Aira Hospital

During the weekend we had 12 complicated delivery cases. 8 cesareans due to obstructed labor, three IUFD (intrauterine fetal death) and one severe eclampsia in 8’th month. The later unfortunately expired during treatment before being delivered.

When you know how much antenatal, obstetrical and postnatal care the hospital is giving it is a mystery why the organization which previously supported the hospital financially withdrew the support with the argument that only projects with focus on mother and child health would be supported. Twelve complicated deliveries in one weekend – is that service not very much focused on mother and child health care?

When a fistula project can be rejected with the argument that it lacks focus on women then you don’t get surprised anymore (see post THE FISTULA PROJECT). The “foreignjies” (the white people) are certainly difficult to understand, but we continue to work hard and wonder as always.

Two of the women with IUFD delivered the dead fetus after induction. The third was a breech and had to be delivered by destructive measures – craniotomy on the retained head.

The pictures and video from that procedure is not for laymen. The previous blog is therefore protected by a password. The exaggerated head down position of a patient on the operating table is named after a famous German surgeon.

The password is the second (family) name of this surgeon spelled with small letters.

Here I just want to show how brave and strong our patients are. After this awful procedure, which was done in spinal anesthesia with the patient fully awake, she was smiling – relieved and happy.

Confident that her next pregnancy will result in a live baby if she comes in time to Aira Hospital –that is if the hospital has not stopped functioning because of financial collapse.

IUFD is the abbreviation of intra uterine fetal death (death of the child in the womb), an entity we sadly enough face repeatedly here in the hospital.

The causes are many, but whatever the cause a cesarean should be avoided at all costs. Opening the uterus to remove the dead, infected and sometimes even rotten fetus, carries an enormous risk of intra abdominal – often life threatening – infection of the mother.

A vaginal delivery must be performed at all costs. If not spontaneously or with stimulation of the contractions - then a destructive delivery (see following posts) must be done.

The only indication for doing a cesarean in a case of IUFD is active life threatening maternal bleeding due to placenta previa or abruption placenta when the cervix is not dilated widely enough to perform a destructive procedure safely. Then the only option may be a cesarean to save the life of the mother.

In that case be prepared to do a hysterectomy if the bleeding cannot be easily controlled, and try your best to have fresh blood ready to transfuse in case of clinical signs of a HELP syndrome (DIC syndrome).

The dead fetus always gets a formal burial. Due to the existing general and profound poverty no one can afford a wooden coffin for the baby, and a carton box has to do.

The following posts “DESTRUCTIVE DELIVERY – CRANIOTOMY” and “DESTRUCTIVE DELIVERY-EXVISCERATION” are protected by a password. The password is the family name (in small letters) of the French Huguenot brothers who invented the obstetrical forceps around 1600.

Actually we do not celebrate neither Christmas, nor New Year at this time. Christmas will be on January 7^th and New Year is on September 11^th. However we follow the same calendar as in Europe when it comes to registration of the operating room activities. I guess by old habit from the time when the hospital was a true missionary hospital run by the “foreignjies” (the white people).

3 786 is the number of surgical procedures performed in 2008, not including the several hundreds of eye surgeries done by the ophthalmic nurse at the OPD.

This remarcable result could never have possible without the hard working and dedicated operating theater staff who are always in full activity, never wasting a minute. Often they do two assignements at one time, like supervising the postoperativer patients and at the same time preparing surgical instruments.

The OR technicaians who have no formal medical training are doing a lot of minor surgeries on their own, and always closing up after major surgeries to speed up the program.

Maternity has also been busy. Often the staff there is overwhelmedd with complicated deliveres arriving simultaneously while at the same time they have to care for critical patients as well.

This lady came with IUFD (Intra Uterine Fetal Death – the baby had died in the womb) and very severe eclampsia. At arrival she was deeply unconscious with convulsions and very high blod pressure. The child was extracted immediately on arrival by craniotomy (destructive delivery). The patient had valium infusion, magnesium sulfate and hydralazine. The later had to be given at 5 minutes interval under continously controle of the blood pressure.

The nurse, who is doing her first clinical year and do not have a lot of experience wrote “Oh, God help us. Please!” And He did. The patients has recovered miracoulsly and is now semi awake after 48 hours.

eclampsia ← click here to watch a remarkable recovery from severe eclampsia in 48 hrs