So it's wednesday 14th january and today is the day..... I start work in the Royal Victoria Hospital in the city! The last few days have been a nightmare as I spent the entire time trying to get my official documents stating my Gambian midwifery registration. I was sent here, then there, then to that person, then to next person who finally told me the person I needed was over there. When I got there I was told very casually , 'oh yes well he is out of town until next month, you should come back then'. As you can imagine, I was pretty pissed off!!! So with a deep breath, some patience, a lot of determination and a handful of money I finally got my certificate and was legally registered as a Gambian midwife!

So my day starts... a bit s***ly to be honest as I woke up looking like I had been in the ring with Mike Tyson over night, a damn mosquito bit me on the eye lid and my whole left eye had swollen up..... yes it was pretty attractive!!! One good thing which came out of it was that I didn't get hassled once on my way to work, pretty surprising I thought!!! Okay so I get myself to work, which was an experience in itself, crammed on the bush taxi with half of West Africa and their animals! Eventually I got to the hospital and find the matron who took me to the labour ward and introduced me to all the staff.

The unit was a real eye opener, iron beds with hard mattresses and no sheets, blood down the walls and all over the floor and lights flickering on and off. It really was something prehaps only a dark imagination could visualise, but no this was real so I took a deep breath and walked right in.

I join the ward round with the consultant, there is a lady in labour, 'mymuna (my gambian name which was given to me as a sign of respect) here let us see you deliver your first African baby in Africa, we will watch and learn from you..........'

So in my naivety I was pretty excited, my first African baby.... I had a pretty big audience of medics and midwives so I was obviously keen to impress. I went to assess her and tried desperately to find the foetal heart using a pinard, a practice I'm not used to, so was unsure if I could hear anything, the midwife took away my pinard and told me not to worry, this unsettled me but I was quickly distracted as the vertex was visible and advancing...... so i deliver this beautiful baby.... only it's unresponsive. I desperately attempt to find a heart beat when I'm firmly told that the baby is dead and to put it on the side. With delivery of the placenta I can see that the women had had a placenta abruption. The staff had known this baby was dead... I was beside myself with every emotion I ever knew existed, as I picked up the limp body I fought back the tears, I wanted to cry so much and I have never had to use as much strength as I did right then, I could see that it would be completely inappropriate for me to cry as this was quite obviously a way of life here and life was not perhaps valued in the same way as we would in the western world. As I fought back the tears I could feel my heart bleeding, and tears running down the backs of my eyes, I felt sick. The body was left on the side in view of its mother and all the other patients having babies in the same room, and remained there all day. I asked for somthing to cover the baby with and was told there was nothing, the mother hadn't got any cloth so the baby would remain naked. I desperately searched around for anything, but found nothing, then remembering I had a T-shirt on my bag I grabbed it and wrapped the body inside. My eyes were burning and I felt completely helpless. Just when I thought it couldnt get much worse a young 16 year old girl was carried though on a stretcher, she was fitting and looked in a terrible state. There was no sense of emergency, the doctor looked at me and asked what I thought was wrong and what we should do, I said I thought it was eclampsia and she should be given magnesium sulphate, very good he said, the nurse went to the drug cupboard, she said that they were out of this drug and she would have to go to the pharmacy to find something. We tried to stablise this woman, I could see her neck swelling and her condition deteriorating, they had no resources and I watched as this girl died in my arms, baby inside, nothing I could do.

What am I doing here, what is the meaning of life, how can it be so different, can I do this??? The answer I dont know.....

I left the unit and searched for a quiet place and sobbed, I tried to answer all these questions, but it only left me feeling more confused, I hoped that this was just an evil side effect of the larium I am taking and will wake up from this disturbing nightmare.

I didn't wake up.... this is real.... this is Africa......