Clive, Myanmar (Burma) - We have arrived in Yangon

These are a few pictures of our first 3 weeks in Yangon. We arrived in December 2009 and were met at the airport by Erwin the Doctors of the World employee who I am replacing.

The final pictures are of the Shwedagon Pagoda which has more gold on it than is in the vaults of the Bank of England. Its massive 2500 years old and is set on a hill in Yangon about 3 miles from our home.

Emily Denness - November - Impressive midwifery skills reach ECHO

The European Commission for Humanitarian Organisations (ECHO), one of our biggest donors, is arriving today to assess the clinic. We also receive word that a woman from a community in Tabasa, about an hour and a half’s drive away from here, is in labour and is coming to the clinic.

She has been in labour for two days and it’s her first baby. There is thick, thick meconium (a tar-like substance that lines a baby’s intestines during pregnancy and usually excreted through bowel movements after birth) in the waters.

The presence of meconium during the labour can be a sign of fetal distress. The baby isn’t happy and the woman is 7cm dilated. She just needs a little push with a drip, but I insist that we rehydrate her and give her something to eat first. Once born, the baby will need resuscitation, I’m certain of it.

Dipping heartbeat

The baby’s heartbeat is dipping. It takes the mother a while to master pushing, as it does with most first timers. Finally we see the baby’s head. The resuscitation equipment is ready, and the adrenalin starts pumping. The baby comes out but it’s not responding, breathing or moving.

We start resuscitation even before the cord is cut. I’m not sure if this one will pull through. We cut the cord on a flat surface. It’s a girl. The heartbeat is good, but there’s still no breathing so we have to do it for her.

Dr Eoin and I take turns in resuscitation. We use suction to get loads of meconium from the lungs. We keep going, and just hope that she makes it. It feels like we’re not breathing either.

The mother is watching with baited breath, as is the grandmother. Ten minutes pass before the baby takes a gasp. She’s still unresponsive and still not breathing by herself, but there’s hope! 

Sigh of relief

Another five minutes pass before she starts breathing. She’s breathing! Yes! She’s not opening her eyes and is still a bit floppy, but she’s breathing! Everyone breathes a sigh of relief and we keep watching her like a hawk.

After ensuring that the baby’s not going to suddenly stop breathing we hand her over to her mum. Babies always recover so much better when they are held by their mothers. After a while she even opens her eyes.

The placenta still hasn’t come out yet, so I give the mother an injection to help. She coughs and the placenta pops out! She wants to keep it, so we seal it up in a bag, otherwise there will be a trail of blood following them home.

The woman starts bleeding. The uterus is high so I press on it but there’s more blood. I remove some large clots which are stopping the uterus from contracting. She has lost a lot of blood, more than half a litre, but the bleeding is starting to settle. They could have both been close to death if they had stayed at home.

Reputation intact

We tell ECHO the good news and they’re all relieved and amazed by the story. My reputation as a midwife is intact. So what if I’m not good at big speeches, I can do my job as a midwife and that’s why I’m here. Dr Eoin is very relieved, because I was in Feina the last time there was a case like this.

The team from ECHO is having a long meeting with the general coordinator and the desk coordinator who’s visiting from Paris. They seem very impressed, and we’re pushing for more donation money to support and help grow the mission for next year. It looks promising!

In the morning we wave off ECHO in the helicopter, and EID, a national holiday lasting five days, begins. It sounds like a nice break, although I know that there’ll be more on days when I’m off! I plan an afternoon nap to help prepare for the days ahead.

I love this job.

Emily Deness - November - Septic Shock

“It starts off as a quiet day, with most of the team away at the other base in Feina. It’s warm during the day but the evenings are getting cooler, with jumpers and scarves starting to make an appearance, along with blankets for sleeping.

I decide to have an early night and start dozing off at about 9.30pm. At 11.30pm the guard knocks on my door saying that Zakia, the midwife, needs me now. Zakia tells me that a woman who gave birth two days ago is being carried to the clinic by her family. Eclampsia instantly comes to mind.

I head straight to the clinic with Dr Eoin O’Donoghue, an Irish doctor who has been in Darfur since July. She hasn’t said anything since giving birth and has been experiencing fits. The fits last less than a minute, but she’s just not coming round properly.

Her eyes are open, but there’s no response. Surprisingly, her blood pressure is totally normal, if rather low. We were expecting it to be through the roof, so that pretty much rules out eclampsia.

We revise the magnesium sulphate protocol together, as we believe that it’s the only way to stop her fits and save the woman’s life.

Septic shock

The family says that she has lost a lot of blood. Her blood sugars are fine, but she has a slight temperature and a very high pulse. I suspect septic shock, so we give her antibiotics immediately. She has another fit, though thankfully it still lasts less than a minute.

We keep her airways clear and stop her from pulling the drip out; if she is suffering from septic shock, it’ll take at least 24 hours to ease off. We tell the midwife to make observations every hour and write down when the fits occur until we return first thing in the morning to give the next lot of antibiotics.

I give Zakia a radio and tell her to call me if the fits occur more frequently or are longer in duration.

In the morning I want to check on her straight away, but there’s an emergency in the clinic. A little boy, probably about eight years old, is crying relentlessly as some other boys have cut in a private place.

The staff sedate him, clean everything thoroughly, and stitch him up. We only hope that he won’t be scarred for life.

Thankfully it didn’t go through any vessels or tubes. We don’t want him to have problems urinating so we empty his bladder with a catheter before he comes round and give him antibiotics as a preventative measure and paracetamol. He comes round and his big tear-filled eyes are heartbreaking.

Still unresponsive

Meanwhile, the woman who has been fitting is still unresponsive, but didn’t have any more fits until the morning. Suddenly she has three within an hour. We give her more antibiotics as we want to cover everything.
My main concern is that the patient doesn’t hurt herself, so we make sure everything is clean.

Dr O’Donoghue administers diazepam to help stop the seizures. She has another fit within 20 minutes, but they seem to settle, so we are less worried about her pulling out her IV line or choking. 

The next day she seems a lot better and will go by truck to the hospital in Nyala.

Clive, Myanmar (Burma) - Leaving via Paris

Clive and Jackie in Paris

We went to Paris for a week of meetings with Doctors of the World (Médecins du Monde) in preparation for the commencement of our "mission" as HQ described it.

We did a bit of sightseeing and had some nice meals but were mainly waiting to set off for Burma and start this exciting year.

Our main worry was about our passports which we did not get back from the Myanmar (Burma) embassy until 4.30pm on the Friday and we were booked to fly on the Saturday Thai Airways via Bangkok.

Clive Mellor our volunteer in Myanmar (Burma)

 

Clive on a visit with Dr Hein Latt Aung (Project Officer) to see the work in the Delta area hit by Cyclone Nargis in May 2008.

Clive Mellor, 45, from Lancashire is volunteering with Doctors of the World in Myanmar (Burma) where he is working as a Finance and Admin Coordinator overseeing two projects in the country.  He is living and working abroad on a year long mission with his wife Jackie who has also been volunteering for the organisation.

Clive spoke to Frontline Diaries about his experiences and why he decided to go to Myanmar.

What was your background experience leading up to volunteering with Doctors of the World?
I had over 22 years work experience mainly in Finance and Health Services, working at a senior level. I worked all over the UK but never overseas, but have travelled widely.

I’m a qualified accountant with 22 years experience including 13 years NHS experience working as a Director.
 
What projects are you working on in Myanmar?
Doctors of the World have been working in Myanmar since 1995. They work in Yangon (the capital formerly Rangoon) and in Kachin near the Chinese border. Since 2008 they also work in the Delta area hit by Cyclone Nargis. I started in December 2009 and will be based in Yangon.

In Yangon Doctors of the World works on Aids prevention and treatment for sex workers (i.e. the highest risk groups) and does outreach work using peers to talk to those at highest risk and promoting the use of our Drop in Clinic. The prevalance of Aids is highest in these risk groups. Our work in Kachin is similar but targets Intravenous Drug Users.
The work in Pyapon in the Delta area is community health work, where we help train community health workers, who are villagers in remote areas, keeping them supplied with medical supplies and supporting their work. Most of these villages can only be reached by boats taking up to 10 hours to reach them.


Why did you decide to go to Myanmar?
My wife Jackie and I had been to Asia many times and love the people, so this opportunity seemed ideal for us to experience a different culture for a longer period and make a contribution towards improving healthcare in Myanmar.

What is your role and day-to-day job in Myanmar?
My role is as head of Finance, HR and Admin. Key aspects of the role include bidding and reporting to donors. Also we have the regular monthly financial reporting to do to HQ in Paris and ensuring financial procedures, plans and budgets are adhered to. A new HR policy has just been implemented for local staff and so there is some work in ensuring it is delivered effectively.
My wife Jackie has started helping an AIDS self help group which is run by locals involved with Doctors of the World. They make and sell bags to raise funds and she has been helping them with their costings and marketing.

How do you think it will impact on your working life when you return to the UK?
Difficult to say – I think it will add something to my CV, but this is more about an experience that will remain with me for the rest of my life.