Rewards from the mission

After all these sad stories, let me tell you some cheerful ones. The first one is about a woman who arrived the other day with pregnancy, coma and convulsion. We tried the anti-malarial treatment although the two paracheck ( test for malaria ) were both negative. She woke up the next day. She can get up and drink today. The second one is about a baby with neonatal tetanus that is getting better. The convulsion is under control. He starts sucking yesterday. I hope he can make it. The third cheerful story is that the other two women with a ruptured uterus are doing remarkably well. Everyone in the team is excited. The Obstetric Team is more organi sed now. We had employed two ex-MSF local staff to cover the ward for 24 hours. My surgical patients are also doing well. I started exercise on my fracture patients and found some crutches for them. They share the crutches for walking exercises. The first MSF patient in Aweil, with a fractured femur, was so excited. He does the exercises three, four times a day. The young man with large left thigh abscess that I mentioned before also showed some encouragement. At one time I was so frustrated that he neglected himself, refusing to stand up, not even sitting up for toilet. He had such poor bed hygiene that everyone asked me to send him out. I did all the cleaning for him and forced him to stand by the bedside. His leg muscles are all wasted with prolonged bed-stay so that he could not stand on his own. I forced him to exercise and stand. He tried but gave up. After seeing the others walking around yesterday, he attempted to stand up with the help of others. Today is Sunday. Stephane and I had a nice 30min jog in the morning. We ran across a railway line. The railway line was not used any more, probably because of the war. There are some ruin train cabins left. We hoped it would be a peaceful Sunday today. Philip asked me to cook some Chinese food. We planned to go to the market and buy some food in the morning after the ward round. Unfortunately, we were called again after return from the market. It was another woman that was around 32 to 34 weeks pregnant. She came in with coma and generalis ed convulsion for one night. The blood pressure and urine protein were both high. It is the first eclampsia case I saw in my life. Eclampsia is a malignant high blood pressure related to pregnancy. We need an urgent operation to remove the baby and placenta in order to save her and the baby's life. We resuscitated her, controlled the convulsion with magnesium sulphate and blood pressure with hydrallazine. We then went for a C-section. Fortunately, the lovely baby girl came to the world with a loud greeting cry. Both mother and baby were doing well. Back in the compound in the afternoon, I prepared two soy sauce chicken and onion with fried eggs. We were called back again. This time was a woman with incomplete abortion since last night. She bled so much that all her clothing and body were soked with blood and mud. I am sure she had to walk for a long distance before getting help and coming to us. We resuscitated her at once. I did the dilation and curettage (D&C) for her (removal of the product of gestation). The bleeding stopped. She was stable afterwards. As I discussed with Philip, all these women would probably die if MSF service was not available in Aweil. But both of us still really regretted that we lost the last woman with the retained placenta four days ago. We discussed it between us and tried finding any steps so we could improve next time. Returning to the compound, I could manage to cook my chicken and fried eggs. All my colleagues enjoyed it very much. They asked me to stay as their cook after my surgical mission. It was surprised that another obstetrician is coming on 21 March to replace Philip. We, including Philip, only learnt this in our general meeting last night. As I said before, Philip belongs to the MSF Emergency Team. He was deployed to his mission on temporary replacement. He said tonight was his farewell dinner and thanked me for preparing the food for us.  He is a man with character and determination. He is so knowledgeable and experienced in humanitarian work. He could organi se the maternity ward and plan the project within his one week stay in hospital. He knows and loves Africa so much and always calls people here his brothers and sisters. He asks the local doctors to learn and help their own people. I enjoy working with him very much.      Au Yiu Ka