Every second week, MAF flies a team of medical and dental workers from the Kompiam District Hospital to one of their satellite health facilities to conduct a 24 hour clinic. In May, a team of 5 went to Yambaitok. There they’ve seen 58 patients for medical needs, immunised 47 people and attended to 6 people with dental problems. Besides this, they’ve done oral education and dental hygiene awareness talks, including tooth brushing activities with 30 children and 15 adults.
One of the patients seen, was Josephine (name changed), a first-time mother who had a difficult labour and whose baby didn’t survive. Reflecting on Josephine’s story, Dr Rebecca Williams, a residential doctor at Kompiam District Hospital pondered a few “If only…“-thoughts. Below, she shares Josephine’s story (name changed to protect identity).
Josephine, perhaps 18 or 19 years old, had got married recently, had fallen pregnant and as far as I could tell had carried her pregnancy to term. On Friday 3rd May, she thought she had experienced a rupture of her membranes and was anticipating that she would go into labour shortly. However, she had minimal pain over the weekend and by Monday (6th May) morning nothing much was happening, so the Community Health Worker (CHW) Buka, who is from the same village as Josephine, made a decision for them to walk to Yambaitok, where they would be able to refer her on to Kompiam on the MAF flight which would have dropped us on Tuesday (7th May) for our patrol. The walk from Josephine’s village to Yambaitok takes a full day. About 30 minutes into their journey, Josephine could no longer walk, thus CHW Buka directed some of the people who had accompanied them to build a traditional stretcher from bush materials so that they could carry her to Yambaitok.
In the evening, when they arrived in Yambaitok, Josephine’s contractions started and CHW Buka encouraged her to push. Her labour took a long time and after a few hours, Josephine became very weak. With minimal obstetric experience or training, almost no delivery equipment, by torchlight, in a cookhouse, CHW Buka did all he could to help. Around 11pm that night, a decision was made to do an episiotomy (this is an incision in the perineal region which is sometimes used to create more space for the baby’s head to pass through). However, despite the episiotomy attempt, the baby did not deliver. After another two hours of struggle, finally Josephine was able to deliver her baby; by now it was 1am on Tuesday morning. Josephine’s baby only took two gasps of breath before it died. With the infant now deceased, CHW Buka then sutured the episiotomy with whatever available suture he had. Also, some antibiotics were given to Josephine before she could rest.
When we came a day later, I saw Josephine lying on the grass in the house where she had delivered, pale and with a forlorn look on her face. There were so many “if onlys” about her story: if only we had come sooner, if only she had made the decision to come to Kompiam earlier… But then we are reminded that the outcome could have been tragically worse: if nobody had carried her to Yambaitok, if CHW Buka hadn’t been there and had not done the episiotomy and sutured her afterward.
Unfortunately, Josephine’s story is just one among so many others who have had to face similar situations, some of whom have not survived.
After examining Josephine, we took her back to Kompiam with us to replace the sutures and do a proper surgery on her in the theatre. We repaired the episiotomy cut. We were keeping Josephine in the hospital to see how she recovers and to educate her in regards to reproductive health as well as offering family planning for her. She recovered well and did not develop any fistula’s. We put in an implant for her, which will cover her for five years before she is able to fall pregnant again.
We operate on women with obstructed labour to prevent a fistula and thereby preventing them from leaking urine and often being treated as outcasts in their villages. We encourage all pregnant women to come to the hospital two to three months before their expected delivery so that they can deliver their baby with the help of medical doctors and midwives.