At Grand Ward Rounds today they discussed a tragic story of a 45 year-old gravida 9 and para 7 woman from Mozambque who used a local herb that acted like Pitocin to induce labor.When she did not progress she consulted an “African Doctor” who could not manage her and she went to a local healthcare center which was unable to help her.She crossed the border to Tengani Health Center in Malawi, by then she was bleeding heavily.She was quickly transferred to Nsanje District Hospital where she was found to have suffered rupture of her uterus.During surgery, the baby girl was stillborn and there was an anterior uterine rupture.The rupture resulted in severely torn tissues and the surgeon was unable to repair the uterus, a hysterectomy was performed.She bled heavily and unfortunately there was no blood in the blood bank. She was described as pale and in shock and stopped producing urine but was still conscious.The last we heard was she was transferred to Queen Elizabeth’s Hospital in Thyolo about four hours away.A number of factors resulted in her predisposition to uterine rupture, multiparity, prolonged labor, cephalopelvic disproportion…
There is a severe shortage of blood in Nsanje. A few nights ago a woman presented with severe anemia with hemoglobin of 2.7gm/dl. Her relatives were asked to donate blood, one of them had HIV, malaria and syphilis infections and a second had malaria. The clinician chose to transfuse her with the malarial blood after the patient received her dose of quinine.
Sorgin is at least 50 km away from Nsanje proper, a health center which was built in 1999 has a set-up exactly like Tegani or Mbenje. It is however a lot cleaner and the structure of the building is sound. The woman who cleans the maternity unit told me that they have run out of soap, chlorine or any kind of cleaning agents. Their sterilizer is broken and she sterilizes the instruments outside with a wood fire for two hours. A baby was just born not too long ago. Outside the unit a baby goat was sucking on its mother’s teat with a violent jerking motion. By lunch time when the heat was getting fierce the mother goat was lying in the shade while the baby goat gamboled on the dry grass.
The ART Clinic was crowded with the registration clerk and the nurse attending to the patients in the same room.The clerk spread the charts all over the table making it difficult for the clinician to function.We suggested that he should register the patients outside this room to enable the medical officer or the nurse to have more space to see the patient. As always invariably one or two patients would present with signs and symptoms for tuberculosis in one of these clinics.
On our way back we checked on the progress on the bridge at Mtaya Moyo, more rocks were packed on the foundation. The locals call the river here Mtaya Moyo or lose one’s life because during the floods the boats are often overturned and many of the passengers are drowned.