Mütterschicksal in Subsaharan Africa – ein Fallbeispiel
Mütterschicksal in Subsaharan Africa – ein Fallbeispiel aus dem Alltag der Flying Doctors
Marsabit – Nairobi, Kenya
At 1200 on Wednesday, March 16, the 24 Hour Control Centre at AMREF Flying Doctors received a call from the Matron at Marsabit District Hospital requesting the urgent emergency aero-medical evacuation of an 18-year-old woman. Her medical condition was well beyond the capacity of staff at Marsabit District Hospital to handle. The Matron had called the AMREF Flying Doctors in desperation to request a Charity Evacuation.
Marsabit is located in a semi-arid region in the mid-north of Kenya and is one of the poorest areas in Kenya. Medical facilities in the region are scarce and ill equipped.
The woman’s case was discussed with the AMREF Flying Doctors Medical Director, Dr Bettina Vadera, and the decision was made to evacuate her from Marsabit to Nairobi. The Flying Doctors team departed Wilson Airport in Nairobi at 1350.
The Flying Doctors had a broad understanding of the patients’ medical condition: earlier that morning, the young woman had delivered a dead baby as a result of premature labour. Following the delivery, she had started to bleed heavily and uncontrollably from her birth canal.
This bleeding (postpartum haemorrhaging) can be quickly controlled by administering a drug called Oxytocin. If the patient does not respond to this, a second drug, Ergometrine, is given, causing the uterus to contract and the bleeding to stop. Both drugs are widely accessible and frequently used in developed countries, however, rural health facilities in Africa often do not have access to these life-saving drugs. Marsabit District Hospital did not have Ergometrine.
The patient had received Oxytocin, but an insufficient dose had been administered largely due to a lack of training at the hospital about the drug and its correct dosage.
The AMREF aircraft touched down in Marsabit at 1450. At the airstrip, Flying Doctors hastily loaded the patient onto the aircraft. She was barely conscious with a very weak pulse, and had received only one unit of blood (all that was available in Marsabit), an insufficient amount to replace the blood that she had already lost. During her transfer from the hospital to the airstrip there had been no monitoring of her vital signs, and supplementary oxygen had not been administered as it was not available. The young woman was in a highly critical condition.
Doctor Rhys Clayton and Flight Nurse Festus Njuguna attempted to stabilise the patient by putting her onto a breathing machine, and administering drugs to improve her heart function and blood pressure. A further two units of blood were also transfused and Ergometrine was administered to make her uterus contract. This appeared to arrest the bleeding; however, her state of health did not improve significantly.
The AMREF aircraft landed at Wilson Airport at 1800, and the patient was rushed to Kenyatta National Hospital in an AMREF Advanced Life Support Ambulance in a critical condition. Her pulse was barely palpable, and she was responding poorly to treatment. Flying Doctors staff monitored and treated the patient for a further hour at Kenyatta National Hospital while waiting for an obstetrician to arrive, and then handed over the patient.
The next day, Flying Doctors were informed of the tragic death of the young woman shortly after their departure from Kenyatta National Hospital.
Despite the quick response from AMREF Flying Doctors and the medical treatment that was administered while in their care, the poor medical facilities at Marsabit Hospital and lack of life-saving medication had already significantly reduced the chance of survival for this young woman.
The patient’s husband could not afford the Kshs 250 booking fee that was charged at Kenyatta National Hospital- an indication of the high level of poverty in Marsabit. Unfortunately, this is not in any way an isolated or unique case.
An 18-year-old woman died while giving life. 1 in 16 African mothers run this risk during their pregnancies.
——————————–
Case Study in Numbers:
§ 300 – Kilometres that the woman and her husband travelled to Marsabit Hospital. The facility was unable to offer the woman sufficient medical treatment.
§ 1 – Unit of blood available for the woman, though she had lost much more than this due to postpartum haemorrhaging.
§ 250 – Shillings (USD$ 3) charged as a booking fee at Kenyatta National Hospital. For many, this amount is prohibitive and a home birth with a traditional birth attendant is the only other alternative.
§ 18 – Years old was the age of the woman who died attempting to give life.
§ 6,040 – US dollars to fund a Charity Evacuation like this to save a life.
§ 0.30 – US cents being the unit cost of one dose of Ergometrine, which could have saved the patient’s life.
Flight Nurse: Festus Njuguna
Flight Physician: Dr Rhys Clayton
Captain: Capt Rob Cork
Aircraft: 5Y – FDK King Air
TOTAL COST: US$ 6,040
