Saturday, December 26, 2009

Christmas Previa

I am sitting at home this evening when I am called in by Sister Patricia, one of the Labor Ward midwives, to see a woman with antepartum hemorrhage. I take a bodaboda into the hospital, pick up the ultrasound at our clinic, and head over to Labor Ward.

I can’t find Sister Patricia, and another midwife helps me figure out that she has taken a baby to the OR for rescusitation. Another woman, who tells me she is an OR nurse, helped me figure out which patient was the one bleeding.

As we are preparing the ultrasound, Sister Patricia and the anesthetist arrive in Labor Ward. I greet the anesthetist and ask about the baby. He tells me “We have failed,” meaning the baby died. I ask Sister Patricia the details. The baby was full term, but had a long second stage of labor (pushing), and a lot of caput. It sounds like birth asphyxia. I think of the mother, who is still lying on the delivery bed, exposed, legs wide open, with the umbilical cord still hanging out, waiting for the placenta to delivery. She doesn’t know yet.

I scan the woman that Sister Patricia called me about. Right away, I see a very clear placenta previa. It is completely covering the cervical os, and is well below the baby’s head. She needs a cesarean or else both she and the baby could bleed to death.

I don’t see any blood, but she is wearing several kangas around her waist. I ask if she is bleeding actively. The anesthetist and OR nurse are translating for me, but they speak only minimal Japadhola. It sounds, though, like she is still bleeding actively.

They know, as I do, that she needs a cesarean. They seem resistant, insisting that she will be sent to St. Anthony. I tell Sister Patricia that the woman needs a cesarean. She tells me that we can’t do it because there is no anesthetist and no OR nurse. I look around and realize that the anesthetist has disappeared – he has gone off duty, and the anesthetist who was supposed to be on hasn’t arrived.

“Why didn’t he come?” I ask

“Probably because of Christmas,” says Sister Patricia.

The patient will be referred to St. Anthony. St. Anthony is a private hospital in Tororo. It is not far, but it requires payment, unlike Tororo District Hospital, which is a government hospital and therefore care is free.

“What if she can’t pay?” I ask.

No one answers my question, because there is no answer. I ask several times, but I never get an answer.

“The last one who was sent to St. Anthony with antepartum hemorrhage came back 24 hours, still bleeding,” I say. I know this because it was the now-off-duty anesthetist who had told me.

Here I am, a trained specialist in Obstetrics and Gynecology, available to do a lifesaving cesarean, and I can’t do it because one person went off duty and the other one didn’t show up.

I don’t know what to do. I try to insist, but what can I say? I write a note in the patient’s Antenatal book, emphasizing the previa and the need for urgent cesarean. I tell the patient’s husband, through a translator, that if the people at St. Anthony refuse to do a cesarean tonight, they should come back tomorrow morning and I will do it (and hopefully there will be an anesthetist and an OR nurse).

I think about Christmas, and the story that people are celebrating, and I wonder what would have happened if Mary had had a placenta previa. She would have bled to death in a barn because someone didn’t show up for work.


Frankie said...

Oh Veronica, such a hard thing to go through. You're doing amazing work-one patient and day at a time. Our thoughts are with you. CHeers,
Paul Damaske

Paul said...

Whoops--ignore the Frankie login--I'm using my mother in law's computer. -paul

danengber said...

Okay, first of all, you've completely crushed my Christmas spirit. Not that I had much Christmas spirit to begin with, but whatever spirit there was-- you know, the stuff that seeps under your fingernails at the mall or when you walk by the windows on fifth avenue-- well, that stuff is totally crushed and crumbled and blown away. Thanks, buddy.

Second, I continue to be amazed by the fact that anyone actually gives birth without being in grave danger. Did Mary have a placenta previa or whatever with Jesus? We're lucky she didn't die in childbirth. (Or did she? I don't remember how the story goes, actually.)