The Latest from Dr. Dan

Thursday a girl was brought in critically ill from a village 65 kilometers away. She had delivered there 7 days prior and the placenta had to be manually extracted afterwards by the maternity nurse, as she had protracted bleeding. She was 18 years old. It was her second pregnancy, but she had no children, as both prior babies had been dead at birth. On presentation, her abdomen was ballooned up as though she was still 9 months pregnant. Her fever was 103.5 and her heart was racing at 170 beats per minute. She was extremely anemic with a hematocrit of 14% (about one third of a tank) Everyone scrambled to find blood as we prepped the operating room. People like this are so outrageously sick that you marvel at the fortitude of their bodies. How can someone really sustain such an insult? We poured in IV fluid, antibiotics and blood and opened her abdomen to be greeted with 1-2 liters of eye-watering anaerobic pus. The best I can tell, she had an unusual problem called placenta percreta. The placenta had perforated through the uterus almost like a cancer. How she could have this and still have managed to live even a few hours after delivery without bleeding to death straightaway, I cannot explain. Now 7 days later, what remained of the placenta was dead, as well as the upper half of her uterus. We did a hysterectomy and tried to clean things up. She seemed to stabilize a little bit initially, but over the ensuing 8 hours, she spiraled steadily downwards and expired. To respond well medically to a case of this magnitude takes a Herculean effort from everyone involved. Lab, anesthesia, nurses, surgeons, everyone drops what they are doing and invests 110%. And when it is not enough, it can be rather demoralizing. 18 year old girls just aren’t supposed to die as a complication of childbirth.
When I informed the family, their response was typical. They received the news with absolute stone faces. “It is Allah’s will” they said- which is nice from the point of view of never having to worry about being accused of causing a bad outcome, but it never sits right. There is a smothering fatalism out here that has incredible numbing power. It is a philosophical anesthetic that allows people to deal with tragedy after tragedy, but on the other hand, exempts any and everyone from any personal responsibility, because, “hey, whatever happens was God’s will.” I found myself thinking, but wouldn’t God have wanted you to bring her in for treatment before 7 entire days had transpired? The tension between Divine Sovereignty and human responsibility wanders like a fault line, dissecting all of life. Both here, and everywhere, I suppose.
We rolled her body into the next building to wait for morning when the rest of the family would come to wash and bury her. I rode home wrestling for the thousandth time with the problem of evil. Things are so stark out here. One is constantly reminded that our time on this earth is but a few years.
155 babies were delivered at the hospital in the month of March. There are lots of preemies and 4 sets of twins in the house right now. It is amazing to see little two pound babies make it when you consider how little technology we have to offer.
We have had several visiting medical teams in the past 6 months. Each team leaves us stronger than we were before, as we are slowly expanding our competence and confidence. It is great fun to see the progress. 2008 looks to finish strong as we are nearing completion of a large storage building and preparing to start construction of the new maternity complex.
Thank you for your faithful prayer and support of us. It is your kindness in giving to the Great Commission Fund that allows us to stay out here.