Maternity Matters in Madagaskar

We are finally going home!  After many months and weeks of waiting for some, we are all returning home on the same day.  Due to the pandemic there will also be no new volunteers to help out Tanja (top right) and her team to manage all the patients and hospital routine here.  Sadly, at this point due to Corona and other factors there has been no new permanent obstetric/gynecologist to fill the position I temporarily filled during my months here.  This means no availability for small gynecological operations and C-sections.  This will put the mothers at higher risk as transfers to a collaborating hospital nearly 2 hours away will now again be the only option.  I truly hope that soon this will change.  Group photo before an extremely long journey home Felicita, the hospital cook, served us up one last lunch of green beans and chicken with rice Lychees!  I'm going to miss this kind of fruit ...

Time goes by so fast in a way.  I had saved this post for a dull moment in between but I should have known that there probably wouldn't be many!  At last I leave here a collection of pictures of mostly scenery from my arrival time (lush green rice fields) to harvest time days before I leave.  So many beautiful memories from my time in Ambovo, Madagaskar.  Here a mix of scenery outside of the hospital :) Rice fields in January Village by the riverside Taking a walk through the rice field next door Zebus hauling hay Zebus in the lush meadow Such intense green of the early rice plants On the scenic way home from the supermarket Celebrating Dr. Joselitto's 30th birthday! The ridge behind the hospital Sunset in Ambovo Short cuts through Ambovo In front of the hospita...

Incredible, I finish here at the same pace I started off with in January!  This Friday evening we were sorting through our cases.  Currently my board was filled with 4 obstetric patients - prolonged delivery with suspicion of macrosomia, prolonged delivery post c-section, suspicion of pre-eclampsia and as we are sorting out these patients the fourth comes in with contractions and transverse position!  We begin with her as the contractions are starting to increase.  Our initial approach is to try an external cephalic version in hopes to bring the baby into axial position possible for birth.  The version is initially successful but ultrasound confirms the head is not quite were it is supposed to be and only tiny parts (hands and arms) are presenting. So off to surgery we go to the first of three this evening.  Surgery goes well, Dr. Joselitto does the delivery under my supervision and it goes smoothly.  I am soooo pleased.   ...

This case has left me feeling and knowing that God works miracles.  A patient around 19 weeks pregnant according to last menstruation (not from our area and therefore not part of any of our pre-natal care) came in the early morning hours with pain in the belly right.  The midwives drew a picture and sent to me on my phone: Its pretty clear and my first though it HELLP but given her early week that is pretty unlikely  The first scan I do makes me hardly believe what I am looking at.  Those not familiar with obstetric scans, this is an abdominal scan that shows lots of free fluid (black) and bladder (fluid filled sac on the right) and most importantly: a completely empty uterus! I find the baby, right next to the liver and no longer alive Conclusion: An abdominal pregnancy with a significant amount of free fluid (blood) in the abdomen The upper abdomen is swollen due to the baby there E...

This is a summary of a case I have been following since nearly the beginning of my stay and that finally resolved itself just as I am finishing up my time here.  The patient presented in February with a positive pregnancy test and some light vaginal bleeding.  My initial thought is a bleed in early pregnancy or potentially an early abort.  Upon ultrasound exam I see the image below and note the large myoma which many patients here have and what is often a common cause of bleeding in early pregnancy.  I cannot detect a gestational sac nor can I exclude an abdominal pregnancy as I didn't have any possibility to do lab work at this time (I didn't manage to establish that until much later).  Given she was pain free and there was no free fluid in the abdomen I decided to have her come back in 2 weeks for check up and of course anytime sooner if she has any pain or an increase in bleeding. February scan She is back after a few weeks in March and still has b...