August 4, 2004

The Roller Coaster of African Obstetrics

Dear Friends,

Those of us who chose obstetrics and gynecology as a specialty in medicine have always known that it can have tremendous highs and lows. I would like to share with you two of these extremes that I have experienced over the past 48 hours here at Mulanje Mission Hospital in southern Malawi. Doctors need to be objective to a certain extent in order to rationally and intelligently take care of people who need their help. On the other hand, entirely separating emotions and feeling from the practice of medicine is dangerous and self-defeating.

Early last Saturday morning as I began my weekend on call, I met the first patient, Pauline, from Mozambique. The nurse saw me arriving at the hospital and told me one of the patients from the operating room who had had a cesarean section had no detectable blood pressure and could I come help. After ten hours of trying our best with the resources we had, we lost the battle, and Pauline died from sepsis and shock.

The story of 18-year-old Pauline’s experience was heartrending. Her labor had started two and one half days previously in Mozambique at a rural health center. After being there for 24 hours, she was taken to a Mozambican hospital, where she stayed for another day.

As the sun was going down Friday night, she was taken to the government district hospital near our hospital in Malawi. There her guardians were told that they could not help, and so she was brought to us at the mission hospital at 11:00 p.m., exhausted, dehydrated, infected, and with a dead baby inside her. The surgery to remove the dead baby and try to save her life was finished by 1:00 a.m.

To make matters even worse, her husband and mother who had come with her from Mozambique did not have any money with them to pay her hospital bill. Although our hospital has a mortuary, the mortuary does not have any refrigeration. On Sunday morning I found out they were still waiting for help from who knows where so they could take the body back to Mozambique. Fortunately, we were able to use money from a special fund to pay her hospital bill. Sometime Sunday afternoon, Pauline began her last journey back home.

One of the very bright moments of a busy Monday morning at the hospital was to see Mr. and Mrs. Nkhoma with their newborn son, ready to go home. They stopped by to say goodbye, their faces full of joy. What a long and fearful nine months of pregnancy it had been for them and for me. They had lost their previous four pregnancies to obstetrical complications, and had only one living son, 8 years old. With special care and extra rest during this pregnancy, Mrs. Nkhoma had carried this baby to close to term. At the time of her repeat cesarean section there was a tear in her uterus, which caused a life-threatening bleeding. An emergency hysterectomy had had to be performed to save her life. After the surgery she had had an uneventful recovery and was now the picture of health. I was thrilled and grateful to God to watch them as they left the hospital.

Visitors from the United States often ask the question, “How do you not get frustrated with the practice of medicine in Malawi, where there is such a lack of resources for health care?” After working 14 years in Africa, I find that this question has little meaning for me. There is a psychological or maybe a cultural transformation after living in a new situation for a certain time. Or maybe it is just a different emphasis or mindset. Who knows? Yes, it is frustrating, but after all, who doesn’t live with frustration on this earth? The question that comes to me in times of introspection is: “Am I still being called by God to the work that is here?” So far, the answer is yes. Every morning new blessings we see in Malawi. I pray that you also will feel the blessings and the call whereever you are.

Dr. Sue Makin
Obstetrician/Gynecologist
Mulanje Mission Hospital

The 2004 Mission Yearbook for Prayer & Study, p. 58