Port Vila Central Hospital

I have put off this post because I haven’t known where to begin…

There is only one shared labor room with 4 beds. Women labor either on the beds or roaming the hall. Most women are very quiet. If all of those beds are full then the laboring women and their families roam the main hall. Most women come in with several female members of their families and occasionally their partners. This means that on a busy shift the halls are lined with adults and sometimes children and lots of bags. The laboring mommas walk up and down the halls until the urge to push is overwhelming and then we bring them into one of two delivery rooms for the birth of their baby. Some women will have one female relative join them for the birth but many chose to be alone. There are different customs from every island. On some islands the mother of the laboring mother is allowed to labor with her daughter but when the laboring momma is ready to push only the mother in law may join her. On some islands men can be with laboring women and on others they cannot.

Each delivery room has two beds/tables and one warmer. The delivery rooms actually have AC unlike the rest of the maternity ward. This is a strange decision since it means that newborns are born in the only air conditioned room in the hospital but it feels really nice to us midwives when we are running around like crazy.

Most women from Efate birth at VCH. I had thought that the 15 births I attended in the last 5 weeks prior to departing for Vanuatu might help prepare me for the hospital volume – so naïve. The Vila hospital handles about 200-250 births per month or 6-8 babies a day on average. Some come to the hospital in early labor and others when they are pushing. Some give birth at home or “in the bush” and just bring their baby in after the birth. If a baby is BBA (born before arrival) they are given a five day course of IM antibiotics in case they got an infection. We are just surprised that there is such a low rate of infection in the hospital.

It costs 675v (about $7) per day of postpartum recovery to give birth at the hospital. Labor does not count and the amount of care you receive does not change the fee. Whether you walk in and push your baby out in 10 minutes or have a “cesar” (as cesarean sections are called) after 3 days of labor the cost is the same. I am told that minimum wage is about $20 per month so this is no small fee for most folks. At our hotel the staff makes about $2 per hour so it is obvious that tourism provides good jobs but knowing what the staff earns makes us feel bad about ordering a sparkling water that costs more than they make in one hour. Also, of course the hotels all charge western prices for everything to the tourists and none of the hotels are owned by locals. All that tax free income goes back to Australia or other foreign countries – very little stays in Vanuatu.

Because there is no charge for laboring at the hospital many women come in as soon as their water breaks or at the first contractions. The vast majority of women spend one night in the hospital after their baby is born and are discharged. So it is typical that we catch a baby in the night and they are sent home at 10 am the following morning. I feel like the moms and babies evaporate. I am so used to the luxury of continuity of care that it is hard to come to terms with the fact that a single interaction is all I get.

There are 24 beds in the big open postpartum area. Each woman has a twin sized bed (non electric – non adjustable) a bedside table/cabinet and a curtain they can pull closed for some privacy. There are a few chairs around but not enough for each bed. So women and their extended families lie and sit on woven mats on the floor. The babies appear to be as stoic as their mothers and it is rare to hear a crying baby. Each baby has a rolling bassinet similar to the ones in US hospitals but these come with mosquito nets.

There is one bathroom/shower to be shared by every laboring woman, postpartum woman and all of their extended families. There is also one private labor room with a private bathroom and a small refrigerator that costs about $145 US for a night. We have seen it used twice. Once by a teacher whose husband works in the hospital and once by the Prime Minister’s daughter. Special meals are provided for the private room, the other mamas are supplied with a small portion of white rice and some sort of vegetable meat stew for breakfast, lunch and dinner. Laboring women, however, rarely eat or even drink water. We have to encourage them to do so repeatedly.