Triplets (!) - two sisters and a brother were born a week ago. The sisters were born first and then came the brother. They do not yet have names, but their mother knows them apart needless to say. They got off to a rocky start but are doing well now.
I got to know this family on February 27 when Dr. Guy, our Congolese expatriate doctor, called me while I was working in the MSF office. A community health worker hired by Medecins Sans Frontieres sent message by mobile phone that there was a mother in a village who gave birth to one baby at three in the morning, but she had not delivered a suspected second one. Dr. Guy asked me to support an effort to bring the mother to the hospital. As is our protocol for such a case, I agreed immediately. The ambulance of the Chadian Ministry of Health then came to our MSF base and obtained enough fuel from us to make the trip to the village and back. We sent an MSF midwife with the ambulance in case medical care was needed en route.
When the mother arrived at our hospital, our MSF maternity nurse supervisor not only assessed the mother by physical examination but he also examined the mother by portable ultrasound. The ultrasound in the hospital was put in place by MSF. At that point, the midwife realized there was not just one other baby left to be delivered, there were two! Both babies in breech position were successfully delivered at 3 p.m. in the hospital, and all three are alive today, as well as the mother. Baby one weighed 4.1 pounds and baby two and three both were 4.4 pounds.
Survival in motherhood is a challenge in this setting and is a key reason for MSF's work in Chad. Another woman who suffered complications from a spontaneous abortion died last night at our hospital, following a hysterectomy for uncontrollable bleeding. She was brought to intensive care from the operating room. I remember the eight staff lifting her stretcher up the stairs and into the crowded, hot intensive care room. One midwife, several nurses and two doctors cared for her but she died this morning after we tried our best. This mother leaves behind seven children.
Back to our triplets -- all three babies are underweight, but each day they are gaining a few grams. We have admitted them to our neonatal ward where daily they are weighed, examined, and are given milk supplementation in addition to their mother's breast milk. The brother is currently the most fragile one, but when I examined him today, he breastfed well. He did not seem to mind me waking him up with a gentle rub on the feet in order to watch him breastfeed. As all three babies are gaining weight, I increased their daily supplementation. As is the norm here as well, I notified the Chadian Ministry of Health of the triplets, since the Chadian authorities financially supports such families.
In the case of this family, all has gone well so far. Together, with a local community and the Chadian Ministry of Health as partners, we were able to address some of the key barriers that limit access to maternal care. These three barriers are:
- The decision to seek health care -- this was aided by our MSF community health care worker who realized something was wrong and called for help.
- The delay in arriving at a health facility -- this was reduced by a co-managed ambulance service by MSF and the local health authorities
- The delay in the provision of adequate care -- this was avoided by having trained Chadian staff hired by MSF in a Chadian hospital.
Much more needs to be done in Chad to make sure all mothers and babies do as well as this family. Nonetheless, it brings me joy to share this happy story with you all who take the time to read about this struggling population.
Farewell for now from the house-call....to Chad.