Birthing Babies in Cameroon

I have been spending some of my time in the Neonatal Intensive Care Unit (NICU) at the Maria Rosa Nsisim Hospital in Cameroon. During the past week, we have had three sets of twins born, ranging from 31 to 35 weeks. The smallest baby weighed in at 2.86 pounds. The nurses here are doing a great job taking care of the NICU babies, but they also have very limited resources.

While the unit has four incubators and two open beds that are fairly up-to-date, resources for caring for the premature babies on a long-term basis is not an option.

Today a 17-year-old girl, who gave birth to premature twins several days ago, left the hospital for home. The twins have been out of the NICU for four days, but they were still receiving tube feedings every two hours. Each still weighed less than four pounds. The mother plans to pump her breasts and plans to feed the babies with a teaspoon. The mom felt okay about the situation and she went home happy. I will worry about those babies until we see them next week.

I also helped with a delivery yesterday — a total natural birth with the mother standing during most of her labor. There was no monitoring for heart tones and no one was really comforting the mother throughout the labor, so I attempted to teach her how to breathe and rubbed her back for her.  The obstetrics nurse did the delivery and helped the mother through the pushing part of labor, and much quicker than I thought, the baby was born.

As soon as the baby was born, they suctioned it with a bulb syringe, and stimulated it by rubbing it and   holding the baby upside down. When they were satisfied that the baby was okay, they immediately bathed it in rain water, and hurriedly dried it off.  A lady, who is also a housekeeper, was the assistant for the baby and she was the one who took the baby after the nurse had bathed it and given it Vitamin K.  I did not see them put anything in the baby’s eyes, although they told me they do that.  Currently, the nurses do not give the baby any type of assessment, but I gave it Apgars of 8 and 9.

The mother had a few complications, but when it was all over, I put the baby to the mother’s breast. The nurses were a little taken aback. I spoke with them about the importance of skin to skin contact and how having the mom breastfeed quickly after birth helps the uterus contract.

The staff did a great job with so little to work with, and mom and baby are doing well. Today, I took pictures of mom, baby and dad, just before they went home.

This morning we had a C-section (planned for mal-presentation).  A GYN doctor from town came to do the surgery. The nurses did a great job with getting the room sterilized and setting up all the equipment.  The room was actually air-conditioned and so it was tolerable to be there in surgical gowns. I missed seeing the anesthesiologist do the spinal, but that was what was used along with some gas for the anesthesia.  There was no major monitoring, except for an occasional blood pressure.  All the equipment in the operating room was fairly good, but they didn’t use any cautery and the physician just used a sterile cheese cloth rag to hold pressure on bleeders.  They did have suction and the mother had two IVs. The surgeon was skilled and knew what he was doing.  The baby was delivered (without the help of a surgeon’s assistant – just a scrub nurse).  There was no documentation and no sponge, needle, or instrument counts. It took a little over one hour from incision to completion of everything.  I checked on the mother later and she did well.

So, as you can see, I am keeping busy and hopefully helping provide a higher level of care.  While some of the procedures are challenging to witness, I love the nurses and we have bonded quite well.  Life is difficult at best in Cameroon, and living without the things we take for granted is a challenge. But the people I have met here are happy people and love their children. Most of the women have 5-7 children.

As my time in Cameroon comes to end, I am confident my replacement, Wendy McQueen, a Certified Nurse Midwife from Miami, will have a lot to offer the dedicated NICU staff.