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Midwives in Vanuatu
				
		
		
				Vanuatu!!!!! The very name conjures up, for 
				many people, visions of long stretches of 
				white tropical sands, colourful coral reefs 
				and drinking pina coladas under the palm 
				trees at a luxurious holiday resort.
		
		
				This is all part of the picture, but few of the 
				tourist dollars filter down to the health service there, which is poorly 
				resourced and heavily under staffed.
		
		
				In July this year (2007), two of us, myself and another Auckland midwife 
				Liz Harding, were privileged to be able to work as volunteers for a short 
				time at the Government Hospital in Port Villa. Their maternity unit has 
				over 2000 births a year and about 15 full time equivalent midwives to 
				run it. Most of these midwives, although well trained, conscientious and 
				competent are over 50 years old. There seem to be very few younger 
				midwives in the service, and no new ones have been trained since 2003 
				due to lack of teachers and resources.
		
		
				When Liz and I were shown around the maternity unit, it was clear that 
				they had very limited supplies of basic equipment. We asked the 
				midwives what they needed most and the invariable answer was 
				“STAFF”. So Liz brightly suggested that maybe we could organize some 
				sort of roster for midwives from New Zealand who would work as 
				volunteers for 2-3 weeks at a time. This suggestion was greeted with 
				rapturous smiles and great enthusiasm. We went away and thought 
				about it. Maybe we could organize it. During the time we worked 
				alongside the midwives, this changed to “definitely we will do our best”. 
				So here goes:………….
		
		
				Firstly, let me try to draw you a picture of a typical day in the maternity 
				unit.
		
		
				When we arrive, there are three women in labour walking up and down 
				the corridor, stopping to lean against the wall during contractions. Some 
				family members are with them, encouraging them, and supporting 
				quietly. There are two Midwives and one Registered Nurse on duty this 
				shift to run the labour and delivery unit, antenatal, postnatal, and 
				SCBU.
		
		
				We attend a round at 0800hrs with the Australian Obstetrician (Jason), 
				who is working there for 2 years with Aussie Aid. He sees the three 
				women in labour, who are progressing normally at the moment. He then 
				checks all those in the post natal ward before attending antenatal clinic 
				where up to 80 women are seen per day.
		
		
				Liz and I go to see what’s happening in SCBU – there are five babies in 
				house, all in really old but serviceable incubators. The smallest who is 10 
				days old, was born at 29 weeks, weighing in at 1060grams. He is being 
				tube fed and has 3 hourly obs done of temp, heart rate and oxygen 
				saturation. His mum sits beside the incubator, patiently waiting for his 
				next feed and the opportunity of a short cuddle with her miniscule son. 
				The others are twins, born at 34 weeks, doing well, a baby under 
				observation after low Apgars at birth, and a term baby who has some sort 
				of “syndrome” (unidentified as yet) who seems to have very poor tone and 
				suck reflex. They are still being looked after by the Registered Nurse. 
				We help her for a couple of hours, and then go to offer assistance with the 
				women in labour. The midwives are very glad for us to take over whilst 
				they try to deal with all the discharges. Liz looks after a multip who 
				births within the hour. All is well!!
		
		
				My mum, having her second baby is coping well with contractions at 5cm 
				dilatation. This baby is in a posterior position. Not much progress over 
				the next 4 hours so I can do an AROM and commence syntocinon after 
				consultation with the Midwife in Charge. There is no pump so I count the 
				drops. Liquor is clear. No medical methods of pain relief are available 
				except epidurals for caesarean sections, and none of the mothers expect 
				any. My mum does really well with massage and verbal encouragement. 
				Three hours later, after an hour in second stage, she gives birth to a  little 
				girl weighing in at 3.2kilos, persistent occipito posterior with lots of 
				“sugar loaf” maulding and good Apgar scores. 
		
		
				In the afternoon, Liz admits another woman in labour 
				(G2 P1) who had a previous 4kg baby 5 years ago, 
				with severe birth asphyxia and brain damage. On 
				CTG (they have 2 monitors, old but functioning), the 
				trace is pre-terminal. Liz shows it to Jason who
				immediately organises a caesarean. Liz scrubs and
				assists Jason and I resuscitate the baby. There is
				thick meconium. I suction him quickly and give
				positive pressure …………………with oxygen. His 
				heart rate quickly improves, his colour improves but he does not breathe  spontaneously for over 4 minutes. He goes off to SCBU where he is given oxygen via a headbox and observed for a while. By this time, we finishup and it’s 1730hrs and suddenly goes dark as it does in the tropics. Wemake our way back to the guesthouse which is 5 minutes walk from thehospital. Luckily Liz brought a torch with her!!!!:(LL Never has a showerfelt so refreshing before or a gin and tonic tasted sooooooo good!!!!:)
		
				
						SO, CAN YOU HELP???????  
				
		
		Well, a lot in several ways……… You may
		not be free because of work or family commitments to actually volunteer
		your services in the hospital, but you could certainly help with donations
		of money to buy much needed items. Perhaps you have some basic
		midwifery equipments, perhaps you could donate your “Maggie Myles” to
		the student midwives and we need 8 for the new intake of student
		midwives.
		
				I am returning to Vila for 2 weeks late October with another midwife
				colleague Gloria Hurley – our first volunteer! Between us, we can take
				some equipments and the rest can be sent by container. The sort of
				things they need are as follow:-
		
		
				Stethoscopes
				 
				Thermometers
				 
				Baby hanging weigh scales
				 
				Incontinent sheets
				 
				Theatre masks
				 
				Op sites for Caesar wounds
				 
				Neonatal suction catheters
				 
				Delivery instruments
		
		
				Equipments can be given to me or left with Delwyn at the SAMCL rooms
				in Manukau. Donations can be made to “MALAKULA  HEALTH” and sent to: 9 Hawthorne Place,  Ellerslie,  Auckland 1051
		
				Maybe you are interested in the idea of volunteering to work at the hospital in Vila. WONDERFUL!!!!!
		
				We spoke with the Nurse Managers and the Medical Superintendant
				who were both enthusiastic about the possibility. So anyone who wants
				to follow up on this should email Liz at janceyj.liz@gmail.co.nz and we’ll
				take it from there. Here is a wonderful opportunity for an ongoing
				exchange.
		
		
				It is important to remember that maternity services in
				Vanuatu have their own protocols by which everyone, 
				including volunteers MUST abide. These protocols may seem
				to be fairly conservative (like active management of 3rd
				stage) but are designed for maximum safety, which is quite
				right in these circumstances, we believe. So please be aware
				of this if you apply. Anyone going to work there would need
				to provide a copy of their APC and a short curriculum vitae.
		
		
				The return airfares are approximately $750NZ. Accomodation can be
				provided free at the Nurse’s home, cheaply at the backpackers or 
				moderately at nearby guesthouses.
		
		
				I believe that all of us involved will gain much from this volunteer
				experience. It is not a one way street. I know that Liz and I learnt a huge  amount from the Midwives in Vanuatu. It haschanged our midwifery attitude and perspectiveforever. So don’t miss out. You can be a part of this. Itcould be the beginning of something great.
		
				
						Chris Likeman 
						Midwife