Day 9 - Blue babies and tons of chilis

Today I saw a c-section on a mother at 32 weeks gestation. This is really on the edge of viability here. In the US, it is really no problem. I really hadn’t ever put much thought into the survivability of a 32 week old baby because it is almost a given in the US. Here not so much. It is a sobering reality to remember that child birth here is a pretty risky process for both mother and baby and a pretty high cause of mortality. The baby from the c-section was somewhat resuscitated. He did breath on his own for a bit, but I think that the effort put into resuscitation wasn’t extensive because it isn’t sustainable in this setting. (Intubation, incubators, etc. They just aren’t an option here.) I don’t think this baby is going to make it.

I also remember pouring over charts on obstetrics that included something like 20+ prenatal care visits. Here it is documented with 1 of 5 check boxes mark 1, 2, 3, 4 5+ antenatal visits. Not to mention that I haven’t seen the box marked 5+ checked yet. (And mind you these are the mothers who actually elect to go to hospital to have a delivery. I can’t imagine what, if an,y prenatal care the mothers who chose to deliver at home get.)

It was discussed on rounds that we should avoid doing c-sections because it “limits the size of a woman’s possible family.” At the time I remember being like, what?!?!  It was then explained that they only recommend that a woman have 4 children via c-section. I doubt this would be limiting family size to most people in the US, but it certainly is here. This point was also driven home when the cultural preference for boys was explained when a woman said with pain in her eyes that she “only had 1 child… and 4 girls.” I think me and Caroline collectively drew in a large(shocked) breath and exhaled slowly trying to not let our surprise and dismay show on our faces that such a preference would be so blatantly stated.

Also the majority of women here have vertical incisions from c-sections. Despite Mombasa being right on the beach, I know that the bikini I brought is not the norm here and  even those women who do venture out to the beach (and there aren’t that many) are wearing 1 piece skirted bathing suits, if not regular clothing. I find this interesting because the only time I have ever heard that a vertical incision was used for a c-section was when the patient is crashing (and cosmetics kind of gets put on the back burner).  Here it seems that vertical incisions for c-sections are the standard.

The c-section was done in the main OR today because there was no power and water in the maternity wards OR rooms. I’m told that it is not an uncommon occurrence for the power and water to go out. They do have a back-up generator in the maternity OR (which I heard click on twice during the case yesterday), but when combined with no water they decided to move the case.

The beaches are really empty on weekday afternoons (and those are Charley's legs in the bottom L corner)

After the hospital, I hung out with Caroline and her roommate Charley (Who is a girl. Charley sounds much more like a girl’s name the way they say it with their British accents). We went to the beach which is right next door to the hostel in which they are staying and read after having a light lunch.  I’m looking forward to having more people that I can hang out with!

After the beach, we went on a tour of Mombasa via car with Sid. He drove us around Mombasa at night and pointed out several of the places that we should check out while we are in town. We tried a bunch of the local street food including this Indian omelet thing with chilis (yummy), some casava chips with chili powder and lime (SOOO GOOD. I will definitely need to get more of these), grilled corn with a TON of chili powder (way too hot for any of us to handle), coconut water, and some ice cream all before dinner. Needless to say, we weren't too hungry for dinner. We split some yummy appetizers for "dinner" before calling it a night. Really cool to see the "real Mombasa" and try all the local foods from someone who knows where to get them. I had an absolute blast, and have a great list of places that I need to check out.