Mountains Beyond Mountains

This was my last week on Labour and Delivery and I'll really miss the excitement of deliveries (karibu mtoto! welcome baby!) and being there to support the mothers through the whole crazy process. So much fun! And so unpredictable...just when everything seems to be going smoothly you get arrest of labour, or a prolapsed cord, or an arm sticking out of the cervix. Anything is possible!

One case that really stuck with me this past week was of a woman my age who was hospitalized with pre-eclampsia and HELLP Syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets). She had lost three previous pregnancies around 6-7 months gestation due to similar health problems. Even though she was only at 28 weeks we decided it was in her best interest and the best interest of the baby to do a C-Section. An ultrasound showed that the baby was estimated at just over 1 kg which was somewhat hopeful since the mortality rate here for babies below 1 kg is 100%. The surgery was also high risk because since the mother had low platelets she had a high risk of hemorrhage. Everything appeared to go well surgery wise and the baby was born weighing 1.08 kg. What a little thing...we had to bag mask ventilate it...then it would cry, then it would stop breathing all together. I've never seen such a little newborn baby except already all wrapped up in an incubator. It most reminded of the newborn mice I used to dissect that had such thin skin you could see all of their internal organs. So fragile and born way too soon in a harsh environment without the resources to keep it a live. I had so much hope...but the baby died at 3 a.m. the next day.

Then we came in several days later to learn that the mother had suffered a hemorrhagic stroke overnight due to her hypertension and low platelets. While the neurologic deficits are still not completely known, any injury to the brain that can be easily identified by anyone looking at the little CT scan results on film has got to be pretty severe. What was already a sad case of a woman whose body just wouldn’t let her have a healthy pregnancy, is now endangering her life and will undoubtedly have lasting consequences. Tragic. Would better monitoring have helped? Certainly the baby would have had a much better chance if it was born at the other Riley. Now I just hope the mother can pull through.

This past weekend I climbed Mt. Elgon, the second highest mountain in Kenya, with a fellowship worthy of The Lord of the Rings…three Americans, three Swedes, two Canadians, and an Englishman. Our guides with AK-47s lead us up the mountain across moorland with funny looking giant lobelia and then scrambling up the side of a cliff to the peak of Koitoboss at 4187m. The view from the top was amazing with rolling mountains and farmland in the distance. We could also see Uganda (and apparently the Ugandan poachers still do some elephant hunting in the area which is why the guards were armed…yikes). I definitely reached my physical limit, but it was worth it. The following morning we explored the elephant dung and bat filled Kitum Cave and I stood beneath the falls at the gorgeous Makingeny Cave. Apparently these caves are ground zero for the Ebola outbreak in "The Hot Zone". Let’s hope the only thing I took away from Mt. Elgon were the memories (and sore muscles)…there’s enough of a strain on the medical resources here even without a major epidemic.