The Little Things

This morning as I stepped out of the car on to the grounds of Bottom Hospital, a woman wearing a bright green chitingi and carrying a red plastic tub of water on her head, smiled and said, "Muli Bwanji, Joanna?" (How are you?). On Monday, my first day in the nursery, the nurse introduced me to the fifteen-or-so mothers in the nursery as they sat on the floor breastfeeding or expressing their milk into small plastic cups. The woman who greeted me remembered my name from that quick single introduction. Her greeting and beautiful white smile made my day.

The nursery at Bottom, like all the other wards is its own adventure. Only the sick babies stay here, the rest stay with their mothers and/or guardians and then are quickly discharged home. The nurse who works in the nursery is responsible for maybe 25 babies in the main room, another 5-10 in an isolation room, and then 5-10 in the kangaroo care room. [Mothers of very premature babies are taught to carry their babies skin to skin between their breasts until they gain significant weight. This process only begins in the hospital and should continue at home, babies are discharged as soon as they demonstrate a steady weight gain - many are discharged home weighing less than 2,000gms.]

The first task after the night nurse hands over the ward is "damp dusting," which involves wiping down all the babies' mattresses and then rewrapping each with a clean sheet. [I love that on my list of clinical experiences, which I will turn into the Nurses and Midwives Council at the end of orientation, the nurse actually wrote "damp dusting."] It's slightly tedious but in the process you also see and touch every baby, which is a good thing since vital signs are only taken once a shift. Today during damp dusting we found a little one under the heat lamp, lying with two others, who had probably died one or two hours before. I rewrapped him and the nurse showed me where to put him while we waited for the mother.

After damp dusting, the mothers come in carrying clean chitingis and plastic medicine cups to tend to their babies. The women fill the room, a few in chairs most on the floor. Many of the babies have problems nursing, so the mothers express their milk by hand into the plastic medicine cups and then slowly pour the milk into the little ones' mouths. It's a tender beautiful scene. Not all of the mothers come at once and of course there is always one or two who are left screaming while their friends feast. So today I picked up a sweet loud little girl not realizing at first that her mother was there breastfeeding her twin . . . These are the little moments that fill my heart - feeling the trust of the mother, watching me, smiling, as she breastfed one twin while the other fell asleep in my arms; then sitting on the floor with this mother, both of us laughing softly as we failed to wake the little beauty for the meal she wanted and needed so badly.

I wish I knew more about caring for sick and premature babies. Yana and Dzung, I wish you were next to me at these moments to give me a little guidance. The mothers and guardians do most of the work, I'm just there holding babies, making sure they're warm and dry, telling the nurse who did or didn't get a meal. Hopefully in time I'll learn more.