RUMGINAE - Two weeks ago at around 7pm I received a call on the hospital’s 24-hour emergency phone from community health worker Puse at one of our remote aid posts situated along the Kiunga-Tabubil Highway.
Puse was calling to say a pregnant woman from the remote village of Kokonda had travelled to Senamrae complaining of having painless vaginal bleeding during pregnancy.
I advised Puse to refer the patient here to Rumginae Rural Hospital where I’m the only doctor – although amongst my colleagues are community health workers, nursing officers, laboratory technicians, administrative personnel and a range of ancillary staff.
With these staff I am able to create an emergency response team when it comes to performing a Caesarean section, which, because of the bleeding, I suspected the woman may need.
Once I gave Puse the green light (meaning I accepted responsibility for the care of the woman and her unborn child), he went looking for someone to drive the ambulance and arrange for fuel.
Senamrae had recently received a brand new ambulance and I knew the woman, Jinna Gideon, could be immediately transported to Rumginae.
I also asked Puse to check his aid post for extra catheter bags and sterile gloves which I had run short off.
I was attending to another patient when later that night Puse brought Jinna to Rumginae. I was especially happy when he presented me with the IDC bags and the gloves.
When I reviewed Jinna, she was not bleeding and I did an ultrasound scan which confirmed my diagnosis of placenta pravea - a condition where the placenta comes before the baby which can lead to dangerous bleeding during pregnancy and a labour which can cause death to both mother and child.
I admitted Jinna even though she was not bleeding because I expected her to bleed again later, at which stage she would need an emergency Caesarean section.
Over the next two weeks, Jinna remained stable without any bleeding.
It was then I received a call on my two-way radio from community health worker Lorna saying Jinna was bleeding. It was just after midnight, around 12.30.
When I heard she was bleeding, I was certain Jinna would need a Caesarean. I quickly focused on what I had to do to assemble our emergency response team at such an odd time.
We had just finished working all day Friday and I was going to depend on the kindness and professionalism of our staff to drop what they were doing and attend to this emergency.
At the hospital there was just two staff on the night shift, community health workers Lisa and Lorna. I needed two more staff to create a Caesarean section team.
In all, I needed a minimum of five people - me doing the operation, an assistant, someone to cover the anaesthesia, someone to act as paediatrician and look after the baby once it was delivered and a scout to move around the theatre as required.
I called the matron and we discussed the case. We then roused two students at the adjacent Rumginae Community Health Worker Training School. It was now 1.30am.
I couldn't do the operation without the students, John and Garisa, because I knew they were blood group O, the same as the patient. If Jinna needed blood, they would be the donors. It was now 2am.
The laboratory officer arrived. His job was to cross match the blood if it was needed.
Around us, the hospital grounds and staff quarters were in complete darkness because there is no 24 hour power here at Rumginae. The generator runs from 8am to 12noon then 5pm to 10pm with the hospital also operating on solar power.
As there had been times during surgery when the power went off leaving us in total darkness I had brought my torch along as a precaution. Having found the lab technician, Unam, John went to look for Elson, who’s responsible for the generator. It was 3am.
Elson checked the generator batteries and assured me the power would not go off during the operation.
By 3.30 the emergency response team was assembled. Unam was available in case we needed blood. Sr Nimmy was our supervisor and scout with the community health workers covering each of the other roles.
We began the Caesarian and everything went smoothly with a bouncing baby boy weighing 2.6kg being born at 4.40am.
It had been a team effort of immense proportions.
Later the patient was brought back to the ward and the theatre, instruments and drapes were cleaned and sterilised.
Mother and child are both doing well.