PUSH!!!

And now PUSH!

Celestine had come to our hospital in labor.  Her twin babies were both breech, but this wasn’t her first baby.  With a little patience (always for breeches), she delivered vaginally with the help of some lifesaving maneuvers to deliver the nuchal arms they both ended up having.  The first baby had to be resuscitated for about ten minutes, but finally let out a good cry.  Both babies are doing well now and are already one week old.  

Every day we provide obstetrical care for the surrounding villages.  We receive many referrals from the neighboring cities of Lai and Kelo for prolonged labor.  Often times from Pala as well (a four hour drive in dry season).  I’ve had ruptured uteri travel the bumpy roads all the way from Pala.  I have about 20 ruptured uteri every year, almost always unscarred uteri, and always from prolonged labor.  

The country of Chad was named the worst country to be a woman in 2019.  In 2018 it had the world’s worst maternal mortality rate.  I know we are making a difference here, but hopefully not worsening these rates.  Just kidding.  I know we are making a positive difference in individual lives.  But sometimes it feels like a drop of water in an ocean.

Our hospital delivers about 1200 babies a year.  We have one obstetrician and two family practice physicians, each with a year of obstetrical fellowship.  We have one local midwife with her masters, and five or six nurses who function as midwives.  Our nurses do all of the normal deliveries, and call the doctors when there is a problem.  

Every Tuesday and Thursday are our prenatal care visit days.  Usually once a month women walk from all around (yes WALK) just to get checked out while they are pregnant.  Prevention goes a LONG ways.  They also know that when they deliver at our hospital, they will get a free baby Bere Adventist Hospital T-shirt and random other baby clothes or blanket/hats.  This has been going on for years, and they will ask for it!  These are women who do not get a fancy baby shower, so it might be the only new thing they will get for their baby.  It’s so fun to give to them!

There are three main causes of maternal deaths here in Chad.  Hemorrhage/Anemia.  Preeclampsia/Eclampsia.  Malaria.  With good prenatal care, the risks of these causes of deaths can be assessed and often death can be prevented.  

Most deliveries in Chad are home deliveries.  The problem is that many of these home deliveries have never had a good prenatal visit, let alone ever had an ultrasound.  Malpresentation goes undiagnosed.  Multiples go undiagnosed.  Often at the expense of the baby, and sometimes the mom as well.  And many of these home deliveries are grand multiparous patients.  So their uterus does not want to contract, and they bleed.  Sometimes to death.  

So many times surrounding places that provide ‘prenatal care’ have never done a blood pressure on a patient.  Thus, the patient arrives completely comatose after their eclamptic seizures at 8 or 9 months of pregnancy.   

Malaria affects everyone here, but it hits hardest on the pregnant mothers and babies.  Malaria also causes anemia, further compounding the hemorrhaging problem of delivering at home.  

All of our nursing students rotate through labor and delivery, but it’s time to graduate some midwives!  We’re going to make it official and open up our midwifery training program.  

To all of my midwife friends who would love to teach a course….come on over.  It will likely be a 4th year to our three-year nursing program that we already have going.  But we need to develop our own curriculum and make things official.  French friends with curriculums already in place would be very welcome! 

So come on people.  Help us PUSH some babies out!  And push some midwives into training.