Several pregnancies with complications

Yesterday was the hottest day I ever had in the last week. It seemed it was a low pressure zone. It was cloudy and dusty. Someone said it was 50'C in the tent in the afternoon. I hoped it would rain. At night, I was woken up at midnight because of the heat. I was wet all over. For the first time, I moved out of my tent and slept in an open space. It was so nice and I could sleep peacefully through the night. Today, it was cloudy in the morning. In the afternoon the thunder storm came during our medical meeting. Within a short period of time, the thunder cloud came and heavy tropical rain fell, like heaven was pouring water down to earth. Our compound, some of our tents, and beds were all wet. Luckily, our tent was the strongest one. We slept on a bed rather than a mat. All my belongings escaped from this small scale flooding. Now I did not regret sleeping with other seven strong gentlemen. The temperature cooled down at least ten degrees after that. Yesterday, the new Gynecologist came. He is called Philip de Almeida. He is a Sri Lankan, educated in UK, trained in Germany and now lives in Germany. He is working for the MSF emergency team and is deployed to this project for six weeks. He has vast experience in his fifteen years of humanitarian work. He had taken a course of Public Health in his early training. Besides gynaecology and obstetrics, he can do some emergency surgeries, orthopaedics, some paediatrics, and knows how to give anesthesia. We had a good discussion last evening. This morning I had the ward round with him on all my surgical and his gynaecology and obstetric patients. It was very good. I leant a lot from him. He also taught the local doctors. As I said before, some of them are very eager to learn, including the guy that gave us the right diagnosis of the retained twin on my first day here. After the morning round, we scheduled a dilation and curettage (D&C) for a woman with incomplete abortion, and a reassessment of a woman with breech delivery in the afternoon. We went back after the rain and the meeting. This young doctor came with one of his doctor friends. Both are Denkas, the local tribe. I could see that they would like to learn more from us to help their people. After the D&C, we went to reassess the other woman. It was her first pregnancy. It was suspected of having breech presentation, which need to be confirmed with the Ultrasonography. The amnionic membrane was ruptured in the morning but the cervix was not opened yet. We would not expect the labour to come so soon. But after our USG confirmed the breech presentation, the young doctor did the vaginal examination. We found that one of the baby's feet was already coming out of the woman's vagina. We asked her for a Caesarean Section because it was her first pregnancy. We did not know whether her pelvis was adequate for the baby's head or not. If we attempted a vaginal delivery, the baby's head could be caught. We could not take the risk. Unfortunately, the woman refused as expected. We called her husband and relatives immediately. But the baby did not seem willing to wait. She was pushing her life into this world, the foot, the heel then the leg. We could not wait any longer. We had the operating theatre ready, but at the same time, we prepared to have the vaginal extraction. At this very critical moment, the brave woman and her mother decided for the C-section. We immediately went in. Stephane, our OT nurse, was having his holiday in Juba. Philip was teaching the two young doctors when he was doing the surgery. I acted as the OT nurse, helping the circulation. The C-section went very smooth. Another lovely, big girl came out to this world on this particular Women's Day. We were glad that we didn’t take risk because it was really a big baby in the African standard. We went back at around eight at night. We enjoyed a nice roasted chicken meal in the cool Saturday night. I returned to the hospital with Philip to review this woman again at 11pm. I'm glad that I could meet all this kind people and I could learn more from them.  Au Yiu Kai