Warning: this blog does contain some graphic medical descriptions which you might find upsetting.
The day began well with beautiful sunshine as we walked to the Hospital Chapel for the morning service. Half way through the service a midwife came to fetch me for an emergency and we rushed to labour ward, to be met with a situation that I had previously only read about in obstetric textbooks.
A poor woman had been in labour in a remote health centre all night. She had only attended for any antenatal care in a government centre once in the pregnancy, 4 months ago, so the fact that she was expecting twins had gone unnoticed. She went to the health centre last night and progressed rapidly to deliver a breech baby up to the shoulders, but the baby’s head was trapped inside, interlocked with the head of the previously undiagnosed second twin. She had to wait like this, in terrible agony, with the body of a dead baby stuck between her legs for many hours before transport could be found to bring her to us at Kisiizi. The road from the area she was travelling from is really terrible and takes two hours. There is a government hospital nearer but apparently there is only one doctor there and if he is off duty then there is no-one. So she endured the awful journey to Kisiizi, and was quite beside herself with distress, exhaustion, fear and agony by the time she got to us.
I gave her a large dose of pethidine and then my worst fears were confirmed when I examined her and found the neck of the dead baby was stretched out like a giraffe in her pelvis and the head was wedged up high inside, trapped behind the head of the other twin. I felt sure her uterus must be on the brink of rupture, which indeed it almost was when we did the only thing we could and performed a caesarean section to remove the upper twin and release the trapped lower one. Both babies had obviously been dead for several hours. I felt the terrible affront as I found myself ceasing to think of them as two beautiful children but rather as obstacles posing a real threat to the life of the woman who had carried them for the past nine months.
So now I am feeling more angry than I can put into words at the injustice of a world where this happens to women and their babies. This is a situation I have never encountered in UK, not because it couldn’t happen, but because we have so many ways to pre-empt it and easily take action to save all three lives. Ugandan women deserve no less, but time and again they get such a raw deal. The only redeeming feature of this awful situation is that we were able to save the mother’s life and prevent her two older children becoming orphans, but that is just not enough. I thought writing about this might be cathartic but now I am even more heartbroken for my patient and her dead children, thinking of all she endured last night. We just should not tolerate such needless and pointless suffering and loss of life.