Great progress has been made with C-sections at Kivunge!
Since the arrival of Jon (Volunteer Anaesthetist) and Nathan (Volunteer Obstetrician), we have performed seven C-sections at Kivunge (one without any HIPZ involvement!). The time with Nathan gave the AMOs, and especially Tamim, the confidence to perform emergency C-sections. Mansour, our MD, as well as another AMO were involved in a successful independent C-section recently.
Although the surgical aspect has made great progress, the biggest barrier to regular C-section is the lack of an anesthetist on site. Although multiple attempts have been made by Jon to provide support, mentoring and teaching for Dulla, he still does not show up to work regularly. He has commitments with Mnazi Mmoja to work on Tuesdays and Saturdays, so will never be available on these days plus Wednesday he is post on call, so it is impossible to guarantee a Monday to Friday service once our volunteer Jon has left. Our midwife in charge, Mwanaisha, who has had 3 months training in doing spinals, has performed a number of spinals with supervision from Dulla and Jon. Whilst she is evidently enthusiastic about doing spinal anaesthesia, she still would need substantial training in order to become independent with this procedure.
Newborn checks, observations and management of neonatal sepsis are improving, with the support of an enthusiastic nurse midwife, Mwanashamba. Neonatal resuscitation training is being conducted by Shuang regularly with AMO/COs and midwives, and it is hoped that every midwife will have multiple trainings in order to reinforce this important skill.
We are looking forward to welcoming Sara, our next obstetrician from the US (!) – We hope that, together with Nathan’s experience, they could help to develop a criteria for C-sections to occur on site vs. transfer.