I WISH I COULD DO MORE!

Ubax is a 25 years old, she has two children and she is the third wife of her husband. Her story represents the typical life of a Somali woman in the nomadic pastoralist life. It is a very harsh life and the pain in her life story will prove me right! She is my patient and as I write this story she is lying on the bed in our hospital expecting me to solve everything for her not knowing that I feel small and helpless and angry at the same time!  She was in labour for about 10 days in her house. She lastly gave birth to a dead baby, a very big dead baby. She endured a very painful and long labour, a typical labour for young mothers in this part of the world.

But her suffering didn’t stop at there! She felt something is wrong with her genitalia and came to hospital. When I asked what prompted her to come to hospital after everything was over, the woman accompanying her says in full confidence “Way Isku Furatay”!

This explanation is not new to me, I hear it almost once in every week, and knowing the fact that Somalis exaggerate things, I decided to carefully examine her to rule out or in a perineal tear. What I found was very sad. The woman has a rectovaginal fistula-meaning that her vagina has opened up to the anus and the whole anatomy is distorted. It was at this point that I felt angry and at the same time betrayed, betrayed by my own skills and technical competence. I just wished I could repair it. But unfortunately I can’t help i am not a gynecologist!

To make matters worst, not only does she have a fistula, but a severe postpartum infection-puerperal sepsis and severe anemia. I later discovered that she bled a lot during and after delivering the baby. Her Hb was surprisingly 3 g/dl and the infection was severe.

At this point I decided to tackle the two major things that I can handle at my station; anemia and infection. We started her on two intravenous antibiotics the usual ones ceftriaxone and metro, and we transfused her with one unit of blood. This time we improved on our transfusion. We could screen for hepatitis B, C and syphilis but again we have to use a non blood giving set!
I am planning to contact anyone who can help her get a transport to and from Hargeisa or Borama or any other center where they can repair. I know the operations are free of charge at Adna Hospital and Borama Hospital so that won’t be a problem. I hope we can find a good Samaritan to help her get the transport!

I usually find cases of all types of perineal tear and I repair them but when fistulas occur it will be out of my scope to try. I welcome anyone who may help this mother.

In my short stay at Hingalool I came to realize that a lot of funding has been given to help the health delivery services in Sanaag and Sool regions but little or none reaches to serve the intended purpose. As far as I know Somaliland development fund has allocated 5 million us dollars to improve the health care in Sanaag and Sool, but that money was poorly allocated and is confined to Erigavo and Lasanod. I don’t know if it is out of ignorance or the leaders at the ministry were ill advised.

There are programs in Puntland such as the CARMMA program (Campaign for the Accelerated Reduction of Maternal Mortality in Africa) and EPHS (Essential Package of Health Services) but no signs of these efforts are seen in Sanaag and specifically at Hingalool district.

For God and My Country.

Dr. Mohamed Bobe, Hingalool, Sanaag.
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