Trying not to act surprised

Categories Medical, Niger

My eyebrows have been getting a good workout at Galmi Hospital. Every day there have been surprising situations that have made them rise incredulously despite my best attempts to appear unfazed.

On my way back from lunch I see Tassala standing at the hospital gate, waving urgently for me to head that way. I was expecting to meet her back in the outpatients clinic but maternity have called – they have an emergency. There is a woman who is six months pregnant and desperately short of breath. Her palms and soles are the same colour as mine, and her conjunctiva are white. Her blood test shows a haematocrit of four percent, severe anaemia almost certainly due to malaria. I’ve never seen someone so anaemic before and it looks like she might die. We cautiously transfuse blood, being careful not to overload her heart. The next day I’m surprised by how much better she looks. We treat her malaria and give her a unit of blood each day.

A woman arrives just as I farewell the midwives after a long day. She gave birth at home yesterday but the placenta is still inside. She has a high fever, and the blood test shows she is severely anaemic. There’s no bleeding, so we give a unit of blood before trying to deliver the placenta. When we try, it is stuck and the uterus is tightly closed around it. I take her to the operating theatre and find again that the placenta is stuck fast to the wall of the uterus – placenta accreta. I do my best and remove as much as I can but it is difficult and she bleeds a lot. She recovers slowly over a few days with more blood transfusions and antibiotics.

The midwives call me urgently to maternity in the evening. A woman has come in from home in labour, but the baby’s knee has prolapsed out. I run the ultrasound over her abdomen and see why: the baby has a massively enlarged head filled with fluid. There is a strong heart beat so we take her for an emergency Caesarean section. The midwife pushes the knee up and I deliver the legs and back. We all see the spina bifida defect on the spine at the same time, and know that the chances for this baby are slim. The head feels huge and is difficult to deliver, tearing the uterus right up to the top. The baby is still alive but doesn’t breathe by itself at all. After five minutes of resuscitation the midwife asks if she should continue. I shake my head and wonder why I am in a position to make this decision. I sew up the torn uterus and make the second difficult decision to tie the Fallopian tubes – a ruptured uterus in future pregnancies might be fatal. Although the woman does not have many living children she nods agreement as the anaesthetist explains.

I’m reminded that Jesus also came across many surprising situations. Ten lepers at a time, women who were rejected by society. I’m not sure if he raised his eyebrows, but he was willing to touch and heal people. I’m so encouraged by the team of people here at Galmi who emulate his example daily. Hospital work here is full of surprises, but the team are always willing to care for those that might otherwise be abandoned.

Andy is a GP obstetrician living in remote Northern Territory, Australia. He is totally outnumbered by girls in his family - one wife, 3 daughters, 2 chooks.

7 thoughts on “Trying not to act surprised

  1. I can see your face SO clearly with your raised eyebrows and furrows between your eyebrows. Although I only ever saw it in light-hearted situations. Mark has always been floored by your ability to stay extremely calm and unfazed when things are going pear-shaped, he will love to read this when he gets home. Love to the girls xxxx

  2. Wow Andy I had no idea you were planning this adventure. Amazing stories. How are your girls? I studied with Anne Sophie at uni – say hi from me. Looking forward to more blog posts. Take care and love to the family, Em & Ben

  3. sending ewes luvs and keeping ewes in prayers, altho we on second week of holiday here, want to let ewes know that from the frist day of Georgie being away from school, the class individually have been praying for ‘Georgie and her family overseas working in Africa. please bring them safely back’ – I loooove the hearts of little peoples!! xoxoxoxo

  4. The time since you left Gove seems to be flying by…You are all in our thoughts and always covered by prayer. Thanks for your descriptive news.

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