Thursday, December 13, 2012

A Poor Woman

What a Cute kid !
Work has been quiet the last few days, but there have still been some memorable incidents. The first, late last week was in the midst of a busy afternoon of births that for the most part were progressing well - suddenly a great crowd of people appeared wheeling in a woman on a trolley who had been sent by ambulance from a village two hours away. She had given birth at home to her sixth baby at about 9am, had arrived at a village "Health Centre" four hours later with a retained placenta and bleeding, and there was given a drip and rushed to Motta, arriving some seven hours after she had given birth. Everyone was calling for me to quickly attend to her and I did - and the first thing I noticed was how cold she was. And then that the bleeding had stopped.And so had her breathing. And there was no pulse - her heart had stopped as well - she was dead! I found out later she was barely conscious when they put her in the ambulance.
Surprisingly, she was the first dead mother I had ever seen. The only woman that I looked after who died when I was here last time was taken from the hospital near death,at the families request and died at home from overwhelming sepsis. I had seen lots of women here I thought would surely die, or who were near death but in every case they were so tough that they didnt. But this poor woman exsanguinated while desperately trying to reach help, and expired in the back of a dusty 4WD. She was a typical poor country woman, filthy from head to toe, the standard ragged and filthy green dress with the zipper pocket across the front, very short hair with a black wrap tied around her head, and bare feet with thick cracked souls and  hard yellow nails. She was the archetype of the poor ethiopian woman, something like one in 12 of whom die, and most often in this exact way, from post partum bleeding after having had a large family. Probably her youngest is only two, but now all her children are motherless. I asked what would happen to the newborn baby - was there anybody who could breastfeed it? The answer it seemed was no, the idea of a relative feeding the baby seemed out of the question, and therefore to compound the tragedy, it would seem the newborn baby will die too. No one would be able to afford baby formula,and in any case even if they could its use usually results in fatal gastric infections because proper sterility is impossible in homes of mud that are warmed by fire.
So I filled in the paper work, declaring her Dead on Arrival. And then as I watched, the midwives prepared her dead body to be returned to her family. I wanted to take a photo but didnt - but it was interesting to watch as they firstly cut her dress off and then covered her face with a big wad of cotton wool. A long strip of ribbon gauze was then wrapped around her head to hold the cotton wool on, and then it was continued around her body to hold her arms folded across her chest, then down around her legs to keep them together and lastly, to keep her feet together, the two big toes were tied to each other.She was then wrapped in the blood stained shawl she came with and laid on the floor of the ambulance, which immediately left. They dont have death certficates here.
The other incident of interest was a scary moment for me when I thought a woman with twins was going to die when her anaesthetic went awry. She was scheduled for a Caesarean because  the first twin was a breech - coming bum first - and I wasnt intending to have a repeat of the ghastly situation that developed last year when I was here, when twins became locked and both died! No Thank you! After she was put to sleep it proved impossible to get the breathing tube down and she started to go blue. Fortunately we hadnt started the operation so we just ventilated her in a very simple way with a Bag and Mask and a basic airway until she started breathing for herself again. After she woke up and recovered, we sent her to Bahar Dar for the caesarean, as she was too high an anesthetic risk for Motta, but that couldnt have been anticipated until we tried to give her one.
Next time I shall think of something a bit lighter to write about.


  1. David I see you are back at it
    Feel a bit guilty here on Mason Bay in lovely weather....

  2. Hi David. I have just read 4 months worth of your blogs in one go. What a terrific read. We too hit some ordinary weather around Fiji as we passed it. We are hoping Sapphire will be ok as the cyclone nears Fiji. Happy xmas to you wherever you may be at the time.