Thank You

To all the wonderful people who volunteered and attended the Blue Jean Ball on Saturday despite the snow and cold: you are amazing. To all the people unable to attend, but who have donated their time, or resources, or money: you are also amazing.

Your efforts affect a wide population that encompasses the Northern Zone of Tanzania. Since KCMC hospital is 1 of only 4 Referral Hospitals for the entire country of 40 million, it officially serves as the hospital of last resort for a population of 15 million people (and also the Kenyan villagers who live right across the border). We have seen patients come from Zanzibar, from Kenya and from the Ugandan border based on the reputation of KCMC hospital. The reality of KCMC is that it has knowledgeable specialists and intensive care possibilities, but frequently lacks the most basic resources such as functioning hemoglobin machines, or blood in the blood bank, or patient gowns for surgery.

None of this is new information, and all of our previous blogs have touched on different aspects of working in low-resource situations. But the one thing that keeps us optimistic is our Duke team's ability to contribute to women's' and newborn's health care.

And on Saturday, 350 people attended and 125 volunteered at (and countless others donated to) an event to raise funds for people that they will never meet.


Because of you:

1. There are women and babies alive in Tanzania who otherwise would not have survived. Due to donations of:
*Ambu bags to resuscitate babies
*Medications to save laboring mothers lives (to treat preeclampsia, postpartum hemorrhage, infections)
*Money for intensive courses on managing emergency obstetrics and newborn resuscitation that have trained more than 255 people in Tanzania so far

2. There are women who have new-found hope in a healthy life. Due to donations: *Allowing doctors (such as Jeff, Masenga, the global health residents) to travel to rural areas to perform fistula surgeries
*Providing women with fistula funds to travel to KCMC and get treated
*Providing women with cancer funds to travel to the only cancer center in Tanzania- located 600 miles away.
*Providing funds for fistula patient's families or nurses to accompany them for support;
* In surgical equipment and supplies to perform more complex surgeries.

3. The doctors and nurses at KCMC and other hospitals in the Kilimanjaro Region have more chances to be empowered. Due to donations of:
*Stipends that allow local midwives and doctors to teach the emergency obstetrics courses to other Tanzanians. Our research has shown that instructors retain their knowledge of emergency obstetrics better.
*Scholarships to allow our local KCMC colleagues to attend important international and national meetings for continuing education as well as disseminating best-practices
*Medical books and supplies that are not available (or are prohibitively expensive) locally, given to colleagues who demonstrate initiative in patient care.

4. Patients have something to smile about. Due to donations of:
*Infant blankets and caps, handmade by people in the US! Sometimes the only gift the baby will have.
*Hundreds of infant caps donated by a North Carolina company, kept the heads warm of so many newborns.
*Money, the poorest patients have received personal items that they could never afford, such as clothes and hygiene items.


Thank you

Sumera

The baby died after the uterus ruptured. Or maybe the baby died first, setting off the cascade of events leading to the uterine rupture. It's difficult to know the exact story. The patient, E., went to the first hospital after she started having abdominal pain and vaginal bleeding. She wasn’t sure if the abdominal pain was normal labor-related or a worrisome sign, since this was her first baby. She had not felt her baby move for a week.

E. was referred to KCMC for the vaginal bleeding and concerns about placental abruption (but without a referral form we can’t tell if they ever heard fetal heart tones).

What is known is that on admission to KCMC, a lack of fetal heart beats led the staff to do an ultrasound which showed a murky picture with possible placenta previa and placental abruption, but definitely no fetal heart beat. An emergency c-section was called, but first some blood had to be found from the blood bank (because of 2 days of vaginal bleeding). Since a hemoglobin level could take 24 hours for the lab to process, E’s anemia was diagnosed clinically.

During c-section, the chief resident (Zuhura) surprisingly found a ruptured uterus, a dead baby of a healthy size (about 7 pounds) floating in the abdomen along with its placenta, and about 1 liter of blood. She called Jeff to assist, but she handled the emergency well, and E’s vital signs were stabilized. The tough question for Jeff was whether to stitch the uterus back together, or remove the uterus by hysterectomy. E. is a young lady on her 1st pregnancy, and since she could not be asked her thoughts while under general anesthesia, Jeff decided to err on the side of fertility and keep the uterus in place.

E. is doing well today, with her fever resolving and in less pain. By now she knows that her baby has died, although we don’t know when or for what reason.

E’s story is one reason that the residents have instituted a Stillbirth Audit with our help. We plan to collect data on babies who died before admission, during labor or immediately after delivery. We plan to do it within 24 hours of the event, so that the history is fresh in the minds of providers. The entire obstetric staff is behind this initiative, because evaluating the problem is the first step in creating long-lasting and effective interventions to solve the problem.

It is a start.

Sumera