CHRONICLES OF LIFE IN A CAMEROONIAN HOSPITAL: EPISODE 8

From Doctor In Training Vanessa Fozao

Source: Freepik

Risks are part and parcel of our lives, but unnecessary risks are detrimental. Sometimes, it is good to take risks, for risks led to the many medical interventions such as the surgery performed by Dr Ben Carson. However, taking risks without appropriate assessment and knowledge may prove destructive.

After returning home from a very tiring and stressful day at the hospital, my only thought was to have a cool bath, eat and rest, but that was significantly halted by an incident at the hospital. I had just arrived home and was settling down when the attending physician on duty called and asked me to return immediately to the hospital to assist in the handling of an emergency case. I immediately returned to the hospital. 

As soon I got to the hospital, I found a woman in the pool of her own blood in the emergency room. The doctor had already rapidly assessed the woman and ordered necessary resuscitation measures since she was brought to the hospital in a state of unconsciousness. At that instance, the nurses and laboratory technicians were working diligently, while the doctor was asking the person who brought the unconscious patient in some questions. “What happened to her? the doctor asked. The person responded, “She had just given birth in the village, and the placenta won’t come out. All efforts made at the health centre were in vain, which is why we brought her here.” As we questioned him further, we discovered that he was a community trained nursing assistant who opened his own health structure in the village. The nursing assistant had reportedly caused a lot of havoc, as well as interest, in the community due to his lack of experience and knowledge, as well as his relatively low prices or his desire to treat people on “credit”. Many people were attracted to his clinic because they had the chance to obtain treatment and pay at a later and more convenient date. The question, however, remains, “Was the treatment received sound, adequate, necessary or based on knowledge and experience?”

For the case at hand, we discovered that the nursing assistant had followed up another woman who had scarring in her uterine cavity and got pregnant less than a year after a caesarean delivery was done for her first baby. For the second delivery, he conducted a vaginal delivery after stimulation of labour with oxytocin. The woman gave birth to a macrosomic baby (weight >4 kg) with vaginal and perineal lacerations. Unfortunately for the woman, all attempts to deliver the placenta failed which led to profuse bleeding. Since the delivery, the woman had been in a state of shock and bleeding profusely, which prompted the community health aide to bring her to the hospital. 

Of course, we were not happy seeing the same community aide back at the hospital with a similar case and similar outcome. As we began to attend the patient, the community aide and her family stated, “Doctor, will she be okay? Please, do everything in your power to save her life. We are ready to pay whatever it will cost.”

Source: Women's health lafayette

It was so surprising to see the family eager to pay “whatever it will cost”, but were so reckless with her health during her pregnancy and delivery. Her husband opted to take her to the community health care centre and place his wife in the care of a community nursing assistant with inadequate knowledge and experience rather than take her to the hospital because he believed she would be treated on “credit”.

 During her time with us, we did an emergency abdominal laparotomy after all attempts to deliver the placenta failed. We resorted to this measure after discovering that the placenta had penetrated into the wall of the uterus at the former incision site, which had wound dehiscence that was bleeding into the abdomen. We successfully delivered the placenta, repaired the uterus, cleaned and closed the abdomen. We also repaired her vaginal and perineal lacerations, as well as resuscitated her and saved her life.

This extremely avoidable incident made me ponder and ask myself several questions. Here are my thoughts:

“What happens to the million others who are living with chronic complications due to such risky practices? Not to talk of those who have lost their lives in the process. Does this mean that the government lacks well-trained professionals to send to these zones? I doubt it because I see thousands flooding the halls every year to write recruitment examinations for fewer positions. For the few that have been posted, how many are ready to go? How many are ready to forgo their quest for gain? I believe charlatans like the community aide continue to thrive due to lack of well-equipped health structures and qualified personnel in these villages. I also noticed that in some villages like the district I worked in with qualified doctors, such people do exist. Does it mean that the SDO is not aware of what is happening, or is he contented with the few francs the people bring to him regularly? I believe any public official should first think of the well-being of the people he was sent to lead, direct and ensure their security and safety before anything else. Maybe, just maybe, the SDO is aware and has attempted to close the health structures and punish the charlatans accordingly (who knows?), but all his efforts have been in vain due to the adverse impacts of dealing with these individuals. What has really happened to our consciences? Do we live in a world where most people give more value to profit, cheap heroism and connection rather than the lives of others? May God help us.”