Another preface: it took almost the entire three months of being here for me to get permission to go to Mulago. It was SO stressful. But, just so happens that there is a Canadian team here this week, two medical students and one of their moms, a senior midwife. There is also a medical student from Australia and another from Vermont. I'm surrounded by people who are trained at the same standard as I am and who understand my language. It is a HUGE miracle and blessing. I am the only nursing student. I am so grateful for them. Tracy has taken me under her wing and taught me so much and inspired confidence and courage. It would have been a very different story had I come to Mulago any other time.
I learned from Tracy, the Canadian midwife, that midwifery in Canada is direct entry. Meaning, she isn't a nurse and she isn't a doctor. She is a midwife. Certified midwives in the States are first nurses, then midwives.
ANYWAY. Somehow, this lowly nursing student has become invaluable amongst these medical students and midwives:
-The women here labor lying on huge pieces of plastic (no sheets. No absorbent pads.) They have only huge rolls of cotton to clean up with. After delivery, the mother is lying on this plastic covered in blood and feces and amniotic fluid and it's all slippery up her back and everywhere. Tracy and I found ourselves standing over a mother and her new baby, gloves mucky, staring at the mess. I looked at the mother and said, "could you roll to one side?" And started gathering all the mess into the plastic and tucking it underneath her, while wiping her down with massive gobs of cotton. Tracy looked at me and said, "I love doing this with a nurse. Everyone else has the mother lift herself up."
-there were two women who were preparing for c-sections. They needed IV's started and urinary catheters placed. None of the medical students or midwives felt confident, so I did it. It gave me the biggest thrill to have skills and know how to use them, and to be trusted and depended on to do it.
-today, I was placing a few more IV's on a couple women who needed to be induced. The curtain was closed around us, and I heard Tracy saying "where's Bethany? She's the IV queen. We need her to do it." HA. Turns out, doctors aren't even trained to place IVs in Canada. At least, that's what they told me.
-one woman had been laboring VERY loudly all day with little progress. Most African women labor very quietly, so this lady was very noticeable. She had sort of become the boy who cried wolf, and no one was really paying attention. I came back from a short break and she was screaming and no one was paying attention to her, so I decided to just go see her and help her feel cared for. I opened the curtain and saw a little baby head crowning. I told the mother to STOP PUSHING while I ran to draw up pitocin, find sterile gloves, get a razor to cut the cord with, get something to tie the cord with, while shouting to the African midwife to come help me. All the North Americans had gone to lunch.
Well, that midwife DIDN'T COME. So there I was, my second day on the unit, delivering a baby in Africa. And there was meconium everywhere. The midwife showed up just as I pulled the baby up onto the mama's chest and started rubbing her to make her cry. Her APGAR was a 4. I cut the cord and told the midwife to deliver the placenta while I ran the baby over to resuscitate.
By the time my team returned the baby was doing better and I gave care of the baby over to Tracy, our master resuscitator.
I learned this week that sometimes, it just takes a nurse. A passionate, well trained, wise nurse.
(Or a student going into her third year with little experience and a lot of adrenaline.) :)
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