Sawa Sawa

4-11-08, 2am; like it has done hundreds af times since starting clinical rotations in medical school the beep of the pager awakens me from shallow slumber. I gather my thoughts, take a deep breath, fumble for the phone and call the number displayed, #450, L&D. Dr Chite, the intern, immediately starts to present the patients to me. She begins to relay to me the presentation of Faith, a 27 yo female with PV (PV means vaginal) bleeding, with last menses in December 2007. The patient was initially hypotensive but had normalized her blood pressure with fluid resucitation. As I clear the cobwebs from my head and try to come up with some semblance of a comprehensible plan I think, “Good, this is an easy one, a simple problem with an easy diagnosis and plan.”
I say, “Get an ultrasound and if the fetus is not living we’ll take her to the theatre to perform a D&C for a spontaneous miscarriage.”
Dr Chite responds, “Radiology will not perform an ultrasound unless the patient has a full bladder. We just emptied her bladder to get a pregnancy test to confirm that she is in fact pregnant.”
Sawa, sawa (OK in Swahili), what would I do in the states? I would get one of the everpresent ultrasound machines that we have in every clinic and crawl space and perform the ultrasound on her myself.
So I say, “Am I allowed to use the ultrasound machine in the Radiology department?”
Dr Chite, “Do you know how do perform an ultrasound?”
Dr Temple thinks, do you know who your talking too? Of course I know how to do an ultrasound. But he answers, “I think I can figure it out.”
So I trudge up the hill to the Hospital, unlock the back door so I don’t have to walk all the way around the hospital and meet the patient and Dr Chite in the Radiology department where I am met by the prototype of ultrasound machines. It took me 10 minutes just to figure out how to turn the darn thing on. I had never worked with anything this antiquated before. So after wasting 20 minutes learning how the thing works, all the while loosing credibility with the patient and Dr Chite, I was finally able to confirm that the patient indeed was miscarrying.
Most women in the US are tearful when met with the news of a miscarriage, especially this late in gestation (approx 16 weeks). Faith however, was nonplussed by the news. Death is common here. The infant mortality rate was 61 per 1,000 live births in 2005. The way Interns or midwives present patients is in the following manner: Gravida 4, Para 2+1, the +1 signifies that she has had one child that died after birth, +2 would have been 2 children that died after birth and so on. I have seen very few women who have a 0 after the + sign.
We took Faith to the theatre and performed her D&C. Hopefully she will have more success next time.
Did I mention that last night in the middle of a c/s the power went out. Lights and all for about a minute. No big deal, apparently it happens here all the time. Fortunately the infant was out and the uterus was already closed. I am thinking about what could have happened at various other stages of the c/s…
The photo is down onto the Kijabe Hospital Campus.