Friday, May 22, 2015

Scenes of a Mulago morning

Today's post was supposed to be a lighthearted one, I promise. I'm well aware that no one likes to read a string of downer posts all in a row. Sometimes you've gotta cut the preachy stories with goofy pictures of lizards (or giant storks! Coming soon), or by golly everyone just gets sad.

But there has to be just one more I-can't-believe-that-just-happened Mulago story from this morning, mostly because I can't stop replaying it in my head. About 9 AM, I strolled into the Gyn Triage Area, well-rested and ready to tackle the patient crowd, and stepped into the little curtained-off exam room. There are two basic beds there, and it seems that before the doctors officially arrive in the morning, the nurses often eyeball the crowd and put the two sickest-looking patients in first. Today, coming in to put down my backpack, I saw that one exam bed held an extremely uncomfortable-looking woman, lying on her plastic sheet, wide-eyed and totally alone. As I walked up, I noticed that she 1) seemed to have a 6 month-pregnant belly, and 2) upon closer inspection, was actively delivering a breech baby on the gyn exam table. 

Note please that this is not the Labor and Delivery area - there's nothing in the Gyn triage area along the lines of, say, baby warmers or post-delivery bleeding medicines. But here we were. I snagged some gloves, got down beside her, and delivered a very small baby girl within about 30 seconds of walking into the room. 

My hands full of very premature baby, I called for help, for tools, for someone to just hold the baby so I could check on the mom's bleeding; no one came, including the faculty doctor I had just walked by on my way in. The baby gasped a few times; I tried to dry and stimulate her, while becoming increasingly aware that this wasn't a place she could survive. (She almost certainly would in the US, or at least would've gotten a shot.) I briefly imagined somehow running with her across the open air courtyard to the NICU, trying to find a baby warmer or a tiny oxygen mask or just a pediatrician of some sort, and knew as soon as I had the thought that it was a non-starter - even if I somehow managed to detach the baby (still no one had arrived with anything to cut the cord), I've seen the Labor and Delivery staff here give up on babies much larger than this one.

This was all interrupted by the mom starting to bleed quite heavily. It probably only lasted a minute or two, and resolved with some basic Ob tricks, but I will say - hemorrhage without a way to give medicines through an IV is a scary thing, but hemorrhage when you don't even have any meds to give is a little heart-stopping. 

At this point, there were no more gasps. On the patient's request, I showed her her now-still baby girl; she seemed calm, practical, probably mostly glad not to be in labor any more. The faculty doctor strolled in at this point, surveyed the scene, and helpfully told me that I had gotten blood on the sleeve of my white coat. And by the time I came back from bleaching my sleeves outside the OR, the patient was gone, moved out so that another woman could hop up on the exam bed.

What kind of place is this? How can a patient like that not merit the tiniest bit of extra fuss or attention? Does this just happen all the time, and is shocking only to me? 

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