You know those jitters you get when you start something new? The excitement. The nervousness. Well, my stomach was a little unsure of itself as I walked into Otona Hospital. My first day at the new hospital. Three patients had just had babies in the
last hour, we had about 30 patients to round on, five uteruses to remove along with putting female parts back inside, two normal deliveries and a c-section. There are also about 20 nursing students and 25 health officer students that are on the service that you teach when you have chance. My day ended with sectioning a woman for fetal distress. The baby died because of congenital anomalies within minutes of birth. And that is a normal day.
Here is the rest of the story…. There was no running water for the first three cases, so you take water out of a bucket that has a small layer of grime on it to scrub before cases. There is not a single thermometer in the entire hospital. You ask the patients if they feel like they have a fever and touch them to see if you can feel one. There are two blood pressure cuffs in the entire hospital, about 200 beds. Probably 10% of the patients have no shoes.
The nurses had never seen a doppler or heard the heart beat of a baby through one. I had to show them how to use it. The employee bathroom wreaks of urine and the floor is always wet. There is a bath tub they fill with water, when it is running, so you can flush the toilet and wash your hands. One patient I saw had been in the hospital for 3 weeks. One vital sign taken the entire time she was in the hospital and it was abnormal. It is amazing what they are able to accomplish with the lack of resources
Now let me tell you about my Thursday. Surgery was supposed to start at 8 am. We had seven major cases lined up for the day. They had not one single clean gown or set of instruments, so surgery was delayed until the afternoon. We decided to round. While rounding a patient was brought in seizing. She was 18 years old and pregnant with her first baby. She had started having headaches a few days back and then started seizing. It took the family four hours to get to the hospital. Her tongue was swollen from biting it and impeding her airway. We induced the pregnancy because mom was for sure going to die if we didn’t. We treated her for eclampsia, cerebral malaria and meningitis. We also gave her on oxygen, but all we have are nasal cannulas. No masks. No ventilators. On oxygen she was hypoxic (32-76%. I never saw it higher than 76%). She continued to seize through out the entire day despite everything that we were trying.
We had other patients to see, so we kept working our way through them. A septic abortion… a “ovarian mass” that was really a bowel cancer that had to be resected by the OB because there was no general surgeon and now her incision was infected… a destructive delivery…. obstructed labor… a woman with a placenta previa… hyperemesis…. pregnant patient with typhoid… a post operative infection… 2 mothers with HIV…
Side note. Dr. A’s stomach had a nice loud growl. I asked if he was hungry. He said no, so I must have giardia or worms again.
After rounding I went to the labor ward and helped with two deliveries. Each time I thought I could sneak out for lunch I was called back in to help. Then, it was time to start our seven surgical cases. As we were getting ready to start our cases, a woman with a ruptured uterus came in. We preceded with two hysterectomies and pelvic reconstruction and THEN did the ruptured uterus. The baby had tried to come out forehead first. It would have had six brothers and sisters, but he died in the birthing process. We removed him from her abdomen and then took her uterus out. During the case the electricity went out, but the sun was still up, so we could see. Her family refused to give any blood and refused to even pay to have her blood typed so we could give her some. The doctor, “Dr A”, I am working with went to the “blood bank”. A patient for surgery the next day had blood available so he took hers, O positive, and transfused it hoping that she wouldn’t react. When she left the OR she had no pulses in her arms or legs.
Another woman came in and needed a c-section and Dr. A had clinic, so I did the c-section. We still didn’t have any electricity and the sun was going down. When the electricity goes out you call the man that lives in the house next to the generator for the hospital to turn it on. The generator was broken. Thank you Walmart for the
head flashlight. In the middle of the case, one of the midwives came in to let me know that we had a woman who came in with the umbilical cord and the arm of a baby hanging out. The baby was dead. I went to OB to evaluate her. The halls were pitch black. I was glad I had a flashlight so I wouldn’t step on patients or their families sleeping in the halls. I noticed a new scent in the hospital, candles. The patients that could afford candles put them on the ends of the beds so they would have light in their rooms/hall.
We sent the family to the pharmacy to get all the supplies (IV, IV fluids, antibiotics, etc). Forty five minutes later they returned to let us know they had been waiting at the hospital pharmacy, but the pharmacist was gone. Maybe he wanted some tea. I had no way to reach the pharmacist. We brought the patient to the OR and the staff had left so we had no supplies AND were waiting for the night staff to arrive. We decided to attempt a destructive delivery. In the process her uterus ruptured. They had found a big OR battery operated light, so we weren’t relying on my little head lamp any longer. The general practitioner and I opened her and started her hysterectomy. Her bladder had also ruptured. We had no ureteral catheters, so we used feeding tubes.
Dr. A returned during the case to help with the intensions of doing three more cases that we hadn’t been able to do during the day. It was about 10pm by this time. We had only done 2 of the seven scheduled cases. Since we still had no electricity he opted to wait until the next day.
After the case, I went to check on the patient that was seizing. Now keep in mind no electricity means no oxygen. She was blue and was coughing up yellow gunk. You could hear her breathing down the hall. She was no longer responding to stimuli. Thankfully, the baby was ready to come out. So I delivered the baby and then went home. There was nothing I could do but pray for her.
I had only been there for 16 hours. I had delivered three dead babies, done a surgery twice that I had never done and was almost certain I would show up the next morning to two more dead patient. Thank God I was wrong. The next morning both patients were alive and the seizing patient was actually responding. The hospital still didn’t have electricity or running water, but another day started.