Joy & Lament

    In the space of two days, we had three maternity cases that brought to the forefront all kinds of positive and negative emotions.   Sierra Leone has one of the highest maternal mortality rates in the world, and for a lot of reasons, Bonthe district, our district, is at the bottom.  One of the main reasons is difficult access to care, plus only 2 hospitals to serve a population in the whole district of more than 200,000 people.  Bonthe district consists of an island, Sherbro Island, which is only reachable by boat ride of 1-2 hours, and many villages that are 4-5 hours away from the hospitals.  The current rainy season increases these numbers as boats and roads are unreliable.

 On Thursday evening, we had a lady referred from a neighboring PHU (peripheral health unit) who went into labor, and the umbilical cord of the baby had prolapsed.  Often when that occurs, the baby dies, but fortunately the cord still had pulsations which meant the baby's heart was still beating.  (The 2 umbilical arteries carry blood from the baby's heart into the placenta, where it receives oxygen from the mother, and then returns the blood to the baby via the umbilical vein--our bodies our fearfully and wonderfully made as the Bible says.) The treatment for this problem is relatively straight forward, unlike some of our medical decisions here--the pressure needs to be kept off of the cord, and a C-section needs to be done.  The best way to keep pressure off of the cord is to press up on the baby with a gloved hand while preparations are done.  I had a difficult time getting anyone to persist in this job. Although I had several nurse volunteers, no one seemed to get the idea of staying there, so eventually I assumed the position.  My hand and fingers all went to sleep, but I stayed put, while my capable assistants, Pa French and Michael Josiah actually did the C-section. Soon we had not just 1, but surprise! 2 babies crying healthily.  A success story that makes everyone feel good, since the possibilities initially were not good.

Jon and his team preparing for a C-section.

 Less than 24 hours later, a lady due to deliver was brought by ambulance from a village about 5 hours away with respiratory distress and she was having bloody, frothy sputum.  This is a sign of pulmonary edema, or fluid in the lungs.  She had a very low oxygen level, and was unconscious due to that.  Her blood pressure was extremely high, so with our limited equipment (no xray, but it is coming, PTL!) we felt that she had pre-eclampsia (high blood pressure during pregnancy, or toxemia) with resultant pulmonary edema--a rare complication of untreated pre-eclampsia.  Once again, the decision to proceed to C-section was made, but this time before the patient could be transferred to the operating table, she went into cardiorespiratory arrest.  In an effort to save the infant, we did surgery right there, and although the baby was pulled out in no time while doctors and others were performing CPR and resuscitative measures, we were unsuccessful in saving either one.  As I went to talk to the father to tell him that his firstborn and wife had perished, this stoical father burst into tears.  To see an man cry in Africa is quite soul wrenching, and my heart and soul were crying with him.  

   The same day, a lady with term pregnancy was laboring, and although the labor was proceeding slowly, she was making progress.  I checked her with ultrasound in the afternoon (to rule out twin pregnancy which was a question) and saw the heartbeat of the baby, strong and reassuring. She was making progress, so a couple of hours later, I popped into the labor room. No nurse was present but I saw the mother of the laboring patient holding a baby in her arms, and felt that wave of relief that everything had come out okay.  That is, until the mother brought the baby to me and said, "Bebi don day" (The baby has died) with sorrow in her voice, and I looked at a perfectly formed stillborn child.  Once again, that thud of weight landing at the bottom of the stomach, and the questions came, "What happened?"  No answers from the nurse--an unexplained happening here in Africa..

   Laments from the Psalms speak to the despair I felt, "How long O Lord?", and " Will he never again be kind?  Is his unfailing love gone forever?  Have his promises permanently failed? Has God forgotten to be gracious?  Has he slammed the door on his compassion? But then I recall all you have done, O LORD;  I remember your wonderful deeds of long ago.  They are constantly in my thoughts.  I cannot stop thinking about your mighty works.  O God, your ways are holy.  Is there any god as mighty as you?  You are the God of great wonders!  You demonstrate your awesome power among the nation." (verses from Psalm 77) In this hope we go forward....

A little baby girl who arrived safely.