columnBy Maureen Ries
Maureen Ries is a an Obstetrician Gynecologist working in Tanzania as a Peace Corps Volunteer with the Global Health Service Partnership program, along with her husband, David Ries, an internist-pediatrician. This story is cross-posted on the Peace Corps blog.
Since July, I have been a Peace Corps Volunteer with the Global Health Service Partnership (GHSP) program, working with Seed Global Health and a busy district hospital in northwestern Tanzania. My husband, David and I moved into a cozy home recently and embraced our new adventure together. It's been quite an eye-opening experience.
In the months that I've been here, I've seen medical complications I had only read about materialize in front of me. I've gained some valuable life lessons from this corner of east Africa and realize this is only the beginning.
Lesson 1: The first day of school is a moving target
I arrived ready to get to work teaching as an OB/GYN both on the wards and in surgery at the hospital. However, when we arrived, the students were not ready. After some adjustments in the academic calendar, I am now delighted to be working with groups of 10-12 medical students on their six-week OB/GYN rotations. This is why I came: to contribute to building local health care capacity. My students will go on to work in various parts of Tanzania after their training here. One of my students sent me a thank you email that included a quote: "A candle loses nothing by lighting another candle," he said. "You were that candle to us, and I will light another new candle someday!"
Lesson 2: Laboring in the village for three days can have devastating consequences
In October, I spent time at a regional referral hospital learning to repair obstetric fistulas in women. Fistulas result from childbirth when prolonged pushing during labor damages tissues and later creates a hole, or in medical terms a "fistula", between the vagina and the bladder or rectum. A woman with a fistula cannot hold her urine, and sometimes her bowel contents as well. Her baby is unlikely to survive, and if the woman survives she is often abandoned by her husband and forced to live on the edge of society because of her incontinence issues and inability to bear more children. Sometimes a woman will stay at home fully dilated for days because of untrained birth attendants, living too far away from a medical facility, or because she lacks the resources to access appropriate care.
Between two and four million women in sub-Saharan Africa live with an unrepaired VVF (vesicovaginal fistula), and there are at least 3,000 new cases every year in Tanzania. Fistulas can be surgically repaired though, and women can return to normal life. I appreciated the opportunity to learn how to repair these devastating complications.
Lesson 3: We have work to do in terms of building bridges with local mgangas
Sixty percent of Tanzanians seek care for their ailments from local traditional healers (mgangas). Some women come into the labor ward with black tongues and black cervices as a result of using local herbs. Tragically, sometimes these herbs lead to unregulated uterine activity and uterine ruptures, a life-threatening event for mother and baby. As an anthropologist, I want to better understand the role of mgangas in their communities. As a physician, I need to understand how the mgangas treat our patients and how to avoid these complications. A number of my fellow volunteers and I recently met with four mgangas. One told me, "You are trained to treat our rulers; you are not trained to treat our people." We have much work to do to build understanding with these traditional leaders.
Lesson 4: Miracles happen
I was in the operating room finishing a case one afternoon when Sister Marie Jose, the medical officer in charge, came bustling in. "There's a uterine rupture; can you help me with the case?" she said. A woman had reportedly labored at home for three days and was outside the operating room in severe pain. The admitting officer had diagnosed her with an intrauterine fetal demise and thought the baby had died. We hurriedly got her prepared for surgery, and to my surprise, I delivered a 3.8 kg live breech baby girl.
When I turned my attention to the placenta, I realized my patient had sustained a full-term abdominal pregnancy. Her baby had grown outside her uterus. This is a very rare medical occurrence, and the baby infrequently survives.
At that point, it appeared our patient's condition became critical. Her pulse rate and oxygenation saturation dipped dangerously low. We ended the surgery quickly and the anesthetist did what he could with the limited medications we have at our hospital.
"It's amazing that the baby is alive, but we're going to lose the mother," Sister Marie Jose said. We gave our patient four units of blood and could only wait, watching her vital signs. As her blood oxygen saturation rose to 85 percent, we took her to the intensive care unit. Incredibly, she recovered, and several days later she went home with her healthy daughter.
Each day brings new challenges from unpredictable electricity that dips out during surgeries, to crocodile-related injuries in our community and carnivorous Safari ants. Yet, we have also experienced wonders like swimming in the Indian Ocean with a whale shark, the largest fish in the world. Overall, it is gratifying work as we help students learn how to save lives, and we hope they will remember some of the things we have tried to teach them as they provide care to the next generation of Tanzanians.