Maternity Matters in Madagaskar

Its Sunday and sunny but the days are getting shorter and noticeably cooler as we are headed slowly into winter time.  The afternoon was spent having a small grill party with the volunteers here.  A patient in the delivery room was having regular contractions and steady birth progress throughout the afterrnoon.  Towards evening I went up after to have a look at progress of the delivery which had been stagnating a while.  The patient I knew well.  She had been in on Friday at 38+3 weeks of pregnancy to our regular maternity visits and wished for a C-section!  This would not at all surprise me back at home as a fair amount of our patients have planned non-medically indicated C-sections.  She was the first patient I had here requesting this.  So we discussed the risks and benefits of the procedure and after careful explanation she had decided to try vaginal delivery.  It was her first pregnancy.  We told her that of course at any poi...

Any guesses on the topic for today based on these pictures? I forgot to take some in action pictures today but as it was a hands on teaching I didn't have much time for that so here the finished results: Sponges make great learning tools it turns out This would be the full model of what I had started to teach a few weeks ago and finished today! Well I'm pretty sure my gynecology friends probably get it by now but the topic was perineal suture.  In the second picture the top sponge covered what was Lesson 1 in which we learned basic suture skills and how to suture vaginal tears.  Lesson 2 was about the perineal tear and I found the sponges with the scrubber portion to be an excellent example of how to teach intracutaneous suture. My midwives are excellent students and I thoroughly enjoy working with them.  Todays lesson was fun and also a bit less of a mess.  Lesson 1 we used meat chunks (our guard dogs lunches!) to suture so a bett...

What an exciting day for everyone here.  It is the second time we are expecting twins.  The last came via vacuum delivery but these two were scheduled for C-section because their position was oblique breech and not favorable for spontaneous delivery.  The difficulty with this case was that the age of the pregnancy was not known.  The mother is homeless and has been presented to us from an social work organization that is trying to help the homeless out during these difficult times of Corona.  I had been doing regular ultrasound scans and doppler to check on the babies and their growth, today they were estimated at 37+1 weeks.  Though we may have been able to prolong the pregnancy a bit due to the uncertainty a few other factors came into play that made us glad we scheduled for today.  Toward the end of the previous week the mother started developing hypertension.  We but her on Aldomet to lower it but it continued to stay borderline high. ...

Again a little behind on postings but better late than never!  So for travel on public roads and at the supermarket it is required to wear masks so it was time to get equipped.  A seamstress by the name of Angela makes these so we picked up a few.  I use them for when we are out an about.  They turned out really nice so I also gave her some of my fabrics that I purchased on an earlier trip to the coast and have asked her to make some clothing items for me.  I’m really excited to see how they turn out. Ready to work with these new additions :) One of the places that still feels normal is the walk to the local kiosk to purchase atody (eggs)!    This stand is just around the corner from where we live and is a typical example of the kiosks that are found in the villages.  They sell eggs, sometimes some vegetables but mostly things like noodles, rice, sugar, flour and cookies.  By the way its heading towar...