One True Success

I realize my entries have been splotchy lately and I suppose it's a reflection of my state of mind. I also have not been spending as many hours in front of a computer with internet access as I was previously. Within a single day at the hospital my emotions continue to range from absolute frustration to pure elation. Yesterday was a case in point. I arrived in the Labor Ward to find an intern resuscitating a baby. Apparently the clinical officer was called and told there was fetal distress but no action was taken until sometime later, when the intern appeared. He then delivered the little girl whose only sign of life was a faint heartbeat. When I came in, he was finishing a 24 hour shift and still had another patient to assess, so I volunteered to take over the resuscitation. This is when the frustration began.

At the change of shift in the morning, the ward is full of clinical officers, nurses, physicians, interns, and students. Yesterday morning, many people were busy, but many were just waiting for the rounds to begin. I needed an extra pair of hands, as I was bagging the baby, for a couple minutes, to do simple things like find the larygoscope, turn on the suction machine, plug in the oxygen machine, etc. But, just to get that much assistance at times is a near impossibility. In fact, to do those few things took at least 15 minutes. One person found the larygoscope handle, but left before they found the blade, another found the blade but didn't hand it to me, another got both pieces but wouldn't put them together, and so on. One medical intern asked why I was taking so much time with the baby and recommended that I take the baby to the nursery and just put her on oxygen. (She was not breathing on her own so that would mean certain death!!) Finally, I saw Mrs Phiri and felt such huge relief knowing that she would step in, and of course she did. I spent two and a half hours with the little girl and at the end of that time, she was breathing, sucking, and kicking. I fear that there was significant brain damage due to the unknown period during delivery when her oxygen supply was compromised, but that will only become apparent with time as she develops or misses developmental milestones, as the case may be.

Dealing with emergencies in this setting is one of the great sources of personal frustration. I assume that people's complacency comes from the need to stretch limited human resources, but even so the limited, or lack of response, at times becomes infuriating. Often, if I respond to an emergency no one will be there to offer support. If I call for help and things work out well, people look at me strangely and ask, "what was it that you needed?" To me, if someone is bleeding or seizing or if a baby is being resuscitated that is a serious event that needs the emergent attention of not just one person but several, and it calls for quick steps, and calm, but quick actions.

At the same time that I was resuscitating the little girl another baby was brought in from a c-section that needed resuscitation. I tried not to pay too much attention to his resuscitation, knowing that I already had my hands full. But, after my little baby stabilized, I took over for the nursing student who needed relief (she actually stayed a couple hours doing the resuscitation herself). Unfortunately, in the end the baby didn't make it. Immediately after that death, I found Dr Meguid resuscitating yet another baby who also died. At that point I went to check on an unattended primip (woman with her first delivery) who was screaming at the far end of the ward, and found that the fetal heart tones were also showing signs of distress. The clinical officer, who was in theatre, was called but without assessing her, told us to wait. Instead of waiting I did a vacuum extraction and resuscitated the depressed boy (he was the one true success story of the day). Sometime around 4 I went to lunch and then when I came back was told that there had been a maternal death. A woman, with her 11th pregnancy, came in with a ruptured uterus, a hysterectomy was done, she was stabilized and transferred to high risk postnatal. She was left unattended for 1.5 hours and when the nurse came to check on her, found her dead. That was the fourth maternal death within 5 days.

These events and numbers are unacceptable anywhere, even here in this impoverished environment. I don't understand why so many people seem to preach about the horrors but fail to act or just see them as part of the setting. While it's true that more women and babies will die here because of what we can't do there are many who can live because of what we can do. I try to remind myself that I'm here for the women, that I should fix my eyes on the women and babies that my hands are touching, that I can only do what I can do, but there are days when I can't help but raise my gaze and those days I feel so incredibly lost in and frustrated with the bigger picture.