Ah.....Berega

When Dr. Masenga told me we were going to Berega Hospital in Morogoro to do obstetric fistula surgery, I looked at the map and was able to find Morogoro: A decent sized city in central Tanzania. I didn't find Berega, 130 km west of Morogoro and 40 kilometers from the nearest electricity pole. The drive was beautiful, but it also acutely illustrated for us the deadly reality of living in remote settings for women in labour.

During the first day of surgery, we paused between the first and second surgery long enough to clean the operating room when a woman came in with obstructed labour. She had been labouring for two days and had been transported 15 kilometers on the back of a bicycle to arrive at Berega hospital. The medical officer in charge and an assistant did the cesarean delivery and the baby was blue and floppy. No breathing, a heart beat of about 60 beats per minute. Dr. Mkambo, , one of our chief residents from KCMC, Dr. Vasquez and I and rushed to the baby to help resuscitate. 20 minutes of Bag mask ventilation, chest compressions and a dose of epinephrine later the baby was pink and crying, a little. Mother was fine. This is what we call a near miss for both mother and baby. Two hours later the baby would have been dead and the mother potentially with greater injury. It was great to see Mkambo, just recently trained in NRP and ALSO, seize the opportunity to do what he knew he could to save the baby.


There are countless women who fall on the other side of that "near miss" line.........Waited for too long to decide to come to the hospital. Family could not afford her to go to the hospital. There was no transportation and it was rainy season and the only bicycle in the village could not make it with a pregnant woman in labour on the back. They reached the hospital, but there was no surgeon there to attend to her or she could not pay for her care and was turned away to another facility 50 kilometers away. She arrived on time to the hospital, but waited in labour for 3 days there before anyone attended to her. These are the stories fistula patients tell.

Berega was beautiful. Mud huts, brick homes, beautiful, friendly people with a connection to the land and themselves. Women collected water from holes they dug in a dried up wash a couple of kilometers from town. Women with babies on their backs who survived intact from their deliveries. It was a good trip.