LOW RISK

Bwaila hospital plus fourteen health centers in the Lilongwe district rely on six ambulances and only one is functional at this time…..
Malawi is in the grips of a fuel crisis. Ever since I arrived here over three years ago there have been periods that it has been difficult to get fuel but none so much as during the past few months. The lack of foreign exchange in a country whose imports far exceed its exporting potential plus important political issues at this time is causing this dire situation. As you can imagine it affects all walks of life, all businesses, all people in some way, but here at Bwaila it means our ambulances cannot function and our women and babies are suffering.
This morning I was attending a young mother who had given birth to her first child in one of our health centers at 2.30am. At 5am. she had her first eclamptic convulsion. This condition, which is peculiar to pregnancy, but that may become evident even after delivery is one of the main causes of maternal death in Malawi. It was necessary to refer her immediately to the hospital so that she could receive the appropriate medications which are mostly not available in the health centers. It was impossible to find an ambulance with fuel. (diesel) At 7am. she had a second convulsion but still the ambulance did not arrive. Zione arrived at Bwaila at 10am.Now 5hours since she first became sick. On arrival she was semi conscious and needed immediate attention. Her guardian informed us that she had also convulsed in the ambulance on the way to us. Each and every convulsion leads her into a more critical condition. We immediately commenced her on the right drugs and management so that we could then refer her to the central hospital for admission to the intensive care unit. Working together with my colleagues we managed to stabilize her condition noting that her conscious level was improving. I sent a student to inform the switchboard operator that we would need emergency transport for the transfer. After 15 minutes I decided to check myself as to when the ambulance would arrive. I found the telephone operator sitting in the kitchen having breakfast. I asked him when the ambulance would arrive to which he answered that he couldn’t make the call as he had no ‘units’ for the telephone .I couldn’t believe what he was saying. Why hadn’t he come to labour ward to tell us this? Using my own mobile phone I called the District Medical Officer who promised to resolve the situation. 30minutes later, just as I was starting to make arrangements to carry her in my own car, the ambulance arrived and I accompanied her to the central unit to be further managed. Her condition on arrival had not deteriorated so I am hopeful that she will recover, although she may still have suffered some cerebral damage due to the convulsions that she had suffered. I will follow up her progress tomorrow.
The health personnel had cared for her well and adequately but the support services had failed. How long will this situation last? How many more women and babies will suffer and maybe die because the fuel tanks are empty? Or the telephones are not working?
This is yet another example of some of the challenges that we are facing when trying to deliver health care in Malawi. Challenges that are unimaginable in the developed countries but that are a daily reality here at Bwaila.

The first follow up HIV test after treatment was negative. I will repeat the test once more to be certain that transmission has not taken place but I am confident. I feel happy and positive. I accept the high risk situation in which I work but continue to known for certain that I am still in the right place, I am where I should be...for now.