Wednesday, January 12, 2011

Taking Care of Business

Things have certainly picked up since I got pack to site a week ago! I was tired of being bored and feeling like I wasn't really doing anything productive, so I realized I was going to have to take a much more proactive approach to make the day to day work more interesting. On one of my first days back I asked my CSB doctor if I could split my time between the clinic and the hospital, and she had no problem with that as long as I still put in at least 3 days at the CSB (I'm not sure why, there's generally not much going on there). So the next day I went to talk to the doctor in the maternity ward of the hospital and she seemed a little confused as to why a vazaha with no actual medical training wanted to help at the hospital, but she said yes nonetheless. So, the new deal is that I'll work Monday and Tuesday in the maternity ward, and Wednesday through Friday at the CSB. Cool with me!

Monday I went to the hospital, and since the rasazy (mid-wife/nurse) wasn't working the doctor seemed worried that there wasn't anything for me to do, but I told her I could talk to the new mothers about nutrition, breastfeeding, hygiene, etc. and it was no problem that I'd be working by myself. I actually preferred it to the group pre-natal consultations at the CSB because I could talk one on one with people which is much less intimidating. Also, I think it's better that way because people get instantly shy in front of me, but when it's just the two of us (well, three if you include their newborns) they're more likely to ask questions than when they're in a group.

On Tuesday I went back to the hospital and luckily for me, the rasazy was working and she's awesome. Girlfriend wore gold lipstick and about 10 rings to come to work delivering babies, so I'm pretty sure we're gonna be good friends. For most of the morning we just hung out and waited for people to come in, but it was nice because she's really easy to talk to and she speaks slowly enough for me to understand her. It's also helpful that she speaks some French and a tiny bit of English, because usually out of three languages we can reach a general understanding of what we're trying to say. In the morning we did a couple pre-natal consultations, and at the hospital they do individual consults because it costs 2,000 Ariary (~$1) instead of being free like at the CSB. Since we didn't have a bunch of people to get through, she was able to take the time to teach me about the other parts of the consultation, like measuring the belly, listening for the baby's heartbeat, and checking the position of it. After the consults we took the lunch break, and usually this is when I stop for the day, but I liked working with her so much I decided to come back for the afternoon.

Well wouldn't you know, this happened to be one of the best decisions I could have made, because that afternoon we delivered a baby! The pregnant woman had been pacing around the hospital all day, so the rasazy had just been waiting for go time. Once the woman gave the word, she was on the birthing table, we were gloved up, and in about three minutes, there was a brand spankin' new baby in Ankazobe. Seriously, it's got to be one of the fastest deliveries ever, but the rasazy said all Malagasy births are fast, and the women never cry or yell during labor because they are strong. Whatever works for them, but I was impressed.

Ankazobe's hospital is probably pretty nice by rural Malagasy standards (actually, the fact that we even have a hospital is amazing), but it was still quite a shock to my hyper-hygienic American sensibilities that there was a woman giving birth in a room with flies and no equipment other than a bedpan and a bucket of water. There was no pulse monitoring, no epidurals, no IV's, nothing. Technically there wasn't even a doctor, just a nurse and a vazaha with no real medical training. And yet, at the end of the day there was still a healthy baby and mother. Ankazobe is lucky to have the facilities and knowledgeable staff it does, because so much of Madagascar doesn't. One of my friends was even saying that when they saw a delivery the mid-wife was pushing on the woman's stomach to try to get the baby out faster. Terrible. Thank goodness the nurses and doctors at the hospital and CSB here are well-trained.

One of the other cool things about my day at the hospital was that I met a girl around my age who does AIDS education in the ambanivohitra (countryside) of Ankazobe. She said it's a pretty big problem in some of the areas surrounding here, so she and a few others (I'm not sure yet who) go out and teach about prevention. I asked her when the next time she was going would be, and she said this Friday morning. As part of my new proactive plan, I asked her if I could tag along, and she said she would be so happy if I would, so it looks like I'm going to the country on Friday! I'm pretty excited because I haven't yet been able to go to the outer fokotanys on forbiddance of my doctor and program director because it's dangerous for me to go alone, but I think if I'm going with several other health workers that should be fine.

After all the excitement of working at the hospital I wasn't exactly looking forward to going back to the CSB, but today turned out to be pretty cool actually. I learned how to do the HIV and syphilis tests that get done at the first pre-natal consultation that the women come to, and even though it's just a basic chromatography test it was neat to get to draw the blood. So now I can do those two tests and the malaria test, so maybe I'll be a little busier at the clinic. We automatically test anyone with a fever over 38 degrees Celsius for malaria, so it's one that gets done a lot. I've yet to see a positive test, though the doctor says it happens all the time.

I'm not sure if anyone from home will be able to help with this, but I figure this is as good a place as any to solicit donations: the ministry of health provides a lot of supplies and testing materials to the clinic, but for some reason not latex gloves. The rasazy mentioned today that she has to buy the gloves herself, and that if there isn't blood on them she reuses them. Once again, this is my American privilege showing, but that's just not quite right. If anyone has any medical connections and could possibly send gloves here I know that they would be really appreciated.

Well, that's been the last week for me and it was one of the more exciting ones I've had so far. I'm hoping that this is maybe a turning point for me and that I'll be enjoying the daily work more than I did before the holidays. So far, so good! I hope everything is super back in the states, take care.


  1. What great experiences you are having. If you do go into the Medical Profession, these are things you can't learn in a book. Keep the blogs coming are they are awsome. I've never read anything better than yours. You be careful out in the countryside.

  2. Brianna - I love how you're making things happen! Good for you.

    Do you know how long it takes the average Malagasy person to earn 2000 ariary in the Ankazobe area? Is going to the hospital quite a privilege?

    Good luck in the countryside. I hope you can take pictures too :-)

    Maman (french lesson 5)

  3. Having CSB in each rural town is one of the best project the Word Bank Organization has ever financed for a third world country like Madagascar. It saves lives.