“When you don’t have what you’d like, you have to like what you have” Akuma states matter-of-factly as his experienced hands lift out a baby during another emergency Cesaerian section. It is the middle of the night, and the only light source is the small flashlight that one of the nurses is shining into the open abdomen of the young woman. A small generator is rumbling outside the operating room but after a few flickers the lights inside refuse to go on."…their joy at the birth of the healthy baby girl is obvious as they speak to me in excited voices even though I don’t understand their language." Thankfully the team is used to the poor power supply and flashlights and kerosene lamps are on hand. I breathe a sigh of relief as I receive the crying baby into my hands. Many newborns require intensive resuscitation if the mother has been transferred for a Cesaerian section, but this baby is off to a good start. After she is dried and wrapped in colourful African cloth I carry her to the “Maternite” on the other side of the hospital, using my flashlight to find my way across the pitch dark compound. Several female relatives of the young woman are waiting there; their joy at the birth of the healthy baby girl is obvious as they speak to me in excited voices even though I don’t understand their language. These ladies will look after the baby as her mother spends the first day or two recovering in Intensive Care.

The ‘Hopital General de Reference Adi’ has approx 55 professionally trained nurses and midwives all of which are Congolese. Many of the staff live in a camp opposite the hospital, which is very convenient especially when more hands are needed in an emergency situation.

Childbirth remains a dangerous event for many women in Central Africa.  When I spend 2 months working with the midwives in Adi, in N/W Democratic Republic of Congo I discovered that, thankfully, for some women good maternity care is available and the risks are reducing. I was very happy to find a well structured hospital with caring, professionally trained nurses and midwives. The ‘Hopital General de Reference Adi’ has approx 55 staff members all of which are Congolese. Many of the staff live in a camp opposite the hospital, which is very convenient especially when more hands are needed in an emergency situation. Besides a very busy maternity department it also offers general consultation, surgical, medical, paediatric and intensive care services. It has two pharmacies for in and outpatients. There is one fully trained medical doctor who spends 2-3 days per week at the hospital. The majority of operations are performed by two surgical trained nurses who in turn are training other nurses to perform basic procedures and common emergency operation such as Cesaerian sections. Some of the nurses are involved in community programs including immunizing, general health promotion, and education about natural medicines found in local plants. The hospital is expecting a medical missionary from Holland who will dedicate her time to training the nurses in counseling and advising people living with HIV/AIDS.

Every day starts at 7:30am with staff devotions led by the hospital chaplain. It is a wonderful experience to pray together for the needs of the patients, the staff, and the hospital in general. Many people suffer from poverty, and they live their lives in complete dependence on God’s provision for all their needs. Prayer is an important aspect of care throughout the hospital. "It is a wonderful experience to pray together for the needs of the patients, the staff, and the hospital in general." The operating room staff pray with nearly all the patients before they commence the operation. The chaplain has a special open air service with all the expecting mothers who are waiting at the hospital, and the midwives pray with them again before they go home after their babies are born. Many patients travel long distances from Sudan and Uganda for treatment at Adi hospital because of the good holistic care it provides.

Pregnant women who live far away or who have no transportation other than their own two feet come to wait out the last month or so of their pregnancy at the hospital. This eliminates the problem of having to travel while they are in labour, and has the added bonuses of being an opportunity to rest from the responsibilities at home, and enjoy a time of socialising with each other and with the midwives. The government is now encouraging all women to give birth at official health centres in order to reduce the high number of labour related complications. The women are well aware that childbirth can be complicated; many of them have suffered their own tragedies.

God has graciously provided the hospital with most of the funds needed to construct a new building which will have separate areas for postnatal and antenatal women, an antenatal clinic, and delivery rooms.

The result of women choosing for better care has had a huge impact on the maternity unit in Adi. The current facility is now far too small to cope with the increasing need for beds. God has graciously provided the hospital with most of the funds needed to construct a new building which will have separate areas for postnatal and antenatal women, an antenatal clinic, and delivery rooms. The new building hopefully will have the hospital’s first ultrasound scanner if the technicians to install the machine and train the staff can be found. To date, the lack of scanning facilities means a high number of undiagnosed breech presentations and surprise twin deliveries. It is also very difficult to confirm if a baby has died in utero with out a scanner, which means that some women have to carry on with their pregnancy for weeks not knowing for certain whether their baby is still alive.

Mother and Child in the maternity unit at "Hopital General de Reference Adi"

Adapting to a completely different culture and working with such limited resources was a challenging but incredibly interesting experience for me. I soon learned that simpler methods also work. What could be perceived as sub-standard care during labour actually resulted in a very high normal birth rate with very few newborn complications. Much of what I saw would be considered out-dated practice in the Western world, but it seems to work in this place that is so far behind most of the rest of the world. What I found most difficult was the lack of neonatal care. Proper neonatal resuscitation equipment was non existent, and most of the sick and premature babies soon died. There were no incubators, but even if there had been the lack of constant electrical power meant that they can not be used.

My fondest memories include the staff prayer and praise meetings, having fun with the midwives and the women, and delivering beautiful black babies. Some of the other things I enjoyed were the friendliness of the locals, the relaxed pace of life and eating fresh mangoes. Besides challenges at work, other things I struggled with were the language barrier, and the swarms of insects that came into the house in the evenings.