Maternity Matters in Madagaskar

Baby Diana  Woke up this morning feeling awful as I had spent the night emptying my gastrointestinal system (rather common here and well its not Corona but actually these bothers are more common anyway).   The midwives informed me of a bad CTG with decelerations and the need for a C-section.   The patient had already one before so I was a bit nervous.   The scar on the skin already suggested the previous procedure had been done in a haste as it was pretty big and not quite at the right level.   The inside was a mess, muscle layers mixed into fascia.   Slowly made my way down to the uterus that looked very scarred and had an irregular surface.   The cut into the uterus went okay but the structure on the distal end of the cut was very hard.   During delivery of the head this structure ruptured and caused a V-like rip in the center towards the bladder which luckily didn’t get injured.   Carefully suturing this area I noticed ...

Just after 5 am and my phone tears me out of deep sleep.  A patient, not one we have taken care of during the pregnancy, has just been brought in on a truck with strong vaginal bleeding.  Her papers she brought suggested she was somewhere near term.  Closer analysis showed that the baby had been measured small so the delivery date had been moved back (this is one way to just pretend that the baby does not have an intrauterine growth restriction or is small for gestational age). She was more than two weeks past her due date.  While this was being sorted I was doing an ultrasound and I find a placenta praevia totalis (reason for the bleeding) and no fetal heartbeat.  We break the news and are quickly on our way to surgery. Case #14. We see this didn’t happen just yesterday.  The sonographer who saw her last week made no comment to placenta location.  Speechless.  The placenta was accrete too and it took some time and curettage to remove it. ...

So one of my c-section patients is back.  Wound has healed well but this time it’s a lactation problem or stall in the pipeline I should say.  Despite conservative approach for the last week it has turned into an abscess despite best efforts.  Since it is of small diameter and there is a good chance to avoid an operation, I opted for puncture and drainage under antibiotic cover.  My medical student, Gyde, assisted me during the procedure with the ultrasound while I proceeded to puncture.  Success!  Lots of pus and some blood.  Normally a culture would be taken but well I guess you probably know by now that many things I normally would like to do are just not available.  Will be seeing her the next couple of days for repeat puncture. Sonographically guided abscess puncture The afternoon brought about our first new challenge in light of the new Corona virus.  Early onset of contractions for our planned re-c-section patient...

Baby Juldana our 3 am baby. First teaching C-section! (#12 and 103 overall :) Absolutely a cutie, it's ok sometimes to have to get up in the middle of the night. This patient had delivered before but had a stagnated opening phase of labor this time around despite supportive measures with oxytocin. It was my first time taking on the assistent role during 80% of the surgery and teaching our new doctor Joselitto. He really did a great job, I was pleased all went well. I have a new appreciation for all my teachers at the beginning of my training. They were incredibly patient. It does make you nervous a bit! At the same time it's really satisfying knowing that you are able to pass your knowledge on. I'm thankful to finally have a young local colleague to train especially after the one who was planned was not able to come.  Baby Stefany came earlier today with midwife Ando and our nurse anesthesia Hasina. They did a great job!  (102 overall:) In ...

Because from time to time a little less medical is nice. Pictures from my walk. Oh what fun when on your walk through the neighborhood you nearly step on a grass green chameleon!  This is one of those moments you realize you are not at home or someone's pet chameleon has just gotten out :) We watched him elegantly climb this agave looking like plant To my delight I discovered this one just shortly after hanging in our garden.  He wasn't to keen on getting his picture taken but I enjoyed watching him move through the greenery. Almost stepped on him outside the hospital! This is our house gecko. Keeps the bugs and insects under control :)

Back to work!  After some adventurous times off (hours of road travel and a few car breakdowns later) it is back to helping out the women at the clinic.  This patient was showing signs of amnion infection and with a stagnated birth process we decided delivery by caesarian would be best. Case 100!!!  We finally have a new doctor! Jean Joselitto who started work less than a week ago is assisting me for the first time.  He is a trained general doctor who also has performed around 30 C-sections.  I was thrilled to have another pair of trained surgical hands to work with.  He speaks only french and malagassy, so I am being tested on my medical french, which is not exactly easy when trying to focus on surgery, but all went well.  Tanja is taking on the role as our operating room nurse, having been trained by our german operating room nurse Anna. Baby Mandrindra (Baby 100 for me :) Guava season has started! ...

After spending some days on the coast we headed back to the central part of the country to visit the volcanic lake Tritriva and the surroundings.  As roads were too off road for our vehicle we explored by mountain bikes.  The rest of the time was spent enjoying excellent food in the town of Antsirabe.   Rolling hills of the central highlands Rice terraces Main Highway (only paved road headed west!) Villages on route, note the chicken.  They are always free range and always organic here.  Haven't seen a chicken pen since being here. They do return home in the evenings to their homes! More lush green rice fields Plateau headed back into the central part of the country One of many river plains Lake Tritriva (volcanic lake) Me enjoying our hike Colorful coffee shop Our guid...

Holidays!  I'm super excited to spend 6 days in the western and central part of Madagaskar.  We are four volunteers that hired a driver to take us on the 15 hour adventure there.  The main road was a mess at times with giant potholes but we managed to avoid major car damage.  Our driver was meant to drive the entire journey in one day, but that didn’t happened and we were not informed of this.  So about 260 km before reaching Morondava we were told we are staying the night here in Miandrivazo!  Well we had to quickly organize accomdation.  All went well.  In Morondava we explored the famous Alley of the Baobabs and spent some time on the beach and exploring the beach town.  It was a good time to relax and eat fantastic sea food.   Alley of the Baobabs (800 yrs old!) I feel small.. And happy :) Fischermen on Morondava Beach The women on the coa...