My trip to Mwanza_Tanzania
Carlee Mark (Medicine)

I spent all six weeks on the birth suite and Josh spent three weeks on the paediatrics ward and three weeks doing general medicine. While it’s difficult to summarise just what our experience was like, how varied each day was and the impact it had on us, I’ve endeavored to provide a glimpse into the life of the hospital by describing just one day. It was certainly a busy day, but not too dissimilar to several other days during my time there.

Being monsoon season, it started by being woken early by raging wind outside our house and then the inevitable torrential rain. Unfortunately, storms like this often cause a power cut and this day was no different. It was beautiful to be in bed and listen to the rain, and I was told time and again that the “farmers will be happy”, but of course, there are significant problems when there’s no power.

While no power at our house is a minor inconvenience, no power at the hospital is a far greater problem. From the time I arrived to the time I went home on this particular day, there was no power or water and therefore no lighting, no autoclave for sterilising instruments, no oxygen concentrator to administer oxygen to a newborn babe with breathing difficulty, no hot water for morning chai (perhaps the most important part of the morning for the midwives), no effective handwashing and on and on it goes.

Thankfully, the morning was quiet, though prior to me arriving, the night staff had managed a few births, including twins, by the light of an oil lamp. Even when it’s “quiet”, there’s no shortage of women in labour. Unless they’re in second stage which is the time when they can come into the four bed birthing suite, they take care of themselves. Often older women encourage the younger women, in one twelve bed “true labour” room.

This few hours of quiet of course didn’t last, though the power outage unfortunately did.  And as I so often found at the hospital, when it rained, it POURED (figuratively and literally)! It started with a woman in the admission room whose waters had just broken and examination revealed a footling breech. At the same time on birth suite, a 19 year old woman presented with fulminant pre-eclampsia, blood pressure of 210/130. Thankfully, she was almost ready to give birth. Meanwhile, two other women were having babies in adjacent cubicles and I was with one of those. The fourth bed had a woman in it too so the fifth woman to need a bed was only able to use floor space, alongside the woman with pre-eclampsia. You can imagine that witnessing all of this, while being in labour yourself, could be quite traumatic!

After the woman I was with gave birth to a healthy baby, I went to be with the 19 year old pre-eclamptic woman. One of the midwives was attending to this woman as well, while the other midwife was getting the woman with the footling breech ready for theatre, where thankfully they had a working generator. As the baby was coming out, I confusingly saw not just a head but feet too. I looked, and looked again, realizing that she was having twins, the first twin cephalic, then second breech (but both at the same time). So now, my blood pressure was up too!! The first bub was really small (1.7kg/3.7lb) and not in excellent shape so I took him for some resuscitation but saw that the second was even smaller (750g/1.7lb) and not fairing so well. There was really only another medical student and I on the ward at this stage so I was trying to resuscitate the first while deciding whether I wanted her help as it would have been much easier with two people, but knowing that if she helped me, we couldn’t attend to the smaller second twin. I sure didn't want to give up on beautiful twin 2 but didn't want to lose twin 1, who was bigger and stronger and had a better chance of surviving. Thankfully, while I was thinking this through and speaking my thoughts out loud, twin 1 improved and I didn't need to make that decision. Not unexpectedly, twin 2 died a short time later anyway.

In my eyes, the birth suite was hectic at this stage (with two women still groaning in pain in the background, on top of there being this woman who was quite unwell and had just had very small, sick twins) but I turned around to find one of the midwives mopping the floor!! Yes, there was liquor and blood on the floor but from my “western” perspective; this wasn’t the most pressing issue. She seemed much more comfortable than I felt in the situation, and her sense of calm reminded me to take a few deep breaths.

The traffic through the birth suite started to settle after this but just as we were wrapping things up to hand over to the evening staff, the distinct cry of a baby just born could be heard coming from somewhere in the corridor…a woman had given birth in the "waiting area", surrounded by other labouring women waiting to be admitted. Given how hectic the past few hours had been, it was an almost amusing end to what was a very challenging shift. Birth suite in Tanzania was a rewarding, eye-opening and at times stressful place to work but I cannot recommend it highly enough.