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Kate Tyson

03 Sep 2012

Kate Tyson is a doctor in Obstetrics/Gynaecology and was in Afghanistan.

In a small maternity hospital in the east Afghan town of Khost, a 16-year-old girl battled to survive her first pregnancy. Diagnosed with eclampsia, an evolution of the high-blood pressure condition pre-eclampsia, she had suffered seizures during pregnancy and her chances of survival were slim. It was a daunting scenario confronting 28-year-old Australian doctor Kate Tyson on her first medical mission with Medecins Sans Frontieres in Afghanistan. The medical graduate from Lismore in NSW helped deliver the teenager's first child via caesarean section, but staff were worried about the young mother's ailing health. Swollen with fluid and in a coma, the fragile patient was monitored around the clock by Dr Tyson and nurses. Over the next week, surrounded by worried family members, she slowly emerged from the coma. And survived.

"Her mother-in-law was crying, saying, 'Thank you, thank you for caring for her,'" Dr Tyson, now back in Australia, recalled. "It was her first pregnancy, she had a c-section, she came very close to death ... but she came out smiling and healthy. "Just seeing her walk out with a big smile on her face was amazing," she said. The young woman's story stayed with the Australian doctor, who was thrown into the newly opened Khost hospital only to be transferred soon after to another part of the war-torn country when it was shut down for security reasons. The young mum was lucky to survive, beating the terrible odds of maternal mortality in Afghanistan, where the World Health Organisation recently estimated about 460 pregnant women per 100,000 die. That figure - released in late 2011 - is a substantial improvement from the start of the millennium when the country's maternal mortality estimates ranged from 1200 to 1800 per 100,000. But Dr Tyson saw many other women die from pregnancy and birth-related complications during her six-month contract with the Geneva-based medical aid organisation.

"It's extremely nerve-wracking ... you have to have confidence in your skills, but also know your limits."

Her second posting at Lashkar Gah, in Helmand province, was at the 250-bed Boost hospital which had been established two years earlier. The MSF-supported hospital had become well known and trusted by the Afghan community as a safe, efficient and clean facility, Dr Tyson said. But standards were still well below those found in developed countries, she said. Dr Tyson was part of a team including an anaesthetist and a gynaecologist, who were the only adequately trained staff available in the event a woman needed a caesarean. Unlike in Australia and other developed countries, where the 28-year-old doctor would be supervised by a senior practitioner during surgery, she was assisted by staff with less experience. "It's extremely nerve-wracking," she said. "You have to have confidence in your skills, but also know your limits."

The Afghan women faced a range of challenges, from complicated pregnancies that had not been monitored to the strictures of living in a patriarchal society.If a woman needed a caesarean, the medical team would need to find her husband or the man responsible for her to request his permission. The stigma attached to the surgery meant men often needed persuading that the procedure was necessary to save the woman's life, Dr Tyson said. Women often presented with undiagnosed conditions that were far advanced because of a lack of medical attention throughout their pregnancies. One of the most common occurrences was pregnant women with extremely distended bellies who believed they may be having twins or triplets. In some cases they were, but in others the women suffered from undiagnosed gestational diabetes or, worse still, a deformed fetus. One of the common deformities Dr Tyson witnessed was anencephaly, where an infant is born without a skull or brain and cannot survive outside the womb.

The resilience of the women in the face of grief was remarkable, Dr Tyson said. Acutely aware of the perils of giving birth and the ongoing conflict that had taken relatives, many just wanted to survive, she said. Dr Tyson, who starts her obstetric training at Melbourne's Mercy Hospital for Women next year, hopes to take part in similar missions on a regular basis.For now, she hopes the experience of her 16-year-old patient will boost the reputation of the Khost hospital, expected to reopen in December, and draw more local women to the facility. "It made me feel like there was hope for the project, that she will then go out and her family will tell other families that we are good people doing good things, and that we don't want anything more than healthy mothers and healthy babies."