Maternity Matters in Madagaskar

Today I was off to the Ministry of the Interior to take care of VISA matters.  I have a VISA with the option to prolong the stay past 90 days.  After some time of wait, I signed some documents and had my picture taken.  I can come back in 3 weeks to sort out the rest.  Things take time here and multiple steps!  From here we went to our collaborating hospital at Pavillon Sainte Fleur (PSF) where we can transfer patients that need more intensive care if time allows (like the patient with the placenta previa from a few Sundays ago).  Here we met the director on my left and the assistant director on my right.  The other maternity hospital belongs to the university clinic, resources are not always quickly available and payment must be made for each medication, gauze, syringe etc.  This can be stressful for the patients family especially when it is an emergency.  Also a visit to the blood bank that serves these hospitals was made.  All in a...

Its rainy season in Madagaskar and this means a combination of frequent showers or occasionally non-stop pouring because a cyclone has hit the western coastline.  It had been raining for days at the time we took this trip into town to some food shopping.  This is the main road connecting our village of Ambovo to the larger community of Talatamaty. Muddy and slippery The merchants on the market are also trying to keep up with the water masses.  Fortunately for us it has kept the numbers of people down as no one really likes coming out in the rain.  This made for some opportunities to take some photos. Fruits The meat market with fresh chickens on your left   What is difficult to find on the market can be found at the supermarket, Shoprite.  The choices of rice are endless it seems but we finally decided on a locally grown 5 kg bag.

This post doesn't need many words I think because the pictures give a better impression. This weekend 7 of the volunteers here took a trip to Andasibe rainforest, about a 4 hours drive away from where we work. We are staying in bungalows at the edge of the wild. Noises here include many cicadas, frogs and most new the sound of lemurs! These animals have fascinating cries, it sounds so surreal. During the time here we took some hikes through the rainforest and relaxed with some game playing in the evening. All in all a nice weekend away! Maromizaha Rainforest Asplenium - locally used as a tea to treat breast cancer. Boil 1 leaf in 1 liter of water and drink. A fern tree! Giraffe Beetle Bamboo Lemur Black and White Lemur Brown Lemur Left to right: Hannah and Sofia (med students), Melanie (midwife), me, Elena and Anna. Girard our mechanical engineer in the back ...

I've started teaching the midwives here how to suture. Last week we started with basic surgical knot technique. I was quite impressed with their skills, they picked up much quicker than I ever did! After learning the basics, I organized some meat (dinner for our guard dogs) which I cut in such a way to simulate the typical tears that can happen during delivery. We covered first the theory (my drawing skills are not great but I tried to demonstrate some important structures). If my boss or colleagues are reading this please don't judge too much the anatomy of the pelvic floor muscles I've drawn, they are not to scale or proportion! I really did try though...

So we have been anxiously awaiting the arrival of this mom because she was expecting twins!  She came in for induction on Saturday morning.  It didn't take much helping on our side before she developed good contractions.  Baby 1 was presenting with head down but Baby 2 was laying transverse across the top of the uterus.  This was her third pregnancy, the other two had been without complications.  We were excited.  Heartbeats on both babies were good.  The contractions were good but not good enough.  As Baby 1's heartrate started to drop we opted for a vacuum delivery.  Success!  Our senior midwife did the delivery under careful instructions.  Now the fun began.  I was doing the intermittent sonogram to check the fetal heart rates and positions.  We immediately began turning Baby 2 so that the head came down.  Tanja was guiding the head and I was guiding the bum while another volunteer midwife kept pressure on the up...

Baby Valimbavaka and mom were discharged 1 week after C-section delivery.  Valimbavaka had an infection and received treatment with CPAP, antibiotics and glucose infusion.  Both are doing great :) Premature baby Fandresena born also a week ago, went home with mom the day before having nicely gained weight and no longer needing any support.  Also didn't report but the other obstetric cases I've shared have also all been discharged and are doing well, including our other intensive care baby from the beginning!

02.02.2020 - Todays date is a palindrome!  It also marks the third Sunday in a row that necessitated a C-section.  This time the patient came in the afternoon and was presenting with a pathologic CTG and a stagnation in the birthing process.  The contractions just weren’t very effective.  We tried to provoke stronger and longer contractions using oxytocin but the baby started to react to this.  So without further time loss, as has been the case in the past where a transfer was necessary to a clinic far away (gynecologists but limited resources) we were able to go straight into the operating theater.  There was a little trouble with external bleeding at a few sites on the anterior and posterior wall of the uterus.  A few sutures sufficed for the bleeding to cease thankfully.  Overall we had a slightly lax uterus so we kept it toned with an oxytocin drip post-partum.   Regarding the baby, it was evident however from deli...