A remote pregnancy: ‘Those few minutes saved two lives’
Ana Moral Garcia, an MSF midwife in Ethiopia, shares her perspective when a young woman in need of urgent care comes to a mobile clinic to deliver her baby.
We were about to leave the village when a heavily pregnant woman approached our car. We’d been visiting the local health centre to support the team there. Now we needed to get on the road – we were in a rural area of northeast Ethiopia, with a three-hour drive back to base. If she’d arrived a few minutes later, she would have missed us.
At that point I had no idea that those few minutes would save two lives.
Communities in this area are still feeling the impact of the two-year conflict that ravaged the region until 2022. The healthcare system collapsed, and even now many hospitals and health centres don’t have the supplies they need, or enough money to pay staff. With the local economy still struggling after the conflict, many people don’t have money to pay for transport to a healthcare facility, or faith that they will receive good quality care when they get there. So, alongside outreach activities to local communities, MSF is supporting the hospital in the town of Korem and four surrounding health centres.
The pregnant woman’s name was Abeba*. She was young: only around 19. She was having contractions and experiencing some bleeding. A small amount of bleeding during labour isn’t necessarily an emergency, but it can be an indicator of complications, so it’s always best for these mothers to give birth at a hospital rather than a local health centre.
Abeba agreed to come to the hospital with us. We hooked up a bag of IV fluids in the car and set off.
The journey was horrendous: it was hot and few of the other patients had been in the car before, so the winding motion of the vehicle through the steep mountainous roads made several people vomit. Abeba was still bleeding a little, but there wasn’t much we could do in the car. Every hour I checked the baby’s heartbeat as the IV bag swung by the window and Abeba gritted her teeth through the contractions.
At last, we arrived at the hospital and hurried Abeba to the maternity ward for an ultrasound. As soon as I saw the image appear on the screen, I knew we had to act fast.
When the first MSF team arrived at Korem hospital two years ago, no health facility in the local area had a functional operating theatre. So they set one up, partly to deal with obstetric emergencies like this one. Quickly, we prepared Abeba for surgery.
The ultrasound had shown that Abeba’s placenta was sitting below the baby, covering the cervix. This meant there was no way she could give birth vaginally. Working carefully, our surgical team performed an emergency caesarean section. I was in the operating theatre to assist as Abeba’s healthy baby girl was born.
As I left the operating theatre, I met a group of around ten people gathered on the grass outside. They were members of Abeba’s extended family, who lived nearby and had rushed to the hospital as soon as they heard she was here. I speak only a very few words of Amharic, but I was able to communicate enough to let them know everything had gone well.
As the group erupted in celebration around me, I couldn’t stop thinking about how lucky this young woman had been. Without surgical care, both she and her baby would almost certainly have died. And if she hadn’t got to our car before we left, there would have been no way for her to reach a hospital in time.
This was my fourth assignment with MSF, and I can tell you firsthand that every day around the world we are delivering babies who would not be alive if not for MSF.
MSF is continuing to engage the community and to support the health centres in this region with supplies and staff training. This means that Abeba and many patients like her will be able to access high quality antenatal care closer to home. Pregnancy complications can be picked up earlier, and for her next pregnancy, Abeba will be referred to the hospital in plenty of time to give birth safely.
Sometimes I think it’s difficult to convey the impact of MSF’s work. Of course we collect data: we can show the number of antenatal sessions we’re doing, or how many midwives we have helped to train. But this was my fourth assignment with MSF, and I can tell you firsthand that every day around the world we are delivering babies who would not be alive if not for MSF. We are treating women with uterine rupture or major haemorrhage: complications that they would not survive without urgent, expert medical care. That day in the village, Abeba and her family knew something was wrong. She was scared and in pain, but managed to get to us, just in time.
* Name changed to protect privacy.
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