Full circle with postabortion care

On Saturday Caroyn and I travelled to Mbale so I could do 2 days of interviews on postaboriton care. *Just a reminder that postabortion care is usually post-miscarraige care, but may also include care after a botched illegal abortion* The trip was pretty, and when we arrived we went to an awesome Indian restaraunt for dinner with Sarah, Lyanne, Angela and two male clinical officers who then took us clubbing- you can read about this in Lyanne and Sarah's previous post. 

On Sunday I worked on the wards during the day (caught 1 baby, managed 1 large postpartum hemorrhage  ~3L blood loss, and obseved 1 cesearean and tubal ligation. I then did two interviews. One with the incredibly lovely Dr. Paddy, a GP who is just on his obstetrics internship. He is renowned for his boyish good looks and the compassion he shows to the labouring women. He kindly volunteered to show me around gynecology and introduce me to people I could interview.

On Monday we started off with maternity rounds- rather uneventful. We then headed to gynecology for rounds. At 10am, before rounds began,  I watched a mother of 3 die at 10am after a septic abortion- there was a crowd of students watching and the nurse only did 9 chest compression then gave up- once a person requires chest compressions there is little hope of reviving them. There were no tears, no last rights. Sometime during rounds the body disappeared and by then end of rounds the bed was filled with someone new. My stomach churned.

I then met a man who's wife has a brain tumour which has resulted in paralysis of half her body and has left her in a coma for 8 weeks. She is 20 weeks pregnant. He requested a termination. The doctor explained that ending the pregnancy wouldn't help the tumour- but I couldn't help but wonder if he was requesting the termination because a child without a mother doesn't stand much of a chance here and it would be terribley hard to lose them both. However, abortion is illegal here unless it is to save a woman's life- and so the pregnancy continues.

I then  interviewed a doctor about the barriers to women receing post abortion care. So many! They talk about the 3 delays

1. Delay in the decision to obtain treatment
2. Delay in transport to the hospital
3. Delay in receiving care at the hospital

There is a lack of supplies and medcations, lack of diagnostic tools, a delay in sterilization of equipment, a lack of human resources, stigma, the lack of integrated family planning services...

When women arrive in the morning they are alreay quite delayed in receiving treatment. Then then must wait for the doctor to complete rounds, and for the more urgent women to be triaged. When it is finally their turn there are only 2 sets of equipment for D&C- these must then be sterilized-another delay. Oh- and there is not light in the MVA room, so women can only be treated until 6:30pm when the daylight is gone. On average 5 women a day present with postabortion complications and only 2 can be treated.  The untreated then leave- maybe they seek help elsewhere, maybe they don't.

Thankfully, 3 MVA sets were donated to Mbale hosptial last week and we finally got a hold of them on Monday.  So after rounds were completed and triage was done Dr. Paddy set to work. He did 3 D&Cs and then a midwife quickly gave him a crash course in how to use the MVA equipment. I helped to fill in the blanks in the theory of MVA use. Halfway through the first MVA we began to lose daylight so I lent Dr.  Paddy my headlamp to finish. There were 2 more women waiting. I wanted to call it quits for the day because I was emotionally exhausted after the death, already an hour late for dinner,  I didn't want to walk home in the dark alone and I had to pack but Dr. Paddy insisted on helping the last two women since he had the headlamp- if he didn't- he said they would have gone home and maybe returned septic several days later. So Dr. Paddy, a student clinical officer and I attended the last two women in the dark with only a head lamp and the light of a cell phone.

Our last case was a woman who had been admitted to hospital after being bitten and beaten by her mother-in-law. The blunt abdominal trauma caused her to miscarry. It was terrifying- I was trying to draw up and give painkiller injections in the dark. The room was black, the woman was black, the procedure table was black...all I could see where the whites of her eyes, wide and glazed over with trauma and the shadow of the surgical instruments on the wall. It looked like a scene from a horror movie, Saw perhaps, like my worst nightmare- but rather than torture her the three of us were trying to help her.

That was the hardest day I've had here.

When we finally finished Dr. Paddy and I walked to the dorm where the gals are staying and we ate the rolex (rolled omlett & chappati), samosas and beers that they had bought for us hours earlier. We had worked a 12 hours shift. Afterwards everyone walked me home.

And so I have come full circle and I am reminded of why I am pro-choice and why I mustn't ever become lacadaisical in my attempts to reduce maternal mortality as a result of unsafe abortion.

Posted by Alix