In contrast, medicine here is very different than in the US, because there are several diseases common here that we never see in the States. Tuberculosis in all its varied manifestations, many end-stage cancers, and chronic diseases like diabetes and heart failure keep the beds in medical ward full, sometimes two to a bed. Estimates are around 80% of inpatients are HIV positive.
Pediatrics, as well, has its share of diseases and conditions that we rarely, if ever, see in the US. From protein-energy malnutrition, meningitis (Kenya is in the meningitis belt),
to pneumonia, rheumatic heart disease, typhoid, etc., children here are much sicker than in the United States. One patient in the hospital right now was actually bitten by a lion! The unfortunate statistic is that about 5% of children here don't live to see their first birthday (compared with 0.7% in the US).Which brings us back to Obstetrics. With or without prenatal care, the miracle that is childbirth happens basically the same way all across the globe. Here at Tenwek, nurse-midwives handle most of the OB, which are mainly uncomplicated vaginal deliveries. They call the consultant when there are complications. The c-section rate at Tenwek is similar to that in the United States, around 25-30%.
I've included some pictures here from a recent c-section. This baby and her mother did very well. That isn't to say that complications are uncommon here either. In fact, I have seen more OB complications in one month here than in 3 years of residency. One common complication is prolonged, or obstructed, labor. Most women in Kenya deliver at home. When labor goes wrong, it may take a patient hours to days to get to the hospital. By that point, it may be too late to save the baby, and in some cases, even the mother. One patient came in this month, for example, who had labored at home since the day before. Fetal heart tones were already absent upon arrival. She hadn't been in the labor ward 30 minutes when she collapsed, and went into cardiac arrest. She could not be resuscitated. Because of a cultural stigma here, it is not proper for pregnant mothers to be buried with the fetus still inside. So we performed a post-mortem c-section to deliver the baby. This "autopsy" revealed the cause of death: uterine rupture.
That was the first of two uterine ruptures I saw this month. The second one happened while the patient was in the hospital. I was able to get to surgery quick enough to save the mother's life, but unfortunately not the baby's. And while we were sewing up the mother, the OR staff came in to the room and announced there was also a cord prolapse that was being rushed over. Just another typical night on OB call at Tenwek! I've also seen three cases of eclampsia here (seizures in pregnancy due to high blood pressure), a condition almost never encountered in the States due to both proper screening and the common use of magnesium, which prevents seizures. I've also had two placenta accretas (when the placenta gets stuck to the uterus, a risk for massive bleeding).
There is an all-too-common term used here: B.O.H. Bad Obstetric History. One mother here, for example, had been pregnant 10 times, but only had 2 children. Another patient had been pregnant 6 times, and had 6 chilren, but now none of those children were still living. We tend to be much more aggressive with these patients, doing everything we can to ensure they have a live infant born during this pregnancy. I've been taking a lot of c-section call here, and have performed over 40 sections this month. It is an honor to be part of the miracle of birth in the lives of these mothers who need surgery. Several of these babies have been named Kipchumba/Chepchumba (boy/girl born when a mzungu (white person) was around).
Please continue to pray as we finish our last month here. I'll be on medicine, but I'll still be taking OB call. We're looking forward to coming home in early June, but also want to have a strong finish to the work God has called us here to accomplish.
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