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Putting Ourselves in the Problem: Thoughts from Ghana
I was operating by the beams of an unsteady flashlight, held by a nervous medical student, while my hands groped inside of a pregnant womb to feel for the baby’s head. Finally, after a long sucking noise, the head delivered and the baby’s body followed quickly thereafter. The power flickered back on, and I could see that the tiny body was limp and blue in my arms. I rubbed him vigorously with a towel and he perked up a little bit as I handed him off to the head midwife. The medical student and I finished stitching up the uterus and the mom’s belly in a hurry and then went to help the midwives who were desperately trying to revive a newborn baby with the limited resources available.
When I look back at those tense moments, scenes that I have witnessed many times in United States delivery rooms, I know, almost for sure, that the baby would have survived at home. He had been born in a mess of meconium, which is baby’s first excrement, a fairly common occurrence, and best treated with suctioning the debris out of the respiratory system and early intubation. We only had a small manual suction device, no intubation equipment, and no ventilator.
Our team did everything that we could, but eventually I was doing chest compressions on a baby that I knew was dead. Everyone in the room looked at me for a sign of when we were to give up. The scrub tech was dutifully bagging the baby with an oxygen mask in between the compressions. I just couldn’t stop. I kept waiting for the baby to cough and gag and start crying. But it never happened. After what seemed like an eternity of trying, a roomful of dark eyes waiting for a sign from me, my hand stopped its repetitive movements and rested on the tiny chest. I held the limp little body to myself and cried. No one else in the room except the medical student and I seemed moved at all. That’s when I first realized that this was commonplace. Watching a baby die. I would do it over and over again, for the next several weeks. I would learn to watch them die, knowing that there was nothing I could do to keep it from happening.
What strikes me now, as I write this, several years later, is that I was fortunate to not have to watch any mothers die. We have all heard the astonishing statistic that there is one maternal death a minute, most of those occurring in the poorest countries. So why, in my four weeks working in a rural hospital in Ghana, where the resources are beyond scarce, did I not see one mother die?
The woman who came in with a belly full of blood, no blood pressure and on the brink of death from a ruptured ectopic pregnancy got an exploratory surgery and a transfusion of her own blood that she was losing. I saw her back for a check up two weeks later and she was living a normal life.
The woman who had life-threatening hemorrhage after the delivery of her infant received medications and a surgery to stop the bleeding. She was carrying her baby home with her after two days in the hospital.
The woman with obstructed labor who was brought in by her family in the middle of the night from a nearby village received a c-section to save her life, even though her baby was already dead. She may not be so lucky as to escape the dreaded consequence of fistula that results from being in labor too long, but she is alive.
All of them are alive because they were able to access one of the most basic medical resources, the human touch. There had to be someone there, at the most critical moment that could offer help. In fact, most maternal deaths in the developing world are preventable with very standard obstetric care, but that means nothing if there’s no one present to prevent women from dying.
Doctors, nurses and medical officers who work full-time in these brutal circumstances understand better than anyone, however, that just being there does not mean that a life will be saved. Often, it’s too late, there’s no blood, there’s no equipment, anesthesia or antibiotics. But by being there, clinicians at least put themselves in a position to help do whatever is possible.
If we want to save mothers who can be there for their children, someone has to be there for them. That means the patient’s family, who values her worth, will get her to a medical facility if she is in danger and if one is available to them. It means that governments will prioritize women’s health programs. It means that more African doctors, nurses and medical officers will use their training and skills to bring life-saving emergency obstetric care to every part of their countries. It means that Americans will continue to help in whatever appropriate ways we can. For starters, residency programs and US hospitals should do more to encourage physicians to take an active role in using their skills to help those most in need at home and abroad.
Maternal mortality has been a problem for a long time, and it’s a complex one without an overnight solution. But this inexperienced young doctor believes that if there were as many people who wanted to put themselves in the problem as want to talk about it and study its implications then we would be halfway to solving it. Who knows exactly what they meant by it, but U2’s phrase seems apt for the situation: Get on your boots, people.
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