January 26, 2014
Dear Friends and Family,
We apologize if you are receiving this newsletter twice. We made a mistake when we sent the newsletter last night and only 1/3 of our subscribers received it. If you received this yesterday, please ignore this post.
Please scroll down for the photos!
So much has happened since we last wrote it is hard to know where to begin. I was awakened early this morning by Surafel, one of our PAACS surgical residents. He had a critically ill pregnant patient in the emergency room. The previous day she had heard the news of the death of a family member and fell face forward on the ground hitting her pregnant abdomen. Shortly thereafter she started hemorrhaging and was taken to the closest hospital. She was transferred to us because the hospital had no capability of giving her blood. We saw her 18 hrs after the onset of her bleeding. Her history revealed she did not remember her last menstrual period. This was her 4th pregnancy. She had one living child and then had two stillborn children delivered by caesarean section. Upon arrival she was very pale, in shock with a blood pressure of 60/40. She was lying on a bamboo mat. Her thin dress was saturated with blood and blood-clots. Her abdomen was tender. She could be aroused when asked a question but could not understand English, Amharic, or Wollatia. She spoke only Hadea. In acute situations it is difficult enough to care for a patient you can communicate with but without the ability to verbally communicate the situation becomes extremely frustrating for the doctor as well as frightening for the patient. Her husband spoke limited Amharic so tried to help out. An ultrasound revealed that she was roughly 27 weeks pregnant and the baby’s heart rate was very low at 60 beats per minute (normal should be between 120 and 140). She had a low lying placenta which was separating from her uterus. I informed the husband that his wife was critically ill and that she had to have emergency surgery. I was doubtful that we could save the baby. His response was, “Please, do whatever you can to save my wife’s life.”
Her hematocrit was only 11 (normal near 40). I asked the lab technician to prepare 4 units of blood for her. She had IV fluids running in her arm and neck. I knew that if she went to the OR without proper resuscitation she would not survive the operation. I ran to the operating suite to wake up the nurse anesthetist and surgery crew and informed them of the emergency situation that we had. Afterwards I ran to OB to wake up my sleeping midwives as well to tell them to get ready for an emergency caesarean section and to prepare to resuscitate a baby. I then ran to the guest house to wake up Dr. Magdy Khalil, an excellent anesthesiologist visiting from Indiana, for help. Eyasus. our nurse anesthetist was taking his first night call of duty and I knew he needed help. I also ran to the lab to pick up the second unit of blood and took it to the OR where it could be warmed up and ready for use. When the patient was stabilized sufficiently, a CS was performed under general anesthesia. We delivered a life-less little boy. Dr Khalil, Zinash our midwife, and Isaac a visiting medical student, all tried to revive the baby but sadly he did not make it. During the surgery our patient lost over 1000 CC of blood. She received her third unit of blood by the end of the case. She is now in our ICU but still very critical. By God’s grace and mercy she will pull through.
If ragged clothing is any indicator, this patient is very poor. They did not have enough money for her medication therefore she was placed immediately on our maternal benevolent fund. Her care is going to have to be fully underwritten. Please consider giving to the maternal benevolent fund, making it possible that patients like her may receive care.
On Friday we had 7 surgical cases, three of which were CS, (2 emergency) and two hysterectomies. One patent had a molar pregnancy; the other had a large pelvic mass. We also repaired a large rectal vaginal fistula. The patient had delivered in a health center four months earlier and tore through her vagina and rectum. They had attempted to repair the tear but the repair broke down leaving a cloaca. A cloaca is one is one shared opening for the vagina and rectum. She was totally incontinent of stool.
Last week was difficult. We lost a mother with her baby. It was such a sad case. She was riding in a taxi when the brakes failed. She took her chances and leaped out of the moving vehicle fracturing both legs in four places as well as severely injuring her head. We were told she was 28 weeks pregnant. Her condition rapidly deteriorated and we performed a CS in hopes of saving the baby’s life. During the course of surgery she had cardiac arrest 3 times, and was brought back. Unfortunately she had DIC which meant she was bleeding from her lungs into her bladder and her abdomen. Regrettably her lungs were full of blood and she died on the operating table. The baby also was too premature to survive.
You may remember me telling the story of the woman who had been married for over 20 years and was unable to conceive. She came to our hospital three years ago with a large pelvic mass. We removed a large fibroid tumor and a year later she came to us 9 months pregnant and we were exhilarated as we helped her deliver a healthy baby boy. A week ago she returned to our clinic having irregular cycles and informed us of the devastating news that her precious baby boy had died at the age of 8 months from asphyxiation. I wept with her. She would like another pregnancy but sadly she is peri-menepausal. I gave her Clomid to see if we could induce ovulation and time will tell if God will grant her another baby.
I apologize that this is such a depressing newsletter. There has actually been much joy in our household these past few weeks. Our daughter Miriam and her three children, Faith, Mark and baby Michael have been with us for four weeks. Today when I arrived home from the hospital after my emotionally exhausting morning my 3 year old grandson ran to meet me at the door, took my hand and said “Grandpa, come play with me!” His exuberant joy for life was just the distraction I needed after the lifeless baby I delivered this morning. The contrast between these last few sad weeks at the hospital to the laughter of my little grand-children at home could not be further apart. My free time has been spent pushing the children on the swing, playing pirates, kicking balls, reading books, building with blocks and long cuddles on the sofa. These last few weeks have also been shared with outstanding volunteers from the US. Their kind hearts and joyful personalities have made these sad experiences much easier to live through.
Our son-in-law, Chris, arrived safely this afternoon from S. Africa. He joined Miriam for the final two weeks of her stay. God willing, Sara, our youngest daughter will arrive on Tuesday if the snow permits. Sara hasn’t seen Miriam and her family in over two years. Allison has spent most of her days cooking for the family and enjoying the kids. She has, however, managed to continue to teach her Bible studies amidst the noise and pursue one of her new passions, building a cement block compost area for the hospital.
Thank you for all you do for us. Your prayers and financial support are a source of strength and encouragement. We seriously cannot do this work without you behind us.
Mark and Allison