Rainy season is nearing its end in Tissi, the little village in Chad on the border with Sudan and with the Central African Republic. Back home rain affects our lives to a certain extent but not in the same way it does here.
The wadis fill up with water and it is often impossible to cross them. Wadis are river beds which are empty during the dry season but become rivers during the rainy season. It proves difficult for people to come to the hospital due to the presence of these wadis and due to all the mud on the roads which in fact are not real roads but tracks. When the most common form of transport are donkey carts getting to places becomes hard, wheels and hooves get stuck in the mud.
One severe consequence of the rainy season is malaria, the world's most important parasitic infectious disease. Another is malnutrition. Stagnant water is a perfect breeding ground for the anopheles mosquitoes, the ones which transmit the disease. We saw an evident increase in patients coming to the hospital with malaria.
In the antenatal clinic all year round we do a test to see if the pregnant woman has fallen ill with this deadly disease. Women who are diagnosed positive in the antenatal clinic are sent to the hospital. Here we treat them with the required drugs.
A lot of women do not want to stay in hospital and we cannot force them to so we give them the drugs to take home. Other times, if they are seriously ill but do not want to stay, we explain to the woman and the husband (or whoever is accompanying her) the need to stay in hospital. At times they accept, at others they still refuse admission. Many women who have malaria are often anemic. It is not easy to see a patient go back home when she is weak and anemic.
Despite the rains activities have continued as usual in maternity.
Collaboration with the three national midwives has been close and interesting. I learn a lot about the Chadian culture just from talking to them. We had a long discussion one day regarding placentas and how different cultures dispose of them in different ways. One of them told me that the placenta of her last born child is buried in the ground in front of her bedroom and she didn't have to go through long procedures of signing of papers to have it!
Midwife Souat and the rain © MSF
Early one Sunday morning we received a woman who had travelled all night on a donkey cart. The midwife called me with panic in her voice so I rushed to the hospital.
When I arrived the patient was lying on the delivery bed and I could see a cut and clamped umbilical cord protruding from between her legs. I automatically assumed the woman, called Kubra, had a retained placenta. Usually the placenta should be delivered not long after the birth of the baby but sometimes it may happen that it does not and it needs to be removed by medical staff.
However the midwife soon told me that the situation was the exact opposite: the placenta had been delivered but the fetus was still in utero. Because she had delivered the placenta the baby was no longer alive as it is the placenta which feeds the fetus and supplies it with vital oxygen. I was surprised Kubra was conscious and that the her iron levels were not too low. She had most probably had a low lying placenta (placenta praevia) which she had delivered during her journey on the donkey cart.
In Europe she would have had a c-section. Had she come to MSF before labour started we would most probably have been able to save her baby by transferring her for a c-section. While examining her I realized that she would not be able to deliver vaginally because the baby was in a difficult position. That was not the only problem: despite not having any contractions Kubra was in a lot of uterine pain, something I had seen a lot of while working in the Democratic Republic of the Congo in women with a uterine rupture. I was sure I could palpate the rupture on this woman.
We had to evacuate Kubra by plane to Abeche where MSF has another project with an operating theatre. Tissi does not have an operating theatre which makes some situations, like this one, quite nerve racking. Fortunately four hours later we managed to the fly her out to Abeche however I was not sure she would come back alive.
A few weeks later Kubra returned to Tissi feeling well. It is true she had lost the baby but she was alive and seeing her getting out of the plane was a big emotion for the midwife who had accompanied her to Abeche and for myself.
Kubra and her mother ©MSF