Tuesday, 24 August 2010


Agnes was 22years old. She was married with one small child. She lived in a small, extremely poor village on the outskirts of Lilongwe.
Pregnant with her second child she went into labour prematurely at only 7months. Before the first pains of labour began she started having convulsions. The local gulewamkulu (witch doctor) was called as it was presumed by her family and the rest of the village that she had been bewitched. Steps were taken to find the person who was bewitching her. Five days later, after numerous fits she gave birth to a small dead fetus. By now her condition had deteriorated to such an extent that on day 6 post-delivery she stopped talking and walking. They continued to use the services of the gulewamkula and local medicines still believing that this was the only remedy.
Agnes was brought to us on Monday morning at 8.05am. 8 days after giving birth and 13 days after her first convulsion though we presume she must have had signs of her illness well before that. I was asked to go and see a woman in room10 who had arrived in a critical condition. My first impression on seeing Agnes was that she was only just alive. She was deeply unconscious and only taking gasping breaths. I called for help and assisted by a midwife colleague and a student we started to resuscitate Agnes. It was difficult to find a vein in which to insert an IV cannula but we managed to fix 2 lines and take blood samples. We started her on oxygen and quickly catheterized her bladder to check her urine for proteins. At some point I ran to the telephone to call for medical assistance. Whilst the intern doctor tried to get some information from her family so we could get a clearer picture of her condition she went into respiratory and cardiac arrest. It was now 8.15am. I sent for the anaesthetist to intubate and started CPR. We continued to resuscitate for more than 20minutes but with no response whatsoever. Agnes was pronounced dead.
The conclusion was that Agnes had suffered from undiagnosed Eclampsia. Untreated for 11 days she suffered a cerebral vascular accident (CVA) Complicated by puerperal sepsis she finally suffered septic shock, respiratory and cardiac arrest and she died.
This was a totally avoidable maternal death. This condition can be treated.
Of course she came to us far too late. We did everything we could but it was already too late for Agnes. Her family cried and wailed. This was the same family that delayed in bringing her to us for more than 13days due to their local superstitions.
How can this happen? Why are these people still so poorly informed in 2010? Why are these superstitious beliefs still so strong to the extent of allowing their loved ones to die? Why do the women not come to receive care in our hospitals?
Agnes was eventually brought to the hospital which means her death will become part of our Maternal Death Statistics. In Malawi around 900 women in every 100.000 will die in pregnancy, childbirth or immediate post natal period. (In Europe it will be 5-10 per 100.000) But how many young women are being buried out there in the villages without any record being kept?
Agnes was a beautiful young Malawian woman. A mother, a daughter, a wife, a sister and Agnes was very, very, poor….could this be the reason why she died?
Lucas arrived back from Europe yesterday after having been away from Malawi for the past 7 weeks. What a joy, what a pleasure to have him back with me. A house should always be filled with that special something that only a child can give. He has obviously had a wonderful time with his ‘papa’ doing all those things that mummy doesn’t do……fishing, catching birds, shooting everything in sight, watching the football at the bar, buzzing around on his motor cross bike and the new mini bike doing incredibly dangerous things and staying up all night! He has also been able to spend time with his big brother and sisters. I am so happy that he has such a close relationship with them all, that they love and care for him and that he in turn is so proud to be their little brother. He talks of them constantly and I know misses their company.
It’s been an interesting 7 weeks for me. Being on my own has been very different than usual both relaxing and liberating but sometimes lonely. I have been working hard and long. Arriving early in the morning and staying late without the worry and guilt of not being at home for my child is a feeling many working mothers will appreciate. I have also been playing hard. My social life has been rich and full. Starting with all the excitement of the world cup football which involved nights out several times a week to support whoever happened to be playing that day whilst remaining true to, first England, then when they ‘went out’ to Spain. We were only a small crowd of serious Spanish supporters which made us even more vocal and loud as we cheered them through to the final and then the championship. It’s amazing how nationalistic one becomes when away from ones origins! I have never been to so many farewells as I have during the past 2 months. This is one of the peculiarities of living in a developing country. Most of the ex-pats will be working on 2-3 years contracts which means making friends very quickly, enjoying them to their full and then moving on. I am lucky to also have very special friends who are Malawi residents which gives our life a little more continuity and stability. With no need of a ‘baby sitter’ I have seen the insides of the Lilongwe night clubs as well as playing a few rounds of Black Jack at the casino. There is really not much more to do in Lilongwe, no cinema, few nice bars or restaurants or places to dance so we make our own social life with private parties and ‘braiis’(BBQ’s) I have missed Lucas but I have been able to find my way without him too and that is good.
Tarek left Malawi last week. After working together in Spain for 3 years he left Acuario to take up his position in Lilongwe becoming head of Obstetrics and Gynaecology in both Kamuzu Central and Bwaila Hospitals. We have a very special relationship both in and out of work. His list of achievements during the 6 years he has been in Malawi is both admirable and extraordinary.
This is a part of what I wrote about him before he left:
……. Kamuzu Central Hospital is the main referral hospital for the whole of the central region of Malawi. It is the Teaching Hospital for the University of Malawi attending to the clinical placements of students from both the College of Medicine and the College of Nursing and Midwifery. Bwaila Hospital is the city of Lilongwe’s only District facility. Together they serve a population of over 5.5 million. Plagued by diseases of extreme poverty and social deprivation with all its incurrent and specific problems they carry a huge burden of severe pathology. Approximately 13,000 births are attended each year. The units are consistently understaffed and often deprived of essential drugs and equipment. Such severe working conditions are also exaggerated by poor discipline and low staff morale making the leadership such a huge undertaking. Dr. Meguid has consistently shown his full commitment
…… Teaching has formed a highly important part of his role. As an exceptional and experienced clinician himself, he has tirelessly shared his knowledge, teaching and guiding medical and nursing staff as well as national and international students
……With a vision for the future of the department, or more importantly, respectful and dignified care for the women of Malawi, Dr Meguid was the co-founder of The Chitenje Trust. Being its manager resulted in achieving the necessary funds for the erecting and subsequent opening of two new, modern, maternity units for both central and district maternal care at Kamuzu Central Hospital and Bwaila
…… It has been a privilege and a pleasure to have known and worked with Dr Meguid. His contribution to our hospital and more widely within the health sector in Malawi has been, without doubt, one that will be remembered for many years. His passion, enthusiasm, leadership, strength and persistence even in the most difficult of circumstances have all led to (this) list of outstanding achievements.
Tarek is a very special person. He has played a hugely important part in my life….because of him I am here. I shall miss him terribly.