A further two beds in the delivery suite

Oh and Gee, are perhaps the politer words to describe what I was often thinking during my rotation in Obstetrics and Gynaecology at NDH. The staff are extremely hardworking and do their best with the resources available, but it was a far cry from services available in New Zealand.

During my placement there were several medical and midwifery elective students in the hospital. We were welcomed into all areas and so spread ourselves out between the wards (medical, surgical, emergency department, paediatrics and obstetrics/gynaecology. I was based in O&G but stayed on the obstetric side assisting with deliveries, and perinatal care. It was also an excellent chance to work alongside the midwifery students from New Zealand and consolidate my knowledge in the practical workings in the care of mother and baby.

There were many interesting cases, including two with cleft palate (the first I have seen) and a 27 week premature delivery, but the most striking thing was the major differences between NZ and Vanuatu. An antenatal clinic was available, but the majority of pregnancies attended the clinic once at most. No ultrasounds facilities and many mothers choosing to birth at home with the assistance of village midwives meant that the hospital delivery suite only saw cases from Luganville or those in trouble. Due to the lack of antenatal care many mothers did not have accurate dates, their malaria, hepatitis or status of other conditions could not be assumed, and the lie of the baby had to be quickly assessed as they often presented in the late stages of labour. Deliveries happened in a birthing suite with just the midwives in attendance (no family members allowed) and the next delivering women a privacy curtain away. There was no gas for pain relief during labour, I saw no epidurals or pethidine and lignocaine was in short supply. I saw cases where women with low grade tears were sutured without any local anaesthetic at all. Post delivery pain relief consisted of paracetamol only.

A midwifery student measures a newborn

One morning we had three women in labour all arrive one after the one, the first was one of the cleft palate babies. Parents and staff all looked worried as these babies tend not to thrive due to the difficulty feeding. Surgeons from New Zealand and Australia come to Vanuatu approximately once a year and donate their time to repair the cleft palates. However some of the babies struggle to survive to this date as without special bottles they need to be spoon feed hand expressed breast milk.
The second was a young 17-year-old primigravid who had no confirmation of dates but believed she was around 36 weeks. She was given numerous doses of tocolytics but the baby was determined and the labour progressed. Once delivery was underway the obstetrician was called but not available (this doctor was also the paediatrician). Luckily for us students and the nervous looking registrar the dates were wrong and a full-term baby was delivered!

The third lady spoke little English but having delivered her last two babies in the same hospital she knew the drill and walked herself into the delivery suite and onto the table. Just as quickly the midwifery students discovered she was fully dilated and not long after neonate had arrived. This was an unusual morning in a hospital that averages one delivery a day and we were happy that no more arrived in the afternoon!

All the babies I saw were breast fed and in cloth nappies. One tradition was for the family to buy clothing and blankets in colours representing the gender of the baby they wanted. It was therefore not usually to see boys in pink and girls in blue. Unfortunately, there was also widespread use of fleece blankets, nearly every single baby was wrapped in fleece which I’m sure would not go uncommented on in New Zealand.

We wanted to do something to help the hardworking staff and easy things for the patients so have set up a give a little page to raise funds for medical equipment that the staff have said would help greatly. We are also encouraging other elective students to go to NDH and take what they can (please get in touch if you are heading there soon and would like the list of equipment requested).

There were many exciting times on the island too! When the sun is shining in Santo there is much to see and explore. I was lucky to see several places in the weekends and evenings and contribute a few dollars back to the local economy. When it rains though it rains hard. During my stay Cyclone Hola hit Vanuatu and although we were reasonability unscathed in Luganville there were reports of roofs off buildings and schools in the outer villages. For those visiting the island I would highly recommend Champagne beach and Port Orly in the North of the island, you won’t be disappointed!