Friday, 2 March 2012

Lady Rural Africa

Tired, sweaty and nervous, I felt a big relief when the Intern-on-call showed up in the ward. It was time to go home. I was still at her bedside; we had been there for some hours now, except for moments when we went to the blood bank to follow up on our planned blood transfusions. I picked my bag from where it had been lying for so long and headed for the door passing the foot of her bed in the process. At first I wanted to say goodbye to her since all of us – she and the doctors in our unit – had established a kind of esprit de corps following our common battle to keep her alive. Turning to her and trying to compose myself to say goodbye to a woman that was barely alive, I instead heard her ask faintly, “Doctor are you going?” I managed to mumble that she would be well taken care of by the team-on-call. She had no reason to worry. But was that what I was supposed to answer? Wouldn’t a simple “yes, it’s time for me to go, the team on call is already here,” have answered her question? Why did I feel as if she had asked, “Are you all leaving me here to suffer alone? I can’t fight this battle alone.”

It was so late in the evening that those of us going to town had to make alternative transport arrangements. The rest of the day went on as usual for me, as I imagine it went for the other doctors also. But the next day the story was different. On our arrival to the ward in the morning, we met her bed empty. Her belongings had been neatly packed in the corner and her husband was outside talking with some people whom I supposed were his relatives. He was very sober. E.A was dead. The little baby was not playing around as usual. Does he know that he’ll never see mummy again? She died in the night during another battle to control her bleeding and replace the lost blood. She was in her early twenties and was a mother of a toddler. She has become one more number in the maternal mortality statistics; just a number.

I looked at her husband, trying to catch his eyes. I wanted to show that we were there for him in this time of great trial. I don’t know if he saw me; he had an eye defect that made it difficult to know the direction he was looking at any given moment. He had lived in the hospital for weeks now. He had spent all his money and even borrowed in order to keep his young wife, the mother of his little boy, alive. He had suffered. Perhaps his greatest suffering will remain with him throughout life: the thought that he may have saved her life if he had given his consent earlier, when he was told that the surest means of saving her was by removing the womb. Would he realise that the delay in giving consent contributed in some way to her death? At this point it was not our duty to remind him. He already had enough to worry about.

Again, were the delays in procuring blood a major contributor to her untimely death? Whatever was the cause of the bleeding in the first place? Could we have found out? Anyway, whatever was the cause, it became obvious that the only way out was to remove her womb. This may sound like killing a fly with a sledge hammer but down here in this part of Africa, a sledge hammer may just be the only weapon you’ve got. And when you have it, you ought to use it well and promptly.

Some months after this incidence, while I was doing my paramilitary service in a rural area in the Western part of Nigeria, I noticed that there was a lot of funding for the Primary Health Care (PHC) programme. I had initially thought that funding for the PHC was almost non-existent. Alas, the problem wasn’t funding but corruption. Some people who are supposed to be dedicated to the delivery of health care to those who cannot afford standardized care are busy taking advantage of their privileged position to make themselves rich. These experiences – and more – have made me conclude that the most important factor that will bring about a revolution in health care in Nigeria will be an increased sense of commitment by the health workers. This will give rise to a desire to improve one’s knowledge and skills. Funding and remuneration still need to be improved but it doesn’t make sense that a man misuses what he has been entrusted with while at the same time he is shouting for more.

E.A. fits very well into my idea of the suffering African woman. She was poor, not well educated, malnourished, and sick. To make things more complicated, she was married to a man in a similar condition as herself. We see them every day in the hospitals; some of them barely hanging on to life.

Whenever we can make a difference, let us do our best to. Many peoples’ lives and future depend on the little difference we can make.