The phone rings. I fumble for the phone, just having fallen asleep.
"Hello?"
"Hello. Now, we have a 15 year old G1 at term who has been pushing since yesterday. Her vulva is edematous. The cervix is complete and there is caput ++. There are no fetal heart tones."
I sigh. No anger. No pity. Just a sigh.
"Prepare her. I am coming."
January 29, 8 am:
A 15 year old G1 at term arrives at a health dispensary. She is examined and found to be complete and zero station. The baby is doing well. The plan is to observe for an anticipated vaginal delivery.
January 28, In the night hours:
A 15 year girl wakes. Pain grips her. Water trickles down her leg. She is in labor.
When I first started treating women with obstructed labor, my reaction to their vast array of complications was sadness. Pity, even. As I became more familiar with these women, I began to feel irritation and anger. Why weren't they coming to the hospital sooner? Kenya has plenty of medical clinics. Transportation is eventually available. Why, why, why?
In January, I admitted 7 cases of obstructed labor, resulting 4 hysterectomies and 5 fetal deaths.
I find myself falling into a routine in the care of these patients. But the sharp edge of anger and pity is not completely gone, not completely replaced by the comfort of my medical check-list: Fast delivery, Triple antibiotics, copious irrigation, delayed foley removal.....yada yada. Instead, with each case, even with the best outcome...live baby, patient maintains her uterus...there is this itching under my skin that doesn't go away.
I know it's going to happen again...and I can plead with them to come sooner next time but its very rarely up to the patient. I keep talking to patients and their families- telling them that: "God has blessed you by saving this mom and baby," or "Please, warn others, so that this does not happen to them..." I cannot stop the lecture from erupting forth.....I am waiting for the one somewhere that will listen.
I've read that there are 3 hinderances to care for OB patients in third world countries (in addition to the physicial issues):
1. Obstruction of Transportation - Does the patient have funds, access to transportation to reach a health care provider?
2. Obstruction of Facilities - Are there health care facilities within walking/driving/traveling distance?
3. Social Obstruction - This involves the peer pressure that mother-in-laws/husbands and other families may place on young women to deliver at home: Everyone else has delivered in our village. They will automatically do a hysterectomy. Social obstruction may cause some of the risk factors for obstructed labor: early childbearing, child brides and female circumcision.
So, where do we go from here? What is the answer? Is it community education? More thorough antenatal care? Social reform? Probably all of the above.
In the meantime, I will continue to operate. I will save what can be saved and continue teaching my patients and their families.... honestly, anyone under the sound of my voice!
A few weeks ago, I was checking out the website of my residency program - just seeing who was there, who had left and how the place had grown. On each physician page, there was a blurb about what each doctor like to do or what they specialized in. "Dr. Jones is interested in general gynecology, infertily and laproscopic surgery."
It made me think about what my blurb would say.
Dr. Huber is interested in obstructed labor, emergency hysterectomies and hemorrhagic shock.
Eek. That's a little scary. And it's really not true....
I am Dr. Huber. I am interested in a Kenya where women do not labor until their babies die and their uterus ruptures. I specialize in hoping for this even when I cannot see the way to achieve it.
Better.
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