NON OF THEM KNEW THEY WERE CARRYING TWINS!!

Today was a happy day at Hingalol hospital, as our first twins to be born safely by normal delivery were born. I won’t give you much detail about our hustle to convince the family that it can be delivered safely without the need to take her to Qardho, small town, 60km east of Hingalool but very expensive to transport the patient. After having assessed the mother, realizing that the first twin was cephalic (head was coming first) and the second one is a breach (the buttocks coming firs), cervix fully dilated and mother having adequate contractions on top of that this was her 6th pregnancy.

However, my fear was not much about the cost of transport, but I feared that those doctors at the other end may justify a caesarean section. C-section saves both the mother and the baby’s lives but you must be careful with its indication. Some
doctors may cut without a defendable indication,something my Cuban supervisor, proff Ivan Bonet emphasized. I decided the mother can deliver normally here in our hospital. Luckily within two hours of admission the mother delivered a bouncing baby girl and a baby boy. They were the seventh kid of their mother and made 13 kids for their father, others coming from his other wives!

At this point you may be wondering why I am telling you the story of normal twin delivery! This is why;before this case we had two previous cases of twin deliveries and this is what happened.

The first case happened early September 2015, it was immediately after my arrival at Hingalol district in Sanaag Region, local people heard that a doctor was posted here, so we had a call informing us that a mother had delivered a baby, who died upon delivery, and that the second one is stuck and refused to come out! We mobilized some fluids and drugs and fueled our ambulance and headed toward the bush. We drove for 4 hours and reached when the second twin already came out but died immediately. We found the mother bleeding, tired and dehydrated. She had post partum hemorrhage. We resuscitated the mother, gave her oxytocin in normal saline and some i.v antibiotics as stat dose. The mother felt better, bleeding stopped and we drove back for four more hours.

The second case was more horrible to remember, it was an 18 year old primigravida (first pregnancy or what Somalis call Ugub). We had a call at around afternoon informing us that a mother delivered one baby but the placenta and the second baby failed to come out, so we shall be ready for them.  We waited them throughout the remaining part of the day and the whole night but they did not turn up!
What they did was actually very astonishing.

They first went for the burial of the first dead twin and after completion they asked a car to come and pick the mother, so the car have to go pick them and come back. They reached us around noon next day.

I have to quickly examine the mother and ask few questions as we try to set up an i.v line. I found that the fist one that died was a breach and on examination the second twin was a cephalic. What the mother lacked was contractions only. She was fatigued.  We delivered the baby; to my surprise it was alive though it scored very poorly.  The baby was a premature at around 32 weeks of gestation; it only survived until next day, when it succumbed to respiratory distress syndrome.  We couldn’t do much, there is no specialist care, no incubators, no electricity and the only thing at our disposal was Kangaroo Mother Care and i.v antibiotics and fluids.  It was too expensive to run oxygen cylinder on the small hospital generator for long!

Somalia faces many challenges in giving quality maternal and child health services. There is a lack of trained professionals, services and resources to assist in deliveries and provide essential health services for women and girls. Maternal and child mortality in Somalia is exceptionally high, as we have heard, with a one in ten lifetime risk of a woman dying as a result of pregnancy or childbirth. One in three children is underweight, and malnutrition is a leading cause in high mortality rates in children under 5.

To make the matters worse, nomadic pastoralists are not accounted for in any of these findings, their health status is even worse, perhaps the worst in the world. Any high risk pregnancy in the nomadic people is a sure death for the mother.

The health of a nation is reflected in the health of its women and children. As they thrive, so too will Somalia.

Dr.Mohamed Bobe,

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