Friday, September 12, 2014

The real Heroes

My time at Jahun has come to an end. It has been an exhausting challenge made somewhat more challenging by the loss of some of the vision of my right eye and with it, binocular vision up close. I cant read with my right eye any more and I had to make a couple of extra grabs at sutures in surgery on occasion. The side effects of the high does steroids were unexpected and weird as well – my balance was disrupted and I felt a kind of dizziness all the time, and my hands developed a tremor. Now I have finished the steroids these side effects are disappearing. I took them in the hope they would help my eye to make at least some sort of recovery but that hasn’t happened.

But it was the work that was the big challenge.  We would almost always express amazement if on the round of patients in the morning we came across a woman who was in labour with nothing at all wrong with her. More usually our patients were complicated, and often the complications were multiple, so for example a woman with twins might also have a history of previous stillbirths, or anaemia, or malaria, or very high blood pressure – or even all of those things together.  I have never seen so much severe anaemia, I have never seen so many people needing blood, I have never seen so many cases of internal bleeding causing fetal death ( abruptions with IUFD , plus or minus DIC) I have never seen teenage women in heart failure or with pulmonary oedema, cerebral malaria, tetanus ...  What is remarkable is that all these very sick women were managed without ANY of the technology and back-up available in the west, things such as laboratory and radiology services, and the advice of other medical specialties such as  cardiology, or  infectious disease specialists, or microbiology.  All these women were managed with just a haemoglobin check and clinical judgments alone. And while almost all of them survived, tragically there were ten maternal deaths in August , and seven occurred in the 18 days that I was working there.  There had been ten in July as well. Most of these women were under 20, and most were of women who were close to death by the time they arrived at the hospital. They could probably all have been saved by earlier arrival at hospital, or better still by proper antenatal care. The maternal mortality rate in Jahun is therefore somewhere around 1200 per 100,000 women – its 8  in Australia. In Ethiopia around 600.  

The babies also suffered – I saw countless stillborn babies – the rate in recent months has been around 15% -  and  many babies that were born alive but would soon die.  “Fetal distress” is a  common indication for doing a caesarean delivery in the west – but here it was always a difficult dilemma – even a healthy baby had a high chance of dying as an infant, and a sick one even more – but if the baby was born by caesarean it would leave the mother with a complication that would affect and amplify her risks in every subsequent pregnancy and could ultimately result in her own death.

The real heroes out here are my colleagues the Nigerian trained doctors who have chosen to come and work here long term, in a town that has power  poles and power lines but no electricity,  shops that have almost nothing worth buying and very little variety when it comes to food, no out of hours entertainment of any kind whatsoever,  an environment that is hot and humid at best and baking dry in the mid 40’s in the hot season, nothing to offer except the experience of working with an International Aid Organisation, and the unique clinical material that floods into the hospital every day.
Amodu, the team leader, an amazing guy
Drs Ebam, Kedala and Abdul
Jimho and son

They work till after 6pm every day and rotate through night shifts, they are the backbone of the service, and are very good at what they do. I am not sure they will have learned anything useful from me – but I certainly learned much from them, albeit about obstetric catastrophes and complications that I may never see at home, but among other things I should be able to tell when the fits someone is having are due to tetanus and not eclampsia.  These guys, with their midwives and a small range of powerful modern drugs, and a blood bank and an operating theatre really do save countless lives every week. 

To those Doctors, I say Thank You for your dedication and all your excellent work, and for welcoming me and making me part of your team for  short while. You are doing great work for the poor women of your nation.

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