Aira Hospital

Breech deliveries are always a challenge since the largest part of the baby – the head – is the last to pass the pelvic outlet. There is a substantial risk that the head will stuck in the pelvis and if not relieved promptly the baby will die from asphyxia.

With primipara (first time pregnant women) we play it safe and perform a cesarean just as in the developed world.

With multipara (women who have delivered before) we allow vaginal delivery. But then you have to BE PREPARED! The risk of not being able to deliver the head is always there.

1)      The woman has to be placed on a table with the buttocks well beyond the end of the table and the legs in holders.

2)      Local anesthesia above the symphysis is given in time ahead so that a symphysiotomy (a cut through the symphysis to open up the pelvic ring) can be done fast when necessary.

3)      A catheter in the bladder is crucial. With two fingers in the vagina the urethra can then be easily identified and pushed to the side protecting it from the cut in the midline when the symphysiotomy is done  (Don’t ever try to do a symphysiotomy without a catheter in the bladder. The risk of injuring the urethra is huge, and if it happens you end up with a fistula which is very difficult to repair – I know from bitter experience!)

4)      The cut through the symphysis cartilage can be done under vision with a larger incision – open symphysiotomy – or blindly through a stab incision – closed symphysiotomy. Knife blade No 22 on a knife holder is appropriate.

Watch the following video. The head cannot be delivered and a symphysiotomy is done urgently to open up the pelvic ring and get the head out. The child is severely distressed, but recovers after oxygen and glucose 40 % solution rectally. Rectal administration works almost as fast as i.v. injection and is much easier to adminstrate.

VIDEO ← click here to watch video

Happy mother – Happy baby - Happy surgeon!

“Women should not die giving life!” A statement in a referral letter from one of our satellite clinics in which I can only agree.

That is also the “Millennium Goal” of WHO and other fancy international agencies.

But as top politicians and highly paid “experts” are consuming billions of dollars on high salaries, expensive secretaries, cars, business class, 5 star hotels and restaurants and not contributing with anything else but talking, we - the medical professionals in the third world - are fighting day and night to accomplish concrete results in spite of having nothing except our hands to work with.

The poorly paid, but dedicated (male) nurse who wrote the line quoted above is struggling day and night in a clinic with no resources, no equipment, insufficient financial support, no running water or electricity. In spite of that he is doing his very best to help the patients. At times things are just too complicated and luckily he (still) has a hospital to refer to.

In the referral letter mentioned he writes that the woman is referred from his clinic at 10 pm.

At 4 am the lady arrived at Aira Hospital in shock due to intraabdominal bleeding and sepsis from a ruptured uterus. It took 6 hours to carry her to the hospital and during that time the uterus gave up and ruptured. Why didn’t the family take her by car? Well it takes 2 hours’ walk to reach the main road, and how many cars are out there in the middle of the night? A part from that they might not have been able to pay the usually indecent demands from the car owners.

She was operated immediately after arrival. Thanks to a dedicated staff who bothers and are ready to work and save lives 24 hours around the clock. Not a given option in many other hospital where the staff would rather choose to neglect her and give priority to a sound sleep.

She recovered fast, as her two roommates who also came with ruptured uterus. One from nearby Guliso had to pay 300 birr to get a car ride (ordinary price 20 birr), but then she walked herself from the parking place to the maternity – with a ruptured uterus!

The third woman had paid 700 birr for a place in a car. Far more than the cost for the lifesaving hospital treatment. All three patients with uterine rupture are recovering fast. That means a lot.

Saving the life of a mother saves the whole family.

Then why is it considered so wrong by so many NGOs to support this kind of medical work financially?

Even our own Church of Sweden Mission does not consider medical work as their responsibility.

Women’s’ project – YES. Human rights project – YES. AIDS/HIV project – YES.

Medical work (apart from AIDS/HIV) - NO.

Recently the Church of Sweden Mission donated a second hand car to the women’s’ project in Addis Abeba (where there are so many cars at the head office that they are standing rusting in the parking lot) and one to the Bible Seminary in Nekemte. With all due respect it is indisputable that no of the women’s worker or the bible school students die from lack of transport, but our patients do.

Imagine how many lives could be saved, and how much suffering could be avoided if the hospital had a four wheel car which could bring women with complicated deliveries to the hospital at a reasonable fare. In that way the patients would not be skinned to the bones by greedy car owners, and the hospital would have at least some sort of income. Will that dream ever become true?

Medical work is never boring. Never is one day like the other.

Sunday we had a visitor from the German Embassy in Addis Abeba. The embassy has supported the hospital with vital monitoring equipment for the operating theater and it was a great pleasure to show the third secretary from the embassy around the hospital.

Unfortunately the wards were half empty with not many patients around. It is said that people are too busy with the coffee harvest to get sick and come to the hospital.

Only two days later the wards are full again. In particular the maternity where some patients are admitted on stretchers because all the beds are occupied.

This night we did 6 cesareans on women with complicated deliveries referred from different clinics.

One of the referral letters was very long and detailed. The closing words were “women should never die” (giving childbirth) written by a male nurse (the profession as nurse is male dominated by tradition).

Another fine example of how the Ethiopian male shows concern for the opposite sex - contradicting the common but untrue picture of the Ethiopian man as chronic woman abuser/oppressor.

6 times up in the night doing cesareans is really not for an old man like me. Today I am tired and the blog is short.

It is said that there are lies – big lies – and statistics.

In Aira we often have ideas and thoughts about different clinical medical trends, but as there is no statistics to rely on we are usually left with speculations.

The last 5 years we did only 3 cholecystectomies for gall bladder stone and/inflammation, but now in the last 3 weeks we did 5 such procedures. I guess that the explanation is the more widespread use of ultrasound scanning in private clinics which is increasing even in the countryside. In the past the only diagnostic means were the clinical symptoms and signs, and I guess that the disease was often misdiagnosed as gastritis or PUD (peptic ulcer disease). Maybe we will discover that the condition is far more common than we used to believe, maybe even as common as in the rest of the world?

We have noticed that different malformations of the central nervous system are common in the babies born in our hospital, and we have a feeling that the incidence is higher than expected, but as we do not have any reliable statistics we really do not know. One colleague suspects the recently introduced use of potent fertilizer. Another claim that the cause could be lack of folic acid. But as long as we have no certain prove it would be futile to start acting blindly just for the sake of doing something.

There is a lot to do for researchers and medical scientists in the future – in that sense the country is a veritable goldmine.

The pictures of the most common malformation we face are protected with a password which is the Latin name for being born without a brain.