Fieldset
After the fight: Returning to routine in Bangui

After nearby conflict forced his MSF team to evacuate a maternity hospital in Bangui, Central African Republic, Finnish anaesthetist Kariantti writes about returning to routine in the days following the fighting.

That evening, the fighting continued into the night before finally ceasing.

To my great relief, our patients and staff had stayed safe. Some staff had left the hospital, but most decided to stay, meaning the hospital was able to function throughout the heavy fighting.

The next morning, we could return to the hospital ourselves. We found everything the same as we left it.

Even Julienne, the patient we had treated for an infection, was feeling better and her tachycardia had passed.

We changed her dressings for the last time as the gynaecologist was able to close her wound. This made her extremely happy and she was singing for the rest of the day while she was waiting to be discharged. She would still have to come back to have the wound inspected and she would possibly need treatment for her hyperglycemia – which was very hard to come by in Bangui, especially right now.

In the following days, things calmed down quite rapidly in the city's PK5 district and we could resume our daily routines. Soon the fighting itself started to seem like a distant memory.

Emergency caesarean

Some days later, the morning started with an urgent caesarean section. The mother, a 16-year-old woman, had placenta previa – a condition where the placenta attaches near or over the cervical opening, putting the patient at risk of severe haemorrhage during labour. She had bled quite heavily.

The baby was born weak and pale, so we rapidly started resuscitating.

In addition, the baby was in a transversal position, meaning she was sideways rather than upside down in the womb.

The baby was born weak and pale, so we rapidly started resuscitating. She responded well, and, within a few minutes, she was already much better and could be transferred to the ward for surveillance. Luckily, the young mother didn’t bleed that much in the operation and she got better after a blood transfusion.

Although these kinds of incidents are quite frequent in the Castor hospital, my thoughts remained with the new baby and the young mother. What a way to become a mother, and at that age! But, on the other hand, at least they were both fine.

Ectopic pregnancy

In the afternoon, we had to operate a woman with an ectopic pregnancy – the embryo had attached higher up than normal, inside the fallopian tubes.

The woman was already in her fourteenth week of pregnancy and the foetus and placenta were both fully inside her abdomen. The tissue was attached deep in the pelvis making it a technically very difficult operation. She kept bleeding heavily throughout as there was quite a lot of oozing from her tissues.

Our international gynaecologist was able to perform good hemostasis, a procedure used to stop bleeding, but still, the haemorrhage during the operation was close to two litres. We managed to get the patient a few units of blood, so both her blood pressure and other vital signs started to stabilise.

We continued monitoring her in the recovery room for some time after the surgery as we still needed to give her one more unit of blood as her haemoglobin level was still quite low after the blood loss.

Later in the evening, she was finally stable and we were able to transfer her to a normal ward to recover from the big operation. Eventually, she recovered well.