Tom is Alive

African sunset

None of us men could even begin to imagine what it would be like. Maybe you ladies could. Try to imagine living in a family; being the first of four wives all living in the same compound; there are plenty of kids from babies to teenagers; you’ve delivered fourteen babies and they’re all dead.

M family home
Usually the husband had the largest house and each wife with her children had a smaller one.

Now you’re pregnant again and your heart is so full of hope!

Your husband loves you, but you share that love with three other wives. The months go past, your belly fattens, the kicks start coming, your hope and your fears grow and jostle in your mind. Seven months gone, only two more to go. A few days pass and your waters break. Oh, no, surely not another so tiny that it won’t survive,

But your husband loves you, so, although babies are usually born at home, he gets a horse and cart and takes you to the nearby infidel’s hospital so that maybe you’ll get a live one at last. He does really love you.

They have funny customs, but they look after you and you deliver a scrap that when you see him you can’t believe that he can live, and he certainly wouldn’t have in your home. They take him away from you. Not to say they are nasty, they care for you, express your breasts (both of them) and feed him through a little tube down his nose. They make another uterus for him out of a card-board box lined with cotton wool. They put an electric light in the end to keep his new home warm. They run oxygen into the box at first but after a few weeks decide he doesn’t need it any more.

IMG_2937 copy 2
About this size he was taken home.

One of the foreign women takes him to her house each night because she explains that she wants to make sure he gets his 2-hourly feeds at night. You can see she loves both of us and wants him to live. You learn her name is ‘Hirut’ but lots call her ‘Ruth’. Her own two boys love to come and watch him with you. They love him, you can see, like a brother.

Gradually they teach you to sponge him down, and to feed your own milk down the little tube. Eventually you’re allowed to hold him for a while. He holds your finger; he pees into your face as only little boys can; he takes your heart in his hands and your hope grows. But then goes back into his box.

Then your breasts dry up and they start to feed him in a powder from a tin which they mixed with boiled water and let him drink from a bottle with a breast slipped over the end. They teach you to test the warmth of the milk substitute by dropping a bit onto your wrist. They always clean up the bottle and the little ’breast’. They explain this is necessary and teach you how to do it properly. They explain it is very necessary to do all this.

He’s soon no longer living in his box. They teach you to do it all so well. He grows so beautiful. You see Hirut would love to keep him, she has spent so many nights and so much effort, but she just encourages you and gives him lots of little clothes that her own boys wore. All the hospital love and they call him Tom. He kicks, he laughs, he cries, He’s beautiful. It’s time to take him home. The nurses give you a little party and then your loving man takes you home. Everyone there is excited for you and they love him.

Five days later, he’s running a temperature; another two days later little Tom is dead.

No one at home boiled bottles and their water came from the creek in which people bathed and near which they did their ‘business’. He got diarrhoea, started vomiting and died.

Later you got the courage to go back to the hospital and told them the news – they cried with you, and hugged you and loved you. As you left you missed hearing them say to one another ‘It was all our fault. We should never have been so clean.’

But sadly, Tom is dead.

A view of Obstetrics

babies

 

 

Having a family is exciting! Maybe not all beer & skittles but fantastic!

 

 

 

Modern obstetric care in the ‘so called’ first world countries is on the whole excellent. In quoting statistics one must remember the old adage ‘lies, damn lies and statistics’. The internet tells us that in the best countries the maternal mortality rate is 2/100,000 live births. In Ethiopia it is 421/100,000 live births, and I’m sure that it was worse 50 years ago. Around the world there is apparently an obstetric tragedy every 11 seconds. I cannot find figures for maternal deaths when the baby is born dead. That is the world I entered in 1968. This doesn’t include those who live with vesico-vaginal fistulae, of which there are 9,000 new cases annually in Ethiopia (quoted by the late Dr. Catherine Hamlin); nor those who survive ruptured uterus. I’m sure many of these died before they reached a hospital where they could be operated on.

I took out the figures in Soddo (my second long stay in Ethiopia) over a year period and we had a 95% survival rate of those who reached hospital alive. I had reopened the hospital in Soddo in 1993 after the country was freed from the communist era. I was the only surgeon there.  I was on call 24/7. After a while we had an obstetrician there who did the day O&G work and was on call at night every second week for obstetric emergencies. But initially I did them all , and later out-of-hours cases every second week. I was also called in to deal with the situation if there was also a ruptured bladder, which occurs in about 10% of cases.

I shall only mention one case here, as I know medicine isn’t everyone’s ‘cup of tea’. My children say they were brought up on such things around the tea table.

In the countryside antenatal care was almost non existent. We ran such a clinic, but few attended and everyone was so busy we didn’t chase things up as hard as we ideally should have done. Most babies were delivered at home. People didn’t come to the hospital until things were obviously seriously wrong. If you lived, for instance, 50km from the hospital, for the majority, there were neither ambulances nor roads so they had to be carried on stretchers over mountainous tracks and crossing waterways. People were frightened to travel at night; and it took, I am told, above 20 people to carry the patient, sharing the work; so it is not surprising that people arrived late.

My first case of ruptured uterus came within a few days of my arriving on my first time in Ethiopia. I was the only doctor in the place. The story apparently was that the labour made no progress, so the native healer tried to do what we call an internal podalic version. In other words by putting his/her hand inside the uterus they intended to turn the baby to get the feet at the bottom so that they could have something to hold onto to attempt to pull the baby out. I don’t know how but whoever it was managed to tear up the front of the vagina and uterus as well as the back of the bladder from top to bottom, and they still could not deliver the baby. The patient obviously rapidly became much sicker and she was brought into the hospital. The baby was dead, but I repaired the long internal tears and she recovered.

abd in ruptured uterus
The double bubble is what is usually seen in a ruptured uterus

Unfortunately she developed a small fistula for which she was sent to the ‘Hospital by the River’ in Addis. She did well and was later delivered of a healthy child. I’m not sure where she fits into the statistics. Later when I was met with both a bladder as well as a uterine tear I used to bring down some mobilised omentum to separate the uterus and the bladder.