May 12th

Today was spent in the clinic, discussing the forthcoming section, and what it involves. This is part of the help I can give whilst here, by doing risk assessments, pointing out the obvious (some might say) risks involved with doing operations under such conditions. The reason for this being, that people (even you) may take notice and offer help in certain areas, gradually improving each problem or risk.
The fact of the matter is, we have a woman who has had 2 previous sections in emergencies, one baby died. She has had 2 incisions one a classical (up/down), and a lower segment incision (more commonly used now in most countries such as the UK). She is only just 5ft and not previously being able to deliver before means she is unlikely to be able to this time. So putting it bluntly if she went into labour she would be highly likely to add to the maternal death rate here. Which I might add is the second highest in the world, although figures are not well collated and the estimates are probably much lower than the reality. At least with this section albeit not as safe as if she was to have the same operation in the UK, both her and her baby stand more chance of survival.
Each person is charged for their treatment but a fraction of the cost in any other health care establishment, prices are kept low, little or no profit is ever made. Meaning new equipment etc must be purchased by donations and fund raising events. Staff wages have been subsidised by Femi himself, on occasions when money is tight, he prides himself on paying them regularly, something many in these areas are not lucky enough to enjoy.
I managed to take advantage of Femi’s laptop and internet, to catch up on my blog and facebook. This in it’s self doesn’t sound much but with the fact that my hotel has not yet managed to get it’s internet provider sorted out, so I am unable to skype home as promised to my 7 year old Beth (Sorry). My diary as I write now has to be done on word and then in the excitement of getting on line, is transferred to my blog etc. When at last as today I get online, you have to contend with the slowness of speed everything takes several times longer then I am used to. This has proved to be a problem when trying to put on photos to share, you wait and wait and then it shuts off. Then you have to contend with the constant power cuts, just as you set up the power goes down, if your lucky enough to have battery back up, you may still be in darkness and struggle to see what your doing.
Another luxury that I have taken for granted until today is water. In my hotel room the bathroom is by no stretch of the imagination of high quality, missed matched tiles, water on the floor, 3 pin plug sockets above the bath, cracked sink etc etc. What I have got is water on tap, a shower and a flushing toilet. In the clinic as in many places and homes there is no running water, no flushable toilets, mains water is a luxury that Lagos appears not to have. At the clinic (which remember is Femi’s abode) water is drawn up from a neighbours well and carried in large containers, when needed it is scooped in bowls to either the toilet, or to wash etc, it is certainly not drinkable .Places like my hotel bore deep holes into the ground and pump water up, which is costly but the paying guest pays for that in there charges. Not something that can be added to the price of a consultation or procedure at the medical centre.

Today I also gave a demonstration on the use of a sonic aid, which there are 3 that were kindly donated by dopplerhire.co.uk. The new doctor that has been appointed this week had not even seen one before. The woman who is due for section tomorrow was used to show the Doctor, nurses and health care assistants/trainee nurses, how to use it and the woman heard her baby, which they usually are not able to, as pinnards (trumpet type instrument once commonly used by midwives before sonic aids) are routinely used here still.
Preparations were also made for tomorrow operation, surgical instruments laid out and listed. Again as with so much here, some were not up to the quality that Femi is used to, but he purchased what he could and what was available. A trough for sterilisation had also been purchased and every thing would be a sterile as possible. If anything breaks or is dropped there are no spares readily available. This is another reason why a planned section is safer than an emergency, as it would take far too long to sterilise and prepare.
The working day ended with the fun of trying to cross the road, to where my lift awaited me. Femi grabbed my hand, I’m not sure if it was as case of if we go we go together! Or he just didn’t trust my capability to run through a gap, with every man, car, bus or okarda (maniac bike taxis) for himself. Back to my hotel, netbook and dining alone, oh and the delicious box of ‘hotel chocolate’, kindly given to me by grateful parents back home and even more appreciated here in Nigeria!