The training session at Tamesna is completed and we are saying goodbye to the “matrones”

Linda Lamb gives Mariam a hug and thanks her for her hard work.

The crew poses for a final photo–proud of our hard work and the success of the program.

One of our most valuable assets at the clinic is Achicha, who also acts as our office manager in Agadez.  She is a trained nurse and speaks all the local languages.  She has worked with Dr. Skankey on every mission and we sent her to a short English course to help her communicate directly with him.  This trip I was almost never needed as an interpreter as her English has so improved.  She is very competent and after Bob tested her skills, she even ran the clinic by herself while Ali was on vacation.  Best of all she is always smiling. 

Achicha explaining medicine

Testing some pretty cool sunglasses

Congratulating the matrones she worked so hard to help train, upon the completion of their second training session.

The next problem is the most complicated to teach.  It is important to understand if high blood pressure is present in a patient it indicates pre-eclampsia.  This can lead to eclampsia which means seizures and possible  death.  But how does a woman who cannot read numbers learn to take blood pressure?  When Dr. Skankey met with Dr. Zeidou of HDI,  in the south who runs this kind of training program in 500 southern communities he was very skeptical about the ability of the women to understand and use this important tool.  Dr. Bob decided to try anyway.  They have shown how smart they are already and how well they retain information.  There is nothing to lose by trying.  So we marked the dials with red nail polish to show high or low levels.  By listening to when the pulsing starts and ends and noting the red lines, even without reading the numbers they could at least tell if there was any danger from a reading above the red line at 140 on the high side and below the red line at 90 on the low.  They were issued their own blood pressure cuffs and practiced for two days, taking everybody’s blood pressure many times.  They seem to understand it.  They know that if the patients levels are above the red line to contact Ali as a dangerous condition could exist.  We will see if this tool will be able to save some more lives.

We decided it was important for the women to keep records of the pregnancies, births and problems in their communities.  Without statistical evidence it is impossible to know what the most prevalent problems are and to know if our solutions are having any success.  So we borrowed from the program of HDI (Health and Development International) in Niamey after a very fruitful meeting between Dr. Zeidou and Dr. Skankey.  (Thank you for all your good advice Dr. Zeidou).   We created a report form with drawings which the women can fill out by making a mark.  I gave each of them a copy and Ali, our nurse, when he makes his monthly rounds will collect them and replace with new ones.
The categories drawn are: New pregnancies, Women who visit a clinic, Women who give birth at home, Evacuations to a hospital, Post-partem hemorrhage, Infection, Maternal death, Infant death.

When I left them alone they practiced until they got it right.

Bob brought a really great gadget which measures temperature by holding it on your forehead.  If there is a fever a red line lights up next to the reading , if it is normal it lights green and if it is below normal a blue line.  Fevers can certainly be dangerous for pregnant women and now the women can determine easily the danger range. ,

After being reassured that they retained the initial training for a normal birth and the use of medicine for post-partem hemorrhage, Dr. Skankey decided to tackle other problems that could arise from different positions of the baby.  Breech birth was the first.  Two of the women had experienced this and so Bob had them go through the process with the pelvic mannequin.  Then he addressed Face up birth and feet first–the last being virtually impossible for them to deal with.  They each demonstrated dealing with the different problems to Dr. Bob’s satisfaction.  He is demanding and exacting and they are very smart, hardworking and willing–a good combination.

Since the Tuareg and Wodaabe deliver in different positions we used the appropriate position to demonstrate.  Here, Fatima, a Tuareg, uses their on the side style, while below Azarra uses the kneeling position favored by the Wodaabe.

Dr. Skankey instructing Aicha

I have been involved with the responsibility for the health and well being of thousands in different parts of the world, have done complex surgery that has relieved suffering and saved lives, but I think that what we did this trip to train midwives who will themselves then save many mothers and babies lives for years to come giving supportive care in humble Tuareg tents or out in the open in the middle of the Sahara desert far out shines anything I have been involved with before. The word is sustainability.