Fieldset
On the Edge

"A 33 year old pregnant patient presented in shock due to heavy bleeding. In her short lifetime she had already birthed 7 babies but had only 3 living children. This is all too common a story in the population of women we see daily in Jahun."

Today we saved a woman’s life.

This statement doesn’t come from a place of ego or self-fulfilment. It’s a statement of truth. As I reflect on this I find myself more and more in awe of the resilience of the human body and spirit and the limits to which we can be pushed.

A 33 year old pregnant patient presented in shock due to heavy bleeding. In her short lifetime she had already birthed 7 babies but had only 3 living children. This is all too common a story in the population of women we see daily in Jahun.

Jahun Hospital, heading towards the delivery room and intensive care unit

The midwife ushered me over with a sense of urgency. The patient’s blood pressure was low, her pulse rate was high, her abdomen was distended and tense, her uterus was full of blood clots and the baby was already dead. Her placenta had prematurely separated and the baby was no longer receiving the oxygen he required – a pregnancy complication known as a placental abruption.

The woman’s eyes communicated a sense of fear and exhaustion while the skin folds beneath her eyes indicated how much blood she had already lost. They were ghostly white, devoid of the normal healthy red colouration. Her haemoglobin level on arrival was 3 and dropped to its lowest reading of 1.9 as we continued the resuscitation and whisked her to the operating theater (N.B. a normal haemoglobin reading is 12-16).

One of the two operating theaters

Once the patient was under anaesthesia, I started the surgery. I delivered the stillborn baby via C-section and the placenta delivered without any additional traction. It had already completely separated. The uterus was still extremely distended. Normally after delivery the uterus should contract and it is this shrinking of its size that closes off the large blood vessels that feed the pregnancy. The uterus is a muscle and like any muscle it can fatigue. Her uterus was beyond exhausted.

I knew if there was any chance of survival for her I needed to stop the bleeding. I looked at the anaesthesiologist over the drape and scrub nurse across from me. “Clamp,” I said as I put out my hand to receive the surgical instrument. I started the hysterectomy – a surgery to remove the uterus and cause of the bleeding.

Family and community members extend their arms and donate blood so that there is always a plentiful stock available for our patients.

With the help of transfusions and more fluids, the patient’s vital signs improved. The uterus was removed and the bleeding subsided. I took a few seconds to breathe a meditative breath and a few more minutes to diligently check every surgical area that could bleed as my heartbeat slowed back to a normal rate. I finished the surgery and we transferred the patient to the recovery area and eventually to our basic ICU.

Family members await their loved ones admitted to the hospital

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Epilogue

Before working in Jahun, I would never have believed that a person could survive an event of this magnitude. Not only that but she recovered speedily from surgery and has since been discharged home to her family.

Critical patients arrive at our hospital multiple times a day. Often times there are many obstacles they must overcome in order to reach us, whether it be great distances, funds for travel, the need to care for their children, a lack of permission from their husband or a host of other factors.

I remain amazed by the resilience of these women; how their bodies work overtime to adapt and rise above the challenges, the strength of their spirit and the ever radiating warmth of their smiles.

A woman walks in the streets near the hospital