After I got back from my hour-long drive to nowhere, Jessie said to me, “Well now you have something to write about.” I thought to myself: well not everything I do is a blog entry; and was there anything extraordinary about this afternoon’s events? Probably not – it’s just a bunch of stuff that happened…that happens, over and over. Only this time, I was there as an active observer.
That afternoon, I was in the pharmacy looking for someone to interpret for me so I could tell my TB patient that he was finishing up his treatment course. One of the nurses, Desalegn, appeared and I grabbed him to pass on the information. He looked somewhat lost and anxious. Kindly, he translated for me, then told me there was a pregnant mother, at term, who arrived unconscious and bleeding
When I walked into the OB room, the patient was lying in the delivery bed, awake and looking around – good! IV fluids were going in both arms – good! The nurses updated me, saying that she had been bleeding since early this morning, and now had what looked like tissue sitting at the opening of the birth canal. After a few minutes of explanation using their hands as crude models, Jessie et al. explained to me that the woman likely had placenta previa, and needed a C-section – bad.
After conferring with our medical staff, we loaded the woman and some family members into the back of the Land Cruiser. We had two of them hold the IV bags so that we could continue fluid resuscitation on our way to Bonga Hospital – our referral hospital. I drove and Desalegn, who is trained as a midwife, came along to provide assistance.
Bonga is about 30 kilometers away on a hilly, bumpy, dirt road. An experienced driver gets there in 30 minutes. At the time, I wondered, “how long will it take an inexperienced driver with a bleeding, pregnant woman in the back to get there?” That’s a question that will never be answered, because we never made it to Bonga. About 30 minutes after we left, we stopped because the woman had started to deliver the baby. Seeing that the baby was breech and not budging we decided to keep on going, this time with Desalegn in the back. Five minutes later, we stopped again. This time the baby came out, then the placenta.
It was a relatively quiet delivery. No screaming mother. Just Desalegn and I talking, trying to get the baby out. No words of encouragement for the mother-to-be. Just Desalegn and I looking, making sure there was no bleeding. No crying baby.
There was no heavy bleeding afterwards, but the baby was not alive. For the first time since I became involved in the case, I took a look at the patient, not to assess her level of consciousness, but just to look at her. She was just a girl, young, late-teens. She had an expression on her face of, “well, what’s next,” – not fear or sadness. She said that this was her second still birth and wasn’t going to become pregnant again.
Driving back to Chiri along the bumpy road, now going a little faster and with a little less caution than before, Desalegn and I were silent. The passengers, on the other hand, sang. I couldn’t understand any of the words, but the songs weren’t mournful. They had an uplifting feeling to them. Every now and then, I heard a “Jesus” or an “Amen” in the lyrics. From my rearview mirror, I couldn’t see if anyone was crying or teary-eyed, which is what I would expect. Who knows what the young girl felt. However, the songs sounded encouraging. I felt it was no longer me driving them back, instead it was their songs carrying us home.
Later that night, Jessie and I celebrated our anniversary with dinner and some dessert. We retired back to our house ready to rest after an exhausting day, when a guard showed up at our door. In his limited English, he told me someone was very sick and I had to come. I followed the guard back to the hospital and he pointed toward the corner bed, where a middle-aged man was crying loudly. As I walked past the bed with the young girl, still recuperating from her miscarriage, I wondered, “wasn’t this the bed with the old woman with the swollen knee? Didn’t we discharge her?” My mind raced, trying to prepare myself for what the guard anxiously called me for. The crying man stepped aside and I saw a blanket covering a small body, too small to be that old woman. Still unsure what was under the blanket, and a little scared, I pulled it back to find a girl, about seven years old, pulseless, lifeless.
“What the hell,” I thought. Who is this? Where am I? To say the least, I was frustrated. It turns out she was referred to us a few hours earlier, from a smaller clinic. She needed x-rays; she needed surgery; she needed a health care system that can respond to emergencies. Unfortunately, this girl had too many strikes against her and didn’t survive. Wanting to let my frustrations out on somebody, I kept quiet, knowing that nothing I said at this point would make this situation better. Jessie, acting with a little more empathy, comforted Desalegn, who was now on-call, because she knew that he was just as affected by the day’s events as we were. He let out an exasperated sigh, smiled, and said, “Lost two, saved one.” Doing the math, you wouldn’t think that this was an optimistic statement. It wasn’t a “glass half-full” versus “glass half-empty” situation. It was more like the glass tipped over, cracked, and a middle-aged man is still crying over the spilt milk…but we still have the glass. So, I kept quiet, trying to let my frustration pass.
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