A Matter of Timing

Earlier this year Australian obstetrician Dr. Alan Hughes spent two months working with Médecins Sans Frontières in Aweil, South Sudan.

Tell us about the region.

The entire area was subjected to decades of warfare. The major result of this is almost a total lack of infrastructure, which has only just been remedied over the last five years since the tentative peace agreement. But it will take probably a generation or so to repair the damage.

And regarding maternal and neonatal care?

Before Médecins Sans Frontières started this project, the level of danger to women and newborns was far greater. The likelihood that skilled help was available to adequately handle complications was, in most instances, unlikely.

Describe the main differences between the challenges in Australia compared to Aweil.

The most difficult situations we had to deal with were ones you wouldn’t see at all in Australia because complications are diagnosed so much earlier.

We had a foetal death that required a destructive delivery. We also had a difficult caesarean section for a placenta praevia, where the placenta is in the baby’s way with bleeding. And we had a couple of obstructed labours that had lasted two or three days before the women came to us. By the time they arrived, they’d already had uterine ruptures, where both the baby and the placenta had come through the uterus and were free in the abdomen.

These were all things I’d only read about. I’d never actually seen them before.

How did you respond in those confronting situations?

I was lucky enough to have handovers over a couple of days and Sophie, one of the senior obstetrics doctors who was there when I arrived, showed me around and got me up to speed with the kind of issues I should be prepared to expect.

What else did you experience?

There were several maternal deaths while I was there, some due to tetanus, some due to bleeding – but at least some of these would have been preventable, particularly ones that involved obstructed labour and late referral.

So it’s a timing issue as much as anything?

Yes, it’s a matter of ensuring pregnant women get help at the right time. And we’re already making progress. The maternal mortality rates have improved considerably in the surrounding area.

I don't have much free time – mostly I'm at the clinic or on the phone to one of our project sites making sure everything is okay there, or helping out if there are complications. In the evening, I collect data and write up reports. There's always something to do, but sometimes to refresh ourselves, I play cards or badminton with my housemates. To be honest, my house is just 700 km from here, but when I look at other doctors who are coming to work here, whose homes are thousands of kilometres away, then I think that what I’m doing is a very small sacrifice.

So what are the key contributing factors leading to neonatal deaths?

Pre-term birth, severe infections like sepsis, asphyxia, tetanus and diarrhoea are really the key issues for neonates. We’re hoping – and this should happen – to see the improvements in maternal mortality rates extend to neonates; it just may not happen that quickly. So that’s the next challenge.

So is the idea to expand these programs?

With more resources, that’s something that we can do – reach more people, let them know that Médecins Sans Frontières is there and that the care we offer is free of charge.