(un)happy endings

After 3 very busy days at the hospital I finally have time to write again.
We have had weeks without almost any cesarean section. But we got the full load in those 3 days. And unfortunately we lost one baby. But we could save one baby of whom nobody had expected it anymore. Actually, it is a really sad story. The mother is HIV positive, she is very poor and has almost no family/friends. There is still a huge stigma around HIV. We also have had positive woman whose family or even partner did not know…
So, this woman came to the hospital to give birth. Alone, because there was no one to support her. She had to beg the families of other patient for some money to pay the admission fee of 5 Birr (0,2 Euro) and some medication. Terrible! The sister and her husband came later, the only family I ever saw.
Her labor was very slow. Her body is just too weak, I suppose, because she has had pneumonia one month ago. At a certain point she finally was fully dilated but we had to wait for the baby to come down a bit more. Only, that suddenly the baby’s heartbeat got very bad. So we tried everything: vacuum delivery, even forceps. But she was so weak she could not really push and without her pushing we could not do anything. In the meantime the babies heartbeat had become about 40-50 beats per minute. Terribly bad and we decided to do a cesarean section (the 7th one in 3 days). But she did not want to have the surgery if she was not sure the baby would survive and she could not effort it anyway. And we have had a few babies in similar conditions that we could not save even with a cesarean and this was what we all expected. So all together we took a very heavy decision: Wait a little until the baby would have died and perform a craniotomy on it (I will spare you the exact details of it). None of us really liked the idea. And I had to think of the ethic lessons we had at the midwifery school: Making an ethical dilemma out of every whatsoever tiny problem. I never liked that. You know me: I like to think practical and not over think everything 1000 times. I thought that this would have been something to really think about it: What do you do? Cutting the woman open (here, a scar can be very dangerous) and she might not even have a living child afterwards. And what if the baby survives: she has barely money to buy food for herself and is so alone that it is very difficult to take care of the baby. And how compliant will she be in treating the baby to prevent transmission of the virus? But it is so hart to decide to let the baby go… so cruel. I did not feel comfortable with it. And I could see in the other faces that nobody really liked our decision even though we thought it was the only possibility. So we waited and waited, but instead of dying, the baby’s heartbeat went up again and remained perfect for at least 30 minutes. Somehow it was recuperating from the stress of augmented contractions and all the pushing and pulling. We had sent the OR-team home again. But now we decided we should give it a go and we called them back to the hospital. And you know what happened: the baby was born crying and well! We will not know the brain damage caused by the stress the baby has been in. But I hope and pray that with plasticity of the young brain, the child will not have too many consequences. Though I will never know. It is a beautiful boy, very awake, looking around and drinking eagerly at his mother’s breast. I wish this child might be like a little light in his mother’s dark live.
And today I was really sad about another case. This young woman came in with contractions. She has had a cesarean section here at the hospital last year and now, within a few months she was delivering for the second time. Her uterus was threatening to rupture (you can see that even from the outside of the belly) so we had to do a cesarean section again. The baby was born healthy and find and we sterilized the woman on her request. After the operation I wanted to help her to have the baby breastfed. But she denied it. She did not want the baby. They were poor and could not effort taking care of one more child. It is not common here to openly say that you do not want your child. We have had mothers that did not want the baby, but would rather let it die than admit it or let the baby adopt. That is why nobody at the hospital really knows about the procedures for adoption. And of course internet did not work so I could not check that out.
But it felt so terrible. You think everything is alright and suddenly everything turns for worse. They asked us to take the baby, but still we could do nothing. While there are so many people that would love to have a baby (in the same room there is a mother whose baby died during birth). One of the doctors finally told us that she would have to wait at least a few months before she could let the baby adopt. We gave the mother all the baby clothes we had left and begged her to start feeding the baby until we would figure something out. We hope that she will start loving her baby, but in the harsh conditions here, I somehow doubt that.
She is also still feeding her other, 10 month old, baby and by the looks and feelings of her right breast, she might also have breast cancer. But we have no possibility to check that out here. She will have to go to a referral hospital to have a proper diagnosis, and treatment (chemo and radio-therapy) is only available in Addis Abeba and so expensive, that those people will never be able to pay for it.
So now the ward is crowded with mothers recuperating from their cesarean sections and we are quite busy with all this and we have a septic woman who would be on intensive care in Europe, one woman had bleeding 3 weeks after delivery and lost so much blood that she went in shock, an eclamptic woman (epileptic seizures for 24 hours) miraculously recovered, but one woman with malign ovarian cancer was discharged with palliative treatment (paracetamol, can you believe that?!). So the happy endings and the dramas are holding hands at the hospital those days. And all this while in my last days I had hoped to get any further with all my plans. I hope my successors will take up some of it.
As I already told, many times, the distances are the actual threat. For example the eclamptic woman came from very far (If we ask distances they often ask back if we want to no Birr or kilometer, because the people do not exactly know how many kilometers away their home is, but they know how many Birr it would cost to come by bus, and that gives an indication of the distance) and had first gone to the health centre near her village. There they would not know what she had and send her to us, but did not
But we still have enough free time to enjoy. Shewaye came to cook for us again yesterday night. We had delicious Injera with 7 different sauces. And I tried on all the attributes and clothes of an Ethiopian countryside woman that I have gathered. Moges and Melesse really liked it, but after the photo session, I changed back to “Anna”.
Today we went to another family for coffee ceremony and it was lovely again. All the houses are different and the people really try their best to make them cozy. And I reserved some hotels to stay at when I will have my short travel to some of the touristic highlights. Although at the moment I do not feel like leaving Motta. I try not to think about it, but the time is coming that I will have to say goodbye. I have one week left here. And I am curious what it will bring. Hopefully less rain than the past 2 days. It reminded me of our Dutch autumn, while raining season should not start until June…
About the photos:
You can see me disguised as traditional Ethio-woman, then there is Shewaye with her mother and two sisters Tigist and Mahalit, the poster I saw in a small shop where we buy our eggs, it looks strange but it is like this in real. On the next photo you can see Selam in the tea-house. She works there every day from 8 am till 9 pm, from Monday until Sunday!!! The car is from a company selling anticonceptives. It comes every few weeks to the shops in town and also to the hospital, but somehow there is still so little awareness of family planning. And finally the hospital soccer team and me and some midwifery students supporting them (unfortunately they lost against the team of the technical school of Motta.) Here, almost all schools, hospitals etc have a football team and a volleyball team. It is meant for teambuilding and as far as I can see it works. The employees of the hospital all know each other and usually get along very well.
Kisses and hugs for all of you,

Anna

PS The mother who did not want her child now accepts it and is feeding it well.