Today I went to the local hospital to follow up on some training from last field service. I went to 3 different departments and asked them 6 questions. The topic was neonatal resuscitation you may remember that we did this in Congo too with pretty good results. So in the first 8 months in Madagascar we did this course 3 times organised by me and taught by nurses with much more neonatal experience! Today I wanted to see who had remembered the process and what we need to work on. This is the benefit of returning to a country for a second time, you get to evaluate and act.

So far it seems everyone remembers having the training, sounds basic but it’s quite a big bonus; they are also using the methods we taught. That’s big news. As I continued asking questions and jotting numbers and letters down it seemed that most had got some fundamental steps of the process incorrect, but that is still an improvement from where they were before.
At one point a midwife who was attending to the aftermath of one birth and shouting instructions to students attending another, demonstrated chest compressions on a washing up sponge in between vigorously cleaning suction units once full of blood. She showed me the ratio and the depth of compressions correctly and talked me through the steps. Another nurse showed me on my bag, another on a pencil case. What ever works.

The midwife and her sponge had answered all my questions, she scored 14/20. I was impressed. As I was thinking about giving her feedback on what she had missed I stopped myself, turned my attention to the other midwife entering the breezy delivery suite. She walked with speed the way we often do on the ship, the disqualified run, alerting a little attention but in a calm and professional manner. She laid the bundle on a hard and cold dressing trolley, that’s what a resuscitaire looks like here. She called for help and started the process, the other midwife dropped her sponge and walked over to the baby. I stood and watched and continued to assess their response to neonatal resuscitation. They followed all the steps that the sponge midwife had just talked me through and she took that baby just like the sponge and with each squeeze brought the blue breathless thing back to life. She made it to the end of her version of the steps with a soundless but pink baby and then looked at me. I smiled and then it seemed only appropriate to shout out the step which she had forgotten, both with the sponge and now with a real baby. She looked shocked that she had forgotten such a thing and ran off to collect the material she needed.

I don’t know if that baby will survive but I know that the sponge midwife will never forget the steps again.  Next time I think she’ll get more than 14/20.

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