The maternity ward was undergoing refurbishment when I first visited here in March. My flying visit gave just the chance to capture 2 years of registry and then I was off to the airport and away. Today we saw it in all its glory – clean, new-painted, good beds with mattress and cover, drip poles and bright curtains, and AC. Wow, AC in the wards! Won’t the women of Berbera district and Sahil want to deliver here when they find out! And when the power goes down, as it did as we arrived today, they have the solar system!
Now it is really very, very hot and I understand why. Because the sun is overhead. We are 10 degrees north of the equator so the sun will pass directly overhead about 10 degrees north of here at this time of year. There is certainly plenty of sunshine. We are also exactly 45 degrees east of Greenwich which means that we are 2 hours ahead of BST, which is something to do with the earth’s axial rotation once in just under 24 hours, which has something to do with the solar system too. But the Hospital Director was not thinking in astronomical terms when she invited us to view the solar system installed a month ago. Behind the maternity ward is an impressive array of inclined panels sufficient to power two AC units and the lighting should the mains power go down, which will keep the operating theatre going and provide lighting for obstetric procedures in maternity. Asha is an MBA graduate with great enthusiasm for health and for the success of this small hospital and her dedication shows. The staff are happy and committed here and the patients receive an excellent level of care within the resource constraints of this setting.
Berbera is the chief port of Somaliland. It also serves Ethiopia, as the border with that huge land-locked country is only 3-4 hours away by road. Imagine then the tragedy of the road traffic accident last night that killed one of the chiefs of the Port Authority. He died just outside the town boundary in the dark as the result of fast and dangerous driving; a number of significant people have died on this road – RTAs involving cars and trucks, and usually important people travel in cars. Not many years ago Ethiopia bombed the port of Berbera leaving rusting wrecks which defy salvage and metal recycling. Now Ethiopia is desperate to keep the port open to maintain its sea link with the Middle and Far East.
In the fishing port normal activity has resumed after Friday prayers and we ate a tasty catch-of-the-day lunch in a quayside restaurant reflecting on the events of the morning. We had a retained placenta after premature birth exactly like the case in HGH except that antibiotics were given for 18 hours before attempting to empty the uterus and ultrasound was used to check the uterine contents before and during the procedure to ensure evacuation was complete. She is well and likely to recover quickly.
We have a 16 yr old lady pregnant just 8 weeks after the Caesarean birth of her 8-month-old baby boy. Again ultrasound was used to check the placental site as insertion on the scar when it was not yet at full strength would carry a high risk of morbid adherence, scar rupture, catastrophic haemorrhage, hysterectomy and death. Fortunately this was ruled out and a routine planned Caesarean will be done at 39 weeks. She is very small.
We saw a post-operative placental abruption (the baby died but the mother survived after 6 units of blood) and a pregnant lady with ITP – low platelets due to autoantibodies. We were able to download recommendations from the ITP support association and we obtained excellent advice from a London professor who responded to her emails in less than an hour and offered to support the patient and her carers until she is delivered. How’s that for service! We had a meeting with the Hospital Director, supervised suturing of a perineal tear 2 days old, taught ultrasound on several patients all before lunch. We definitely earned that fish!
And now the sun has set. The surf is pounding on the beach. The air cools as we sit outside drinking chilled water and eating more fish. The moon is high in the hazy sky but the dust obscures the stars, and the solar system at BPH awaits another dawn and another productive day at the hospital.