Thursday, September 23, 2010

A routine manual removal

I just put this together for one of the MAF pilots about a medivac we did yesterday. It didn’t initially stand out to me as anything out of the ordinary… but it really shows how things can go well. There was a trained, caring health worker in a remote village with adequate knowledge and supplies. The village had a functioning HF radio (with solar panels and battery) and were able to call CRMF in Goroka for help. CRMF were able to call a doctor at Rumginae and we could then liaise directly. Wawoi falls has an airstrip which the community are looking after, so it was possible to ask MAF to fly in and bring her back to Rumginae. The cost of medivacs is a burden for the hospital, but it can save a life. In this case, I think MAF were able to access some recently donated funds. It would be nice to not have to worry so much about money when dealing with peoples lives!

The story doesn’t stop there! Years of work have gone into building up a functional hospital at Rumginae, and then there is the dedication of MAF pilots, CRMF and presence of doctors. The final link in the chain is very exciting to me. PNG nursing staff and a lab technician were able to go ahead with resuscitating this patient, arranging for blood for transfusion and remove this retained placenta without a doctor! It is very satisfying to see people becoming more capable and independent. It is good to think that it won’t just be a few healed patients left behind, but some capable staff as well… who can themselves then go on to train others.


I remember Wawoi Falls as being the place where we successfully did a medivac from Rumginae with Dr Mike (Emergency Specialist) and our Midwife James a couple of years ago. This was to a lady with a retained placenta. They were able to remove the placenta at WWF and did not need to bring her in to Rumginae.

Move forward a couple of years and we find the same lady (!) Yu** having another baby. The health worker there is competent. She had diagnosed twins. The family and community did not have money to send this lady to hospital for a safe delivery.

This week Tuesday the health worker spoke with a Dr because this lady was in labour with twins, a previous retained placenta, it was her 5th time to give birth (3 single babies, 1 previous twins (with a retained placenta, one of those twins died)) AND with this pregnancy the first twin was coming as a breech (buttock first instead of the normal, safer, head first). They were given advice over the radio and told to call if there was any problem. Late that day, the health worker called me and told me the first baby came out ok (breech) and was doing well but it was now 5 hours and the second baby was not coming. I gave some further advice and told them to call at 7am for a medivac if that was needed. As it was getting dark, a medivac that day was not going to be possible.

The next morning, the loud alarm on the HF radio told us that there was still some problem. The second twin had come out alive and well at 730pm... but the placenta was stuck. There was really no choice now, she needed to come in to a hospital.

Probably around 1000 mothers die from childbirth related complications in PNG every year (600-700/100000 deliveries) - bleeding, especially from a retained placenta is one of the big 5 causes of death. (Others in the worldwide top 5 are: Infection, Eclampsia (fitting etc), Unsafe abortion and Obstructed labour)

When Yu** reached Rumginae she was unwell with a pulse of 140. She had obviously lost a lot of blood. She was resuscitated very skillfully by national nursing staff who were also able to successfully remove her placenta. A lot of time is spent helping our staff become proficient in as many skills as possible and it was exciting to see them capable to deal with this situation.

She is now doing well, her babies are well... and you'll be pleased to know she plans to stop after 7 children (6 still living). We have her booked for a family planning operation on Tuesday. She should be ready to return to Wawoi Falls the following week.

I don't know how much the flight cost... but the K3000 charter or K400 fare or whatever has saved this lady's life, and kept her around to care for her 6 children.


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