Last Busy Day at the Maternity Ward- June 16

 Friday June 16

Today was my last day at the maternity clinic. We were mainly with Dr. Amankuwa, the head doctor, and Dr. Da. 

We started in the labor recovery room. When we first walked in, we saw a mother who had literally just given birth. The baby was lying on her chest so that was good that it seems like at least in most vaginal deliveries they do skin-to-skin right away before they take the baby to a separate area where the baby lies on their own for a while. We saw the midwife student deliver the placenta.

In the labor ward recovery room, there was a 19yo mom who is a “head potter” (a street vendor who sells food or items in a basket or tray carried on their head) who had not gone to any appointments during pregnancy but showed up in labor. There were some complications but very luckily the baby was born and they didn’t have to do a C-section. She has no family here and the doctor said this is an extreme case of several hard circumstances; no family (she came here from the North), she’s a teenager, and in poverty (she worked right up until labor). The doctor said that they try to give her lots of baby clothes.

Two moms were recovering after stillborns. One mother was the one who we had seen in the outpatient clinic visit. The doctor said that they gave her opiates to help with the pain. The second mother was getting a transfusion. 

Then we went to the “lying in room” for admitted pregnant moms. There were 5 mothers, a few were anemic along with other conditions. One mother was in for hyperemesis gravidarum (constant nausea) and so they were giving her fluids but said that Zofran was too expensive.

Two of the mothers had reactions to the blood transfusion they had been given and another mother previously had a reaction too so the doctor asked where the blood was coming from. It was from the Korle-Bu teaching hospital (the main hospital around here) so it was probably fine. Blood donation here is interesting, usually you have to find someone, usually a family member, to donate blood specifically for you. The doctor said that one mother needed it and he had to “put the fear of God” in the husband to get him to donate blood. 

In the postpartum ward, we saw the 3 moms who got C-sections yesterday, they were all doing well and we saw one of the babies getting vaccines. They were happy to show us their babies.

We also visited the family planning clinic there. Everything is very discreet because most women have to hide birth control from their husbands. IUDs are not common here and the most common types seem to be arm implants and a new self-injectable birth control that we don’t have in the US, I think because of osteoarthritis risk. 

In the outpatient clinic, we saw several pregnant mothers who came in for short visits with various conditions. 

One mother had blood tests with conflicting blood type results- two said one blood type and two said another. So, the doctor told her to go to the most reputable lab at Korle-Bu to get tested again. 

One mother had been shocked by an electric rice cooker and wanted to make sure the baby was ok because it wasn’t moving right after the shock but had started moving again. They checked the fetal heart rate and it was fine. 

One labor nurse had an abscess on her hand so the doctor assessed it and we watched the drainage of it. 

One mother came in 43 weeks pregnant and the baby’s measurements weren’t good so they needed to do a C-section. She had not been to an appointment since before her due date and she did not want to do the C-section for a while but finally did agree. We waited for a few hours for them to prep and she wanted her family to come first, then it was finally time.

It didn't go smoothly and when they finally got the baby out, he wasn’t crying and was covered in green meconium. 

The anesthesiologist had to come over and help. For a few minutes, they shook him gently upside down and rubbed his back and suctioned from his mouth. They also had to give breaths using the bag valve mask. It felt very chaotic and they were running around trying to find some of the items. My PA student peer said that in the US they would have this all laid out and ready to go but it’s wasteful (ruins the sterility) so they can’t do it here; they have to work with what little they've got and think fast. He didn’t make any noise but finally he cried a little, but it wasn’t consistent and it was several minutes of suctioning (including with a longer tube to go into his airway) and rubbing him. 

It was a long process of getting him more stable while they stitched up the mom. The mom only spoke Ga and only one nurse could translate so that also made things harder.

Finally it was done and the mom went to recovery and the nurse took the baby out to show the family. I gave the doctors thank you cards and Seattle magnets since it was my last day here. Dr. Da talked to us a lot today about Accra and said that while most of it is very safe (even our area, Mamprobi, which is very poor- he laughed when we said we were staying there and asked us why- he said was safe to walk around), still, there are some areas where crime is rising and he wasn’t too shocked to hear of my peer’s phone being stolen out of a moving car. I told him my crazy car ride story and showed him the video and he was shocked and thought it was hilarious.

Lunch from the hospital was red red which is a spicy bean stew with fish, and fried plantains.

 

I then went out to the post office (20 min drive) to try to mail some postcards with my peer, but it was closed by the time we got there. While waiting for our ride home, we walked around a little and I bought more postcards from a vendor. 

Some kids were very fascinated with us and the mother brought them across the street to us to say hi. They were older toddlers and their names were Ezekiel and Elvis which was interesting. 

Then we had a lecture from Dr. Christian on causes of illness and death here. Anemia seems to be very very common here and maternal mortality is extremely high here. Here are some of the slides. 

They do sickle cell screening for every baby born. If they know the mother is positive for HIV, they start the baby on treatment. 

Dinner was some leftover salad but we also got some chicken from the most popular fast food place here, KFC. It did taste different than the US chicken and their sides were rice or fries, not mashed potatoes.

Today our AC stopped working in our bedroom and a light blew out in the main house so a handyman had to come to fix it but it works now luckily.