News

January 21, 2008

Off With a Bang!

Greetings from Mulanje Mission Hospital. My first day on call after an absence of five months while on mission interpretation assignment in the United States was a thriller. I happened to be on call on Tuesday, January 15, 2008, which is John Chilembwe Day in Malawi. John Chilembwe is a national hero and martyr who led a rebellion against the colonialist regime in Nyasaland in 1917. On national holidays, the hospital is still open, of course, but with a reduced staff. So, Sam Matandala, an intern clinical officer, and I were in charge of all of the 190 beds of the hospital.

Sam and I saw a young pregnant woman with twins and a fever at about 8:00 am. We decided to give her a dose of quinine intravenously over three or four hours to fight the malaria attack she was experiencing, and then to go to the operating room to do a Casarean section for the twins because the first twin was breech. So Sam then went to see 60 children on the Pediatric Ward, and I went to the Female Ward to see 25 sick women. Male Ward would have to wait. At 11:00 am, we were called to go to the Labor Ward to see the woman with twins as a foot was coming out. So, since her labor had progressed guickly and normally, we decided to have a vaginal delivery rather than a Caesarean.

One of our midwifery students, Sam, and I delivered the first baby, a girl weighing 1.5 kg, and the second baby, a boy weighing 1.5 k g. Then I examined the mother and found there was a third baby, who was delivered also, a boy, weighing 2.1 kg. Triplets! Although the babies were small they were all crying and looked vigorous. The attached photo shows some of the crew in the Labor Ward with Sam our only male presence at the time, except for the two baby boys. It is hard to see the babies but all three of them are in the photo.

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We finished rounds and had a brief respite in the afternoon. In the evening, there were more normal deliveries. Then about 11:00 pm, a woman with a previous Caesarean section for her first pregnancy was delivered by vacuum extraction,an instrument like a plumber's helper that goes on the baby's head to help
the delivery. Her second child was strong and healthy, but she started bleeding heavily after the delivery. We went through all the standard procedures to stop the bleeding and by 11:30 pm, all bleeding had stopped.

However, at 2:00 am, Sam called me to the hospital for more bleeding from this same woman. As soon as I saw the amount of blood loss, her low blood pressure, and how pale she was, I knew the situation was desperate. In a developed country, blood from a well-equipped blood bank would be immediately available. Unfortunately, we had no blood at all in the blood bank, and only this woman's elderly mother available as a possible donor.

We called our medical assistant/ anesthetist from home to come to administer anesthesia for an emergency operation to save the woman's life. This young man, Tingo Chipanda, expertly took in the clinical situation, put an endotracheal tube down the trachea, obtained adequate anesthesia, and supported the woman throughout the subtotal hysterectomy that was required to stop the bleeding. I am very proud of Tingo Chipanda, who up to now has had two months of training in anesthesia at Queen Elizabeth Hospital in Blantyre, but who will start a two-year training program, supported by the hospital, in one week to become a clinical officer anesthetist.

It was almost time for the morning sun to come up on January 16 by the time I got home to rest for a while before Wednesday morning started at Mulanje Mission. I am back on the roller coaster of African obstetrics, thankful to God for the strength and opportunity to serve in Malawi.

Yours sincerely,

Dr. Sue Makin
Mulanje Mission Hospital