In my position, “the flying paediatrician”, covering the two projects of Chaman and Dera Murad Jamali (DMJ), I am constantly away from one or both projects. Remote management is something that I have to get used to. As a clinician, I am reliant on my first hand interactions with my patients – listening to the history from the attendant and seeing and examining the patient myself. Learning to rely on someone else’s assessment has been a real challenge. Thankfully I have some excellent doctors who become my eyes and ears when I am away from the projects.
One of my roles here is education and training of the staff – but often I am the one asking for their advice. Many of these doctors have worked in the project for several years and their expertise surpasses mine in many scenarios. Before coming to Pakistan, I had never seen a case of neonatal tetanus, but here it is seen far too frequently. And I could count on one hand the number of cases of TB and malaria I had seen before coming here, but here, that is just an average week. Every day I am confronted with new situations that I have not been confronted with back home.
This week I have had the opportunity to work in Peshawar in a project with another MSF section – so now I am covering three projects. While it is difficult to be away from my projects in Balochistan, it has been really great to see a different project in an urban setting such as Peshawar. This project is in a women’s hospital and I am working their newly established newborn care unit. It has 12 beds, and like the newborn units in Chaman and DMJ, it is usually over capacity.
This month has seen a run of triplets. And on the early hours of Friday morning (5am to be exact), came the third set of triplets in as many weeks! I get the call from the neonatal nurse that a woman has come into the hospital at 29 weeks gestation with triplets, all in breech position….and she is in labour.
So I jump out of bed, throw on my shalwar kameez and we rush into the hospital – those first few minutes are so crucial and we do not want to miss them as these triplets are likely to need our help. Thankfully we arrive in time.
We rush to theatre and it is strangely quiet - no C-section is happening – the decision has been made to let this woman deliver the triplets naturally without C-section. I am a little concerned as I am not used to seeing vaginal breech deliveries, let alone for premature triplets. So I anxiously set up the three resuscitation tables. But within only a few minutes the first triplet arrives, a little girl weighing little more than 1kg, but after a little help she gives a hearty cry.
Then comes the second not far behind, and then the third..….. three little but healthy triplet girls. The very skilled local obstetric doctor managed to deliver all three breech triplets normally and avoid C-section, which is an excellent outcome for this woman.
So again, I am reminded that I too can learn a lot here in Pakistan. And with the arrival of the third set of triplets in three weeks in my third project, I have learnt that all good things come in threes!