Monday, December 24, 2012

Communication Breakdown

Heading Home after the Market

I asked for it didn’t I ? – mentioning the “Q” word I mean. Shortly after that post was written I was reading my Kindle having a cup of tea sitting on my plastic chair in the sun at the back door when Zebiba appeared, somewhat breathlessly, saying they needed me in the Hopsital “Fastly come” she said. “Strange” I thought, “no one phoned me” and checking the phone I could see it was “On” and the signal was strong..
In the Hospital, a woman had arrived after a very long labour at home with her sixth baby, but it was still not born. These are the women who often die at home with a ruptured uterus, or arrive here barely alive with a ruptured uterus and dead baby, but this woman had neither – the baby was alive, and it didn’t appear her uterus was ruptured. However she was so dehydrated there was no urine in her bladder and because she had been in labour for such a long time she had developed an infection in the water around the unborn baby and was discharging the most foul smelling brew of pus, meconium and fluid I have ever encountered. As usual, being so very poor she was dressed in the filthy one piece dress, no underwear, and filthy from head to toe. She was very sick indeed.
Her baby was coming head first but facing the wrong way, and this was why it was stuck, and not deep in the pelvis either. I applied forceps – the baby needed to be delivered as soon as possible as rupture of the uterus could happen even now and seriously complicate matters for the mother. I pulled hard and nothing shifted. I puIlled even harder, then as hard as I possibly could – I knew I might fracture the babies skull but reasoned to myself that the baby was so sick it had little chance of survival anyway – and twice before when I have pulled as hard as I could and fractured the babys skull it came out and survived, apparently none the worse for wear, to my complete amazement. So I pulled again and found myself wishing the skull would fracture so I could get it out – but it didn’t, and I couldn’t. She would need a caesarean.
And then I found out why Zebiba had come to get me – the Mobile Phone network was “Non Functional”. Fortunately our anaesthetist lives in the Hospital Compound like I do and someone was sent to fetch him and the other two people we needed, while we rapidly prepared Zewedie for theatre. After an interminable 15 minutes waiting for the anaesthetist, word was received that he wasn’t at home and no-body knew where he was! Various people arrived and everyone was frantically checking their mobiles to see if the network was back on, but no. People started shouting and arguing about what to do, the hospital manager himself appeared, I noticed a hospital car and asked the manager if someone could drive to town and find  the anaesthetist – but the car was Non Functional also. Eventually one of the male midwives, Bawket, was sent off on a push bike and we stood around waiting while people carried on , gesticulating and shouting and walking back and forth in the walkway outside maternity. There was nothing to do but wait and I decided to just remain calm – we were doing all we could.
It got dark while all this was going on. And finally the anaesthetist arrived, and as I had made sure everything was ready, we started the Caesar not long after, perhaps an hour later than we would have if the phones had been working, a really long hour which I hoped would not result in things getting even worse that they really were. We had at least resuscitated the woman with fluids and started antibiotics.
The caesarean was straightforward, and we pulled out a very sick floppy, pale skinny baby that stank like you wouldn’t believe. Almost pure blood started to drain from Zewedies bladder indicating the severe trauma it had been receiving from that babys head sqashing up onto it for hours and hours. But – and I was going to write “remarkably” but I am slowly realising these amazingly tough woman are almost  indestructible – she and the baby appear to making a steady recovery, 48 hours later. The urine in the bag is yellow not blood stained, the baby has started sucking and feeding, there is no fever, so hopefully they will be going home in a few more days. To give the bladder a better chance of recovering completely from the trauma, I will leave the catheter where it is for a few more days yet – ordinarily it would be out by now.
So I wont mention the Q word again – on average about 20 babies are born every week – but there 7, including Zewdies that night, and a further 6 yesterday, so our little lull has ended with a strong gust.
And speaking of gusts, I have to thank my neice Tiffany – and probably rethink my attitude to social media and facebook – because she found the Vuda Point Facebook Page, asked someone on it about Sapphire and was told that the tarpaulin had been torn away as I expected but otherwise she appeared to be undamaged! How good is that! And my two emails have yet to receive a response –  email is just so last century!

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