The month of May was the busiest ever. The trend does not seem likely to ease any time soon. The expat team has been on their toes, literally, sparing only a few hours for sleep and perpetually being on 24 hour call! The only advantage of this is that the days seem to fly by, and one tends to listen less to the sound of gunfire that never misses in Mogadishu on any given day.
Some of the days have been characterized by chaotic scenes of critical patients arriving from different directions. One patient comes in from hundreds of miles away, having been attempting to deliver at home. She has obstructed labor and the baby has died inside the womb. An examination reveals two tiny hands protruding from her birth canal. Another woman is wheeled in convulsing and unconscious, having developed eclampsia while on the way to hospital. This also requires emergency C-section. She is escorted by her two sisters. They inform us to wait. They have to call their brother who is 20 km away to come and sign the consent form, since they are not allowed to take such a responsibility!
As the theatre team prepares to go in with the first patient, yet another one is brought in screaming. She has had 10 prior deliveries at home. She has spent the last two days with a traditional birth attendant, and was started on oxytocin, a drug that augments uterine contractions to help hasten the labor process. It seems it never worked well for her since she was not showing signs of progress despite her very strong contractions. Within no time, she faints on the floor, and goes pale. She has just ruptured her uterus! The accompanying husband quickly signs the operation consent since he can see the situation is critical. The surgeon tells him to sign for hysterectomy (removal of the uterus) in case it is found to be damaged beyond repair. He blatantly refuses. He says his wife would rather die than have her uterus removed! She is taken first to the Operating room. It takes the skilled hands of our gynecologist and the dedication of the theatre team to repair the torn uterus and save her life, 4 pints of blood later. She loses her baby, unfortunately.
This scenario is replicated several times in any given week. Some of the patients are attended to in other hospitals where they have to pay, and once they have been diagnosed to be having conditions requiring C-section they abscond and come to try their luck at WAHA’s Hanano maternity. Despite all this, we have been able to handle our elective fistula operations on an average of two each day. We still have bookings until Mid-June, and they still come every Sunday for screening and schedule for surgery. This is a clear pointer that the fistula menace in Somalia is still real.
One unique case we attended to was a woman with 11 children who developed some bleeding during the early months of her current pregnancy. She went to a traditional healer who introduced a red hot metallic rod into her genitalia to burn the cervix so as to stop the bleeding. I’m not sure it helped at that stage, but the result was a severe stenosis (narrowing) and scarring of the cervix that could not permit the passage of the baby. The woman ended up with elective C-section and she is now happily nursing her 12th child.
To read Eric's previous post, click here.