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August 1, 1999
Dear friends,
Yesterday was Saturday here at Mulanje Mission Hospital, and
I was "on call." Taking call is one of the responsibilities
of working as a missionary doctor here. Fortunately, there are
two other individuals who share this responsibility, so weekend
call is every third weekend, starting from Friday morning and
lasting until Monday morning. On these weekends, there is only
one doctor on call for the whole hospital. There are about 140
beds, and usually every bed is full with some patients lying on
the floors. A description of yesterday’s experiences will
perhaps give an idea of some of our problems, challenges, and
triumphs.
The morning came with bright sunshine and blue skies. Mulanje
Mountain was beautiful at 7 a.m. as I headed to the hospital to
make rounds. I saw about ten postoperative patients before morning
prayers in Chichewa at 7:45. Then I went to the Female Ward and
saw several new patients. After that I went on to the Children’s
Ward where there were about 20 patients, but no nurse. Without
a nurse I am very handicapped because my Chichewa is limited,
and also, I do not know the patients on Children’s Ward.
So I passed on to the Men’s Ward and asked the nurse there
if there was a nurse for Children’s Ward. She said she did
not know. I asked her to find out.
Later, while I was on the Labor Ward, the nurse from Children’s
Ward came and told me she wasn’t at her post because her
mother was sick, and she had taken her to the Outpatient Department
for medical attention.
By 11 a.m. it was evident we needed to do a cesarean section.
Everything went well, with a healthy baby and mother. After the
operation, I returned to Labor Ward where I was told one of our
just-delivered patients had a bad headache and a blood pressure
of 190/120. She was suffering from pre-eclampsia, which is high
blood pressure late in pregnancy. I wanted to start her on magnesium
sulphate intravenously to prevent her from having eclampsia seizures,
but there were three other laboring patients, and only one nurse
for Labor Ward. So I thought it would be better to not start this
medicine because it needs to be monitored carefully. I was hoping
that her blood pressure would go down slowly and her condition
would improve on it’s own, which sometimes happens.
After lunch it became necessary to do another cesarean section.
Our faithful Labor Ward nurse told me there were only two nurses
at this time for the whole hospital, herself and one for Children’s
Ward. Taking this into consideration, I thought we should still
do the cesarean section. There was one nurse on call at home who
came to the theater to assist in the operation. Everything went
well and expeditiously for the mother and baby. After the skin
was closed, I took the patient’s chart and the theater record
to Labor Ward with me so I could do the paperwork while watching
over the patients there. When I got to Labor Ward, there was a
patient pushing who needed to be delivered, so I prepared our
equipment and put on sterile gloves for the delivery. Right at
that moment I heard a noise, and looked over and saw that the
patient with the headache and high blood pressure was having a
seizure. I was the only one in Labor Ward. The two nurses who
had helped with the section were taking the postoperative patient
to the ward. So I went over to the seizing patient and held on
to her so she would not fall off the bed. These eclampsia seizures
usually last a minute or so, but it seems like an eternity, and
they are terrible to watch. So I decided that the patient who
needed to be delivered would have to wait while I started an intravenous
line for the eclampsia patient so we could give her magnesium
sulphate.
Fortunately, the two nurses arrived on the scene to help. I asked
one of the nurses to deliver the patient who needed help. The
other nurse helped me start an intravenous line. We were able
to give her the necessary medicine. The only trouble was there
was no one to watch her and especially to make sure she did not
disturb her precious intravenous line. We needed to keep on giving
her magnesium sulphate to prevent recurrent seizures. As always,
when in doubt, ask a nurse. So I asked the nurse, and she suggested
that the patient’s mother could come into the Labor Ward
and watch her daughter’s arm. We did, and she did. After
that, I went to the postoperative ward and looked at the two postoperative
cesarean section patients who were doing well, even though there
was no nurse to monitor them. The other lady in labor had delivered
safely.
By this time things were calming down, and it was time for supper.
After supper, I went back to the Labor Ward for evening rounds.
I was very pleased to see our eclampsia patient sitting up in
bed eating her supper and feeling fine—no headache. Her mother
was with her sitting on the floor beside the bed with her newborn
granddaughter. There was a little girl sitting under the bed chewing
on a chicken bone. This is Africa. We like to have a family atmosphere
in Labor Ward.
I made a tour of all the other wards, and it was quiet. I left
the hospital at about 8 p.m. with only 36 more hours of call to
go.
So here is a "slice of life" of missionary medicine.
Any one out there fascinated or challenged?
Sincerely,
Dr. Sue Makin
The 1999 Mission Yearbook for Prayer & Study, page
41
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