The following article is written by Penny Armstrong to commemorate an entire year at Edna Hospital without any Maternal Deaths:
The year 2012 has come to an end at the Edna Hospital and, thankfully, this is the first year that the hospital reports no maternal deaths.
The statistics have been compiled. In and of themselves they are impressive, but it is the stories behind the statistics that intrigue me. Being in this arid land, a land of a resilient and determined people, has challenged me, astounded me, and confounded me in turn.
I would not expect that I, or others to follow, could in a short time span grasp the complexities of the life in this land; the influence of clan, the challenges of pastoral and nomadic lives, the weighing of the value of the wellbeing of mothers and babies. It would be a life long journey to understanding and, not even then, can I imagine that the subtleties would be adequately grasped.
But what is within my grasp is my comprehension of what I see on the medical front. Within the context of what I see, and what I sense as I navigate life and practice here, the statistics take on a larger meaning:
- Total deliveries: 1,271
- Total Cesarean sections: 177
- Maternal mortality :0
Here I pause, zero maternal mortality in 1,271 deliveries. Perhaps in the U.S. that number would not be remarkable in a small hospital given that high risk moms and babies are rapidly transferred to larger and more sophisticated facilities. But the zero maternal mortality figure at Edna Hospital causes me not only to pause, but to marvel. I marvel because I have experienced what comes to Edna Hospital, unannounced, often in the middle of the night; things we experience stateside, but which generally come through the door in the acute phase, not after days in the field and a rough and lengthy journey to the hospital. Conditions which must be dealt with here or not at all as there is no such thing as a transfer to anywhere else.
And so when the end of year statistics were printed and I saw the zero, I instantly thought of how many times we must have come close to adding a woman to the maternal mortality list this year; and what it took to keep that zero, a zero.
In the case of a mother of twelve it went this way:
She labored for days in the countryside, expecting to deliver, as she had so many times before, a baby by her own efforts. Her uterus tired of the work as it tried to deliver a large baby wedged in the breech position. After days, the baby died inside her and the labor stopped.
Once at Edna Hospital other complications arose when it became apparent that the uterus had ruptured posteriorly and the initial team of a doctor, an anesthesia tech, and a scrub nurse became two doctors, then three, and eventually five as doctors came from other places in Hargeisa to assist and consult. Edna herself coordinated while the Director of the newly formed BSN program came from her office to assist and brought with her additional nursing support. A second anesthesia tech arrived to assist with anesthesia and sequential transfusions. Men lined up in the halls to meet the escalating need for blood.
When the 5.5 hour surgery concluded, the mother had survived. Ten days later the abdomen opened again and this time a British surgeon, a specialist in the area of the problem, led the OR team.
Tomorrow this woman, who now walks the halls and beams at the staff, mothers and newborn babies, will leave Edna Hospital and will return to her village. In her journey I saw medical heroism, invention, and a balance sheet, the facts of which look like this:
- 30 days in hospital
- 15 units of blood
- 2 surgeries
- 6 surgeons: 1 Aussie, I Brit, 4 Somalilanders
- Total cost to family $586
But beyond these facts lies the real power of the story; the story of her journey across the desert, her children left at home, her personal strength, her resilience, and the large measure of the grace that was meted out to her and which continues to shine in her.
May 2013 continue to benefit from the ingredients that made 2012 at Edna Hospital an outstanding year.
Penny Armstrong, CNM, MSN