Dr Mercy Kiprono was one of more than 100 participants who attended the SAFE Obstetrics Anaesthesia and Paediatric Anaesthesia courses in Kenya, Uganda and Zambia so far this year.
The SAFE (Safe Anaesthesia From Education) course, developed by the WFSA and the AAGBI trains local physicians and anaesthetic officers on how to give the safest possible anaesthetic care in the challenging situations, with minimal personnel and anesthetic equipment, that are often faced.
This is Dr Kiprono's story in her own words.
It was on Tuesday morning on 25th December 2012 at around 3.30AM when I got a call from the hospital requesting me to urgently go and help a patient who had been referred to my hospital from another health facility in the county. Since I was not the one on call, and it was the wee hours of the night I did not respond very quickly. Instead I started questioning the covering nurse on why she had disturbed me while I was off duty, and on Christmas Day.
The nurse insisted that I go since the anaesthetist who was supposed to be on call could not be reached on his phone and that the patient was very toxic, semi-conscious, in shock, and with a possible ruptured uterus diagnosis. Being a mother myself, I got up immediately and went to the hospital.
As I was making my way into the building I met a hospital watchman at the door really shaken and saying “Please doctor, even if you’re not on duty, please help that mother, she’s dying.”
Upon reaching the operating table, as an anaesthetist, I got to work and instructed one of the nurses to warm saline fluids as I was fixing a green cannula gauge, while the Medical Officer Intern - who was the only senior personnel - gave oxygen by mask, as I also prepared drugs and other necessary gadgets for intubation.
Unfortunately there was no qualified Medical Officer, nor a Gynaecologist Consultant around, so using my phone, I called the Gynaecologist who told me that he was in Nairobi and could not help. I then decided to call one of the best and most experienced nurses, who was also off duty, and told him to rush to the hospital as there was a real emergency and we had nobody else to help.
Since the Medical Officer Intern was still new and couldn’t do much, the nurse performed an emergency C-Section but discovered the mother’s uterus had already ruptured and was bleeding badly, though the baby was still alive.
I immediately requested blood from the laboratory but since the technician did not understand the urgency of the blood, he said the only pint of blood in the fridge was reserved for another patient. I had to rush to the laboratory in my scrubs and gloves to plead with him and emphasise the urgency of the situation, and eventually he gave it to me.
The patient’s vitals were not good so I called a Gynaecologist from a neighbouring county for help. He instructed the Medical Officer Intern to do a subtotal abdominal hysterectomy. However, since the nurse had more experience in theatre cases than the Medical Officer, he ended up doing the operation and brought the bleeding under control.
I transfused the blood I had been given from the laboratory, which meant that the patient was stable within an hour and a half, with her vitals back to normal range.
What I always remember is that if we hadn’t been so dedicated to the mother in the face of challenges, then we would have lost her and the child. The mother already had so many complications before she arrived at the hospital on Christmas Day: she had been subject to FGM, had three previous miscarriages and developed vesicovaginal fistula, and so delivering a healthy baby meant so much.
Today I am proud that this mother has a life because we worked quickly and did the right thing. To this day, when I am called to attend to an emergency, I act very fast and act as though I was the one who needed the same kind of assistance.
More SAFE Anaesthesia courses and are scheduled to take place Ethiopia and Malawi later this year. For more information about the WFSA’s Education programmes please click here.