Many of our patients are of short stature and that accounts for many of the Caesareans we do. If they are short the pelvis tends to be small. In some cases the babies are proportionately small so those should deliver normally and thankfully often do. It also follows that many of our nurses are short and one of them called for me during the morning service on Sunday.
I have been without a mobile phone for 3 weeks because of issues with ID but that will soon be resolved, I hope. Meanwhile, at night someone shouts ‘Hodi!’ outside my house and I respond ‘Karibu!’ and set off for the hospital. During the day they have to find me; in church, if need be.
Dutifully and speedily I followed her down the aisle, out the door and round the corner watching carefully where I tread since the ground is irregular in places. Smack! A sudden blinding pain in my head and I found myself on the floor. She picked up my books, I picked up myself and hurried on towards the hospital rubbing my scalp and seeing blood on my hands. The church roof overhangs and is very low on that corner and I am much taller than the nurse.
The patient is a schoolgirl, 16 years old and 18 weeks pregnant, also in pain and bleeding. Ultrasound shows the baby’s head in the cervix and miscarriage is inevitable. She is transferred to the labour ward (rather a grand title for a small room with two ancient delivery beds propped up on bricks because some of the castors have collapsed) and a sublingual tablet brings the process to a rapid conclusion. She aborts, stops bleeding and the pain subsides. It was a little girl.
Teenage pregnancy is not always unwanted but access to contraception and to appropriate education is a challenge for those who need it. Almost one quarter (23.4%) of our pregnant patients in the first 9 months of this year are teenagers. Each one will get contraceptive and sexual health advice before leaving for home, but reaching them before the first pregnancy is not so easy.
Back at home I washed the blood from my hair and decided to wear a cap for the rest of the day; it saves unnecessary sympathy and explanation. I was soon joined by Hilary who left church (avoiding the overhanging roof) after the first hour of the sermon, leaving the preacher in full flow. He was wearing fluffy bootees and a gangster tie, and energetically repeated the words ‘watoto’, ‘shamba’ and ‘kanisani’ suggesting his theme was children helping in the harvest when they could be in church. However, we often loose the thread and the relevance of the fluffy bootees was certainly lost. We are grateful for the YouTube and Zoom services from home, a spin off from Covid, that keep us in touch and in fellowship with our church family in North Wales. Together we joined a moving Remembrance Service involving many of our friends and featuring the war memorials in our area.
While all this was going on, an expectant patient in Mlangali town, 70km away, experienced her membranes rupture. She got on the next bus for Milo and arrived at 4pm, walking the last 10 minutes from the village to the hospital with a cord prolapse. When the umbilical cord emerges first, the baby will die unless delivered very quickly and true to expectations, this one had. But, surprise, surprise! The ultrasound scan revealed twins! Hitherto undiagnosed, the second baby was still very much alive. Yet another Caesar; another baby rescued, and a mother who got what she came for – the safe delivery of a healthy baby. It is very sad that the first twin died on the way, but the woman was completely unaware of the problem and she now has 6 children and that’s plenty.
From walking into the church to pulling out a bonus baby, it was an eventful day to be sure, and to be fair we do benefit greatly from our church friendships. Tough luck this Sunday I came away with a headache. Next time I’m about to walk into the church I shall keep my head down!
brechdan 