South Sudan is hot. It is an average of 40°C (104° F) every day. The cold showers are so refreshing and it feels great when first stepping out all clean and cooled off. Then, within about 10 minutes, you are a sweaty, disgusting mess again and you just learn to live with it. It isn’t so bad after a while.
Days like today, when I am woken up at 5:30am to a radio call from maternity, I don’t even get to brush my teeth or have my French press coffee let alone take a shower, because yes, even asleep, by morning, you are a disgusting, sweaty mess. This particular morning, the call was, “Patient referred from another facility with cord prolapse and we have a patient with APH” (hemorrhage during pregnancy). So there were 2 critical patients. Nothing wakes you up better than coffee, unless it is a cord prolapse and an APH!
I threw on some clothes and ran down to maternity. As I expected, I found a woman in the birthing room with an umbilical cord hanging out of her. It looked fairly full and blue. I quickly grabbed the doppler and found a nice fetal heartbeat. I told the midwife that the baby must be breech and indeed, on exam I felt a butt and two feet. The cervix was gone and I told her she could push when she felt like it. Soon, the bottom emerged and the feet along with it – he was a BIG boy! The baby came out with perfectly crossed legs. He didn’t rotate completely and his arms had not come down. Due to the prolapsed cord, even though that one set of heart tones were good, I didn’t waste time waiting as I would normally do, so after the next contraction, I did a side to side maneuver which released one arm, the other was still up, and I reached up and brought it down. The head came all the way down easily and then he was born. He was a big boy! I did a little resuscitation to bring him around and he did well and by the time his mother delivered the placenta, he was ready to nurse.
In the meantime, there was the APH patient and while I was helping attend the breech, I was calling out instructions and asking about that patient. She was in bed 8 so I knew she was the patient with placenta previa. The bleeding had basically subsided but we still needed to get her into OT. She was about 33 weeks and we had been hoping to get her a little further along when we admitted her a day prior before having to take her into surgery. But we had given her 2 out of 4 doses of dexamethazone to help with the baby’s lung maturity in the event she did need surgery sooner. That was a good call. So the staff prepped her for the OT while I called the surgeon on the radio. In no time at all she had 2 IVs, a urinary catheter, blood type and cross and her husband sent down to donate blood at the lab. Patients always need to bring donor with them if they are going to need blood.
During the time that mother was in surgery, we also had a VBAC mother give birth – she had had 2 previous c-sections. We had another mom birth a baby born in the caul, and then that mother proceeded to hemorrhage. All of this took place between 5:45am and 8:00am. I was tired before the day even began.
The surgery was a success for both mother and baby and she is recuperating well on the ward now, although she did have a fairly significant blood loss and her hemoglobin fell to transfusion level so she got a unit of blood. The baby is tiny but doing as well as can be expected at such an early gestation.
The VBAC mother was discharged the next day as was the mother with the breech baby. We kept the mother that had the PPH an extra day just to make sure she was strong enough when discharged; they go back to the camp and life is neither relaxing or easy. There were several other patients during this time as well, including a young woman pregnant with her first baby who was hospitalized due to a domestic violence incident. There was a patient with a molar pregnancy, we usually have at least 3 per week. There was a 16 year old with a 26(ish) week demise, her first pregnancy. We have a mental health department so I made sure that she was referred to that department prior to discharge. We also had a woman birth who was HIV positive and her baby is now receiving ARVs.
There is very little downtime in maternity but we do find small pockets of time to sit down and “take some tea”. The staff is made up primarily of young men and women, most of whom have not even been alive as long as I have been practicing midwifery. They make me laugh every day and they frustrate the heck out of me every day. Such is the nature of this work and the learning curve that comes from being a new expat on a project. I wouldn’t have it any other way.
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Thrilling work!