Saturday, July 20, 2013
One baby to hospital, one baby’s legs amputated, one unborn baby at high risk.
This was a tough week. Within the past 24 hours we correctly diagnosed a 9-month old baby in the rural community who was severely malnourished with Kwashiorkor and got her and her mother to the hospital days before she would have died (according to the doctors). Last year this same mother lost a child to malnutrition after spending SIX WEEKS in the hospital. They had arrived to late.
Next we met another 9-month old baby who “somehow” was found in the middle of a cooking fire and whose legs were burned so badly that they had to be amputated. The baby had been discharged on April 16th and still had large 3rd degree burns exposed. They had been told to keep the wound open so that it would heal. Based on my learning from Benjamin’s burns I knew that the skin would never grow back and he would need skin grafts. In addition the wounds were infected and they had no antibiotics or even bandages. We were able to get him to the hospital and directly to a surgeon who cleaned up the wounds, treated with antibiotics and scheduled a meeting in two weeks to discuss skin grafting. Total cost to help that day was $6 USD.
But neither of those situations were what really sucker punched me. It was the 9-month* pregnant woman who is dying of Multi-Drug Resistant Tuberclosis in the hospital and was believed to be in labor.
When I dropped in to see Nomsa on Wednesday she told me about this woman’s tragic situation and we tried to speak with the woman to encourage her, but she is totally deaf now from the TB treatment. She is bone thin from extreme weight loss and her eyes were sunken back in her head. She would slowly reach out her hand to ask for help, and would shout out as she couldn’t hear the volume of her own slurred words. After praying with her we left and went on our way. The next day I stopped in to see how she was doing on a “nudge”, only to find that Nomsa was convinced the woman was in labor. She had a urinary tract infection, which I am told can bring on labor. An ultrasound suggested that she was 36 weeks pregnant, but to the naked eye looks like she is 6-months pregnant and hardly showing.
This is a long, long story that I will cut short for Saturday morning purposes. After voicing my concern to other patients and our volunteers (not helpful) I went to the nurses and asked specific questions about how and where the woman would give birth. The nurses told me that she can’t give birth naturally because childbirth would like be the death of the mother, and possibly unborn child. She would need a Cesarean Section. I asked where that would be performed (believing she was in labor at that moment) and the nurse said she did not know. No plans had been confirmed at that time, but she did know of several local hospitals who had explicitly said that they would not allow the woman to enter the hospital for fear that she would spread the horrific disease that she was living/dying with.
MDR-TB is highly infectious and highly deadly, especially for people who are HIV positive and whose immunity is already compromised. With an estimated 46% HIV rate in the country some hospitals have chosen to not have any MDR-TB patients admitted to their hospitals. But then what? Where would she go? The nurse didn’t know and were clearly uncomfortable that I was asking (pushing). They assured me that when the time come that the doctors would have a plan, but I suggested that the time might come at 2AM and with no plan in place now, both mother and child would die.
I am not putting thoughts in their minds, but I wonder if they were thinking that might be the best option for both mother and child? The mother is likely to die from this terrible disease and if the baby lived it would be pawned off to an unhappy family member who is already looking after her other three children. They would have one less patient in misery and the world has one less orphan?
Well, I don’t think that way, but they were clearly stuck. Finding a hospital to take this woman to was way above their pay grade, responsibility and skill set so they were stuck. I pulled out my phone and called an OBGYN at the Women and Children’s Hospital who had cared so wonderfully for Benjamin and his burn care as well as the inducement of Baby Daniel’s mother. They are arguably the best (or in the top two) private hospitals in the country. I explained the whole situation and she after I had finished there was a long pause, and then she said, “WOW!”.
Yes, wow. What do we do? I am not going to lie, knowing that the doctor I called was pregnant (and was also Helen Muli’s OBGYN) was part of my hope that she would have extra compassion. After more pause she said that she would go and speak with the Chief Medical Officer and call me back. And she did. Only 20 minutes later she called and said they would do it! (!!). There were criteria that we would need to work with because they would need to fumigate the surgical room and let it sit for 24-hours after the surgery before it could be used again (i.e. over the weekend) and then they would provide her with an isolation room for three days before she was transferred back to the TB hospital. I really couldn't’ believe my ears.
The next day I called the Chief Medical Officer at the TB Hospital and gently introduced myself and tried to explain the situation without suggesting that they did not have the situation totally in control, but I did say that IF we could help and IF our help was needed that we were willing and able. Note here that I did not have funding for this (likely $2,500+ USD), but I believed that if this was what the Lord wanted then He would provide the funds. The Doctor thanked me for my call and said he would look into the situation. By the end of the day he called back and said that he had personally gone to examine the patient and they believed that she was not in active labor. He assured me that they did have a care plan in place, but they believed that our offer was a much better solution and would provide a better chance of both the mother and the baby living. He thanked me again for stepping out and taking the risk of helping and that he would like me to connect him to the people at WCH to make a plan. Within an hour of that call the hospitals had spoken, and OBGYN was assigned to go to the TB Hospital to examine the patient and a plan would be made for delivery.
I want to mention here that I/we in no way were doing this or involved in order to receive her baby at El Roi. That never entered my mind because I believed (or chose to believe) that she had family that was ready to take the baby. When we contacted her brother to get consent to move her to a different hospital for child birth he thanked us, fully consented and then asked if there was some way we could keep the child? It was then that he told us he was caring for her first three children. We will cross that bridge when we get there, but for now I believe that this young woman has a chance at life, and so does her unborn, innocent child.
I woke up this morning at 3AM and had a message from a dear friend in the US. She asked what the cost of the C-section and hospital stay would cost? I told her I was guessing $2,500. She has offered to pay the hospital bill.
El Roi sees us all. He is our provider and our protector. I am so thankful that Nomsa is a patient at the TB Hospital because God is using her in a MIGHTY way. It is not a place I would want to live, and nor does she, but she does see that HE is using her and she has days were she is less hopeless because of that knowledge.
Live from Swaziland … I love when educated and powerful people work together to help others.
PS – on a very happy note I am thrilled to tell you that Helen and Peter Muli have a brand new baby girl! Her name is Rosylen Muthikwa and she weighed 3.5 KG. Mother and baby are doing well. Her OBGYN missed out on the delivery due to the unexpected death of her brother, but she made the TB/C-section situation happen before she left for home. Thankful.
*I do find it a strange coincidence that all three stories above with “9-months” old including the pregnancy.