Human Conveyor Belt!
As I approached the hospital gates, my heart was heavy, my spirit weary. I worked in a baby manufacturing plant. A human conveyor belt. That’s what my perception had become. But it wasn’t always this way. It started as a dream. A dream to make a difference. But one day I woke up and realized I hated the nature of my work.
As a junior doctor, I was sent to work in the busiest maternity hospital in the city. It was known then, as a filthy, overcrowded hospital with poor quality of care and inadequate facilities. Patients who delivered there went for lack of choice.
I arrived on my first day- on a chilly Monday morning- bright eyed and bushy tailed with anticipation in my chest. I had heard all the gory stories about this place but I was determined not to let it get to me.
I walked in through the front entrance and was met with the familiar putrid smell of antiseptic. The reception area was poorly lit with no one in sight. The peach concrete floors were littered and wet with stains of blood signifying the recent passage of a bleeding patient. Further in, I got to a place with a flurry of activity. A nurse was escorting countless women to a bench on one side of the corridor. They seemed to be in great distress-these women.
I turned to see where they had come from and I was horrified by the sight. To my left was a large endless room with a flurry of activity. I peeped in and felt someone grab my arm.
“Wewe ni nani?” A middle-aged nurse asked me.
I introduced myself and explained to her that this was my first day and I was there for orientation. She pointed to a door next to where the agonizing women sat. “ Go in there. It’s the operating theatre. You will find a doctor to take you round, but it’s really busy.”
The orientation was as brief as the life of a fly. I walked into the OR and found a tall, lanky male doctor chugging down milk from a packet. What happened to cups, I thought. After brief introductions, he got up and took me back to the corridor, then from one central point, pointed to the different areas in the hospital. He looked exhausted and kept asking me when I was set to start. “In a nutshell, you only need to know three things. One, you will either work in labor ward or the operating theatre alone for your shift. Two, eat before you come in or you will be forced to survive on two packets of milk for the twelve hours. Three, there is a call room upstairs-you will never use it.” He then introduced me to a few members of staff and that was it. The disquiet within me begun with that description. Just how bad was this place? It didn’t take long to find out.
I started work officially a week later. It wouldn’t be that bad, I thought. I was there an hour early, ready to set up and get started. This time I met one of the nurses stationed at labor ward. She took one look at me and said, “ That will not do.” As she pointed at my outfit. I was clad in a pristine pink blouse, collars well pressed, black trousers and office shoes. “ Go and get some scrubs, gumboots and a mask from theatre.”
When I got back, she gave me two packets of milk. “This is for you to keep up your energy.” I didn’t think I would need the milk so I shoved it in my bag. She then took a large, blue, translucent polythene sheet and fashioned it into an apron for me-what we ideally call a Macintosh and told me it would protect me from the splashes of various fluids coming my way. With that we got started.
Labor ward was a market-place. The women looked like the cast of a poorly choreographed play in utter disarray. Some were singing dirges, others were dancing to self composed songs, others were contorted in inhumane postures, yet some just sat quietly bearing the pain. How was I supposed to manage all these patients? There was clearly no time to continue being a curious onlooker. The nurse was joined by her colleague and we constituted what we needed for the ward round. It was as dramatic as they come. By the end of that day, I could barely speak. I found the milk at the bottom of my bag as I was leaving. There was no time for decorum. I latched onto the milk packet like a newborn and emptied the contents into my mouth.
Weeks later, this work, begun to quench the fire of change I had. I became mechanical. I started to watch the clock and would leave promptly when my twelve hours were up. Taking a break to drink my milk and go back to work. I was mentally drained.
If I thought, labor ward was bad, then the OR was worse. In theatre, we were conditioned to operate at the speed of lightning. Be fast enough yet careful enough to do as many cases as you could. The pressure was immense. My scrubs would be drenched in sweat after a few hours because of the adrenaline rush. We would be on our feet for thirteen hours straight. Cut, open, deliver, suture, dress, repeat. The work never stopped, the emergencies never ended. The conveyor belt kept moving. And then the day I dreaded came.
I was in theatre operating on a patient. I had just made the cut that opened the abdomen when the nurse rushed in saying that there was a cord prolapse. This is a complication where the umbilical cord drops through the open cervix into the vagina ahead of the baby. The cord can become trapped against the baby’s head. It’s an obstetric emergency, because the cord is at high risk of compression, blocking oxygen and blood flow to the baby; leading to fetal death. Ethics dictated that I could only attend to the patient on the operating table at that time. There was the choice to refer the patient but all the bureaucracy that surrounded the referral system would take so much time. By the time we got the ambulance and rounded up staff to accompany her to another facility, I probably would be done with the patient on the table. I tried to get my colleague to help by opening another theatre but it had no anesthetic equipment. Sigh. I called my senior colleague to inform him about the situation and instructed the nurse to put her in a knee chest position to avoid compressing the cord.
I composed myself and steadily operated as fast as I could while trying to be as careful as possible. They say misfortune does not travel single-handedly. As soon as I got the baby out she developed post partum hemorrhage. I knew then I had to make a decision concerning the other patient. There was no telling how long this would take. I asked them to organize a referral for her as I tried to control the bleeding. There was no blood available at the hospital and alas the ambulance had no fuel. By the time I was done with the bleeding patient, and she was stable, the ambulance had not been released yet. I asked them to quickly wheel the next patient into theatre but when I felt the cord, it was no longer pulsating. The baby was gone. To say I was destroyed, is an understatement. I was knocked sideways and I still had to deliver her, and explain to her what had happened. I hated the feeling of playing God. The feeling of helplessness this work came with. The fact that even after all that, you still had to pick yourself up and keep working until your shift was done. I steeled myself for the remainder of the shift.
In the morning I got into my car and drove home and never went back.
I am ONLY one. I can’t attend to more than one patient at a time. My hands were tied and because of several glitches in the system, we lost a baby and it was not the last. That was just a preamble in the daily life of a Kenyan doctor.
I have since recovered and moved on but with a drive to change more than one life at the same time through my writing.
