Twilight eases over our compound, heralded by the gentle cooing of doves rustling amid the branches shading our tukuls, our round mud-brick and reed-thatched houses. The air wraps round me, humid and warm, as I wend my way between the tukuls; soft voices of Italian, German and French drift over the darkening evening as my colleagues reach out to family and friends far away.
It is Sunday night, the end of my first week back on mission, this time in Am Timan, Chad, in Central Africa. It’s Sunday, normally our day of rest, and I’m preparing mentally and physically for another busy week. This assignment is going to be a challenge for me, as I had strongly requested a posting that would allow me to work in the maternity department, which has been part of my work in family practice for more than twenty-five years. I also requested a French speaking assignment, as I had been studying on my own and wanted to have the chance to immerse myself in the language. Thus, I was invited by MSF’s Operational Center in Amsterdam to come and work as a midwife in Chad, and I am delighted.
My day of rest began dramatically with the harsh trill of my cell phone, somewhere outside the mosquito net that enveloped my mattress. I groped for it, knocking it further away.
“Allo, La-neece? C’est Dr. Ahmet.”
I took a deep breath, grappling with French while not fully awake, piecing together that I was being called to the hospital to help arrange a Caesarean Section for a woman with obstructed labour. I threw on the requisite MSF tee-shirt, grabbed water, an apple and my radio, and ran to the compound door to await the MSF car that would take me to the hospital. My role would be to ensure that the supplies were available, support the team and ensure the resuscitation of the infant.
Dr. Ahmet quickly filled me in on the history of the woman awaiting a C. Section. She had not progressed for several hours, and with no descent of the baby’s head and all options exhausted, it was time for the “theater.” As she underwent surgery, I couldn’t help but think to myself that the theater was a good description for the operating room as the drama unfolded.
A very competent male nurse, working in maternity, and I prepared to resuscitate the infant, while the operating team prepped for surgery. A finicky breaker switch on the electrical panel meant that a third midwife had to stand by and flip the breaker back on after it cantankerously turned itself over every ten minutes or so. However, the national staff team knew their work, and the surgery proceeded without incident.
During my first week with the midwifery team, I noted that the team worked well together, they were competent with skills for difficult deliveries, such as twins and breaches, normally delegated to obstetricians in Canada. My predecessor had noted that neonatal resuscitation needed reinforcement. I ensured that our resuscitation box was stocked, and checked the suction and oxygen daily.
In Canada, those of us working in maternity must keep our neonatal resuscitation skills up, with training repeated every two years. It is one thing to practice cardiopulmonary resuscitation (CPR) on a doll, but another when a slippery wet blue-grey baby arrives on your table. The suction that seemed fine the day before really struggled with sucking up the thick meconium. The oxygen mask needed a quick change. The chest compressions that I had practiced a hundred times on a doll felt similar and yet entirely different on the little one’s chest, as I began the rapid push with my thumbs, counting out “Un, deux, trois, respirez’ while my colleague used the ambubag to gently squeeze air into the neonate’s lungs.
In French, resuscitation is called ‘reanimation’. This did feel very much like a body becoming re-animated, returning to life as the little baby’s pulse picked up, rose to a healthy 120, and he began to take laboured breaths. My highly skilled colleague started an IV, another midwife attached the sat monitor, we checked the glucose, and prepared to transfer the baby to the neonatal ICU after stabilization. While it took longer than ideal, mostly due to equipment issues, the and an infant arriving unable to breathe on its own, the resuscitation proceeded well and I had hopes for a good recovery.
Sunday evening, darkness had fallen, the compound quiet. A list of to-do’s tumble through my mind: get the finicky suction tubing fixed, one oxygen concentrator needs repair, we are low on a number of supplies, the doppler needs a new battery, I have to get help translating some of the finer details of our neonatal resus to review with all the midwives. Lulled by the warble of crickets, I settle down for the night, inspired and hopeful, awaiting another busy week.