Access to care and Drinking games

I’m working today and off tomorrow, but I figured it’s best to follow through and post anyway

 

Writing clinical stories is incredibly tempting, but I’ve been hesitant because of the sensitive nature. On the other hand, to accurately describe the maternity health conditions in Aweil (and possibly the rest of South Sudan), I want to share a preventable and disturbing case from this morning.  

A patient presented this morning with an obstructed labor and full term fetal demise.  She was fully dilated on arrival and had been pushing at home for over 12 hours. Her history and lack of access to care make this death preventable. First pregnancy resulted in a full term fetal demise from obstructed labor, and her family did a “destructive delivery” at home. Her second delivery was at Aweil Civil Hospital by c-section for obstructed labor, and the baby lived. She was instructed to immediately present to the hospital with her next pregnancy because of the significant probability that it would also result in an obstructed labor and require a c-section. Because of the size and shape of her pelvis, a normal vaginal birth would probably not be an option for her.

Due to distance from the hospital and her family’s extreme desire to avoid a c-section, she labored at home and pushed for a full day before looking for transportation. Upon arrival, there was no fetal heartbeat. Vacuum delivery failed, but we finally got the baby delivered by forceps under spinal anesthesia. All I can say is that at least the mother lived. It was very sad and represents a few maternity issues in the area.

On a lighter note, I’ve moved into my new tukul (hut) and am settling into daily life in Aweil. We have quite the work and social calendars. We kind of oscillate between the most intense work ever and summer camp. Tonight’s activity is a fashion show and drinking games. Kings, also known as Circle of Death, has already been suggested. I must be getting old; I don’t remember the rest of the fun games! On the fashion side, one option is for our clothing to represent our country. I’ve already been told I should incorporate my baseball cap into my outfit. I was surprised to find that a baseball cap was a specifically American accessory. I'm very open to outfit suggestions, particularly those that involve my hat!

I would also love to post pictures, but we can’t upload or download because of the slow internet connection :-(  ... I'll catch up with the pictures when I come home in March.

I have to go back to the hospital, but I really hope to post more frequently because by Saturday I can barely remember Monday's catastrophes.

Still no pants.

Still no pants

Another week in Aweil. I’m going to stay away from a lot of the clinical stuff for the time being because a lot of it is shocking and sad. I want to get a better feel for the big picture. A lot of the national staff are very qualified, but I’ve also seen large gaps in knowledge leading to less than stellar outcomes (eg. fetal monitoring of any sort is rare).

For my clinical friends, I want to share one story. Last night we did a c-section on a patient who presented to triage after bleeding heavily all day in her village. 8 months pregnant with a complete previa, an IUFD, and a hgb of 6.8.  We did a straightforward c/s with minimal blood loss and decided on no transfusion. (To put that in context we had a pt in the gyne ward the day before who walked in with a hgb of 3.4. She got transfused).  The mom saw the baby after delivery, and I told her she could hold the baby in recovery. I asked the maternity attendant, “Can you wrap the baby in a blanket so that the mom can hold it.” I was bringing back a family member to see the baby (hospital policy), and as I entered the delivery room, I realized the maternity attendant (though saying, “yes, yes, yes”) had no idea what I said other than “wrap.” The entire baby was wrapped in a chuck and taped up. It was terrifying, and I’m really glad I stopped the patient’s mom before she saw it. We got a blanket and things went as well as possible after that. Communication, language barriers, and IUFDs are really rough.

Also, another week without pants! The president of South Sudan decided to come to Aweil a day earlier than scheduled, and we are not allowed in the market today due to the increased military and police presence. I’m not sure how I feel about delivery babies in a skirt, but maybe I’ll give it a try. I think an ankle length flowing hippie skirt will be good for tomorrow.

On a fun note, our group of expats reminds me of home. We try to have some sort of activity every Saturday night. Tonight is a drag competition involving lip-synching and judges. Unfortunately, no videos allowed for this event. Hopefully I’ll have some good pictures to post.

So much for my avoidance of posting about clinical situations.

Life in Aweil

Wow. It looks like Saturday may be the only day I can be in touch with the rest of the world!  The hospital is very busy with an average of 12 deliveries a day, and there is only one midwife/nurse practitioner in the labor and delivery rooms. The nurses can be very helpful and do vaginal exams, suturing and often deliveries as no one else is available.  Unfortunately, a lot of them aren't proficient in any of these skills. This midwife/NP also covers postnatal mothers and infants. There is one other midwife/NP who covers the steady stream of patients in triage many of whom lie on the floor when bench space fills. This provider also technically covers gyn.  Nurses help with all of these responsibilities, but in the end the midwives and NPs are responsible. And MY job  as the clinical coordinator, is to supervise the midwives, NPs, nurses and other staff. The place is so disorganized that I’ll have my work cut out for me.

Today I got to move out of the guest room and into my own private Tukul. I’ll post a picture later, but it’s essentially a little hut with a bed covered by a mosquito net. I’m not going to lie, I love how the mosquito net makes it feel like I’m sleeping in a shitty canopy bed.  The weirdest thing about living here isn’t that we’re in the middle of nowhere or that the market smells like shit. For me, it’s the fact that the MSF compound (where we live) has 4-5 security guys and is surrounded by double barbed wire. I guess I feel safe, but escaping might be tough.

I haven’t seen too much of Sudanese life because I’ve essentially been traveling from the compound (which I prefer to call the house) to the hospital. Even though the market is on the way to the hospital, I haven’t had the opportunity to stop and browse.  Because of security issues the only place we can walk to alone is the hospital. To browse the market we have to go in twos. Hopefully I check it out soon. I’ll keep you updated on the shopping prospects. I’m hoping to buy some pants. Should be interesting  ;)

Day 1

I made it to Juba, the capital of South Sudan today, and I will keep this short because it's after midnight. I learned a few things today ... Skype sucks here, Juba airport is unreal, and expats are amazing. I'd love to expand on at least the last 2 of those later :)   - Katherine