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Obstetrics in Afghanistan: Those life-saving moments
MSF gynaecologist Nana Bündgen shares her experiences from a busy maternity hospital in Lashkar Gah, Afghanistan, and an assignment marked by insecurity and patients she can't forget.
Brief glimpse of everyday life
The four of us sit in the back seat of our landcruiser and try to take in as many impressions as possible of life in the streets. In the car ahead of ours sit our male colleagues, strictly separated by gender, as required by the rules in Helmand.
The daily drive from our accommodation to Boost Hospital does not take long, but it is our only chance to get brief glimpses of everyday life on the streets of Laskhar Gah.
In the mornings, it is still chilly in mid-February, so you see many men tightly wrapped in their patus, the traditional cloak, whizzing through the streets on rickety bicycles. Often several fresh flatbreads, which can be bought at the roadside early in the morning, are tucked under their arms.
Suddenly one of the midwives rushes in from the delivery room. I understand that it is an emergency, even without knowing Pashto
There is always a lot going on in front of the language institute at this time of day. Young women completely wrapped in light blue burkas, only their shiny high heels peeking out from under them, wait in front of the women's entrance. Barefoot children, even the girls already wearing headscarves, wave to us from the roadside.
We would love to get out and mingle, to participate a little more in daily life, but the still tense security situation in Helmand will probably not make that possible in the foreseeable future.
The longed-for blue fingerprint
Arriving at the hospital, I make my way to the early morning consultation in obstetrics, knowing full well that anything can await me - empty emergency beds in the corridor and a relaxed delivery room or several patients in critical condition at the same time.
I can't get our patient from yesterday out of my mind.
Gulalai* reached our clinic in a very critical condition. After giving birth to her eleventh child at home, she had not stopped bleeding. At the clinic, we quickly realised that surgery was needed to save her life.
Women are generally not allowed to give consent for medical procedures in this region of Afghanistan. Before we are allowed to operate, we have to get the permission of the male "care taker".
This is first of all the husband or also the brother, brother-in-law, uncle.... Like yesterday, precious minutes of desperate waiting often pass by until we finally hold the longed-for little piece of paper with the blue fingerprint of one of these persons – indicating their agreement – in our hands.
Then we can take the patient to the operating theatre for the life-saving procedure.
Women among women
The moment I pass through the large double doors of the maternity ward, which remain closed to men, I sense a relaxed atmosphere this morning.
The midwives of the night shift laughingly exchange the latest news with the day shift. They are all dressed in pink uniforms, different only in the magnificent headscarves that are allowed to slip off our heads here among us women.
I recognise Gulalai in a bed, relieved to see her smiling faintly back. She seems to have survived the night in good shape.
The team management reports more than 40 births during the night. So, despite increasing warfare in the surrounding areas and numerous roadblocks, almost a normal number of births again for the delivery room of Boost Hospital.
At the moment, all the patients seem to be stable, so I can start my rounds with the two young Afghan doctors.
We are just in the 10-bed room where our patients are recovering after caesarean operations, when suddenly one of the midwives rushes in from the delivery room. I understand that it is an emergency, even without knowing Pashto.
While we run into the delivery room, my colleague barely translates: "shoulder dystocia".
An obstetric emergency, whether in my home country Germany or here in Afghanistan.
The handgrip that saves lives
My gaze briskly scans the eight birthing cots with women who have already given birth or are in labour, only sparsely covered by thin curtains.
In the centre left I see two midwives standing next to a woman. The atmosphere is tense. We hurry over and immediately see the stuck head of the baby.
Relieved, we look at each other and the tension slowly falls away
My colleague and I quickly perform the so often trained moves, and after a seemingly endless minute, we are able to release the baby's trapped shoulder and place the baby on the mother's stomach.
The newborn is pale, limp and does not start breathing even after stimulation. We hurriedly cut the umbilical cord and bring the child to the supply unit. We start the ventilation.
My colleague checks the heart rate and happily informs me: "about 100 beats per minute", a good sign.
After several deep breaths with the ventilation bag, the newborn slowly becomes rosy and starts to breathe regularly. At first, it only whimpers hesitantly, but then we hear two strong cries.
Relieved, we look at each other and the tension slowly falls away.
Exhausted but happy
We bring the little boy back to the exhausted mother. When she sees the sex of the baby, she starts to beam.
My colleague interprets for me: This is her seventh child, but she only has one living boy at home.
Bibi Sahida* comes from a remote district of Lashkar Gah. She travelled for several hours to give birth in our hospital. Her colourful, beaded dress is stiff with road dust, her hair traditionally braided into many plaits. Numerous dusty bangles clink on her arm as she reaches for my hand. She will pray for me, my colleague translates.
How wonderful that Bibi Sahida was able to reach our clinic despite the difficult security situation and that we were then able to help her in this medical emergency,
I am very happy that the little boy survived and that my young Afghan colleague managed the difficult situation for mother and child so well.
But, also a kind of sad feeling always rises in me at these moments: knowing that women here in Helmand are often happier when they have given birth to a boy rather than to a girl.
*Names changed to protect patients' privacy