Dr. Gary Johnson shares one of many stories from his recent work in Tikonko, Sierra Leone.
So, I get a call one morning while I’m still living in Tikonko from our new friend, Anita, a Maternal Child Health Aide in the remote village of Kassama. There is a woman with a 32-week pregnancy lying in her health post, bleeding briskly from the vagina; “Can you help?”
“Sure, I’ll be right there.” Right there, in this case, means in about an hour in the RHCI Lifesaving Hilux; the road is something to be experienced.
I get there, and we prepare to transport Mom to Bo. But, in one big whoosh, a 1.1 kg neonate and his placenta arrive. His placenta appears torn, the probable cause of the bleeding, and he’s not breathing. 32 weeks, 1.1 kg, not breathing, and miles out in the bush.
I look at Anita, and she looks at me. “We have to try,” I say.
“We have to try’” she says.
“Do you have a bag and mask?”
“Yes, I’ll get it.”
Anita returns with the bag and mask. The mask covers the entire face of the newborn. Nonetheless, we are able to ventilate reasonably well, and get the child dry. I had recently attended a course entitled, “Helping Babies Breathe,” in Tikonko, sponsored by Rural Health Care Initiative volunteers and Carrie Jo Cain RN from World Hope International in Sierra Leone. They were there to train partner TBA’s to assist skilled care attendants. So, that was helpful. Mom was weak from blood loss, but her vital signs were stable.
The baby will not breathe. I set him aside (see the image, used with permission), and begin to attend to the mother. I look back, and Baby Boy takes his first breath, and then another. Nice!
Long story short, we pack up a breathing, extremely fragile child and Mom for the trek to Bo. Kangaroo care, skin to skin with Mom, continues to give the child a very slim chance at survival. Here is the child skin to skin with his mother who is lying down in the back seat of the Lifesaving Hilux on the way to Bo.
The child’s good fortune continued in Bo where we were able to hand him off to Niall Conroy MD, a visiting neonatologist from Ireland. The child made it, so far as I know. I need to give Anita a call. The odds are still stacked against him, of course.
The central figure in this story is the MCHA Anita who can accomplish a great deal in a remote and very resource-poor area of rural Sierra Leone, given some support and the tools to serve her patients.given some support and the tools
