Wednesday, December 29, 2010

More than a statistic....

 (Warning: this story speaks of death and maternal mortality.)

Early Monday morning, I was called to attend a young woman in labor. It was her first and she was scared. As I checked her in and listened for the baby’s heart tones, I could hear a patient in the other room trying to breathe. A wet, gurgly rattle of a sound filled the clinic, distracting me. I pushed it to one side of my brain and refocused on my labor.

Her name was Debora and had been coming for prenatal care for months. I got her situated and set up for the birth. Everything was going smoothly, so I thought I’d sneak in a bit more sleep. She was only 4 cm and had three doulas monitoring her every move. I wasn’t needed just then. So, I told the health worker on shift, James, to keep an eye on her and call me if anything changed.

But before I left, I couldn’t help but peek in on the patient in room one. What was causing all that noise? James followed me into the room and showed me her chart. A man, somber and tired was holding her in a semi-recumbent position. She was unconscious and had been that way for over a day.

As I read her chart, I was startled to learn she had delivered two days before. A stillbirth. She immediately got sick and passed into a coma. They waited a day before they came for help. But by then, there was little we could do but watch her struggle to breathe.

And struggle she did. Foamy saliva formed in her mouth with each breath. She was drowning. An older woman sitting by her side, kept wiping it away. Brow knit in desperation, she studied me as I studied her chart. Dr. Tom had seen her. He had done all he could.

I went back to bed but her death-rattle haunted me. I couldn’t sleep. Questions kept taunting me. What had caused her baby’s death? Why was she unconscious? Why did they keep her at home so long? Would she live? No answers came.

It was only a few minutes later that I heard James knocking on Tom’s door across the compound. Murmured whispers exchanged. Doors opening. Gates slamming. Something told me she had died. I got up and James confirmed it. She had stopped breathing. The fight was over.

I wanted to go to the family but ... I also wanted to hide. What did I have to offer this family's grief? I tried to go back to sleep but God kept insisting. “Go now. Go talk to them,” He whispered. I obeyed but my heart in my throat. What could I say?

When I got there, I found the patient covered from head to toe in a blanket. The man was gone but the woman still sat by her side, hands clenched and pale. Tearless, she sat shaking uncontrollably and searched my face for answers. I called James in to translate and sat beside her. I asked her if I could pray for her. She nodded, still shaking.

As I took her hands in mine and prayed, my heart broke. This precious woman died in childbirth. She is the face of maternal mortality. A statistic -- but oh so much more! She is a daughter. A wife. A sister. A friend. Her motionless body, hidden under the blanket, couldn’t hide this fact to me.

Her name was Abuc.

After praying, I asked the woman to tell me her story. What had happened? She hesitated only a moment, then spoke for sometime without pause. My translator listened, nodding encouragingly for her to continue. This is the story she told.

Being of age, her daughter was married earlier this year. But her husband caught her cheating with another man, who impregnated her. Understandably upset, he retaliated by putting a curse on her and the child. This was the result of that curse, she explained. First the child died and now her. She added that this was her only daughter and she was too old to have others.

-- “How long was she sick?” I asked.
-- “Four or five days. She delivered a dead baby two days ago and then got really sick.”
-- “Did she get prenatal care?” I couldn’t help but wonder if this had been preventable. What medical reasons caused this death? Was it preeclampsia? Hypovolemic shock? Malaria? Pulmonary embolism? Stroke?... What?
-- “Yes.” She explained. “She went once to the clinic in Malualmok.” (A small neighboring town.)
-- “Only once?” I asked. She nodded.
-- “What was she complaining of before the birth?”
-- “Headaches, neck and joint pain. But that is all.”

That means it could have been anything-- malaria or perhaps preeclampsia. I couldn’t say for sure. The fluid in her lungs made me think it was a pulmonary embolism. I wanted to grill her with more questions but I didn’t have the heart. She didn’t need answers. I did. She already knew why her daughter had died. She was cursed. So I dropped it.

We sat in silence. Nothing more needed to be said. I wanted to ask her if she knew Jesus but her grief was so fresh. So I sat and held her hand instead. Her shaking slowly subsided and together we waited for the men to return. They had gone to get transportation. The body needed to be buried.

They returned with more men to help dig the grave. Abraham, a family member, asked in perfect English if we could drive them back to Malualmok. I got Mike (our compound manager) and he agreed to take them. It wasn’t even light yet when they drove off with her body.

I couldn’t get her out of my mind but I had to. Debora needed me. Turning my attention to her, I was happy to watch her labor so well. She handled the pain with slight moans, walking the baby down. She was tired but healthy.

In my mind, I couldn’t help but compare these two births. Both were first time moms in their teens. One had come for prenatal care for months, taking vitamins and getting her shots. The other was seen only once. One had delivered a stillbirth at home. The other was delivering with me in the clinic. Her baby was fine.

Later that day, Debora delivered a gorgeous little girl while surrounded by friends and family. It was beautiful watching her go from girl to woman; from pregnant to mother. And best of all she lived. I’m not saying that had Abuc come to deliver with me, she would have lived. I will never know that for sure. But I do think her chances would have been better.

Was her death preventable?

Pray for Abuc’s family and the superstitions that plague these people. Pray for these women to come for prenatal care and to deliver at the clinic. May there be no more preventable maternal deaths. May it stop here! Now!