Outcomes

Poor but Happy

Since returning from Ethiopia I have been quite surprised at how many people have told me they found what I wrote about Motta almost too confronting to read. I was told it sounded so awful nobody would want to volunteer to go there to help, it would be just too depressing and too sad. This impression is mostly a fault of my writing, though I don’t think I overstated what a grim place it can be for women in general and especially for women wanting to have a baby there. In fact those 14 weeks were the most extraordinary and unforgettable 14 weeks of my life in medicine, without doubt. It was hugely challenging, it was frustrating, it was exhausting and at times heartbreaking – everyone got that message! -  but I agree, I didn’t write as much as I could have about the  many wonderful moments of joy, of immense satisfaction, of the rewarding and warming interactions with exceptionally supportive and friendly Ethiopian doctors midwives ancilliary staff and patients and their families, or of the fascinating village life where tradition and the technology of every day existence is centuries old and happening right in front of you. Utterly unforgettable.  Nevertheless, as I wrote at the time  I left feeling quite despondent, as everything seemed to have gone wrong at the end, but since then a couple of things have happened that have helped dispel the gloomy mood.

The first was  remarkable news about the poor woman I had expected would die a few days after I left, the one whose ureters I reimplanted into a reconstructed bladder – a complex operation I basically made up as I went along – well, against every expectation she recovered and went home. She is going to need further surgery at the Hamlin Fistula Hospital in Addis Ababa but that will be free and be done by one of the worlds foremost urological reconstructive surgeons. I found this out just before Zoe and I left Ethiopia when I phoned my replacement at Motta to see how he was getting on  - “Good save” he said.. I emailed this news to Myrte who was ecstatic, saying that her survival against the odds, on its own made Myrtes time in Motta worthwhile.  I was left in awe of the resilience and toughness of these incredible women, who, given half a chance seem to be able to prevail against the most appalling odds. It was definitely only half a chance that I had given her.

                                                                                             Heading to Market

The second tonic I received was when I looked back at what all the Volunteer Obstetricians and midwives  had achieved at Motta in 2011. It had been the first full calendar year with specialist obstetric cover at Motta. For comparison purposes. I brought back statistics from the hospital records for 2009, the last of the many years that Motta had been functioning without any Obstetricians. The 2009 figures were incomplete but it is thought that of the 750 women who went there in 2009, about 70 died. No caesareans were done because no one there knew how to, and about 20% of the babies also died. By contrast, in 2011  the death rate for babies was halved to 10%.. For mothers the figures were even better : there were 88 caesareans, 4 caesarean hysterectomies and 11 destructive deliveries – all of these women would otherwise have died or survived with the dreaded urinary fistulas that render them outcasts in their own communities. In fact there were only 5 maternal deaths even though the number of women givng birth there increased by  almost 50% to 1009. This  reduction in maternal death rate  from 1:10 to 1:200 means that in 2011 about 95 womens lives were saved at Motta Hospital.. It made me feel good to have been a small part of that.