Case Study 4 :
Saving Women's Lives in Non-EOC Facilities,
Baglung
![[speaker icon]](images/im-icon-speaker.gif) Audio
: Narration of Case Study 4
Flash player is required to hear the audio. Click
here to get it.
A 30 year old pregnant mother of two at full term, living 3
days walk from comprehensive obstetric care (CEOC) facilities,
was brought into the remote Primary Health Care Centre (PHCC) at
Burtibang with labour pains which she had been experiencing for
some 5 days. Auxiliary Nurse Midwives (ANM) tried to deliver the
baby vaginally, with some drug use, but it was evident from the
foetal hand protruding from the vagina that this was a prolonged
obstructed labour and surgery was needed.
The patient was referred to Baglung hospital where CEOC (Comprehensive
Essential Obstetric Care) facilities were available but her family
was unable to take her there because of the cost and urged PHCC
(Primary Health Care Centre) staff to do everything possible
to keep her alive. Despite their best efforts the baby could
not be delivered and it was decided to await the mobile family
planning (FP) team who were due to come to that PHCC (Primary
Health Care Centre) for the FP (family planning) camp.
Late that evening, after an exhausting 10 hour walk, the FP
team reached the Centre, aware that there was a complicated case
awaiting them. By this time the patient was very pale, distressed,
dehydrated and unable to pass urine. Vaginal examination revealed
the necrosis-swollen hand of the dead foetus. Although the doctor
(the FP Camp team leader) tried to motivate the family to take
her to the hospital they again pleaded lack of funds. They said
that if the team was not able to do anything it was better to
let her die.
Faced with a life-threatening situation, the team decided to
perform surgery and those staff who were trained for the procedure
assembled the necessary equipment. They performed a caesarean
section using ketamine injections and mini-laparotomy instruments
and delivered a macerated baby. Following delivery there was
profuse bleeding which took more than 3 hours to control and
the patient's haemoglobin level fell to just 3.5gm%. After completion
of the FP (family planning) camp, the team returned to Baglung
leaving the patient under the supervision of ANM (Auxiliary Nurse
Midwife).
Under the care of local health workers the patient gradually
recovered and after a month went to Baglung hospital for further
treatment for an infected wound. The doctor was happy to see
the patient looking well, despite her loss of weight and referred
to the case as a 'miracle'. After 10 days of treatment and care
in the hospital she recovered well and was discharged, thanking
staff for what she termed her 'second life'.
The emergency fund sanctioned by the Hospital Support Committee
(HSC) in aid of the poor covered the cost of food, medicines
and blood transfusions during this spell of treatment at the
Hospital.
Had the FP (family planning) team not decided to perform surgery
in a difficult situation at a remote PHC (Primary Health Care)
Centre, this patient may well have died. The fact that the team
was able to deal with a difficult situation emphasises the importance
of taking essential equipment and drugs necessary for emergency
surgery on such camps. |
