St Francis Hosp

St Francis' Hospital Katete

In November 2011 a team of four doctors and one midwife travelled to a place called Katete in Zambia to train maternity staff in Emergency Obstetric and Neonatal Care. Borders General Hospital has developed links with St Francis Hospital. The maternal mortality rate there is 470/100,000 deliveries (approx 10/100,000 in the UK) and training courses of this kind helps reduce both maternal and neonatal mortality rates.

Dr Brian Magowan Consultant Obstetrician was our team leader on this occasion and gave the group various tasks to complete prior to departure in order to spread the work load. My part was sourcing and organizing the training kit for the planned workstations. It is always a little nerve wracking prior to these trips as very often the team has no idea of the layout of the venue. We were lucky as Dr Magowan’s wife Ruth had made a reconnaissance trip two weeks beforehand. This was very useful as we were able to plan ahead. The team also had the added bonus of knowing medical student Kirsty, who had just recently left BGH to do her elective at St Francis, and she helped us settle in.

Planning Course
Planning the course

Sort Equipment
Sorting out the equipment

We flew to Lusaka (Zambia’s capital) and then traveled by road the next day to Katete which took approximately 6 hours with limited room due to the extensive training kit in the back. Identifying rooms, setting up workstations and administration issues took most of the first day then candidates arrived ready to register at 1700hrs for their 2 day intensive training course. We had no idea of how many candidates would turn up. We were relieved to find 34 candidates on 1st Course and 42 on the 2nd course, along with training of the trainer’s day in between.

Course1 Candidates
1st Course Candidates

Course2 Candidates
2nd Course Candidates

The course focused mainly on obstetric emergencies and practical situations such as managing post partum hemorrhage and resuscitation of the newborn. Simple airway techniques and methods of keeping baby’s warm especially preterm are very important for survival. It was very encouraging as the candidates were so interested, keen to learn eager to participate in the practical workstations and wanted to make a difference to saving Mother and babies lives in hospital and in rural areas.

Instrumental Delivery
Instrumental Delivery Training

Manual Vacuum Aspiration
Manual Vacuum Aspiration Training

After the first course the team then picked 8 candidates, trained them as instructors and supported them to deliver the second course. We left an essential training kit for which they were grateful.

After the course the team were privileged to be given a guided tour of the hospital in particular the maternity and neonatal unit and we have some stories to tell. The delivery rooms were very small, the equipment basic and sparse, midwives trying their best to do what they can with the resources they have. In the neonatal unit there were approximately 8 mothers expressing milk to feed their babies by cup. I could see that there was a lot more to be done to improve preterm babies’ survival in this area. The incubators were made from wood and Perspex, heated by light bulbs and humidified by a tray of water. Simple pieces of resuscitation equipment will save a baby’s life providing staff understands how to use it.

Mothers Awaiting Labour
Mothers Awaiting Labour Outside

Mothers Awaiting Labour 2
Mothers with Babies

A story close to my heart was a mother I met who was having triplets. She had no idea of her gestation but was thought to be 32-36 weeks. On the third day of our training I was informed that she had her triplets and I was anxious to visit her. I was delighted to see that the triplets were with her in the post natal ward, were being kept warm and were apparently doing very well. Sadly Dr Magowan has since received an email from Kirsty that 2 had died from an infection. Despite this sad news the team received very positive feedback and indications are that we will be welcomed back.

Triplet Delivery
Triplet Delivery

African is the heart of the “big five’ so the team decided to spend 2 nights on safari in South Luangwa which was the most amazing trip I have ever been on. We stayed in a tent, had hot water (we had not had a hot shower for over a week) this was luxury!! At 2am my colleague and I were awoken by a rather large elephant, a few rhinos who helping themselves from the leaves cheekily scratching their backs from large trees outside our tents, a very scary experience.

Africa is a beautiful country but there is so much to do to help. I very much hope that other BGH Midwives will have the same opportunity to share their skills in the future as I have.