Every once in a while, I (Scott) must chime in to tell a story from the Obstetric side of our shared building. Pull up a chair and a coffee, this will take a while.
This is a story of creeping towards and then slowly backing away from the precipice of death – many times. This is the story of Mary (not her real name).
On May 26th, one of the medical officers on our service performed what seemed like a relatively routine Cesarean Section on Mary. For reasons that are not clear to us, she developed a severe post-operative infection a little less than a week after her surgery. The infection was so severe, she was taken back to the “operating theatre” for a re-exploration. To look for anything that could have been left behind in the previous surgery (like a sponge or gauze). Nothing was found. The abdomen was washed out and second-line antibiotics started.
A week later, the surgical site opened up again showing more signs of severe infection. She was taken back to theatre for another exploration. Again, no explanation found. Washed out. Closed. And taken back for more post-operative care.
At Naivasha District Hospital, we don’t have the benefit of microbiologic cultures, so we could not culture any of the fluids or pus. We had no way of knowing what bacteria was causing this infection or which antibiotic would best fight the infection. But shortly before this event, Jennifer had sent a baby to Kijabe Hospital who was critically ill and beyond our capacity. They did blood cultures which grew a bacteria (Klebsiella) resistant to all but two antibiotics. Based on that culture result, we began to wonder if Mary could have been infected with this resistant Klebsiella (there is a lot of traffic between the Post-Op Ward and the Newborn Unit). At this point, I began to doubt whether Mary might survive. She was critically ill. She should have been in an ICU, but that was beyond our capacity and her financial resources. And our hospital didn’t even have either of the ideal antibiotics to fight the Klebsiella. So, I decided to go to an outside pharmacy and purchased the Meropenem out of our own pocket. That pocket is not really my own. We live and work in Kenya as the hands and feet of many generous churches and donors. From their generous support, I was able to buy a full ten days’ worth of Meropenem at a cost of about $500 (which is about 9 months’ salary for the average person in our area).
After a few days of the Meropenem, Mary started to improve and I began to feel hopeful, but then I came in to change her abdominal wound bandage and found fecal material oozing from her surgical wound. Somehow, her bowel had been injured in the second exploratory surgery and now her abdomen was filling with feces. We called the general surgeon. Understandably, he didn’t really want to touch her. She’s like a hand grenade. Nobody wants to be the last one to touch her before she dies. But finally, he was convinced and he did yet another exploratory surgery. Surprisingly, he couldn’t find the bowel injury. So, he did a colostomy on the proximal part of her gut to let the lower part “rest and heal.” This left her with a stump of intestine draining from the skin into an adhesive bag. And the hospital didn’t have these in stock either, so we purchased those @$12 each from the outside pharmacy (who gave them to us at his cost).
After getting the colostomy and a full course of Meropenem, Mary finally turned the corner. She began to gain strength and to eat again. She grimaced whenever the colostomy bag had to be changed, but she improved. She got her baby back from the nursery and began breastfeeding again. The milk came back. But she still had that colostomy.
The surgeon said he would reverse the colostomy after six weeks. That put the surgery date perilously close to the Presidential Election. But we thought it could get done. And then the surgeon tragically died. That is a story for another time.
So, we had no consultant surgeon to reverse the colostomy. What to do? There is a law that government hospitals are not supposed to refer patients to private hospitals. This is to prevent a conflict-of-interest scenario in which a government employee refers patients to a private facility in which they have a financial interest. But in this case, I felt like Mary’s best hope was to go to Kijabe Hospital where there are competent surgeons (who I know). So I contacted Kijabe and the head of surgery agreed to take her. That was contingent upon her clearing her bill at Naivasha and paying for her care at Kijabe. The estimate for the care at Kijabe was going to be about $1000. With the help of our donors, I thought we could handle that. Maternity Care in Kenya is “basically free” (subsidized by the government). Her bill at Naivasha was $5.
Mary’s experience at Kijabe was amazing. Her colostomy reversal went smoothly and she was discharged after five days. And while we expected to pay the bill, it turns out they had registered with the Kenya National Health Insurance plan (NHIF) which paid the entirety of her Kijabe bill. I had given the husband $300 for the initial deposit. That was refunded to him upon discharge and amazingly enough, he brought that back to me. That was a true demonstration of his thankfulness and appreciation.
Unfortunately, two days after discharge from Kijabe, Mary’s wound started draining bloody fluid. Seriously? Yes. So she was admitted back to Naivasha Hospital – again. We dressed the wound and Mary spent the Election week in the hospital.
For ten days we dutifully dressed the draining wound and slowly but surely the drainage dried up. Today the wound is dry. And today Mary was discharged home. 80 days after she had her first baby.
It’s a tale of prayer and perseverance. I don’t think we can necessarily step up with these resources in every complicated case, but God put Mary in my path and seemed to call us to action. So thankful today for her great smile and her life.
Soli Deo Gloria.
(photo used with permission)