Last week of 2011...

My silence this week has stemmed from a fierce desire to stay sane despite a post-Christmas birthing spree.

Apparently, a large number of babies were dead-set determined on being born in 2011. Three of the labors were teenagers.

The first was only 15 years old, but she was strong and resilient. She awed me with her determination and trusting spirit. Although her labor was painfully long, she rallied at the end and pushed with all her might. When her baby girl was finally born the whole room sighed in relief. She was amazing! 

Sweet baby born to, Elizabeth, the 15 year-old girl.

The next teenager was the exact opposite. She argued with me, ignored my advice, and fought me at almost every turn. Despite her attitude, her mother and I got along smashingly. We understood it was the pain talking, and found ways to laugh about it. When her baby boy was finally born, we laughed even harder at his enormous eyes! Apparently it’s a family trait. 

What big eyes you have!

However, the third teenager to deliver brought much sorrow. She had only been in labor for 2 hours by the time she got to us, but she was already fully dilated. There was no way to prevent the birth.

Since we weren’t sure how premature she was, we prepared for the worst but held on to hope.

After the birth, her baby needed some initial help breathing, but her APGAR scores were good. We were hopeful she’d do well despite her 1.2 kgs.

Long story short, we had to resuscitate her three separate times and start intravenous fluids. Although her color was good while on oxygen, she couldn’t maintain her own breathing without it. 

The preterm baby girl born this week. She lived only 5 hrs.

She quietly died 5 hours postpartum while we watched on and prayed.

Her young parents wept openly as I prayed for them. But by then, their family had gathered and was able to comfort them in their grief as well. They even comforted me. This might seem strange, but I’m grateful I had the opportunity to be a part of her life... if only for those few hours.

Thankfully the rest of the births were less complicated --but not by much.

This week I also had another severe hemorrhage. But fortunately I was on my guard after last week’s hemorrhage and I was able to control it much faster. Her birth was a blur to be honest as she arrived at 1 a.m. and delivered mid-REM cycle. 

It was almost a full day before anyone thought to tell me that she was one of our translator’s wives! Thinking back, I thought it was strange that he’d showed up at 1 am for no apparent reason, but in my foggy, sleep-deprived brain it never occurred to me that it was because she was carrying his child!

Yes... I really am that slow. But it would have been easier to believe if someone had bothered to tell me he got married! 

Peter Malok, his wife Akutet and baby girl.

So let me be the first to say (for anyone who has been to Tonj and reads this blog) that Peter Malok got married --there is still an issue with cows of course-- but he’s married, has a beautiful wife, and now a delightful daughter!

Let’s see... what else happened this week?

Oh, I also had to transport a woman for CPD (cephalo-pelvic disproportion) after an unsuccessful trial of labor. She arrived before dawn in a frantic state, saying she had been pushing for hours at home.

This was her 10th pregnancy --but only 4 were living. The rest died during delivery or shortly afterward. Fortunately, we had enough time to diagnose her situation and ready the ambulance for transport at first light. 

Transporting for the CPD.

I’m happy to say she got to Wau and was taken to surgery almost immediately. Both of them are doing well, I’m told.

There were a few other straight-forward births this week with happy moms and healthy babes. But the most memorable of them was Arop’s birth.

I’ll end with her story.

Arop lives 3 hour away by foot. But after her first three babies died during delivery at home, she decided to see if we could help for this next one.

She was faithful to come for prenatal care and we watched her closely, encouraging her to deliver with us no matter what.

She took our advice and started walking to the clinic once she was confident her labor began. She arrived fully and delivered a precious little boy 40 minutes later. Her birth was delightful and remarkably simple.

Afterward as I watched her breastfeed for the first time in her life, I was overcome with joy. She has carried 4 babies to term; she has labored 4 separate times; but this was the first time she’s ever heard her child cry. This was the first time she’s ever held one to her breast! 

Arop breastfeeding her baby. What a smile!

What a delightful way to end a year!

Happy New Year!

Updates: Triplets, Clubbing, Car Accident...

Car Accident:
Kuac, the boy run over by a truck, had to wait almost 24 hours in Wau before he got surgery. But he eventually got it. Thank you so much for praying!

His family is running out of money, though. Please pray they obtain the funds needed to get the rest of the surgery he might need. The man who hit him will be held liable, of course. It’s just an issue of liquid cash. The hospital charges for each item used (i.e. gauze, gloves, IV fluids). They have to pay up front.

Clubbing:
Baby Tong, the boy born with severe clubbing, is doing well. His parents brought him in for a check-up today. He’s breastfeeding well, and his joints are more limber.

After several recommendations, I researched Arthrogryposis, a rare congenital condition that displays these symptoms. No one is sure how this condition develops. Nevertheless, I believe he has it.

If he has it, there is a 50/50 risk he’ll die within the first year of life (assuming he has one type of the condition). But it’s equally possible he’ll live a long, albeit disabled, life. There is no way of knowing for sure how severe it will turn out to be.

Please pray for his family to know how to care for him properly and that he’d one day have use of his hands and feet. If you are interested in learning more about this condition, I recommend this website. 

Triplets:
The triplets are alive! Can I get a hallelujah?

Yar, their mother, came in because Ngor has a cold and needed medicine. I took the opportunity to check them all out. Each has gained weight since I saw them last, but they are not growing as would be expected for their ages.

Yar told me they eat only twice a day. She gives them cow's milk, even though she still has breast milk. Once again, I did a long teaching on what should be done to help them gain weight. But I don’t think she listened. She’s hard to read. I’m not sure what to think.

Anyway... please keep praying for them. Their names are Ngor, Chan and Adit. Thanks.

Preterm:
Since I haven’t seen our preterm baby for a check-up this week, I’m starting to think she may have died. She was just so small.

However, I reserve the right to be wrong. Perhaps she’s doing so well that her mom doesn’t think it’s necessary to come back for a check-up. Perhaps.

Pray as the Lord leads. Thanks.

2.1 equals 1.1

Yesterday a young girl came for help. Reported to be early in her third trimester, she complained of malaria symptoms. Fever. Chills. Pain.

Margaret saw her and called Dr. Tom to help evaluate. I’m told she was severely pale so they asked our new lab technician, Caroline, to check her hemoglobin.

She had a hb reading of 2.1 g/dl.
    --Yes. You read that right. A hemoglobin of 2.1

(For those who don’t know, that reading is crazy low! Normal hb in pregnancy is 11-12 g/dl if you are moderately healthy.)

She needed a blood transfusion.

Remarkably, her baby was still alive. I was told Margaret and Tom were preparing to refer her to Wau for a transfusion while starting aggressive treatment of the cause --malaria.

Since church was starting soon, I decided to visit her after church. But once service ended, Margaret approached me saying she’d delivered.

What? I thought she wasn’t having contractions. When did she deliver?

Apparently in an effort to save her life, her body expelled the child spontaneously. He was born alive but severely preterm weighing just 1.1 kg (or 2.4 lbs).

Once I heard the news I went to check on him. He was breathing well but starting to show signs of distress. His mother looked sad and exhausted.

She explained that all her family was far away or in prison. There was no one left to help her get to Wau for the blood she needs.

Sigh.

With time Dennis was able to start an IV on this precious munchkin and we gave formula through an NG tube. He looked like he wanted to live.

After doing a Ballard’s score (a rating to help determine the gestational age of a newborn), we guess him to be around 31-32 weeks gestation. This explains his ability to breath well but not his size. I believe him to be small for gestational age (SGA) as well. Long term anemia will do that in a pregnancy.

Please pray for them. Her name is Ayen. She is family-less, severely anemic, with a tiny preterm baby. Please pray for God to keep them both healthy and alive. Thanks.

Preterm Update:

Baby Sebet came in today and is doing great! You’ll remember him as our surprise preterm birth a few weeks back that needed a lot of help breathing. (Read his stories here and here.)

His family were all smiles as they proudly unwrapped him for me to see. He has grown considerably and is thriving!

They named him “Sebet” which means two things. It means ‘Saturday’. But it is also the name of our clinic which comes from our director.

In fact, I work at “Clinic Saturday” or “Panakiim Sebet”.

Anyway, as a thank you Sebet’s family brought me ground nuts (aka: peanuts) in a bright blue container. They couldn’t be happier for this precious boy’s health and wanted to show their appreciation! What a treat!

Just thought you'd all like to know. Thanks for praying for him!

Update: Eye, Preterm

Preterm: 
So Amour came in yesterday with her preterm baby boy for a check-up. Both seemed well at first but then I realized she was showing signs of malaria; it may have caused her preterm labor.

But he was doing well and had actually gained a tiny bit of weight.

The best part was her milk was very well established, and she was no longer complaining "I have no milk."

I was so sick of hearing her say it after the birth that I warned her sternly that if I heard it again I'd charge her 5 pounds each time. She laughed but never said it again.

And during the check-up she told me that she believed me now; she has lots of milk. And she was right it was leaking profusely from her breasts! 

Thank you so much for praying for them. She promises to come back for visits; and I promise to let you know how things go with them.

Eye Team:
The eye surgery team was able to complete 172 cataract surgeries in the 5 days they were here. Some patients even got both eyes done.

On the last day a 31-year-old woman got both eyes corrected. She had not been able to see for several years, meaning she had never seen her youngest child!

Thank you so much for praying for this team. It was a great success, and many heard the gospel; many prayed and sang to God in worship. It was a wonderful time to see this community served and loved in Jesus' name.

Happy Endings ~

When she arrived telling me she was bleeding, my eyes flitted to the small protrusion around her middle and then to her face; she was serious.    
        -- Papa? Another stillbirth? Really....?

Bleeding this early means just one thing but I didn’t tell her that right off. Instead I motioned for her to lie down and describe her symptoms.

She reported large blood clots the size of her fist and copious frank bleeding. It all started two days ago.    -- Oh dear! Is this a placenta previa? Abruption? Lord... please help us.
-- “Two days of bleeding?” I asked a bit surprised, “Are you have contractions too?”
-- “Yes. Can you feel it right now?” She asked and motioned for me to touch her belly.

It was hard as a rock and small and she looked to be about 7 months pregnant. This was a almost play-by-play repeat of yesterday’s stillbirth. The only difference was I had time to ask her questions before the birth. Yesterday, the young girl arrived and before I could get her inside she delivered.

Shaking off that memory, I refocused on the woman before me. She looked remarkably calm.

-- “Can you feel your baby moving?” I asked. She just shook her head in response and I reached for my doppler.

I wasn’t expecting to find even placental sounds, so when the steady toc-toc-toc of a heartbeat blasted through the room I jumped; her baby was alive!         --Thank you Lord!

But my excitement was fleeting and I soon remembered such a small baby would probably die shortly after delivery. I steeled myself for the eventuality of it then informed her family of my suspicions.
They took the news with steady, knowing expressions but said nothing.

When I did a speculum exam, her cervix was dilated and it appeared to be either the head or the placenta. I couldn’t tell. So I poked a finger inside to see. It was soft but had hair. Not a good sign.
        --Her child would be premature for sure.

We set up for the birth and waited. But we didn’t have to wait long. Her contractions were strong and she pushed like the G4 she was!

Two pushes and a precious head was out. But then he wouldn’t rotate.
        -- Oh Lord, help him come out easily.

Fortunately he eventually rotated and the shoulders collapsed down below the pubic bone. But he was born with a tight cord coil around his neck and body --like a sausage chain.

He was alive but didn’t move or grimace for the longest time.
           --Apgars 3/4/5/7

I started oxygen immediately but he didn’t take his own first breath for several long minutes. I begged him to breath and prayed, but things didn’t take a significant turn for the better until Dennis came to assist.

Dennis was more aggressive with the resuscitation efforts. He made that boy breath!

Once stabilized he has improved remarkably. He’s maintaining his own temperature, he’s sucking a bit and his respirations and heart rate are solid. He is most definitely only 32 weeks gestation (or roughly 7 months), but I think he’ll make it.

Please pray with us that he’ll be able to breastfeed better. I’m determined to keep them at the clinic until he can. I so want him to live! Thanks.

Heart-shaped perfection.

A heart-shaped face perched atop elegant shoulders, drooped slightly in despair as she explained; there was bleeding. It started at noon. It was getting worse.

At first I didn’t know what to think, but then I saw it --Dark red stains and clots. Oddly, there were no contractions.

Painless vaginal bleeding tends to indicate placenta previa (when the placenta grows over the cervix causing bleeding during labor). There was just one thing... she wasn’t term.

Her brown taut belly only measured 25 cms, and the child palpated to be about 6 months along.

Questions raced through my head.   
--Previa? Stillbirth? Preterm? SGA baby? What?

Checking for heart tones, I was surprised by a steady thuk-thuk-thuk-thuk that echoed throughout the room.       
--Her child was alive and remarkably NOT in distress, but for how long?

Her name was Abuk.

Studying her chart, I learned that she had come to see me once several months ago, and then again came last month to be treated for STDs. She said the medicine she got hadn’t helped. She still had many of the symptoms.

While calling for a consult, I set up for a speculum exam. I needed to know exactly what I was dealing with. I would be able to see the if the placenta was in the way... or if she was even in labor.

Dennis arrived quickly, and we stopped to discuss her case at length.

Even though her LMP put her at 22 weeks GA (or 5 months), she was obviously more; her fundal height clearly indicated more like 6 months. But if she was having a simple preterm birth, why was there so much blood loss? Why the clots?

This had to be something more. Right?

Since night had already fallen, we could no longer safely refer them to Wau. And even if we could, what would Wau do for them?     --Nothing. Not at 6 months.

Dennis went to talk to her husband while I did the speculum exam.

Once past the obvious bleeding, I was able to clearly see her cervix. She was almost completely effaced and was well passed 4 cm dilated. Tinged blue, the bag of waters glistened under the flashlight’s yellow glare.         --She’d deliver soon.

Abuk listened carefully as I outlined the options:
“One, you could go to Wau right now, since your contractions were so far apart, but getting there at night is tricky. Two, we could admit you to our clinic, make you comfortable, and wait for your child to be born. Or three, we could induce you... but induction is painful... and well, it is hard on the child, too.
Piercing black eyes flashed from me to the floor, to her hands, to her blood, as I spoke.

“Think about it, talk to your husband, and I’ll be back in a few min...” I barely had the words out when she interrupted: “Just help me stay alive.” Only then did it occur to me she thought she was dying.

“Abuk, I promise you. You are doing fine. No matter which choice you make, you will not die. Please, don’t be worried.”
Nodding at my words, she sat there studying my face. Could I be trusted?

“Please... talk to your husband. Decide together what is best.”
“No. I don’t need to. Why wait? My child is going to die no matter what. I want to be induced.”

As the truth of her logic settled in my heart, my tongue went numb. I had no more words.

“Still, think about it a bit more.”
Nodding, she curled in a small ball on the bed and rested, and I called for her husband to join her.

“Abuk, can I invite my friend to come pray with you?” I asked.
“Yes. I would like that.” Her face softening a bit at the thought.

Suzy, my director and prayer warrior, came to pray with them while I discussed her case with the rest of the staff. We all agreed. There was no stopping this birth. There were no drugs we could give. It was inevitable.

I would induce.

While preparing the room, my heart sagged with questions.

Why the hurry? Why not let the child come naturally? Was I doing more harm than good? Was I killing this child? Was I saving her life?

Understanding never fully came, but her baby did.

An hour later, a beautiful little girl was born. She had the same heart-shaped face of her mother. Beautiful.

Weighing just 900 grams, she never tried to breathe.

After examining her perfection, I wrapped her in a blanket and asked the father: “Do you want to hold her?” He didn’t hear at first, so I asked again.

I had to ask several times before he lifted his head from the table. The day’s events were too much for him; they weighed him low.

“Why don’t you hold her. She is so beautiful,” I said gesturing towards the beauty.
“Yes. I want to hold her,” he said softly, and took her in his arms.

He unwrapped her, once or twice, for a closer look, and then tenderly balanced her tiny frame on his knees.

“Will you name her?”
“Yes. She will be named after my mother,” he said hesitantly, then later added, “No. I can’t name her that. I can’t name her now that she’s dead...”

Abuk returned to a fetal position on the bed -- too tired to cry.

Six months of hopes. Wrapped in a blanket. Breathless but perfect.

Suzy and Sabet came together afterward, and we all prayed again before taking them home. It was a sad birth, but one showered in prayers.

Please continue to pray for them as the Lord leads. Thanks.

IUGR or Pre-term?

This morning one of my prenatal girls proudly brought in her precious little girl for me to meet. She was beaming! When I looked beneath the blankets though, my breath caught in my throat. She was tiny! So small in fact, I had to touch her briefly to make sure she was alive.

“When was your baby born, honey?” She certainly didn’t look like she just gave birth. She was too rested and relaxed.
“Last Sunday.” She said with a smile.
“Oh, you had her yesterday?” I offered.
“No. The Sunday before.” I must have looked confused, so she repeated herself. “You know, a week ago.”

I had to marvel at this little package of estrogen. Could she really be a week old, already?
“She is so small. Why didn’t you come before now?” I asked.
“Oh... we have a tradition in our culture. You cannot take babies out of the home for several days. If it’s a girl you must wait 4 days. But if it’s a boy then you wait only 3 days.”
“I see. Can I do a exam on your baby to see how old she is?”
“Of course you can. I’m here for a check-up anyway.”

I smiled and held back my concern. She certainly didn’t act like she was fighting to live... but she was so small. When I got her on the scale, flash backs of last weeks premature births blasted through my brain. In fact, the second premature baby weighed more than she did! She only weighed 1500 grams (3.3 lbs!).

But as I checked her out... all her vitals were stable and she seemed healthy in every way. So I did a Ballard’s Score on her. This is a test done on newborns to help determine if they are premature and, if so, how much. It tests reflexes, neurological development and physical maturity attributes. It’s only meant to give a general range but it can help differentiate between a small but term baby and a premature newborn.

When I checked her reflexes, postures and muscle tone, she passed with flying colors. Her neurological development was spot on. In fact, I didn’t see anything amiss except her size. At the end of the exam, it was clear to me I was dealing with a severely IUGR baby and not a preterm one.

For those who don’t know, IUGR stands for Intra-uterine Growth Restriction. It means the baby was unable to develop and grow at a normal rate in utero. Something hindered her. It could have been from placental insufficiency or maternal life-style (alcohol, drugs, cigarettes). It is also caused by poor nutrition and illness (chronic or infectious).

I’m not sure what caused hers... but it’s the most severe case I’ve seen to date.

Fortunately, she is fine and eating fairly well. I asked her mom to bring her in regularly so we can monitor her growth. She said she’ll come. I have a feeling she will.

Preterm Sadness.

Another preterm baby came in today. His mom was in a lot of pain but didn’t look anywhere near as bad as her baby did. We did a Ballard’s score (to tell how preterm the baby is) which placed her at about 27 weeks gestation. She only weighed 1.8 kg.

It seems prematurity is epidemic around here.

The baby had a number of problems. Her breathing wasn’t good-- nasal flaring, chest retractions, apnea. Plus, she wouldn’t suck. She looked like she was barely hanging on. My heart went out to her. But I had hope.

Then something changed. As Denis was doing the physical exam, he couldn’t find an anus. He called me over for a second opinion. Nada. The baby had an imperferate
anus (in short: the anus is missing). In the states, this requires surgery and pretty quick.

But here?

Denis referred them to Wau but they didn’t look even remotely interested in going. Lord, may this tiny treasure find her way to Your precious arms soon. May her suffering cease.

Namesake.

Regina holding her little girl.

This week’s theme seems to be prematurity. Twice already we’ve had two mom’s deliver  preterm at home and then come in because of complications. Each time the baby died. Both moms were referred for different things-- One for a blood transfusion due to massive hemorrhage postpartum, the other because she was in a coma for some unknown reason and wasn’t improving. So when a young girl come into the clinic today in premature labor, I wasn’t sure what to think.

She was acting pretty melodramatic. I admit I thought she was exaggerating a bit... or I did until I saw the contractions. There was no doubt something was going on, but could it be labor? Maybe it was just Braxton-hicks contractions? She was 7 months pregnant by LMP and only measured 27 cm. Not good. Her belly was way too small.

The last time this happened, we tried to refer the mom to Wau, but she never made it. She just ended up having the baby at home. Fortunately, all went well. But we weren’t there for them in their need. I didn’t like that. So, this time, I decided to keep her at the clinic.

I thought keeping her here would be a no brainer but her family wanted to take her home. I cautioned them that if the baby was really  7 months gestation, it was better to have our help. To my relief, they agreed.

Baby Stephanie Akac, weighing in at 1.5 kg.

So when Regina started pushing, we were ready. We had resuscitation equipment set up and mentally, I was ready for another anything -- even another death. I know that’s pessimistic of me, but I had to steel myself for the possibility at least. Not one baby born that early has survived here in my (short) experience.

I prayed over her and left it up to God. The Creator of all life certainly knows how to preserve it. I prayed for His will to be done. Besides, He knows what I can handle. I’ve mourned these children all week. If I am meant to mourn another... He’ll walk me through it.

The birth went smoothly. Regina only pushed a couple of minutes -- surprising for a first time mom. And as the head passed the perineum, I was surprised to see a tiny face looking up at me. :- ) (She was born completely posterior!)

Although she was minuscule in stature, you wouldn’t have guessed it from her lungs. She screamed and wailed and made such a ruckus that Margaret and I couldn’t help but laugh... and sigh in relief. No resuscitation necessary.

But would you believe she is only 1.5 kgs and (by Ballard’s score) only 28 wks gestation. That is how old the baby boy brought into our clinic on Monday was as well. But he weighed half of that (only 600g). Dennis and I were so confused we did the test twice but the results were the same. This little one is only 7 months old.

The good news is that... by God’s abundant mercy and grace.... this little girl is doing great. She is vigorous and very interested in breastfeeding. Pray that continues.

Her father was so happy with the good news, he asked if he could name her after me. So I have my first namesake. Rejoice with me as I’ve discharged little Stephanie Akac this afternoon. Both mom and baby are doing great. But they need prayer... lots of it. The risk of complications and infections are higher with prematurity. Thanks.

Premature.

After lunch, I was quickly called back to the clinic because a woman had delivered prematurely and her placenta was ‘stuck’ inside. My translator looked worried and so I rushed. I told the rest of the staff (who had started lunch a bit later due to other emergencies) about it and they agreed to come soon.

However, Jessica (volunteer/Nurse) hurried after me, eager to learn as much as she could. I wasn’t told anything more than that the baby was preterm and the mom had a ‘stuck’ placenta.

The last time this happened the placenta was sitting in the vaginal vault and needed the slightest tug to come out. Today was a much different case.

When I walked into the room, the mom was covered in blood and motionless on the bed. A family member was holding her baby, wrapped in a blanket and gasping for air. The baby girl only breathed every 15 seconds or so and her heart rate was a cool 60 bpm. (It should have been in the 130 range). She was dying.

I started to resuscitate and Jessica was quick to help with chest compressions. The Ambu-bag we had was much to large (due to her prematurity). She had lots of secretions and was pale.

Caleb and Maggie came in shortly afterward. Caleb took over my job in resuscitation and Maggie helped me assess the mom.

All the while, I kept calling out for more information. When was the baby born? How long has she been bleeding? How much blood has she lost? How long was her labor? How many babies has she had? Which ones of them are alive? Has this happened before?

The story unfolded for me question by question as I continued to assess the young girl. This was her forth pregnancy. Each of her babies were born premature. Each of them died.

I remember looking over to the table where Caleb and Jessica worked tirelessly on the baby girl. She wasn’t breathing spontaneously. Her heart rate would jump from 30 to 100 depending on resuscitation efforts. It didn’t look good.

Meanwhile, Maggie was getting an IV started as we could see the young mom was in hypovolemic shock. Her blood pressure was bottoming out. Her pulse was through the roof. She had been bleeding non-stop since birth (which was 3 1/2 hrs earlier).

I could see her heart beating in her chest. I didn’t need to take a pulse to count it.

When I evaluated her placenta, it was partially detached (the reason for all the bleeding). What’s more, is it was very determined to stay that way. I had to do a number of maneuvers to knock it loose. But when it came out, all the membranes were still inside.

My only option then was to do a manual exploration for the membranes. This is not comfortable but it was the only way I could be sure the membranes wouldn’t continue to cause bleeding. Fortunately it worked. Her bleeding stopped.

A second IV line was started, as we flooded her with fluids. She got 5 liters before her blood pressure even remotely stabilized. She was pale as a sheet, desperately needing the one thing we couldn’t give her; blood. 

The baby died but she didn’t. I think the baby could have survived if she was born in the clinic. But even then, I’m not sure. Maggie tells me that babies born that early here rarely survive.

The young mom, turned her head from me in sorrow when I told her but she didn’t cry. So I cried for her. I cannot begin to fathom her pain. Four time pregnant. Four time heartbroken.

The only reason I can think of her premature labor is an incompetent cervix. I told her how to fix this problem next time she gets pregnant. But I’m not sure she believed me. I think she’s lost hope of every having a baby live.

Pray for her. She’s in desperate need of blood but her family doesn’t have the resources to get her to the hospital for treatment. I think she will recover. It might take months without the blood but it’s still possible.