Separation in life or death

Just returned from hospital at 9pm and finished my dinner. We had two emergency obstetric cases again this evening. The first case was another woman who delivered at home yesterday, admitted with a retained placenta. Luckily, she did not bleed so much as the last case. Philip allowed me to operate on her with a local doctor. I taught him how to remove the placenta manually. The second one was a woman with her second pregnancy. The first pregnancy was an intrauterine death on delivery. This time again the baby was big and the mother's pelvis was small. The f ather refused an operation at the beginning. We gave her a trial but she could not deliver. The baby had foetal distress. We pushed the father to give consent for operation. Again, I operated with the young doctor. It was a big baby girl. (I just stopped writing this diary for a while and rushed to answer the call. It was because I heard someone called Paul. I thought it was another emergency. I found that they were chatting around the dining table. Jeff, the hospital logistician, was joking with Philip. They know that whenever there is emergency, Philip would call "Paul", then I will be there. They tested and I did respond. ) Yesterday a mother that was around 24 to 26 weeks pregnant came to hospital. She had vaginal bleeding. Philip did an USG and found placenta previa (placenta covering the cervix). It was a breech presentation. The mother went into labour very soon. Philip had called me stand-by and helping for resuscitation. He delivered the legs and body but found difficulty at the head as the cervix was not dilated enough. I had to help him stretching the cervix. The baby was finally out but it was small. He was blue on delivery and the heart rate was 60 only. We decided not to resuscitate him as it was no chance for him to live in this environment. We knew the father would like to come in during delivery. We did not allow it. Later we found out that the father was very aggressive. He is a soldier in uniform, luckily not carrying a gun. He threatened the guard that we might be in trouble if his wife had any complications. He took his wife's file away. Later, I found him in the courtyard. I called him to the ward. He was very angry. Someone asked us to call the police but I decided to let him go in to see his wife. Ｈe saw that his wife was safe with blood messing around in the labour ward. His wife told him the story. He saw the baby, he kneeled down and prayed, and then he calmed down. He took the file to see the Medical Superintendent. Later he brought the file back, presumably accepted the explanation from the MS. There was a moment when I was worried that he might shoot us. But when I saw him kneeling down and prayed, I felt sorry for him. It was all his emotion and reaction. It was confirmed that I will go on 24th from Aweil. Then I will stay in Juba for two days till plane from Juba to Nairobi. I will be back to HK on either 28 or 29th depending on the flight availability. See you soon.                                     "Paul" again. This time it's a real alarm. The patient with the removed retained placenta bled. We rushed back to the hospital. The uterus was not contracting and it bled. We gave her all the oxytocin, ergometrin and the new prostaglandin. Luckily, the bleeding stopped. If not, we may end up removing her uterus or lost the mother . Philip always says to me. We all are human beings, it just happened that we are born and brought up in another part of the world. We have better chance and opportunities. We should make use of our knowledge in a better way.  Au Yiu Kai