Friday, April 1, 2016

“It is better to have spilt water than a cracked pot” African saying

I feel like a failure, sure it’s a pride thing but still. 

Up until now my adventure have been in chronological order of my trips, I have decided that they don't have to be, I think the stories should all be told and I have decided to tell about my adventures in the order that I want and some are really important and I have to tell them, this is one of those stories! 

Most of you may remember that in October of  2014 I went to Africa/Kenya to lead a Helping Babies Breathe (HBB) Facilitators training. This training would train healthcare workers in the practice of HBB and help decrease the number of babies that die each year in childbirth. Pamela Meharry,  a nurse midwife and fellow HBB facilitator and I led a 2 day course and trained 7 facilitators.

HBB focuses on the crucial first 60 seconds, that golden first minute in a baby’s life. It stresses that being prepared is so important, and having the correct tools to help if resuscitation is needed. Being a good labor nurse is about being prepared….. prepared if something happens with the mother and with the baby. Being caught unprepared can be the difference in life and death, and is NOT a feeling that I care for. There have been times in the states in a hospital setting where I have had a patient that had a precipitous delivery (fast) and I wasn’t quite ready, thanks to my coworkers and their quick actions everything was okay. That’s what being a good labor nurse is about, being prepared and having a great team of other labor nurses helping you out. I’m not trying to take anything away from the obstetrician’s, but that’s their job, things are much calmer when they do the delivery compared to a nurse…okay I am rambling, back to point.

I just returned from my latest adventure with Project Humanity and it didn’t go without a little drama! Whenever we travel to Rusinga Island (in far western Kenya on Lake Victoria) we always check in on the clinics where HBB providers are trained. We go into the labor and delivery areas and check the condition of the HBB supplies and if they are still using them as trained.  The first week of the trip I wasn’t able to go in for an inspection, I got very sick and we had a dental clinic going on so it was chaotic to say the least. At the end of the first week a pediatric resident from the US, Dr. Sheena Gupta joined us. Sheena is a trained HBB facilitator as well and I had plans for us to do refresher courses and new trainings if needed while there. On her first day we went by the Minister of Health’s (MOH) office for introductions and to take her on a tour of the facility. (Mbita Hospital)  While we were in the maternity ward I took a chance to inspect equipment and you can imagine my surprise when there were no HBB supplies to be found in the delivery areas. I talked to them about the importance to always be ready and they needed to get the HBB supplies back to the area ASAP!

On her second day Sheena started by doing rounds with the staff at Mbita (they do a lot of deliveries and have an inpatient area that is always busy) The pediatric area was FULL, some beds had 2 children in them.  While she was there I was visiting with high school girls on Rusinga to talk about hygiene and about girl stuff. Once we finished we headed to Mbita to catch up with Sheena and go to lunch. On the way I got a call that there was a patient that was in labor and going to deliver, if I wanted to take part in it I should head on in, so our driver increased his speed!

Meanwhile back at the hospital, Sheena prepared to go in for the delivery. She asked where the supplies were, because they weren’t there even with the recommendations from the day before. She instructed them to get the supplies before delivery.  The next thing she knew a very inexperienced midwife ruptured the bag of water on the patient since she was completely dilated, and of course there was meconium, thick meconium! (Baby poop) I walked in right as the baby delivered and could see a limp baby and Sheena looked and me and yelled for me to go find supplies to resuscitate this baby! I ran out quickly to the room that I knew they should be in and nothing, I quickly ran back in, the cord had just been cut (the midwife decided to milk the cord, which is fine with a healthy baby, not one that needs resuscitation!) Sheena had to tell him to quickly cut the cord and she grabbed the baby and we both started to frantically work on drying the baby. At this point a fellow hospital worker thought the baby had died and she left the room. (HBB teaches you try for 10 minutes before stopping) Experience and knowledge tells me that the baby needs to be suctioned first but we don’t have the supplies! We continue to dry and wipe the baby’s mouth out with a towel, we had to yell to get that! We worked and rubbed and dried and stimulated begging the little guy to breathe… about the time he started to breathe and cry a bulb suction showed up, and not the HBB penguin suction they are suppose to have! Once he started crying Sheena and I gave a sigh of relief, but I was angry inside. Where were the dang supplies??? Sheena assigned apgars of 1/8, all the baby initially had was a slow heart rate.

Once we finished and the baby was okay Caroline, one of the practitioners (who I trained in HBB in 2014) made the statement “Another HBB success!” I looked at her and replied, that was not a success, it was a HBB failure, you guys were not prepared, even after the visit the day before and Sheena’s instructs to get ready right before the delivery. If I were to grade you right now you get a “F”, she looked shocked. 
We already had a HBB training planned at their facility the next day and we encouraged that all new employees or ones without the training take the class.

Sheena led a small HBB class that afternoon at the Tom Mboya clinic that we work with and trained 2 people. The next morning we showed up at the hospital and trained 9 more and Caroline was there for a refresher I’m sure.  We stressed even more about the importance of preparedness, HBB doesn’t work if you are not ready. Sadly the inexperienced midwife from the day before wasn’t there and only one of the new midwives was (she did great!) the employee that walked out when she thought the baby was dead wasn’t there either. I asked about those not in attendance and told them that they need to have those people trained in the next 30 days. 
                                             Instructing at the class at Mbita Hospital
Jerry Uhuru, a Project Humanity in country volunteer!
                             Dr Sheena Gupta and our small class at Tom Mboya Hospital

I found out a few days later that since I taught the first HBB class that the fetal death rate for 2015 was higher than 2014. I discussed this with the MOH and he shares his concern over this number. In talking with the providers an African saying came up “It’s better to have spilt water than a cracked pot” The meaning is simply that they save the mother over the baby, they focus more on a mother at/after  delivery than the baby, and it is so easy to do both. Their premise is that if the mother dies there is no one to look after her other children.

The next training in HBB is Essential Care of Every newborn  and I was scheduled to teach that this fall, but until I am sure they have the first concept of HBB down this will not take place. I am okay with this decision, it is better to have one skill mastered before attempting the next, it makes you a better nurse/midwife.

I am still learning, and teaching in another country that has differences, how they learn, their cultural views on the value of the mom’s life and the newborn’s is not the same and yet I understand.  I found this quote from C.S. Lewis and I thought it fitting especially with the reference to water
“The task of the modern educator is not to cut down jungles, but to irrigate the deserts.”
So I guess for now you can call me  Farmer Kay RNC

If you would like more information on how to volunteer with Project Humanity in Africa or join me on my trip in September to Zambia go to or email me at

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