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Thursday, January 26, 2017

Sadness

I'm not sure what to write. I think I'm a bit numb, pushing it all down, so I don't start crying every day. So many dead babies, ruptured uteruses, hysterectomies. Here, the value of a woman is measured in pregnancies. Some will agree to anticonceptives, because they know it's just for a while. Few want to tie their tubes, and that only if they've already had... 7-8 kids. We had an uterine rupture back to back with an ectopic, both women in their 13th pregnancy. One had 7 alive, the other 4. Can you imagine being pregnant 13 times and have only 4 living children? I don't know if they were all to term, some might have been miscarriages. But truth is, a lot of them die in their first week, or before they turn 5. The prevailing culture is that it's good to give water to newborn babies. We hammer into their heads that they cannot, under any circumstance, give them water before 6 months, but it happens. And the babies who are born at home (by far the overwhelming majority) don't have us hammering into their mom's heads not to give them water. 

There is no water/sewage system here. You walk around and see people defecating on the ground. Waterborne diseases are rampant, and we treat ALL our pediatric cases for parasites, regardless of presentation. Imagine what that does to a newborn baby, who should be safe and protected from any food/water borne disease by drinking only breastmilk. But isn't.

Yesterday I was out of commission myself, having eaten something someone kindly made for us, but gave me diarrhea. Today I was better, so I walk into the OR to see Dr. Danae in the middle of a hysterectomy. Ruptured uterus. The patient went to a village health center 40km away on Tuesday evening for prolonged labor and they referred her here. Who knows how long she had been in labor up to that point. Today is Thursday, and that's when they brought her here. The baby was dead, she was hemorrhaging, and a little longer, she would have died too. The baby was long dead, skin peeling off, flacid, like jelly. 4.2kg worth of a baby boy, who would have been big and strong, if only... so many things. 

She asked to see the baby. I wrapped him carefully, trying to cover the worst parts and took him near her face. A tear ran down from the corner of her eye. I almost lost it. 

Being in Chad is always hard. There are always cases that get to you. But the previous two times, I was working at a hospital with no OB-GYN. No ruptured uteruses, no ectopic pregnancies of 10wks with bellies full of blood, no hysterectomies, no dead babies. I've lost count how many we've had, and Saturday will be only 3 weeks since I got here.

There are good cases too, of course. To finish on a ligther note, I'll leave you with a picture of darling twin girls, born by C-section (mom had pre-eclampsia). My first (and so far only) set of twins. 

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