Working

Dirty work!

Ive had an horrendous couple of days at work, and there have been lots more power cuts than usual so there has been no water. Normally water is pumped three times a week to the hospital and then on those days Moges fills my buckets. But right now, at 3 am I think we’ve turned the corner and things are settling down again, nobody is in labour and its raining, so I am collecting rainwater coming off the roof. This is why I am writing instead of sleeping because I am waiting for the small bucket to fill so I can fill up the big ones which wont fit under the downpipe.

Ive just got back from helping deliver a stillborn baby from a woman I think  was probably diabetic. The baby died only yesterday, before labour had begun, and we discovered it when the mother came to tell us her baby had stopped moving.  I induced the labour with a misoprostol tablet which to make a safe dose I had to break into 4 pieces. The baby was born face first, which is a rarity, was very fat, and she weighed 4 kilograms, which is huge for this place, and makes me suspect diabetes. In Australia if we had diagnosed diabetes we would have induced labour 2 weeks early to avoid this very thing, but nobody routinely tests for it here.

Earlier tonight I did a caesarean for a healthy breech baby, and immediately before that did a caesarean and then a hysterectomy on a woman who arrived with the dead babys arm hanging out. The baby had been trying to come sideways, and getting it out was difficult, the result being tears in the uterus and lots of bleeding. This poor woman had now produced eight babies – 4  were stillborn, one born alive died a few months later , and she had three that were healthy! But this is not an unusual story.

And the third caesarean I have done in the last 24 hours was for another dead baby that I wanted to perform a destructive  vaginal delivery on but the head wouldn’t stay in the pelvis when I tried to puncture its skull, for reasons that became obvious when I opened up the woman abdomen – the uterus was torn open  - ruptured -and the baby was outside the uterus , lying free among the  bowels and a whole lot more blood. In her case the  best treatment was  to repair the  uterus but I did a sterilization procedure as well, something we had discussed with her before the operation.

In the last 24 hours we have also induced  labour – again, with a ¼ misoprostol tablet- and delivered a stillborn baby to a mother with eclampsia – she arrived 18 hours after her first convulsion . She hasn’t had any laboratory tests of any kind as she arrived too late on Friday for them to be done, and none are done on the weekend other than emergency blood crossmatching. However her urine looked like coca-cola, indicating dangerous destruction of red blood cells in her circulation, a worrying sign of complicated eclampsia, but tonight she is beginning to wake up, thankfully, and her urine is yellow again, a reassuring sign of improvement. We also have another woman with severe pre-eclampsia at 30 weeks of pregnancy. The treatment is blood pressure medication and delivery of the baby, which will not survive. Delaying delivery to give the baby a chance unfortunately is not an option as it risks the mothers health.

Oh yes, and at the beginning of Friday, before all this hit the fan, because it was quiet, I did a hysterectomy and pelvic floor repair on a women with a degree of prolapse we rarely see in the west but is common here, where – forgive me – the vagina is everted and hangs down  with the uterus behind it between her thighs! The procedure went very well and I was looking forward to a quiet weekend!

At one point today I hurried into the market to get some more bananas and tomatoes, and on the way passed the guys in the photos at last applying the mud/straw mix I had seen being prepared a month ago.