Wednesday, January 18, 2012

Last Week in Motta

Feet and Sticks of People standing around wtching Myrte buy some eggs

I had hoped my last week in Motta would be quiet. I needed some time to get things properly organized for Zoe’s arrival and for our tour, for Dr Ruth who was coming to take over from me and fill in a small gap before the next long term volunteer arrived in five days, for all the farewlls and goodbyes, even to have some quiet moments for reflection, to enjoy that peaceful evening rural scene over the fence from the flat one more time – but it was not to be. There was a flood of births, so the place was busy, and then a woman requested a hysterectomy rather than a 3 month trial of medication which I also offered her and hoped she would take – so I had to do that on Tuesday morning – we had another woman collapse with an ectopic pregnancy, I did a really difficult forceps delivery and fractured the babies skull – I thought I must have killed it but the next day it was behaving perfectly normal and the asymmetry of its head had almost disappeared – and then a woman arrived with a dead baby and a ruptured uterus. This turned out to be the most difficult case I have ever managed, because the rupture occurred under the bladder and the babies head tore its way up through the bladder and out the top, creating such  a mess that when I first opened her abdomen, the local Doctor assisting me said it was the worst case he had ever seen,  she couldn’t possibly survive “she is terminal “ he said and he urged me to  just close her back up. “The main thing” he said “ is that she doesn’t die in theatre. You have done your best”  I seriously considered taking his advice because initially, looking into her pelvis and at the bleeding and at the damage I thought to myself “This is impossible for me, Ive got no idea even where to start”  but then again, she was a mother of six living children…..
This looks much less chaotic than it actually is
Eventually I realised both ureters – the tubes that connect the kidney on each side to the bladder – had been torn off the bladder and her only hope was for them to be found and reattached to the miserable remnant of her bladder that I  identified deep in the pelvis. I had seen pictures in text books of this sort of procedure but had never tried to do it before – indeed I had never even seen someone else do it – but I was her only hope. “What we need are ureteric  stents” I said aloud, knowing we didn’t have any in Motta – these are specially designed fine tubes that can be inserted into each ureter to support it once resewn into the bladder – I may as well have been asking for  moon dust. However Myrte, who loved to be involved in everything interesting going on, and had been watching all that was happening, offered to ring her Dutch Oand G colleague Dr Hans who was working In Bahr Dar to see what he could suggest..” If you have any infant feeding tubes you could try those ” he suggested – and yes we did have some and Myrte knew exactly where they were. We were so lucky she had decided to stay and watch. I found the ragged ends of the ureters, trimmed them up and inserted the infant feeding tubes, then refashioned a bladder out of what was left of it and reattached the ureters! All that remained was to complete a hysterectomy, but it had taken over three hours, and she had lost a lot of blood. On the plus side she was still alive and urine was appearing in her catheter bag, but no compatible donor could be found amongst her eight relatives and then to make matters even worse for her I was informed that the Pharmacy had run out of a vital antibiotic I wanted her to have. This kind of thing send me ballistic – its too ridiculous for words for a hospital pharmacy to run out of vital medications – they blamed the Supplier but later I learned that the Hospital in Bahar Dar had stacks of the stuff – it was sheer incompetence and is the sort of thing that infuriates me more than just about anything – the fact that some petty idle unaccountable office worker can lazily subvert all our desperate attempts to keep this poor woman alive.. She – her name was Tiru - would need to be unbelievably lucky to survive, but I knew I had done all I could, and was glad we hadn’t just given up on her.

So when I left Motta two days later I was almost overwhelmed with a sense of frustration and failure and disappointment, that right to the very end all my struggling and fighting and energy had been useless against the inertia of the bureaucracy and a system that seemed moribund, and utterly incapable of change. In the midst of all that Zoe arrived, looking wonderful, and Myrte left, but I was exhausted I had been so busy I couldn’t get to the Bank to pay for our holiday, when Dr Ruth and her husband arrived I hadn’t had a chance to properly clean out the flat for them, the ward was full of difficult patients, and the woman with the ruptured uterus was not expected to live. I was walking away from a mess.

We said our goodbyes and climbed aboard the minivan and without much fuss left for Bahar Dar. My head was still spinning, it seemed imposible it was all over but I was too tired to think about much more than a long hot shower - the first in 14 weeks - and a lovely deep sleep in the Ethio Star Hotel in Bahar Dar, $28 dollars a night for a twin room with free WiFi and Breakfast.

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