It’s hard to believe this is the half way stage already. The last two weeks have been concentrated effort collecting data from daily registers, monthly reports and patient dossiers from two hospitals by day and cross-checking, analysing and refining the data by night. The culmination of all the work was a series of presentations in Banteay Meanchey and Siem Reap provinces comparing the activity and outcomes of 5 hospitals and learning the lessons that may help improve their performance.
It’s been a mixed blessing. The audience in Banteay Meanchey comprised around 20 staff from the district but not one representative from my base hospital which was the main reason for coming here. Several factors combine to explain this, mostly of a non-personal nature, but it was a very difficult day especially as I intended to visit the hospital 5km down the road after the session finished. I went ahead with the visit and saw several midwives, the duty doctors and a medical student I knew and I encountered no suggestion of a boycott of the training session, more an ignorance of it or indifference to it.
Three days later two feedback sessions in Siem Reap province were more successful and well received and after the second session short films showing the delivery of a breech presentation and the management of shoulder dystocia were shown. The road to the final venue I travelled three times and enjoyed seeing the rice harvest, the transporting of sheaves, threshing and stacking of the straw. The animals are working hard too, cows, oxen, water buffalo all playing their part and the latter creatures submerged to their necks in the deep roadside ditches, cooling off at the end of the working day.
So tomorrow we relocate to the provincial town of Battambang with its French colonial buildings revealing a very different past. That is a large hospital and we will have to decide what data to focus on as we cannot do justice to all of it. The management of eclampsia and safe transfer to tertiary care, outcome of referred cases and the indications for Caesarean delivery have been the topics covered so far. Maybe we shall take a closer look at the babies that die.
Meanwhile I have a communication crisis and need to use the blog site to get through to home so please bear with me and ignore the messages which are not a regular feature of my blog. I hope normal service will be resumed as soon as possible.
One short story to finish. There have been three maternal deaths already this month in the hospital I am working in. One near miss too. The team were out in a health centre and came across a lady bleeding heavily from placenta praevia. A poor family. Her husband away in Banteay Meanchey helping the harvest. The three team members clubbed together to pay the taxi to bring her to hospital. Her haemoglobin was around 4 grams when she had a Caesarean. The baby died. Her husband arrived in the afternoon while we were sitting outside maternity doing the final register checks. We provided for his food for a week and pleaded with staff that she be given blood urgently. Sometimes it feels like getting blood from a stone. She survived for long enough for the staff to finish their meeting and arrange blood transfusion. That was 5 days ago and her last haemoglobin check was 3.4. Midwife Emily donated a unit of her own blood to her top her up. They are both group O. I would have given mine but I’m group A. I gave a unit last week but they only take 350ml here as people are so small and at my size I can afford another. That’s life on the edge.