BLOODY MATTERS

A new blood bank is being built in Lilongwe. Until this is finished the blood comes from a central supply in Blantyre., more than 3 hours drive from here. It is ordered and received daily but invariably there is never enough. Most of the donors are young students which means in holiday times there is a marked shortage. Iam sure that the particular lack of supply two weeks ago was the cause of many tragic incidents all over the country but I can only tell you of those in which I was involved. The lady that I talked of last time was eventualy delivered of a still born infant later in the day. A normal delivery saved her from a c/section. Her life was not put at risk by operating with out the necessary blood supplies but for her baby it was too late. The following day I was attending a very young girl, just 17 years old, having her first baby. She had been suffering from severe malnutrition and chronic anaemia for some time. (Hb 4.2) As her labour progressed I prepared myself and her for possible complications. An IV line was inserted and the appropiate medications were prepared and ready for use as soon as the baby was born. Her blood loss should be minimal if she was to maintain her condition. I aided the last part of her labour by assisting with a vacuum extraction. Such severe anaemia brings with it an overload on the heart and inability to cope with extreme effort such as pushing out a baby. The placenta was delivered quickly with minimum blood loss. It was then she started to haemorrage. I knew that I would be lucky to find blood for her but had send off a petition earlier. It was still not available. After following all the procedures in event of severe haemorrage she still continued to bleed. We were begining to get worried. As with any wound or area of blood loss, compression of the site willreduce bleeding. It was the only thing left to do and for the time necessary to stem the haemorrage or untill the arrival of the blood so that she could be taken to theatre for a hysterectomy.The poorly contracted uterus was the cause of the haemorrage with the underlying chronic anaemia. This meant that removing the uterus would be the only option. So it was that I found myself performing bi-manual uterine compression for more than 30 minutes. This means that I had to compress the uterus between my two hands, one externally and the other internally, in the vagina. It is a procedure that we are taught in our training and that I continue to teach for emergency situations but is rarely needed as by this stage the woman should be in the operating theatre. The senior obstetrician was called to review the situation. She decided to go ahead and operate. The anaesthetist was not happy. "She can die here from her bleeding and we do nothing or we can try and operate and she dies in theatre.... we must give her a chance. Some things we just have to leave to God" the obstetrician remarked encouragingly. I found myself in operating theatre with this young girl. At worst she would not survive and at best she would be 17 years old with no uterus! I waited by her side for the surgeons to get ready and the theatre to be prepared. I was continuously checking for the contraction of the uterus and signs that the bleeding had ceased. All was ready. "Please can you check the vaginal packs once more " I asked, " I think she has stopped bleeding ,her uterus is contracted " And it was! There was no need to operate, I couldn't believe it! She was taken to post natal ward where later that night she received 5 packs of blood. When I went to see her the next day she was sitting up feeding her baby!
Maybe I should end with that story so that you can all feel better and happy? But no .... I cannot, you need to know the whole truth, all the stories. The following day the situation was still the same. Little or no blood to be found. The lady who was brought to us from the health centre was already in a poor state as she had started to haemorrage in her home, in the village. The placenta was lying low down, in front of the baby's head (placenta previa)as the cervix began to stretch it was pulled away from the uterine wall and began to bleed. She had already lost a huge amount of blood when she arrived in the early hours of the morning. The treatment for this condition is emergency c/section. She was unstable and there was no blood available. The anaesthetist decided her condition was too precarious to operate.The young clinician could not contact his superior and the woman bled to death one hour and a half after arriving at the hospital. Her baby was still inside her. Should she have been taken to theatre in any case? without any posibility of transfusion! Maybe yes? Maybe no? Would any doctor like to be faced with that decision? would you like to be faced with that decision?
Don't worry you won't have to ! You'll always have blood available for transfusion. Your blood banks work, your donor schemes work. You are rich, you can protest and complain! The women...especially the women...the poor women of Malawi have no voice, will not be heard, so they die because there is no blood to give them.
The new Bwaila hospital is well underway and nearing completion.It should be ready March of April next year and I'm getting involved!
The Rose Project from Ireland (www.roseproject.org). are funding the building and equipping. It will then be turned over to the Malawian district health authority to staff and run. So thats where I fit in. I will be co ordinating and advising to help to achieve the vision and aims of the donors and sponsors. To create a maternity hospital of excellence here in Lilongwe.
More about that next time.Suffice to say its all very exciting for me and a whole new challenge. Keep supporting me, please, I'll need it!