Fortunes and Misfortunes

It was a sad day today in Lacor. I came in to find a 27 year-old mother of five had passed away in the ICU. She came in on Saturday night with a placental abruption, had a stillbirth, and followed by massive postpartum haemorrhage and consumptive coagulopathy. Despite best efforts over the weekend with surgery, 4 units of red cells and 2 units of fresh blood (donated by student nurses on site) she died overnight. 

Then at 1PM today I reviewed a new patient we received from the emergency department - a two year-old girl who became unwell five days ago with bloody diarrhoea. She went to her local hospital where she was treated for dysentery with antibiotics and fluid. When she failed to get better, spiked a fever and started vomiting after three days, she was transferred to another hospital in the region. There she rapidly deteriorated and lost consciousness on Saturday. She was transferred to our care this morning. Unfortunately she was in florid septic shock and had not regained consciousness since Saturday with a Glasgow Coma Scale of 4/15.

At 3.05PM I went to check on her again – I found she had no pulse and she wasn’t breathing but she was still warm. There are no monitors or alarms in the ICU to have alerted us sooner. I did 15 minutes of CPR and gave adrenaline boluses but I knew my efforts were futile. Even if we got her circulation back, after three days without oxygen in a village hospital and three days in a comatose state from septic shock her outcome was always going to be dismal. We called her time of death at 3.20PM.

Unfortunately resources are very limited in African hospitals. I consider myself very fortunate to be working in the only hospital outside the capital city in Uganda to have access to oxygen, working ventilators, and a formal intensive care unit staffed by trained nurses. I am also very fortunate to find myself under the mentorship of a UK anaesthetist who set up this ICU over ten years ago and who has personally overseen its growth and development. With over twenty years of experience working in Africa, he has been teaching me a huge amount about medicine, anaesthesia and intensive care in the resource-limited setting. In Ireland oxygen is our very first intervention in almost every single sick patient – completely taken for granted at home, yet a pure life-saving luxury here in Uganda. What an oxymoron.

I consider that little girl today very unfortunate that she had to go to two hospitals before Lacor – hospitals that are so under-resourced they couldn’t possibly have the means to save her life, but which are tragically considered the standard of care here.  In 2013 under-5s childhood mortality in Uganda was 66/1000 compared with 4/1000 in Ireland.

Finally, not forgetting the 27 year old girl who passed away last night, the maternal mortality ratio is forty times higher in Uganda than it is in Ireland (360 vs 9 deaths per 100,000 live births respectively). Although I was not directly involved in her care, I find it hard to accept the loss of a mother who is less than two years older than me, with five children who will literally wait forever for their mother to come home.

Particularly considering what I have seen today, I have never felt as fortunate and as privileged to be Irish as on this St Patrick’s Day 2015.