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FROM THE FIELD

A Miraculous Evacuation
05 Oct 2009 10:11:00 GMT
 Source: Medair - Switzerland
Medair

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Medair’s Afghanistan team responds to a medical emergency in one of the world’s most isolated districts.
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Medair’s Afghanistan team responds to a medical emergency in one of the world’s most isolated districts.

Background

•  Health and diseases

•  Afghan turmoil

•  AIDS pandemic

•  Chikungunya

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On a Saturday morning in May, a young woman named Bibi Leila was carried by stretcher into Medair's clinic in Khwahan, Afghanistan. The 22-year-old woman had been in labour for two days when her contractions abruptly stopped, with the baby already partially born. She was carried on foot by her relatives from her home, four hours away, to be helped at the clinic.

Khwahan is an extremely remote district in mountainous Badakhshan province, consisting of two distinct areas: very high mountain villages and low, lush valley regions. Medair's clinic is in the valley but it is surrounded by mountains and can only be accessed on foot or by horse through the high mountain routes. Communication between Khwahan and the rest of the world is limited to travellers through the area. Medair uses a thuraya, or satellite phone, to keep in touch with the clinic, but the topography and weather make the signal unreliable.

On this Saturday, Medair's base in Faizabad was alerted to Bibi Leila's predicament via the thuraya shortly after she arrived at the Khwahan clinic. Unfortunately, on this rare occasion, the clinic's doctor was away in Faizabad on a medical training workshop and the community midwife was in Kabul for a national midwifery conference. Meanwhile, Bibi Leila was in need of advanced obstetric care, with no one around to provide it.

Desperate Times Bibi Leila's baby was lying in a sideways position with the arm prolapsed. Under other circumstances, a skilled midwife could have tried to turn the baby for delivery, but with the arm prolapsed this was not possible. Medair specialists at the Faizabad base were able to give limited advice over the thuraya to the nurse at the clinic, but communication was difficult.

"We were devastated to hear from the nurse that the baby died a while later," said Emma Le Beau, Field Communications Officer. "This was such a tragic case."

By Saturday evening, it was clear that Bibi Leila would require a Caesarian section (C-section) to remove the foetus and save her life. At 22, she had already suffered two miscarriages and had no other living children. Medair staff feared she had a ruptured uterus and that she would not be able to have any more children, a devastating situation for a childless young woman in Afghanistan. She needed to be transported to Faizabad to have emergency surgery performed by its skilled female surgeons. However, this journey takes three to five days by foot and horse, depending on the changing weather conditions, not an option for Bibi Leila in this critical situation.

Extraordinary Measures Although Medair is the only NGO working in the health care sector in Khwahan, we do work with another NGO, PACTEC, who fly planes into the area to assist with the humanitarian work. The weather conditions and the expense make it difficult to fly to Khwahan very often but, thanks to PACTEC, Medair can afford to fly there twice a year. That Saturday night, Medair staff made the decision to charter a plane with PACTEC to fly in at dawn the next morning and evacuate Bibi Leila.

"Taking this action was also an important demonstration to the local community," said Gabriele Faender, Projects Coordinator. "It shows that if they make efforts to come to the clinic as soon as possible, we will do as much as we can to help them. Education on the importance of using the clinic, especially for maternal care, is a large part of our work."

Emma Le Beau and Gabriele Faender flew to Khwahan on Sunday morning. What was at least a three-day journey by horse was just a 15-minute flight by plane.

"The plane descended through a narrow access between the mountains to land on the grass in the valley," said Emma. "After we had landed, I really did feel in the middle of nowhere. It was very beautiful surroundings but you do get a sense of being trapped because there are so few options of getting out of there if you need to."

On arrival at the airstrip, the patient should have been waiting to be transferred onto the flight, but she was nowhere to be seen. The nurses had not moved her, because Bibi Leila was in a more critical state than Medair staff had expected. Gabriele advised Bibi Leila's brother and the nurses that there was a risk that the patient could die during transport, but they agreed it was a risk worth taking. Bibi Leila's brother and sister accompanied her as everyone boarded the flight, with a crowd watching. A plane in Khwahan is a rare sight. People in the crowd called out, "God bless Medair," and "We will be praying for you."

"I had no feeling in the plane," said Bibi Leila afterward. "I was not really awake. But I can recall the very bumpy roads when I was in the Medair ambulance."

A Miraculous Outcome On arrival at Faizabad Provincial Hospital, the ultrasound revealed an astonishing result: Bibi Leila's uterus was not only still intact but also, miraculously, her baby was still alive! Doctors performed an immediate C-section and delivered a baby girl, alive and well. The tiny baby (1,100 grams; less than three pounds) was placed in an incubator while Bibi Leila recovered from the surgery. In total, she had been in labour for five days, travelled many hours on a hand-carried stretcher, flown 100 kilometres by plane, and been driven 40 minutes by ambulance on rough roads.

"We were totally amazed to hear that the baby was still alive after all that trauma," said Emma. "To share honestly with you, I just cried with joy and amazement when the news came through."

Today, both mother and baby are doing very well, and the doctor believes that the child's injured arm may fully recover.

"When I was told that my baby was alive, I was flying, so happy," said Bibi Leila. "After God, you are the reason why my baby and I are alive."

After a few weeks of additional nutritional care in Faizabad, the family plans to return home on horseback, where Bibi Leila will be able to receive all the antenatal care she needs from the Khwahan clinic.

"After the procedure, we immediately contacted the Khwahan clinic and our nurses by thuraya to tell them the news of the birth," said Gabriele. "They were all so amazed and excited. It is such an encouragement for everyone to see what can be achieved when we are all working together."

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Medair brings life-saving relief and rehabilitation in disasters, conflict areas, and other crises by working alongside the most vulnerable. Its internationally recruited staff are motivated by their Christian faith to care for people in need, providing practical and compassionate support, regardless of race, religion, or politics. Founded in 1989, Medair has an unwavering commitment to bring hope to the world's most vulnerable.

In Afghanistan, Medair provides essential health care (in six permanent clinics and over 40 health posts), as well as water and sanitation to the people of Bamyan province, and in the Ragh, Yawan, and Kohistan districts in Badakhshan province. Medair's basic package of health care services in Afghanistan is supported with the assistance of USAID/WHO/MOPH, and complemented by UNFPA for the reproductive health care activities.




[ Any views expressed in this article are those of the writer and not of Reuters. ]

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[ Any views expressed in this article are those of the writer and not of Reuters. ]

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Last updated:Mon Oct 5 10:17:03 2009