Malindi District Hospital Report – November 2013
By Sophie Ndungu
(with minor edits to clarify medical terminology used in Kenya and correct grammatical confusion)
“It started at 18:30 when I reported on night shift. A pregnant mother was lying on a hospital bed in a pool of blood.
Nurses and doctors were busy attending to the mother while I took the history about the patient from one of the relatives. The patient’s mother-in-law said that the patient was 27 years old from a village called Baulala. It was her 1st pregnancy and she was 30 weeks gestation (pregnant). She had started bleeding in the morning after abdominal massage because she had abdominal pains. Mother-in-law went on telling me it wasn’t her daughter-in-law’s first time to get abdominal massage. She started being massaged as early as 20 weeks gestation (pregnant) and it was continuous massage at least once a week because she used to have abdominal pains. She was paying ksh 20 per massage to the traditional birth attendant (TBA).
The patient was brought to the hospital because she had bled a lot and was almost fainting.
In the hospital, an IV was fixed, blood taken to match type, and patient was started on a normal saline fluid drip. By this time she was already in shock.
The lab reported that her blood group was O-VE, which is a very rare blood group to find.
At 19:00 the mother was rushed to the operating theatre for an emergency C section. At this time there was no blood group O-VE in our hospital laboratory or in any of the neighboring hospitals.
The only solution remaining, however, was to operate on the mother to know the cause of bleeding and try to arrest it.
At 19:15, the uterus was opened and it was very dark in color (a sign of abdominal massage) with placenta abruption (low-lying placenta) which means when she was being massaged the TBA massaged the placenta and she started bleeding.
A macerated (rotten) male infant weighing 2000gms (4.4 lbs) was extracted. Before I left the theatre she had already bled more than 2 liters of blood. That’s a lot of blood for a mother who had already lost so much before coming in.
At 21:00 bleeding was minimal and the uterus was closed but her condition was very unstable because of losing a lot of blood. All her extremities were cold and she was in shock.
The doctor decided to refer the patient to Mombasa Hospital for a blood transfusion. From Malindi to Mombasa Hospital it’s a 2 hour drive.
Shortly after leaving Malindi the patient’s condition changed. She (collapsed) and she was certified dead.
All of the descriptions above were caused by an unknowledgeable TBA doing abdominal massage.”
Sophie sees similar cases on a daily basis. Through continuous education and the provision of simple sterile medical supplies, Teaching More can continue to combat these archaic practices that are killing so many women and children.