Friday, 29 April 2011

Worlds Apart

Two experiences of a doctor: one as an Intern in a Teaching Hospital and another as a Medical Officer (National Youth Corps member) in a village. Both occurrences are about 1 year apart.

Scene One.
Teaching Hospital: Delivery Room
A young banker has just been delivered of a bouncing baby girl; her first. Her husband and mother-in-law are outside rejoicing. She is tired but manages to thank the doctors and nurses who have assisted at the delivery: an O&G resident, an intern, two nurses and a nurse-midwife. It was a normal delivery and the baby weighed about 3kg.
Suddenly, there is panic in the room: she is bleeding profusely.  In a matter of minutes her blood pressure is unrecordable. Every personnel at hand is busy with work: IV line and fluids, BP and pulse monitoring, grouping and cross-matching of blood for transfusion, determination of the source of the bleeding, etc. The senior resident-on-call is informed and the other three interns-on-call are recruited to join the resuscitation effort.
Finally she pulls through; the problem solved. Two days later she is discharged. 6 weeks later, she attends her Post-natal visit.

Scene Two.
 Primary Health Centre: Delivery Room.
A young secondary school leaver has just been delivered of a bouncing baby girl; her first baby. The baby cries immediately and the mother, mother-in-law and sisters begin to dance to the tune of popular Yoruba songs. She tries to mumble a ‘thank you’ to the health team: a health assistant - 'messenger', a junior community health extension worker (J-CHEW) and an inexperienced - as far as deliveries are concerned - medical officer. It is a normal delivery and the baby weighed 3.5kg.
Within seconds, blood starts to gush. She had sustained an extensive tear and was bleeding profusely from it. The doctor tries to assess his first major tear but is horrified at the site of the gushing blood. He recalls similar incidences he had witnessed; but those were in better settings. Before he can make up his mind what to do, the J.CHEW - the very one he thought acted confused on some occasions - makes for suture materials and begins to suture. Blood is still gushing out. Around her body are pools of clotting blood.
Fortunately after several attempts at arresting the bleeding, the patient is stabilised. No transfusion cos facilities are not available, inappropriate IV fluid is used, etc, etc. Everybody is relieved and tired at the same time. The doctor is amazed that she was able to survive the incidence without serious hemodynamic effects.  A few hours later, the family demands the discharge of the new mother. The doctor protests but sees they are not yielding. He lets her go, hoping she will come for her post-natal visits.