onto mum's chest.  This seems to be the stuff of dreams.  In my African experiences, this was miles away to what happened.

Often with luck, rather than judgement, the baby would be delivered in the delivery room.  A room in which a mop and bucket was kept, but both, as well as the water within the bucket had seen it's best days; and the water never noticably changed, but at least smelling of bleach.  A room which never looked clean.  A room which had sharps bins overflowing with used needles.

Baby would initially be placed onto mum's chest, but more for convience than anything else.  In this country which never had enough staff, the mother was purely used to hold baby whilst the cord was clamped, with pieces of wool tied around it, and cut with previously used scissors.  The baby would then be taken away from the mother.  If well, breathing and crying it would be rubbed with a Kanga, then weighed, and wrapped up tightly in a fresh Kanga.  It would then be placed on the side until mum was ready to leave the delivery room.  Whereby it would be carried to the post-natal room and placed next to mum.

If baby was not in a good condition it was frequently left to us, foreign students, to help revive the baby.  In practices more closely related to eras gone by, we would swing the baby by the legs, rub its back, rub its sternum (breast bone), anything to stimulate a cry.  If all of this failed, we would 'suction' the baby.  This had to be a last resort though.  Why?  Because the hospital did not have suction catheters, they had IV tubing cut down to size.  These 'catheter's were not single use either.  Not only had the been used for running medication through them, they then had been used on other babies, prior to being placed in bleach to disinfect them.  There was no removal of the disinfectant before popping the tube down babies nose and into it's lungs.  It was an unhygienic practice, but one of which we had no choice.

I was horrified by some of what I experienced.  Us, foreign students would hold the babies, rather than leave them on the side, side by side with the babies who never made it, who were also wrapped up but this time with their faces obscured.  We'd do our best to maintain safe, hygienic practices; to learn from the students who had gone before us, from those of us who had greater experiences in our own countries.  Whatever we could do, had little impact, but may be, just may be we made a difference to one mother or one baby somewhere.

My African Experience: Prematurity

This post follows on from Pre-Eclampsia: My African Experience.

The hospital I spent time observing in had a SCBU unit, although how functioning that unit was, was difficult to tell at times.  It seemed to accept any baby who had survived birth.  Although from my time there, I never once saw a baby be seen by a paediatrician post-natally.

The unit itself had three incubators.  Only one of which the temperature settings worked on.  It also had 5 plastic cots, which were covered with a mosquito net.  Although each of these nets had holes in, and on requesting a new net for the cot, the 'new' nets also had holes in.  Each incubator held up to three babies (depending on size and requirements).  The babies seemed to give given very little care.  A 26 weeker was given steroids, as there was no ability to give them to mum whilst baby was in utero.  It had a nappy for a new born, which came up to its nipples.  It seemed so fragile, but due to the local knowledge, technical ability and resources, nothing more was done for it, that wasn't being done for the other babies.  This consisted of ensuring all babies were cup fed every 2 hours, day and night.

'Feeding time' was a different experience in this hospital.  All the mothers with babies in SCBU slept in a dormitory just off the labour ward.  Every 2 hours a bell would be rung.  All of the mothers would then queue up in SCBU.  They'd wash their breasts, take a cup and hand express into it.  They'd then take their child and cup feed it.  Even to the smallest and weakest baby.  They had no NG tubes.  This was the best they could do.  Some of the older babies, could cope with this, but for the younger gestations it was too much.

The midwives/neonatal nurses (who knows what job title they actually held), seemed to do very little, save for 'babysitting' these babies.  In fact the only thing I distinctly remember them doing was sharing their lunch, in the same room these babies were living in.

The 26 weeker, who may have had a chance with maternal steroids, NG tube feeding and other techniques and medications that the western world holds, died after a mere 3 days, lying in a working incubator with two other babies.

My African Experiences: Pre-Eclampsia

During my pregnancy with Little Miss, I spent 7 weeks in Africa.  As part of my medical studies.  Gaining an appreciation of medicine in a different setting, in an impoverished country.  And that is one thing I certainly did.

The area I spent time in has a birth rate of 32 per 1000, with a population of 1 million.  So around 32000 births a year.  The hospital I spent time in seemed to be the main focus of where women attended.  However, in times of need the mothers could be sent to another facility in the area.

There were never enough beds, the women shared a bed.  In a unit of approximately 20 beds, or 40 women, there were only a small handful of midwives.  The women were unable to go to the delivery room until they were fully dilated, then they walked, with all their belongings, to the delivery room.  Many never made it and delivered on the floor.  If all three beds in the delivery room were in use, then you had to deliver on the floor.  An hour after having baby, still born or alive, you had to leave the delivery room.  The only exception I saw, was one mother who was having a blood transfusion after having a still born.  She was allowed to complete her blood transfusion in the delivery room.

What was more shocking than this, was the lack of modern medical and midwifery care that was available.  The stark differences between care of a pre-eclamptic woman in the UK in comparison to the region I was in.  In the UK I was monitored twice weekly, Little Miss and I were hooked up to monitoring, and my blood pressure would be taken. I had scans every other week, checking for growth and blood flow to the placenta.  I was given anti-hypertensives and two steroid injections to help Little Miss's lungs to develop.  Once they were concerned they took me into hospital and monitored my blood pressure hourly, and finally every 10 minutes, before getting me into a HDU room for medications to stabilise my condition and for an emergency c-section to deliver Little Miss.  Little Miss was put into an incubator and was able to have an NG tube to bed fed with formula milk.

Had I been in the unit I visited, it would have been a different story.  I would have chosen how often I wanted antenatal care.  I would have chosen, and paid for each scan I wanted.  My blood pressure may never have been picked up on.  If I was lucky enough to have visited the hospital/antenatal care and found to be pre-eclamptic I would have been put in a bed, and they would have waited.  No monitoring, just waiting to see what would happen next.  They had magnesium sulphate, a life saving drug.  But it was in the 'emergency use' box, and pre-eclampsia was common place enough that it wouldn't have been seen as out of the ordinary.

I never once saw antenatal steroids given.  But I did see them given to the babies in SCBU.  I never once saw a c-section for pre-ecampsia.  I did see eclamptic fits.  They gave paracetamol.  The mother, and child would invariably die.  If Little Miss and I had been there when things went wrong, that would have been our fate too.

Born Too Soon: Global Action Report on Preterm Birth

FACT: Preterm birth is on the rise
FACT: 15 million babies are born before 40 weeks gestation every year
FACT: 1.1 million of these babies will die
FACT: >75% of these deaths, are avoidable without intensive care facilities
FACT: Poorer families are at greater risk, world wide.

The new report 'Born Too Soon: Global Action Report on Preterm Birth' looks to address this.  Not Even a Bag of Sugar and Mummy Pink Wellies both address the report much better than I could, but in 2010 I spent 7 weeks in an African country, working on my medical elective within a hospital.  I spent time in the 'maternity' areas, and the paediatrics department.  Within this series I will draw on these experiences.

It really stands out in the report that it's not talking about ground breaking new developments, but introducing a level of care across the world, which is currently available to some mums and babies and not others.  The use of tocolytics (to slow labour), of corticosteroids (to strengthen babies lungs), and of good antenatal care.

The report looks further into the problem than just this though.  It is looking at the role of poverty, of gender equity and the improvement of maternal health.

It also states that, as I will discuss in a later post, sometimes it is the medical and nursing professionals failing to undertake the simple basic care, which fails the infant.

Saturday, 5 May 2012

Sibling planning

I love Little Miss with all my heart.  She is my whole world (sorry husband dear!).  But I don't think my family is complete.  I have space in my heart for another little one.  

Little Miss is such a happy, sociable little girl, who loves other children.  She would make a fantastic big sister.  When she's been in the little baby room at nursery, I've often caught her stroking a upset babies hair or hand, trying to calm them.  Or hovering over a sleeping baby, keeping watch, and warding off other children.  She's happy to share, as long as it's not her shoes, bag or coat.  Those are Little Misses only!

My feeling originally was not to have a little one during my first year of work.  To get this over and done with, as one of the more stressful years (pre-registration, although i'm sure no more stressful than any other), and to settle into the work.  Then this stretched to, not having a new little one before I get my full training post.  Not wanting to go to interviews pregnant.  And now, not wanting to turn up to my first day of that job pregnant.  

My fears of many years ago, of pushing back when to have children are happening again.  

There's the added complication of the pre-eclampsia I had with Little Miss.  The risks of this recurring increase with time between pregnancies, and increase with older age of mummy.  So not wanting to be pregnant for social reasons could be putting my life in danger.  Which isn't somewhere I want to be either.

I need to put my head to this and think.  The most difficult thing, is that we all know it's not possible to plan exactly when a baby will arrive.  There's hope that 'doing the deed' will lead to a pregnancy and that pregnancy will come to fruition at the right time, but no dead cert.

Wednesday, 2 May 2012

Easter egg hunts

Little Miss, Little Miss, here's one.....come over here Little Miss, quick, quick, quick.

Ahh the annual Easter egg hunt.  A week or two late, as it was the first time we'd properly caught up with the family.  Little Miss's aunty loves the annual Easter egg hunt, despite being rubbish at it.  She needs so many hints and clues about where the bounty is 'cold...cold...hotter...hotter...bingo!'.

This year there were 18 of us, all hunting for the eggs.  I'd managed to get last minute at the supermarkets, when our usual creme eggs had already been sold out.  So Sunday had us wrapping mini-eggs in cling film, before granny and great-aunty set them out on the field.

I'd warned Little Miss's aunty that I'd had Little Miss in training during the previous year...and it worked.  Aunty found none of the general parcels, and had heavily laiden clues to find the three chocolate bunny rabbits (bought especially for Aunty, so she'd get something), whereas Little Miss and I found 7 packets.  Not bad for going the speed of a 22 month old!

For next year Little Miss needs to go it alone in finding the parcels, so that we can get even more together!  Better get her back in training.