She came from a health center after 2 days of malaria treatment. She was six months pregnant. On arrival at our facility she rapidly delivered a dead fetus. Then she began to hemorrhage. Her eyes were yellow from jaundice and she was anemic from malaria. We rushed her to the OR and examined to verify there were no lacerations requiring repair. We packed her uterus with compresses to tamponade the bleeding and gave medications to contract the uterus. No success. The bleeding soaked through the compresses. Her heart rate was high and blood pressure too low to measure with the machine. We did not have enough of her blood type in our refrigerator. I decided to do a hysterectomy to stop the bleeding.
She was oozing blood from every surface upon entering the abdomen. The blood was not clotting. An ominous sign indicating a person has lost the ability to form blood clots and stop bleeding from even small abrasions. Took the uterus out. Her blood pressure did not rise over 60/30, causing dreaded acidosis. We did not have any more blood to give her. Her heart stopped, restarted with epinephrine, stopped again and did not restart.
Megan was also six months pregnant at that time. I spray our house with insecticide almost weekly and Megan only leaves the house in daylight. One evening at dusk a lady came wanting to sell bananas. Megan stepped out for 2 minutes and when she came back in she had a mosquito bite. Eleven days later she developed fevers, chills, fatigue, and headaches. At the same time she began having painful, frequent contractions. Malaria parasites concentrate in the placenta and can instigate preterm labor. My mind sees the jaundiced lady dying in front of me in spite of my best efforts.
Megan started Malarone for malaria. She continued having painful contractions. Then after 3 days the contractions began to improve. The fevers and chills resolved and she began to feel better. Yay, we can hang in there until we leave to give birth in the US. She still has contractions at times. They improve when she lays down or rests. Frustrating for a type A personality.
I finish a case and sit down to write my operative report. A text from Megan reads, “Our flight on June 24 was cancelled.” COVID 19 has kept the airport in Chad closed, but certainly it will open some flights soon? The flight was rescheduled for July 6.
We search for other backup options. What other countries surround Chad? The part of Nigeria bordering Chad is home of the Boko Haram and even most Nigerians won’t go there. Niger is not friendly. The part of Libya bordering Chad is hostile. It would be unwise to cross the border to Sudan as a white person. Central African Republic is unstable. Cameroon is the best option for a land escape from Chad in spite of being in a civil war between the English-speaking and French-speaking people of Cameroon. However, the border is closed with military guards due to coronavirus. The Cameroonian embassy refuses to give visas until Chad officially opens its borders. I have patients who can sneak across the border on motorcycles via back roads, however me trying to do that with Megan and Adelie might get us shot or in jail.
The US embassy had a repatriation flight in early April, and has communicated that no further flights are being planned. We suspect that the embassy staff have also left, since we have been told the embassy is essentially closed. If the baby was born here, we would be unable to leave for a while since it would require a consular record of birth abroad and a new passport, which according to the website, are unavailable at this time.
Work has been busy here. A man came with a necrotizing infection of his neck and chest that turned his tissue into pieces of grey dead matter that would almost knock you over from the smell. My assistant had to take frequent breaks to keep from fainting while I performed the debridement. I thought the patient would die. The infection tracked under the sternum toward the mediastinum on the right. I placed a chest tube on the right, but no pus came out. I told him to prepare to die and pray to live. He lived. He required several debridements as new pockets of infection turned up further lateral on his neck and inferior on his chest. His dressing changes take a long time, but today there is no longer any infection!
Another man presented with an abdomen full of stool from an intestinal perforation after he fell from a mango tree. He was also near death, but pulled through. I closed his ileostomy today. I was going on to another case when a boy came with low blood pressure, tachycardia, fever and severe abdominal pain after having fallen from a camel a couple days ago. He is one of the nomadic Fulani who roam far from civilization.
I perform a laparotomy and evacuate lots of blood. He has a hematoma in the back of his upper left abdomen (zone II). It does not seem to be actively expanding. Not too much blood oozing from around it. Hopefully it does not re-bleed. His 3 family members tried to give blood for him, but they all tested positive for Hepatitis C. They somehow found one unit for him and we gave him an additional one unit from our precious stash. He’s improving.
I’m sitting down to write my operative note and see this text from Megan: “Our July 6 flight was cancelled and Air France plans to not schedule any flights the rest of the summer.”
We strive to provide the best care possible with our limited resources here and continue to improve. Patients travel hundreds of miles and bypass numerous other hospitals to receive higher quality care here at Bere Adventist Hospital. However, this is still not where I want to risk my wife giving birth. Things could go great and it would be no problem. Things could be complicated. When will this COVID-19 insanity end for Africa?
The baby inside of Megan is happily trying to do triathlons already. The baby kicks, runs, and swims. The fetus is now at the gestational age where it could likely survive if born here in Chad where there is no NICU.
Adelie is healthy. She is finishing a course of quinine for a bout of malaria she got in spite of Malarone prophylaxis. We’re grateful she has taken her horribly bitter pills like a champion. She likes to go running with me in the morning. She points out cows and says, “Moo.” She chases goats. We are grateful for health ourselves and the ability to help many people here attain it.
