Team work and good communication are key to looking after women well and saving lives.

I arrived back in Brikama on 6th May to take over from Dr Johan Creemers as a senior doctor in the Major Health Centre training junior doctors and midwives in MCAI's Advanced Obstetrics & Neonatal Training Programme. Having worked in the unit last autumn, I took a break to go back to the UK and study for a Diploma in Reproductive Health in Developing Countries at the Liverpool School of Tropical Medicine. We looked at the public health challenges in Maternal and Childhealth and the best ways to improve services in units like Brikama, so I walked onto the tarmac with plenty of ideas and a certain amount of trepidation as to how things would be when I got back.

I have to say, over the past week, I have been pleasantly surprised. Here are some of many examples:

• The unit staff have been great and embraced most of the changes we put in place.

• The paperwork is used routinely

• There is a regular morning handover meeting

• The clinical guidelines are implemented pretty well.

All this sounds pretty dull but team work and good communication are key to looking after women well and saving lives.

On my first afternoon, our two trainees organised and ran a refresher session for the midwives on the best way to keep track of a woman's progress in labour using a partograph chart. Back in December, we had a kind donation of a large washing machine which is now in place and being used for all the hospital laundry, so no more hand washing soiled linen by the laundry staff. The renovation of the health centre has come on well and the grounds are transformed with concrete roads rather than dirt. There are still problems, resources are still pretty stretched and the renovation has stopped before reaching the maternity unit due to lack of funds. It is fairly disconcerting to see daylight through the ward roof a month before the rainy season begins.

Having said that, there are plans in place to for either a definitive or temporary repair. The staff continue to work hard in difficult circumstances with a great sense of humour and mutual support. One of the best pieces of news was that the reputation of the unit in The Gambia is starting to turn around and student nurses are now very keen to have placements with us. Apparently they learn a lot - though they have to work harder than in other units.

So what of the future? Well, I'll be joined by my colleague and project lead, Alice Clack and then we will have a couple of months finishing the advanced obstetric and neonatal training programme with our two trainees. The Ministry of Health has agreed that they can stay on with us after their training is completed which will be great for us and for them as they consolidate their skills.

We're looking forward to a challenging and rewarding summer.

Pictured here are Abdulhamid and Arfan, both trainees at Brikama.