March 4th
Into my final month in Gimbi- I can hardly believe I have been here for 8 weeks and now have only 3 weeks until I go back to Addis to meet Mark for our holiday travelling in Ethiopia- There is so much to do here that sometimes the bit that I can do really does feel like a drop in the ocean (a phrase from my original fundraising statement)- so it is reassuring to have some confirmation that what you have done has made a difference to the life of a woman (as how ever much we feel we can soldier on regardless positive feedback always feels good).
In the future some epidemiologist is going to struggle to work out why there is a localised popularity of the name "Leonie" in South London and the "Leonies" so often had premature or other problem births but it will create a bit of academic interest. You will be relieved to hear that so far no Ethiopian girls have been named after me here but I did get the opportunity to name a boy born in Gimbi this week.
It was the mother's first pregnancy and thankfully as she has a relative who works at the hospital she chose to come to hospital to give birth (this is unusual as the majority of women with apparently uncomplicated pregnancies will deliver at home with only a traditional birth attendant or a female relative to care for them) . I say thankfully as although she had a quick labour and a normal birth of her son (who was a healthy 3.9kg-huge by Ethiopian standards) she proceeded to have an unexpected and very severe post-partum haemorrhage (loosing almost 2lires of blood). In the UK about 5-10% of women have increased bleeding after delivery (but most of these are still much less than 2litres) and this was one area that I was expecting to be a big problem here due to the lack of transfusion and the fact that women have lots of babies (which increases the chances of a haemorrhage even more) but the rate of haemorrhage for reasons I cannot fathom is much lower than the UK in our hospital (I've wondered whether it is genetic that women have uteruses that contract better after delivery due to "natural selection" or maybe that it is something to do with the altitude making blood "thicker"- neither theory has any foundation in medical fact that I am aware of but my resources fro research are non-existent at the moment).
The midwives here called me very promptly but by the time I arrived she had already lost a lot of blood. We worked quickly in stopping her bleeding (compressing the uterus to make it stop immediately & giving drugs to ensure it stayed contracted), resuscitated her and lined her relatives up to donate blood to transfuse to her. The midwives were fantastic and followed every direction I gave promptly, working together as a team. Throughout the woman herself appeared calm in spite of the fact that my limited vocabulary in Oromifa was definitely not sufficient to explain what was happening, to give her much reassurance. Or to apologise for the discomfort that treatment inevitably causes in such an urgent situation.
As things calmed down and came under control I asked the midwife to apologise if I had hurt her (any kind of apology is not typical behaviour amongst Ethiopian doctors and midwives but they have learned to humour the strange habits of foreign doctors) and I also suggested that we brought her baby to her and put him to the breast as this also helps the uterus to remain contracted preventing further bleeding. The midwives were not absolutely convinced that breast feeding was appropriate at this time as when there are problems with the mother the immediate response here is to put the baby to one side often for a number of hours but I persisted, explaining that it would be beneficial for both of them and they slightly reluctantly agreed to do as I suggested.
She was delighted to have her baby brought to her and my efforts were rewarded with that wonderful Ethiopian smile from her and a baby that latched on quickly and was equally contented.
In the UK we are perhaps a little complacent about blood loss as we know that we can get blood cross-matched easily and have a large selection of drugs to try to ensure the bleeding stops but in her case I decided to stay around a little while to ensure the bleeding really had stopped as I was still not certain we would get blood (we did get two units donated by her family) and I had given her both the drugs we possess to stop haemorrhage (the next sep here is hysterectomy as you can't afford to waste time and allow a woman to become seriously compromised).
After 20-minutes I was happy that all was going to be well - I communicated this to her and indicated that I would leave her in the care of the midwives. She responded by asking me a question in Oromifa which I asked the midwife to translate-"she is very grateful for your care and wishes you to name her baby" I was told. I smiled and declined, saying I didn't think I could do that as I didn't know Ethiopian names & their meanings well enough- "she doesn't mind & will call the baby by an English name in your honour" came the reply-it somehow didn't seem fair to call the baby Harold or Ernest or any of the other equally unsuitable names that flooded my mind at that moment as I realised that she was very serious about me naming the baby and also that she might be insulted if I declined the honour I had been offered. Fortunately I managed to remember that biblical names are popular here (& I knew that they are a Christian family) and so I suggested John as a boys name feeling it was unlikely to cause any offence now or in the future. She was very happy with the suggestion and so he was named Johannes, the Oromifa translation of John
Johannes and his mother were discharged home this morning both doing well- in the UK I might have received a card or a box of chocolates but the honour of naming a family's first born son will live on as a memory for me beyond any such material thank-you.
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