April 24 , 2012 3pm

The internet isn't working which is common, so I am writing this to post at a future time. In my first few days here, I have seen more than in 18 years of practice, and 4 years of residency. Yesterday morning's rounds felt surreal, and not in a comforting kind of way. We had over 35 patients on the postpartum ward, all in the same room with grandmothers in mats on the floor next to each patient bed. The over flow patients are in the “bamboo room” where they sleep on mats on the concrete floor and it is often over 100 degrees just in that room. Of the 35 patients, almost half had delivered a dead baby either at the hospital or at home. We would know that only because there was no baby with them, yet they are surrounded by other mothers holding their babies. Most women here have had at least half of their babies die if not at birth, then within the first year of life. Five women had ruptured their uterus in labor ( I have only seen this once), and all of those babies had died. Three women had ecclampic seizures, and 2 women had severe blood pressure issues but were too early to deliver. We are hoping to keep them pregnant so their babies have some chance of survival and that means 36+ weeks around here.

It is not unusual to see a woman with a hematocrit <10....for you medical people, yes, I did write “hematocrit”. We have women with hematocrits of 4, 6 and 8 on the ward currently. For those non medical people, hematocrit is our blood count and “anemia” is defined as <35. In the US we transfuse for sure at 20, and I have never seen anyone walk with a hematocrit of <15. Malaria is the most frequent reason.

All of this felt overwhelming also because Hal had called me to help him in the middle of the night with a horrific scene. A woman had arrived at the hospital with a dead baby hanging out of her and the head was stuck inside. I honestly couldn't believe it. The baby was full term, and a little girl. We were finally able to get her out, and I was unable to get the picture of that baby out of my mind, so I barely slept. I do believe she is in the arms of Jesus, which is the only way to find hope in this suffering.

After rounds I started a hysterectomy on the only slightly obese patient I have seen. Most are extremely thin. She had a fibroid uterus and 2 huge >10cm ovaries. Both were stuck with adhesions and difficult to extract. I was thankful to have Hal there to help! After the surgery, I opened both cysts and one was an obvious dermoid (look this up on the internet to get grossed out if you don't know what it is), and the other looked malignant on the inside. There were no other signs of malignancy, so I hope and pray she does okay. There certainly isn't estrogen here to give this newly menopausal woman. The 110 degree weather won't help her hot flashes either.

Just when we thought things were calm (first mistake), we were called to see a patient with severe abdominal pain. By ultrasound she was 12 weeks pregnant, and the baby seemed to be in the abdominal cavity. Sure enough, we opened her and found over 2 liters of blood and a ruptured cornual pregnancy (the corner of the uterus had blown apart because the pregnancy got too big for the “corner” of the uterus). In the middle of the surgery, someone came in and told us she was BD+ (HIV or bad disease positive). We asked permission from her husband to tie her tubes, which I quickly accomplished. Another pregnancy could have resulted in her death ( because of the risk of recurrent uterine rupture) and the death of her baby (from HIV).

The part of the day that shook me the most was 3 of our patients died. One who had malaria and had arrived last week with a ruptured uterus and dead baby, one who got a severe infection from a 20 week intrauterine fetal demise, and one we never met but was scheduled for a D and C. This morning when I woke up, I said a prayer for the families and children these women left behind. It's easy to feel defeated when death is so common here.

This morning I was able to hand a woman her live baby boy. She had a scheduled c-section because she had three babies die at term. I will not forget the look on her face when she heard her baby cry!

The verse in my devotion this morning reminded me how big God is...

Psalm 47:10 says “Be still and know that I am God; I will be exalted among the nations, I will be exalted in the earth”.

We all feel your prayers, and are grateful.

Drea