The guard greets me at the hospital gate as I weave my way around the groups of patients and relatives waiting around the outpatients department. Galmi Hospital is laid out like a giant letter “E” with three separate parallel wings. I head for the middle section, the Maternity ward. It’s a long, white-tiled corridor, with a high roof and patient rooms on each side. It feels new and clean. People with colourful outfits line the corridor on each side, waiting with their sick relatives or waiting to be seen.
It’s my first day on the ward and I’m feeling pretty apprehensive. I can’t speak French or Hausa, and I’ve heard how sick the patients here can be. I’m aware of all the sets of eyes watching me as I walk through the ward!
I meet Saadi, who is the head midwife here. She realises quickly that I’ll have no hope communicating myself and finds Tesala to interpret for me. We start the ward round after a prayer. Saadi has been running the ward and clinic with support from two of the long term doctors here, and so she is very good at letting me know the protocols to follow and help with decision making. Tesala tells me she has been here since 1978. She has a big voice and a big personality and helps me feel a bit more confident.
We see many women who have severe anaemia due to malaria, many of whom have lost their babies as a result. Most of them need daily blood transfusions to gradually improve their haematocrit to a safe level.
There is a mother who had obstructed labour in a village, and despite the baby’s head being on view for many hours she did not give birth. She was referred by her clinic to Galmi and had a Caesarean section. When I review the baby he is struggling to breathe despite antibiotics and oxygen, and he has a big infected haematoma on the back of his head. Over the next few days the baby gets sicker and sadly dies. The mother has paralysis of the muscles in her lower legs from pressure on the nerves in her pelvis, and she has urinary incontinence. I think she may have developed a fistula, a hole between the bladder and the vagina.
It is extraordinary how stoic the mothers are.
The midwives and assistants are all trying hard to teach me Hausa and laughing at my attempts. I’m enjoying the challenge and trying out some greetings with the patients on the ward round. The week is full of surprises – we had some premature twins, and then a set of triplets! They are doing well so far. One lady had a ruptured ectopic pregnancy with lots of blood in her abdomen. She is also doing well after surgery.
The other doctors here have been really supportive in helping me find my feet. Diagnostic uncertainty is magnified many times when there are such unusual conditions and limited investigations available. All the staff have been forgiving of my initial confusion and uncertainty. I’ve been so appreciative of their skills this week.