Sad stories of mothers in south Sudan

(Please note: This is going to be a very sad, bloody and horrifying story. I want to record it as it's going to be part of my memory for life. If you are interested in reading, forgive me for the medical terms and be prepared.) The story started two days ago. In the afternoon, we received a 14-day - old baby with neonatal tetanus, a condition we have only read about in a text book. The umbilical cord wound was a bit dirty. I guessed the source of the infection was from that. The baby was born at home. I presumed that they had used unclean scissors to cut the cord and the baby was infected. He had the typical tonic, clonic convulsion. We do not have the anti-tetanus immunoglobulin in pharmacy. We could only give him a dressing, penicillin and anti-tetanus toxoid. We have to control the convulsion with a regular injection of diazepam. We guess the poor baby was not going to make it. The mother refused tube feeding. He could die of aspiration and pneumonia in a day. Later in the evening of that day, we received another man with a gun shot wound on his left elbow and both legs. He was shot by a soldier for suspected personal conflict. We went back to the hospital to see him. As it was neither a life saving, nor limb saving procedure, I postponed the wound excision till next morning. We may have more support in day time. I did a surgical exploration  for him yesterday (11 March) and I found that all the bones of the wounds were fractured. He may end up as a cripple and a stiff left elbow. Many people here carry guns . It is a disaster waiting to happen. Yesterday was an extremely busy day. After I reviewed this wounded policeman in the morning, I found there was a man in the emergency ward with also typical tetanus convulsion. This man and the 14-day-old baby were the first two tetanus cases I saw in my life. The man had a badly infected leg wound. I immediately got all the anti-tetanus toxoid, antibiotics  and Intravenous Fluid (IV fluid) prepared and asked for the relatives consent for the wound debridement. Before we could do anything, he died in front of us. We did not resuscitate as we did not have the resuscitation and life supporting facilities. The family kept calm and quiet. They covered the body with their own linen and paid their last respect to their beloved one. Their calmness shocked me. It seemed that this is so usual and expected in their life. They have to accept all these sufferings without any protest. Later, it was very busy in the maternity ward. A full term woman came in with pre-eclampsia. The blood pressure could not be well controlled with an anti-hypertensive and Magnesium sulphate. Philip decided to have induce her labour. She had good progress with a stable foetal heart beat. While we were worrying about who would look after her during the night, she delivered the baby at evening. Before we became delighted, we were informed that the baby was in bad birth asphyxia. We immediately took the baby to the Operating Theatre for oxygen (of course, from oxygen concentrator) and bagging. The baby girl recovered spontaneous breathing, and colour returned. But the baby remained flaccid. We did not know how much damage had been caused. Another woman came in with premature rupture of membrane for three days. There was no uterine contraction. Philip decided to use oxytocin infusion to induce the labour. It is rather dangerous to use it without foetal heart monitoring. He had to keep on eye on her regularly. There was still slow progress in the afternoon. We decided to have C-section for her before evening. The third came in with retained twin. It was a breech presentation. Luckily, the baby was delivered by Philip. Unfortunately, I had no chance observing him perform the procedure. The f ourth one came with labour for three days, abdominal pain and distension, and in shock. It was her eighth pregnancy , with three living children, two dead and two abortions. We suspected a ruptured uterus. The baby was dead. We could feel the foetal parts beneath the abdominal wall. We only had one set of instruments each for different major procedures. So we had to clean up and sterilize the instruments immediately after use, in case we need to use the same set again later. However, since w e had a number of procedures done during that day and all the instruments had been used and not yet cleaned up, w e had to get the instruments ready before we could operate. Anyway, we needed time to resuscitate her before surgery. As expected, we found the dead baby and lots of blood in the abdomen, with a rupture at the lower segment of the uterus. I repaired the perforation successfully. We decided to perform the tubal ligation to prevent further pregnancies that may end up in another disaster. We did not know how to handle the baby’s body. I wrapped it in a paper used for wrapping instruments and put it in the bin and covered it up with some paper. Later, the father came and took it away. It seemed that he was emotionally attached but also so detached. He quietly received the baby and accepted all that had happened . It was around 11pm. We all got tired. We needed to postpone the fifth mother with retained placenta for next morning (i.e. this morning). But Philip found the sixth new comer with around thirty-two week's pregnancy and high fever, she was unconscious and convulsing . The blood pressure was not high. There was no sign of pre-eclampsia or meningitis. We gave all the antibiotics .We suspected cerebral malaria. Philip and I had the paracheck (checking for malaria) for her. Although the test was negative, we might have to cover her with the anti-malarial treatment. Her condition did not improve and she had a spontaneous abortion this morning. But she remained unconscious. Near mid night, we had another call from the Emergency room with a man chopped by others. Luckily, it was not serious. We could wait until today. By t he time we were back to compound was nearly one o'clock in the morning. After returning to hospital this morning, we had to fight another battle. A young woman came in severe shock. She delivered a baby at home yesterday, but with a retained placenta. She bled quite a lot. We resuscitated her with intravenous fluid. Her condition improved but she was very anaemic. But we could not find blood for her. We went in later in the morning. We tried to remove the placenta manually. Philip could not get into the uterus with his big hand. Before he decided to go for a dilation and curettage (D&C), which might cause more bleeding , he let me try . Luckily, I could get into the uterus and safely remove the placenta. We thought that we could save this woman. Our happiness lasted only for few hours. After returning to the hospital in afternoon, we found her unconscious again. She was in severe anaemic hypoxia. Her brother came and agreed for blood transfusion. I immediately took her to the laboratory. Later we found that the service was there, but patients had to pay. MSF agreed to pay for any emergency tests in our patients. We got the blood group of the brother. When I took the technician to the mother, I found that she was dead. It was the t he first time I saw an African young man weeping in front of his beloved sister. They took her body quietly again. I am so upset. We all are human beings. I don't know if it's unfair or not. We happened to be born in a modern society, but they are in this poor country. Women need to face the risk of death and complications during childbirth. They have no choice. High death rates in children also push them to face the danger repeatedly and bravely. The natural resources in Sudan and other African countries are so rich. Most of them have been stolen by the developed countries. Most have been spent in all these everlasting wars. They may have a much better economy, living, welfare and health if there is no more man made disasters. We are fighting an endless and battle that can never be won .  Au Yiu Kai