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An Evening Shared in the Labor and Delivery Unit at FAME-Africa

By: Ann Marie Gilligan, Registered Nurse

I have worked the last several nights with a team of nurse-midwives in the Labor and Delivery unit at FAME-Africa, a grantee partner of Every Mother Counts. A nurse-midwife is a Registered Nurse that has additional training in pregnancy, childbirth, and postpartum care. All of the nurses at FAME-Africa who work in the Labor and Delivery unit have the title of “Midwife.” They are an incredible team, and I want to honor them by writing my first blog about what it is they do, day in and out, with a smile on their face. In the US, my job as a Labor and Delivery RN is hard. At least, I used to think so. This Tanzanian team is responsible for phlebotomy, level 2 nursery, ICU (intensive care unit), OB (obstetric) patients, OR (operating room), Post-Partum care, gastrointestinal examinations, the pharmacy, AND they deliver 50% of the babies. They are not assigned a patient, they work as one. Their individual care is woven together in a seamless fashion, creating a layer of excellent care provided at FAME.

Evelyn, Ruhama, Agness and Jacob, nurse-midwives at FAME

Yesterday, after an already trying day, a patient was brought into the unit after suffering a seizure at home, seven days post-partum. She had global confusion, no ability to speak and responded only to deep pain stimuli. When told she would be arriving soon, none of the team members were on edge or changed what they were doing to prepare for this patient’s arrival. “We have seen this many times,” was the answer when I asked about their calmness. This team cared for her in a way in which I will never forget. The patient was brought in with her newborn in her mother’s arms, wrapped in several colorful African cloths. She was placed in a semi-private room with two other patients. One was a twin pregnancy with premature rupture of membranes and the other a laboring young woman.

Agness, Jacob, Evelyn, and Ruhama were part of her team of care. Agness got her settled, took her vital signs and welcomed her family. Jacob restarted her infiltrated IV within seconds in a hand where I couldn’t begin to see a vein available for use. Mama Evelyn put in a Foley catheter and got labs as the others handed her supplies without the need to be asked. Ruhama put in an NG (nasogastric) tube and spoke to the physician on call for orders. You have to realize how critical this patient was – she easily belonged in an ICU in the States.

Salina, two days post presenting to FAME-Medical with a complication

These nurse-midwives already had a full unit of women laboring, postpartum and antepartum. When orders were placed by the efficient Tanzanian physician, they included a very critically needed yet potentially heart-stopping medication. In the US, this is prepared by a registered pharmacist. Ruhama calmly broke open the vials, confidently drew them up into her multiple syringes and gave a very combative patient her anti-seizure meds via IV and IM (intramuscular). After the patient calmed down, porridge was prepared by yes, a nurse-midwife, and placed, warmed, down her NG tube with precision and respect, having made sure the temperature was just right by placing a droplet on her forearm before pushing it into her stomach. The nurse-midwife talked to her comatose patient each time she came in contact with her, checking her mental status but also knowing the importance of including the patient in their care. My role could have included assisting with a number of those skills performed last night but I knew in my nurse bones that I was witnessing a symphony. So, I stood and watched, taking note, and beaming with gratitude that I can be included in this group called Registered Nurses.

The next morning I arrived on the unit. This new mama was lying in bed, surrounded by her immediate family, nursing her newborn with a glowing expression on her face.