Sunday, August 15, 2010

Reasonable Tradition?

I don't know how to begin my story, so I’ll start in the middle. Earlier I wrote how a woman was in “labor” with a stillbirth after severe bleeding for a day and a half. (read her story below: VASA PREVIA.)

You prayed. I prayed. Here’s what happened next.

Well, She had been at our clinic all morning, stable and ready to go to Wau once the family got the money. They found the money but then needed to get bus tickets or a car. They went to look for it and some more money. I waited patiently for the family to return with the good news...  and take her to Wau. They didn't come. Then I waited a little less patiently. I even got loud.

What's going on? Don’t you know she's sick? Why aren't you doing anything?
They just looked around confused. She looked fine to them... what's the big deal? So what if she’s barely able to sit up and urinating blood so dark it’s purple? She doesn't look that bad! I wanted to beat something... someone. They had given up.

But part of me doesn't blame them. They tried to raise funds and got enough to get her surgery but when they went to buy a bus ticket to Wau, the driver extorted them for more.

A ticket that should cost 30 pounds would cost THEM 150 a person because she was desperate. Yes. You read that right. They'd have to pay five times as much... double even... because a care taker must go as well. Pay 300 pounds and we'll take ya! I understand why they gave up. Three hundred pounds is more than most people make in a month.

But I don't understand why the bus driver would do that. Here a woman's life is in the balance. They saw only dollar signs! AAAAhhhhhhhgGGGG! I was so angry I could have spit!

Fine so the bus option was out. But the good news was they had enough money for the hospital stay. We were driving to Wau the following morning and would take them with us. All she had to do was stay alive through the night. I was prepared to do everything possible to make that happen.

It’s at this point that I decided to induce her. Perhaps if we could just deliver the baby, the bleeding could be controlled. Perhaps, by God’s grace, she wouldn’t have any further bleeding. It was a risk but one I was willing to take.

Just as her contractions picked up, they started talking about taking her home. What? But if she goes home, she might hemorrhage even more and a blood clotting disorder can happen. (This is called DIC -- disseminated intravascular coagulation). If it happens, she'll not be able to clot her own blood and bleed out quickly. It's dangerous. It’s better she deliver at the clinic where we have life saving measures available. But the family kept insisting. They wanted to take her home.

I begged them to stay until Sabet came back from his trip. He had been away all day with the car. (That's why we couldn't take them to Wau ourselves). He was due home at 5pm. They agreed to stay... but were anxious.

However, as God would have it, Sabet got delayed. And with each passing hour, they insisted louder. I told them they were free to go whenever they wanted. I couldn’t make them stay. But I kept praying they’d stay. I felt like a prison guard keeping her hostage. She wanted to go. Why? I wondered. To die? Eventually after waiting 3 additional hours, I unhooked her IVs (she had two) and let them carry her away.

As she was unable to walk, we drove them home. And as they loaded in the car, her brothers assured me they'd be back tomorrow morning to go into Wau with our truck. Just then Sabet arrived. But it was too late to convince them to stay.

They drove off and my stomach sank. Ten hours I kept her stable and alive. The induction was working and she was already 4-5 cm dilated. *When I did the last vaginal exam, I felt only placenta. My best guess is placenta previa but one that was completely detached. (I say this because she had absolutely no pain.)

So to answer all your questions, I don't know if she lived. All I know is she left our clinic alive. We called numerous times the following day but no one answered. That morning on the way into Wau, we drove by their house but it was empty. The locals I asked all think she was taken to the witch doctor. I don't know if she lived. I wish I knew. It eats me alive to think they chose to take her home than spend the night at the clinic. But that is the case.

I asked Sabet why they'd insist on taking her home when we could keep her stable and transport her to the hospital the following day. He explained that the Bongo tribe (of which she is a part) do a number of rituals on a dying person. It's VERY important for them to make sure all the rituals are observed. They would not have had the chance to do them at the clinic.

So in the end, tradition won out over reason. And in this case, it may have cost a life.

*(midwife disclaimer): I know I'm not suppose to do a vaginal exam when there is bleeding. It was a judgment call. Once I knew there wasn't a chance I was going to get her to the hospital, I needed to know what I was dealing with. Please understand. And if necessary, forgive.