Last week we walked to church through the woods, passing a small cemetery covered by the graves of all the new borns who die at our hospital… and lastnight I wrote a review for a government epidemiologist of the 7 maternal deaths the hospital had in the first 6 months of the calendar year.When asked what our “numbers” for neonatal mortality, I reply grimly “I don’t know, a couple a week, I’ll have to go count.” Daniel is at the hospital right now preparing for a cesarian delivery and rationing out our magnesium sulfate to another eclamptic lady, this one just arrived from an outside hospital and has been seizing for 3 days.
Home deliveries gone awry, septic infants, premature babies, anemic, febrile, infected. Mothers seizing from eclampsia or malaria, febrile from disseminated TB or schistosomiasis, hemorrhaging from placenta previa or abruption, septic from their uterine rupture or concomitant typhoid perforation… this happens all the time.
But it's not all heavy. We have fun moments where our odd homeschooling strategies and patient care sometimes work out well together! Let me tell you about one such case:
Last week Monday I was carrying for a lady with a septic abortion who was anemic, with a Hgb < 4. We treated the infection, removed the retained placenta… but she still needed blood. I left family with the task of finding someone to donate blood, and went home, praying. Tuesday morning is a school day for me (meaning I magically become a kindergarten and 2nd grade teacher) but at breakfast I got the distressing news that the young woman, whose family is from “the bush,” only had elderly ladies with her and were unable to donate. So after our math assignment, I told the kids we were doing our science experiment early. We we walked over together (along with our dear friend Luis, who does school with us) to “Hemoterapia” (our “Blood Therapy” ward) where I donated blood. We then walked over together to maternity… everyone taking turns carrying the bag of fresh warm blood. The boys were interested; Naomi, seriously worried. “Are you going to die? How can Philadelphia blood mix with Kalukembe blood? Are you strong enough right now?” She scowled watching the blood being given to our young lady, worried for a bit, that this life-giving blood was going to take my life. But in the end I laughed, picked her up, and we skipped out of maternity together. On our walk home we all had a sweet talk about biology (how amazing our bodies are!), bigotry (how we are all the same inside), and the blood of Jesus.
And guess what? Just like that she got better! I showed the kids her smiling face on the day of discharge and we all celebrated, even Naomi. This week we also re-double our efforts to prevent maternal and infant mortality. We restarted our ultrasound outreach (funded by Hope for our Sisters), where we invite ladies to come for a free prenatal ultrasound (usually costs a day laborer a week’s wage). It is sweet to give surprise notices of twins… but it is also a time to counsel risks. In three days we did 47 ultrasounds… a small step, but worth celebrating too.