An unusual afternoon.

This morning I was in theatre. Our first case was a c-section. The indication was a twin pregnancy with the first twin in a breech position (feet first instead of head). Two beautiful healthy girls came out. I was excited (as have seen many not survive) but mum was less than amused. Mum’s name in Zulu was ‘happy’ but the surprise of twins made her cross. She is 22 years old and already has two children at home and cannot afford another two. After a tea break, we were supposed to do another c-section. Prior to inserting her spinal, I was examining her and realised she was not 38 weeks but in fact 26 weeks! This is a common occurrence here – I would say half the women I see do not know their last menstrual period! Our third case was (very sadly) a rape case. I will not go into the details as it is very depressing but needless to say it involves one of my lovely paediatric children who has now developed an ano-vaginal fistula.

After lunch I was in OPD. My first patient complained of hot and painful feet. This symptom – peripheral neuronitis – I have learned is common in both TB and HIV patients. Typically, the patient has both conditions. Whilst prescribing TB treatment, in steps the medical manager of the hospital. He asks me if I would be willing to remove a dead baby from a dead mother. I look up entirely perplexed. Two minutes later, I was in mortuary about to carry out the procedure. The reasoning behind the request relates to Zulu culture. This dictates that as mum and baby are brought into the world separately they should leave the world separately (even though they are going be buried in the same coffin). The case was of a 19 year old pregnant woman who complained of abdominal pain and then died suddenly in one of our community clinics. I am very aware of needle stick injuries so completely gown up with ski goggles, two gowns, two pairs of gloves and of course mask and boots. (I look quite funny in full kit but don’t care). As I conducted the post-mortem and c-section (thankfully with the help of the mortuary technician), I uncovered lots of congealed blood directly under the abdomen (she was cold) and after some searching, realised she has a ruptured right ovarian cyst. I removed all the blood and then conducted my c-section. The baby boy was approximately 5 months old and looked healthy. I then needed to remove the placenta (which was intact) as this too needs to be with the baby. We then sewed up the body.

Yet again my day had taken a very unexpected course.