Our Final Clinic of 2019…

by Gaurav Sikka, Floating Doctors Lead Medical Provider

Floating Doctors’ final clinic of 2019 was a multi-day at Ensenada, a community on the shores of the eastern side of Bahia Azul. Access to healthcare for this population is particularly difficult because, although located on the mainland, it is only really accessible by boat and the closest hospitals are expensive trips for our patients.

The clinic was run over two days. Our crew saw patients well into the evening hours and by the time we had the clinic equipment packed on Wednesday night, ready to leave the next morning, everyone was exhausted but in good spirits.

This being the last day of the final clinic for the year, however, there was sure to be some deviation from the normal end-of-clinic experience. Thursday morning started with a sudden awakening for Angeli, our Executive Director. The woman who had been catering for us during our stay was alerting her to a new arrival at Ensenada.

With a look of excitement and anxiety, she explained to Angeli that her daughter was in labour.  Angeli came to wake up two Lead Medical Providers- Nisha and me, Gaurav- and Jess, a volunteer registered nurse. We all rushed to the scene and another volunteer, Joe, joined us a few moments later with the all-important emergency bag.

The walk to the new mother’s house was short but treacherous, stepping on half-floating logs and washed up debris from the sea, but we quickly made it up to the raised floor of the hand-constructed wooden house that stood on stilts.

There, in the corner of an empty room was an exhausted looking woman, with her legs open wide to accommodate her baby girl that she had just given birth to. Births are beautiful moments to witness, yet can occasionally be rather gruesome, even when there are no complications.

Upon entering the house we heard a loud, high-pitched, shrill cry. This was music to our ears- hearing the baby crying is the best indicator that it is breathing and expelling the fluid that fills their lungs while in utero. The baby’s colour was still blue initially, the umbilical cord was still attached, and the delivery of the placenta (also known as the third stage of labour) had not been completed yet either.

This moment in childbirth is critical and as we rummaged through the emergency bag to find the obstetrics kit I was reminded of how the simplest of pieces of equipment can prevent common medical complications. Two sterile cord clamps and a scalpel, for example, allowed us to safely cut the umbilical cord without introducing tetanus or other pathogens to the baby.

Then, with the placenta not yet fully delivered we encouraged the mother to breastfeed and offer skin-to-skin contact with the baby because this is known to speed the third stage up. We also coached the mother to push a final few times to complete the delivery.

The first priority after delivery of a newborn, even before attempting respiratory resuscitation if required, is to dry the baby with a towel and wrap it in another dry towel, then put a hat on its head. This is to avoid the inevitable increased rate of heat loss, even in the tropics, that a wet baby will experience due to an increased surface area to volume ratio.

Though certainly exhausted, with the labour over the mother seemed relieved and other than applying pressure for a short amount of time to restrict a small amount of bleeding we had little to do but offer moral support.

The surrounding female relatives rejoiced in the birth of a new member of their family and in the kitchen next door we could hear a chicken being slaughtered in preparation for the copious amounts of chicken soup the mother was to be served in the coming hours and days to help her recover after such a herculean effort.

Joe then kindly grabbed some more equipment for us from where we had been holding clinic- weighing scales, measuring tape etc. so that we could examine the newborn, just as we would in a high-resource setting. Thankfully, the baby girl was healthy and intact in every way; she even breastfed within moments of being born.

We, the Floating Doctors crew, felt privileged to have been at the birth of a healthy child in this community. We offered our assistance but thankfully not much intervention was required. In the process of the elder ladies in the family deciding a name for the new baby girl, Jessica was ruled out due to it being a common name there already, Nisha was considered but was just pipped to the post when one of the elder female family members found out Angeli’s name and decided it was the one that suited the newborn baby girl best.