Well, our baby is still alive and the mother is bonding with it as, happily are the staff a mixture both of pride, now the baby has survived five days and the labour ward being very quiet. On the down side I was called to a very septic and fitting baby and there has been difficulty getting the fits under control, but now on phenytoin and a change of antibiotics so we can only hope.
An interesting day with an early start as we went cross country to Aiya(?) hospital. Lovely drive in the early morning, with stunning views particularly when we cross the pass and look down on the mist in the valley. The rolling hills a patchwork of green with teff, grass and the local equivalent of oil seed rape. We also stopped and looked at the coffee seeds that are now beginning to grow. At least we have now seen and might be able to recognise a coffee bush. The road is completely red sand with no gravel as we discover when we come back after a rain shower as it rapidly becomes very slippery mud, though not noticeably reducing the speed of the drive, which becomes more white knuckle than usual.
The hospital itself is a German Evangelical Mission hospital which, according to the stone in the front was set up in 1928, and I wonder what happened in the war years, but today it is thriving, clean and clearly very competent. There is currently no obstetrician the resident Danish surgeon remarking sourly that he had been stolen by Gimbie Adventist hospital. This was followed by the comment that they needed an extra 10,000 Birr (£400 aprox) per month as a top up salary in order to attract some one. This it would seem is the cost of disloyalty, apart from the fact that its total isolation makes Gimbie look like the city of lights! That said however, the midwives we spoke to radiated both competence and confidence and as far as we could judge a real pride in their work. The labour ward made a real effort to give the patients some privacy and dignity, gowns were provided and they had both a CTG machine and a scanner together, wonder of wonders a working incubator attached to some oxygen, though currently without a resident. The midwives do ventouse deliveries and there is a metal cup, though I gather the suction is a little uncertain. Currently the surgeons, of which I believe there are two, carry out the operative deliveries and repaired the ruptured uteri, which appeared with depressing frequency in the labour ward book (aprox 2 per page of 12 entries) but I could find only two maternal deaths in 2010 which was encouraging. Never the less each uterine rupture represents a neglected labour (all you natural childbirth mothers - for that is what it is – please take note). Midwives do the retained placentae but the surgeons are required to do the EVACs etc. interestingly Eric, the Danish surgeon said that our local obstetrician’s dissertation which in reality is probably gathering red African dust somewhere, like most MSc dissertations I know, was comparing the mortality of uterine repair following rupture with hysterectomy. This might make an interesting paper me thinks.
The other very interesting thing we saw was the ‘waiting house’ a dormitory for pregnant women who came a 36 weeks and stayed there, cooking for themselves while waiting the onset of labour so they could go to the hospital for safe delivery. The absence of any known dates and the unreliability of dating scans, means that this is safer for the unborn child.
Interestingly, and ultimately rather sadly I noted that I was being followed by a young woman who asked if she could consult me about her infertility problems and a corridor consultation followed which was listen to rapturously by an increasingly growing crowd. Her problem became apparent fairly quickly-anovulation and I had noted in the local pharmacy that clomiphene was available. However at that point we got shouted at as this consultation would reduce the revenue of the hospital not withstanding that they do not have the appropriate expertise. We told her to wait at the car but she was spirited away-Kafka strikes again!
Their delivery rate is lower than that for Gimbie but both, in areas of enormous need seem to only attract a tiny proportion of the local population, whether because of cost (despite the Maternity Worldwide safe Birth fund) or because of transport difficulties and getting the mother to a safe place of birth seems to be the issue. As a medical student and a junior doctor I was taught that the pain of a rupturing uterus was one of the worse pains imaginable, so severe that even an epidural did not filter it out so God knows what these poor women went through. Thus it seems to me uterine rupture must be the sine qua none of the neglected labour, crying out for intervention and perhaps ones role is to make that intervention possible – how many I wonder never make it hospital at all and become the great unmeasured statistic?
We return to Gimbie to scenes of wailing some young man it seems chopped a tree down on himself, and has died of his injuries and I wonder as I pass this scene if death in childbirth of a woman would produce the same outpouring of grief.
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