Well, here’s to moving forward, understanding your place in the world, and keeping faith. After an absolutely frustrating and heart wrenching week – complete with the delayed receipt of the death of the second twin yesterday – I’ve worked myself into a motivated fervor. At least I can burn through some of this helplessness.

Here’s a little catching up. I went into Mansa Friday night arriving at the house after dark. I stayed, cooked, vented, and wrote until Monday morning. Then I headed back to site to visit my kitten and get back into the swing of things. Upon arriving at my hut I discovered to my horror that my IPod had malfunctioned and would not respond – not a good point to start off on and definitely a bad moment to be without music and the sounds of family & mum’s songs.

Wednesday morning I found transport back to site with ZPCT II and the Saving Mothers, Saving Lives program. We arrived and set to work transferring, reorganizing, and shuffling around equipment and materials.

Back to a background paragraph – our clinic is too small to effectively provide the necessary services it’s tasked with. In ’09 the district started construction on a maternity ward for the clinic. Corruption and dis-regard for standards followed and we ended up with a sub-standard, small building. It’s 5m too short, the rooms are cramped, it wasn’t wired, there’s piping but its unfinished, there’s no provision of running water, no tank or pump system, they stole clay bricks the community made from the waiting shelter instead of using cement bricks like they quoted and left the top half of the building unfinished installing ceiling board instead.

Maternity Ward - Chisunka Unfinished and too short

The clinic staff had forsaken the building’s purpose and were utilizing the space for voluntary counseling and testing (HIV), PMTCT (Prevention of Mother to Child Transmission) counseling and testing, some screening, storage – and lay counseling.

Realizing that the space wouldn’t be modified or fixed unless it was in use for it’s allocated purpose and complaints being sent to the Ministry on every birth – and noting that the current provision (a modified female ward) was insufficient, undignified, and inappropriate, we decided to shift the maternity ward into the building and work to make the best use we could of it.

There were some immediate benefits – first and foremost there was increased privacy and preservation of the delivering mothers dignity. The previous ward space was next to the screening room causing embarrassment and shame if women cried out during delivery. It had no provision for washing/bathing, improper ventilation, and waiting mothers and delivering mothers were crowded into the same space.

Washing and toilet provision in the new building - not plumbed but usable

The new space, once properly organized, is removed from the screening area, has curtains (my extra chitenge) a separate post-natal room and bed which is cramped (the size of the bed) but private, and with some creative hammer and rebar-chisel work, a functioning bathing shelter for bucket bathing after delivery. It’s got ventilation issues but the increased privacy makes it worthwhile.

Delivery bed, Chitenge curtain, and ventilator

We got even more creative and cut into the clinic’s wiring. We ran copper wire across the yard into the ward, allowing for a single light bulb assisting night deliveries – if we have power hah…

Got the Ward set up and infection prevention protocol in order. I photographed the setup of equipment, materials, medicines, and gear and will print out the photos to glue to the walls above the stations allowing for better organization.

Equipment Setup, and organization structure for materials

Infection prevention buckets for bleach solution and disinfection

The result of our hard work? The day after – let me emphasize that – THE DAY AFTER!!!! – we finished, we had 6 deliveries. From 10 Avg in a month we’re at 6 by May 3rd! Whew!

Expected yearly deliveries 480, average facility deliveries last year 120, expected minimum monthly facility deliveries 25 – desired 40.

We’re really excited and hoping that the combined change in maternity ward use – and it’s inevitable upgrade – combined with Safe Motherhood Action Group trainings will bring us more in line with our goals and the service need in the community!

We sacrificed our female ward to the counseling center, are using and actively reporting on the inadequacy of the maternity ward facility in an effort to get it fixed. Made necessary upgrades to the space with a bit of elbow grease and some donations, and put up a fishing line clothes line to dry the clothes and cloths used during delivery – getting them up off the ground and bushes.

Here’s to little victories; Reading letters from home, asking forgiveness for actions rather than permission, making great strides in protecting mother’s dignity and privacy during birth, re-organizing, cleaning, re-instituting IP processes (we didn’t have any bleach for 4 months) and keeping people healthy and safe!