At Grand Ward
Rounds today they discussed a tragic story of a 45 year-old gravida 9 and para
7 woman from Mozambque who used a local herb that acted like Pitocin to induce
labor. When she did not progress she
consulted an “African Doctor” who could not manage her and she went to a local
healthcare center which was unable to help her.
She crossed the border to Tengani Health Center in Malawi, by then she
was bleeding heavily. She was quickly
transferred to Nsanje District Hospital where she was found to have suffered
rupture of her uterus. During surgery,
the baby girl was stillborn and there was an anterior uterine rupture. The rupture resulted in severely torn tissues
and the surgeon was unable to repair the uterus, a hysterectomy was
performed. She bled heavily and
unfortunately there was no blood in the blood bank. She was described as pale
and in shock and stopped producing urine but was still conscious. The last we heard was she was transferred to
Queen Elizabeth’s Hospital in Thyolo about four hours away. A number of factors resulted in her
predisposition to uterine rupture, multiparity, prolonged labor, cephalopelvic
disproportion…
There is a severe shortage of blood
in Nsanje. A few nights ago a woman
presented with severe anemia with hemoglobin of 2.7gm/dl. Her relatives were asked to donate blood, one
of them had HIV, malaria and syphilis infections and a second had malaria. The clinician chose to transfuse her with the
malarial blood after the patient received her dose of quinine.
|
Sorgin Health Center |
Sorgin is at least 50 km away from Nsanje
proper, a health center which was built in 1999 has a set-up exactly like
Tegani or Mbenje. It is however a lot
cleaner and the structure of the building is sound. The woman who cleans the maternity unit told
me that they have run out of soap, chlorine or any kind of cleaning
agents. Their sterilizer is broken and
she sterilizes the instruments outside with a wood fire for two hours. A baby was just born not too long ago. Outside
the unit a baby goat was sucking on its mother’s teat with a violent jerking
motion. By lunch time when the heat was getting fierce the mother goat was
lying in the shade while the baby goat gamboled on the dry grass.
|
A Make-Shift Sterilizer |
|
A Brand New Baby |
The ART Clinic
was crowded with the registration clerk and the nurse attending to the patients
in the same room. The clerk spread the
charts all over the table making it difficult for the clinician to
function. We suggested that he should
register the patients outside this room to enable the medical officer or the
nurse to have more space to see the patient. As always invariably one or two
patients would present with signs and symptoms for tuberculosis in one of these
clinics.
On our way back we checked on the
progress on the bridge at Mtaya Moyo,
more rocks were packed on the foundation.
The locals call the river here Mtaya
Moyo or lose one’s life because during the floods the boats are often overturned
and many of the passengers are drowned.
|
The Bridge at Mtaya Moyo |
No comments:
Post a Comment