A Gynae In Samburu

 



photo Courtesy

She passed away 7 days after giving birth, she got an infection on her CS wound that spread so fast by the time she went back to the hospital it was too late. I get a chill after hearing those words because exactly 7 days after giving birth, I had an infection on the wound but thankfully it had not spread at all, dear God, that could have been me. That is the statement that made me know that Anne* is a Doctor and so is her friend, Betty* because they went into detail about what happens at the hospital when a mother comes in for delivery. When a maternal death happens, there is a lot of investigation because a mother is a healthy person and a healthy person just doesn’t die. The first rule in the labour ward is; THE MOTHER SHOULD NOT DIE.

Anne works at a hospital in Samburu, when she mentioned that, I adjusted myself on the couch because I knew it was going to be a bumpy ride, I have always wondered about mothers in ‘those’ places, Samburu, Lodwar, Pokot, Marsabit, Rendile you get the picture. Working in Samburu, you know you are working on a wing and a prayer, during our training in a hospital around Nairobi, when I had a patient who needed blood; we would have at least 2-3 paints available immediately.  In Samburu,  we are not always assured of blood due to supply issues from the national blood unit.

My daily prayers as I wake up to go to work is always, please don’t let me lose a patient today and for the time, I have been in Samburu I haven’t.

Me: Tell me a happy ending experience

Anne: They are many

Me: Your favourite

Well, it’s not my favourite but it brings both culture and modern medicine together. One day I got to the hospital and I was informed of a patient who had poor progress in labour . The mother and baby were fine, the baby’s heartbeat was strong and stable but she was just not dilating, she had been in labour for hours with poor progress.

Since the mother and baby were stable, she decided to monitor them herself for a while just so that she could know for sure there was not progress at all, after one hour, she examined the mother and still poor progress. Since she was above 18 and of sound mind, she explained to her and her mother, who was present the situation and the ‘patient’ consented to go in for a CS, she however, requested for her husband to be informed that she would have to go in for a CS. The doctor’s primary care is to her patient and the baby, so she explains to the husband over the phone that the wife will need a CS , after about 10 minutes of a back and forth, he requested that Anne waits for someone to come to the hospital as he was not close by. She says if the person comes before the procedure starts I will explain but my actions will not be dependent on this.  A short while later in walks a young boy, the husband’s brother to give a go ahead for the procedure.

‘While it didn’t affect my care for the patient I was more pissed at the fact that he sent a young man to come and ‘authorise’ a whole procedure.’ Culture in Samburu is crazy, that a woman even your mother has less of a say even to maternal matters. Had the woman been in critical condition though, we would not have waited; that there is where we have to draw the line, because the mother is our first priority, before anything else. The same family called a prominent person in administration thinking it would sway my decision luckily he was respectful and allowed me to do my work as a physician. I said “Mheshimiwa, I understand the family’s concern, please let them know I am doing my job to make sure that both mother and child are safe; it’s my duty as a doctor. Both the mother and baby had a good outcome.

Do you ever go for counseling? How do you debrief? Decompress?

There is so much happening my debrief is sitting down with fellow doctors, we talk for 30 minutes about our day at work and it ends there because we can talk till the cock crows and we will never be done. A few minutes are enough, as a doctor, you have to have a doctor friend because they know.

Betty is at Thika and you would think she has better days than her friend in Samburu but no. The strike, we just want a better system that works for our patients, period. I remember once I had a CS mother whom I had informed the people who deal with blood (she used their title, for the life of me I can’t remember) and by the time I was to start the surgery they still did not have blood. I had to call an assistant to come hold onto the mom as I rushed to make sure that they gave me blood, I found the lady and she reluctantly tells me, my shift is over! “Your shift is over I am calling for blood working on my second surgery since my shift was up and you cannot match the goddamn blood.”

I have had patients who come when they are crowning, they have never gone for any antenatal clinic and this is not their first baby. I can say a majority of the complications we have had is because the mother just never came for clinic, no ultrasound and some are caring twins, so you have no idea what to expect when they walk in.

Anne

I could talk until tomorrow morning, you are never prepared as a doctor to deal with culture. I had patients who would be dilated 10 cms, it’s time to push but she just won’t why? Because she is very angry at her husband who insisted she should give birth at the hospital, it’s a sign of weakness, strong women give birth at home by themselves.

Others walk in and they say they stopped feeling the baby kick about 1 month ago! This means they have been walking around with a dead baby for 1 month.

Apart from resources working in Samburu, what is your greatest challenge?

Time, we have to make critical decisions factoring time, this mother probably travelled 5 hours to get to the hospital, since I do not always have adequate resources in Samburu I have to factor in the time it will take for an ambulance to get to me and transfer this mother to the nearest major hospital which is another 5 hours away. What I lack in the hospital, is it so critical that the operation cannot go on without it or we can replace it with a prayer? Most of the girls who come to the hospital are young, 13 years was the youngest I have had delivered in our unit, but most of them were between 15 and 19, that is the average age, so they are high risk already just by matter of age.

Being in Nairobi with access to private doctors gives you the illusion that Medicare in Kenya is working, but Thika, which is 30 minutes from Nairobi, is nothing to compare to Nairobi. A lot of education needs to be done for mothers outside of Nairobi. The Traditional Birth Assistants (TBAs) need to be equipped on how to care for mothers, we have had cases where a 70-year-old TBA comes complaining and we do a blood test and she has HIV, she was infected as she helped a mother deliver and she had no idea. Imagine how many more mothers are at risk of infection just from her.

Like my new doctor friends, I could go on and on about the stories they shared, but I hope I visit Samburu soon and get those stories myself. Thank God every day when you get to easily walk into a medical center and get specialised care.

*I gave the doctors new names

Happy Parenting

  • samoina wangui

    This is such a sobering read.





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