In August of last year I boarded a plane for the sweet sounding Honiara, capital of the Solomon Islands. I arrived with four other Australian Volunteers International (AVI) volunteers who were soon to become close friends and vital confidants. I had signed up for 12 months working (for a minimal living allowance) as a “Midwife Mentor” at the National Referral Hospital, locally known as Number 9 on the Labour Ward. Although I had been given objectives before I arrived I had been warned by the country manager that the best thing I could hope to achieve was to make the midwives treat the women with compassion!
Number 9 is an old and dirty hospital that is so under-resourced that as you walk in you feel like you have stepped back in time. The first thing you notice is the smell of stale urine. Inside the Labour Ward the smell was no better. There could be up to 15 women in labour in one small stuffy room with only a couple of dust covered fans and four bare and worn mattresses to share! Two nurses or midwives would diligently check their blood pressure and listen to the baby’s heartbeats every hour. There was a curtained old bed for the strict fourth hourly VEs (vaginal examinations) where the labouring women are ushered and poked and prodded without any consent, their waters would be broken by the nurse and if they had not reached the allocated dilatation in the allocated time they would be given a drip with Syntocinon in it to speed up the labour. They don’t have the fancy machines, like we have in Australia, to regulate dose and ensure that the baby is coping alright with the augmented labour.
Once they were ready to push they would go to one of the “2nd stage” rooms to sit on a metal contraption that looks more like a torture device than a delivery bed. They would be sternly instructed to spread their legs wide, “WIDER!!” and put their feet on metal poles that stem up from the end of the bed and PUSH! Every woman having her first baby at Number 9 is given an episiotomy, no woman could have anyone to support them and so as you can imagine they were all terrified. Although the nurses were horrible to the women, they were lovely to me and one of them had a baby girl while I was there and named her “Natalie” after me!
In my first week while questioning why I had come and wondering what I could possibly do to improve the conditions, a woman came in to birth her 9th baby. The birth went well and her tiny little boy had entered the world. But instead of the placenta coming next, there was a hand. It would seem that she was also having her 10th baby today! Mind you a hand is not the most ideal body part to come first, luckily a doctor was able to turn the baby and it was born breech….. amazing!!!
During the 5 months that I enjoyed and endured (I came home early) working at Number 9, I was exposed to heartbreaking birth after birth. Even if the baby was born alive, without the scarily common severe abnormalities, it was a harsh and scary way to enter the world.
One of the paediatricians was telling me one day after a baby was born and later died due to its extreme abnormalities, that in the village where he comes from they dip their premethrine soaked mosquito nets in the stream to kill the fish to eat. They know that this causes birth defects, but they continue to do it.
In my time there I wrote Clinical Practice Guidelines for the Labour Ward, each one encouraging the use of basic hygiene, which was much needed. I even wrote one on restricting the use of episiotomies! I presented these guidelines to the staff in a workshop and left copies for them to access on the ward.
To end on a light note, I loved learning the endearing Pijin language. My favourite term was the one for the cervix, which was “dor blong pikinini” which translate to the baby’s door!