"You cannot change the circumstances, but you can change yourself"

Security is quiet. Normal activities. The motivational words for the day, given by our obstetrician: “You cannot change the circumstances, the season or the weather, but you can change yourself.”
The morning meeting; that’s how the day starts here at MSF Khost Maternity Hospital (also known as the ‘baby factory’), where roughly 50 babies are born daily. Today feels colder than most days – weather forecast says it is two degrees Celsius. So one hot cup of coffee later, I head to my ward.
Round one
While doing rounds in the neonatology ward, I was trying to locate the whereabouts of a baby who was born yesterday and was noted to have a bulge on the forehead. The obstetrician was concerned and wanted an opinion on the baby but I could not locate this baby anywhere in the ward.
Suddenly, a midwife from the delivery room came into our ward, muttered something in Pashtu and left. I asked my midwife what happened. ”Baby not good in delivery room,” she said. My ears perked up. “Baby not good? Come, let’s go!”
We ran over to the delivery room which was just opposite our ward and saw them resuscitating a lifeless looking good-sized baby. We quickly took over and listened for a heart rate. Nothing.
“What happened?” I asked. There was a flurry of conversation in Pashtu but none of which I comprehended. Finally I caught a “Came os full Delivered. Baby no good”: The woman came with her cervix fully dilated and ready to push the baby out. With not much information to go on, we continued with the resuscitation. Still no heart rate. The anaesthetist happened to walk past and quickly jumped in and did the resuscitation with me. After more than five minutes and no response at all to our resuscitation efforts, I knew it was futile.
I looked down at the sweet little face of this normal good-sized baby and silently apologized to him in my heart. We continued for ten more minutes and pronounced him dead at 11am. The baby was not a premature baby, whose chances of survival would have been much worse. What probably happened was the mother took too long to come to the hospital and the baby was compromised/asphyxiated for too long before being born.
Feeling dejected, I went back to my ward. The midwives had managed to locate the baby with a bulge on the forehead and brought her here. I looked at her. She was swaddled in the thick furry baby blanket and I could only see part of her face. “Well hello, little one.” I lifted her from her cocoon and really saw her. My heart sank. Crouzon syndrome(1). A fancy name which brings with it a sentence of “all the odds stacked against her”. She was barely a day old. To be a girl in this country is already challenging, but to be a special girl, is even more difficult.
We explained to her mother about how she is a special baby and how the bulge at the forehead is not as a result of the vacuum cup as she and her family had so firmly believed – an easier and more temporary explanation to accept perhaps. The mother remained silent. Partially veiled, it was difficult to gauge her reaction. I placed her baby in her arms. She looked down at her and asked if the bulge will go away eventually and I knew she was still in a denial phase. I wondered if life will be more difficult for the baby or for her. It never was easy to begin with.
Round Two
I went back home after completing the ward work and had just sat down when my phone rang. ‘Anaesthetist 1’ flashed. Not good. I picked up the phone immediately. “Come now to OT (Operation Theatre). Baby not good”. While desperately trying to stuff my hair into my hijab I ran to OT as fast as my legs could carry me, passing some caretakers and staff garnering quite a few stares as women generally do not run (fast) here. But in neonatal resuscitation, every minute counts.
I arrived in OT breathless and saw my midwife breathing for a baby with an ambu bag(2). I listened for a heart rate. Good and strong. “Good job,” I told her. She continued. Slowly but surely, the baby started to breathe regularly and soon we let the little fella breathe on his own. He needed just a little help to adapt to this new environment, and he made it.
Woohoo! After making sure he was stable, I walked back slowly. Phew…sprinting in the cold is certainly breathtaking, and not in a good way! I sat down for lunch with the others, talking about erratic weather and flight plans to Kabul when halfway through my meal, my phone rang again.
Round Three
It was the midwife. “Can you come to delivery? Baby is not good”. Oh gosh. Not again! I had just caught my breath and a sense of déjà vu came over me as I struggled with my hijab again and ran towards the delivery room, weaving through a mass of caretakers (family members or guardians) with their new babies at the entrance to delivery room. I wished I had a siren.
As I threw open the doors to delivery room, the first things I saw was a woman who had just gave birth lying semi-reclined on the floor in the middle of the room with a puddle of blood at her feet as all the beds were occupied. I turned to the right to get gloves and gingerly made my way between a trail of blood to my destination and back to where the baby was. The midwife was helping a good-sized baby covered with meconium(3) – the first faeces a newborn passes – to breath with an ambu bag.
“What happened?” I asked, in between trying to catch my breath. It was a complicated breech delivery and they had had difficulty delivering the baby. I put my stethoscope on his chest. Good heart rate. Good. I continued the resuscitation and after about five minutes, there was a small gasp. And then another. And slowly, he started breathing and moving his arms and legs.
“Hey, little fella, you almost gave us a scare there”. With no further means of assisted ventilation other than ambu bagging(2), I was thankful he was a strong baby. After stabilizing him, we brought him back to the neonatology ward for post-resuscitation monitoring. No more, I pleaded silently as I made my way back to finish my lunch later. My lungs are tired!
Thankfully, the rest of the day was quiet. Come evening, it was time to hit the gym – needed to improve my stamina seeing how today’s sprinting in the cold literally took my breath away. Twice.
“You cannot change the circumstances, the season or the weather but you can change yourself,” remember? Next time will be better, Insh’Allah.
(1) Crouzon syndrome is a rare genetic condition in which sutures in the head are prematurely fused resulting in abnormal growth of the skull and face.
(2) Ambu bagging is a technique used to help babies who are not breathing to breathe with a device called an ambu bag or bag valve mask (BVM). We pump oxygen enriched air into the lungs by squeezing the “balloon” part of the ambu bag. Another name for this is positive pressure ventilation.
(3) Meconium is the first stool passed by a newborn baby. In some cases, the baby passes meconium while still inside the uterus. This can happen when babies are under stress in the uterus due to a decrease in their supply of blood and oxygen. The baby may breathe meconium into the lungs, partially or completely blocking them, thus making breathing difficult or impossible.