Guest post by Philip Luker, a journalist with Médecins Sans Frontières.
Midwife Theresa Clasquin will never forget 22-year-old Anastasia, who had her first baby in a Bougainville mountain village and 24 hours later was brought to a small health centre, bleeding heavily after her placenta failed to separate and deliver.
Theresa tells the story. “By the time Anastasia reached Buin Health Centre, where I worked for Médecins Sans Frontières, she had lost nearly 80 percent of her blood volume and had septicaemia. Her haemoglobin on arrival was 3.7mmol/l and her condition was not just critical but beyond what I had previously believed to be compatible with life.
Theresa Clasquin with the Sister-in-Charge of the Buin Health Centre,
“With no intensive care capacity besides oxygen via a mask, IV antibiotics and IV fluids, she needed blood and lots of it. I told her family she might not survive. The baby’s father left the hospital that night and returned next day with six family members prepared to donate blood; next day, four more people arrived offering to be donors.
“We were able to screen, cross-match and counsel 10 people and found four matches for Anastasia. Two weeks later, she walked out of the postnatal ward with Hb of 7.0mmol/l and a healthy baby girl. Nearly 20 people from her village came to thank the health-centre staff for saving Anastasia’s life. It showed the amazing outcomes possible when good maternal healthcare in provided.
Bougainville is an autonomous province of Papua New Guinea with a population of about 175,000. An estimated 20,000 people died in a war between the Papua New Guinea Defence Force and the Bougainville Revolutionary Army between 1987 and 1997 and most people lost a family member.
The rugged, volcanic island is all tropical jungle; the roads are dirt tracks; most people live in villages, in huts they build with palm, bamboo or sago branches, and grow sweet potatoes, bananas, tapioca, coconuts and green vegetables, plus catching fish.
Theresa holding a fish she and some local Buin Health Centre staff caught.
Theresa is 28 and has previously worked at Royal Darwin Hospital and Wilcannia Hospital in NSW. Bougainville was her first work for Médecins Sans Frontières. Its main focus was to improve Buin Health Centre’s capacity to handle both normal and complicated pregnancies, births, newborn and postnatal care and other health issues for women and children. The health centre had no surgeon, so any women needing a caesarean would have to travel by four-wheel drive for at least six hours to the hospital in Buka, the capital.
Theresa specifically remembers a baby named Brenda, who was born in her
village eight to 10 weeks premature. Her mother did not think she would survive but continued to feed her and keep her warm, although she was very small, dehydrated and sick.
The mother brought Brenda to the health centre weighing 1.3kg and with severe dehydration, infection and breathing difficulty. Theresa did not expect her to survive for 24 hours, but gave her much-needed fluids and antibiotics via a needle into the bone in one of her legs and oxygen via a tube and kept her warm, being constantly wrapped against her mother’s chest.
Brenda was a fighter and slowly improved. “But a few days later, she inhaled a small amount of vomit into her lungs, developed a lung infection and died. I had poured myself into trying to keep her alive but did not succeed.”
The international Médecins Sans Frontières team with Theresa at Buin Health Centre varied, in the seven months to October 2012 that she was there, from eight to 12 — usually a doctor, another midwife, a nurse, two logisticians, an accountant, electrician, pharmacist, a laboratory technician and the project co-ordinator. The only other Australian was the doctor, Nadim Cody, from Ipswich in Queensland. Médecins Sans Frontières also employed about 35 local staff; the other health-centre staff were government employees.
“The most common complications I handled”, said Theresa, “were postpartum
haemorrhages, retained placentas, obstructed labours, breach deliveries, twins and preterm labours and births. The most challenging complication was managing premature or growth-restricted babies for weeks in a health centre with limited resources. In the general emergency and outpatients departments, the main ailments were upper respiratory tract infections, pneumonia, violence-related trauma and severe infections such as meningitis, particularly in young children.”
Theresa, from Glenhaven in Sydney, lived with the other international
Médecins Sans Frontières staff in three Queensland-style houses, each with
three small rooms and a toilet. “We shared a large outdoor entertainment and eating area and kitchen. Having flush toilets and running water made it heaven!
“Working conditions changed dramatically while I was at the health centre. I remember trying to resuscitate a newborn baby by torchlight and with no oxygen. Later, I could go to an emergency in the middle of the night and be guaranteed power and oxygen.
“My most memorable work was training and supporting the local staff,”
Theresa continued.”I especially remember the day one of my students, Martha, helped birth her first baby. She was worried about getting it right, but the baby was born screaming and healthy. When she put the baby on the mother’s stomach, Martha was so excited, she started whooping and jumping around, which spread to everyone. They started yelling at the top of their voices and it took two minutes for me to quieten them down and remind Martha that she still had to deliver the placenta!”
Theresa was attracted to working for Médecins Sans Frontières because “it is primarily focused on ensuring that the people who really need help get it”. She plans to go on another posting soon.
For more information about Médecins Sans Frontières, phone 1300 13 60 61
or visit the website.