Bahai Beach 50

Bahai Beach 50

Two difficult deliveries in two days

March 5th, 2007.

The energy level of the doc is kind of low of late. Time to tank up in N’Djamena. Have a swim, eat fish and fruit and sleep in an air-conditioned room. Perhaps even a hotel as the guesthouse in the capital doubles as an office and I am not so much interested in that. A few weeks after that I am planning to go to India (f I get my full leave days)

Yesterday when we arrived early in the camp straight away we were asked to see a difficult delivery.

A young lady had been in labor for more than 10 hours and despite the fact that the head was nearly outside of the birth canal the last centimeters seemed too far. While doing a vaginal digital inspection it became clear why. The head of the baby was in a slight mal presentation and the lady had suffered from female genital mutilation. In other words her vagina had been sutured close leaving an opening of 5 centimeter. No longer am I surprised to see this in Oure Cassoni and even though the official number of women having FGM is 48 in the camp, all the woman I have seen during delivery have been incised and sutured. With external pressure to the uterus and a firm episiotomy (cut to open up space for the head of the baby to pass through the baby was born. Yet when clamping off the umbilical cord the clamp was not used correctly and an arterial umbilical vessel started to shower blood over Zahara and myself. Within 5 seconds the clamps where back on and Zahara and I could look and laugh at each other as the child and mother were doing well. All present in the delivery room learnt a valuable lesson that the umbilical cord and the clamping thereof is a delicate affair.

Another lesson learnt is that 6 midwives present at the delivery makes the delivery a busy and highly inefficient affaire.

This morning again we left early due to the food distribution taking place in Oure Cassoni starting today. On arrival we found that two children had been delivered during the night. Two healthy baby girls although one was only 1.2 kilo and she needs close follow up.

There was a 17-year-old girl delivering her first born. As she had been in labor for over 12 hours the TBA had decided it was time for the mother-to-be to start pushing out the baby but the baby head had not proceeded far enough in the birth canal for that. This girl/mother had also been cut. After the delivery it became pretty clear that the exit of the birth canal was narrow and obstructed as the head was very much deformed and the baby came out without breathing, blue and floppy.

Here what the midwives do is grab the baby by the ankles and slap it on the back. If that does not work the child is also hit on the feet while water is being thrown at it. What the baby girl needed was to have all the mucous sucked out of her nose and throat clogging up her capacity to breath and a ‘kiss of life’.

The feeling when a child is not breathing for 2 minutes is very stressful I can assure you. The good thing about this girl was that he heart was beating firmly and rapidly. After mouth to mouth-nose breathing for about 1 minute she started to hiccup, clear her mucous and breath on her own.

An observation on my side after this narrow escape to the midwives;

“A human is not a fish, it requires oxygen in air in order to breath”
“Many hands make the work light but too many hands make it a mess”

At the moment of delivery of the baby there must have been 7 midwives, 3 relatives and myself in the delivery room. In the building because of the other two deliveries there were another 15 women and as it was nearing consultation time another 10 pregnant ladies were awaiting on the porch.

Well at least this week the majority 6/7 deliveries are taking place in the health center. Let us hope this mini trend continues and the difficult and at risk deliveries are observed early and helped out in an appropriate way as well as referred on time when needed.

The lady we had referred to Bahai on Friday with generalized convulsions was returned back today with a healthy baby boy n her arms.

Reproductive Health was originally not supposed to be part of my tasks but as there is no expatriate manager and only since one month a doctor I do tend to lend a hand when needed.

Well next time more about the other programs.

Namaskar,


Ashis