Working for a brief period of time as a medical doctor in Nigeria had exposed me to the challenges of both the patient and the doctor almost in equal measures. The doctor constantly grapples with the challenge of convincing patients of the necessity of some measures and decisions as informed by his medical knowledge, while the patients are at the same time grappling with balancing the weight of her pocket, societal demands and views, against her own health issues and needs.
No hiding from the fact that medical costs could cripple the finances of a struggling family in the blink of an eye. More painfully so when said medical service might have been largely unnecessary. There have been instances where patients were advised to proceed with cesarean section when the chances of natural bath/delivery have not been completely exhausted. The average cost of cesarean section, depending on the city, ranges from tens of thousands to a couple of hundreds of thousands.
Not to justify the callousness of some medical practitioners, but doctors are not faring completely well as should be the case either. Most of the bad decisions and practices found in many doctors are born out of desperation. The doctor at graduation took an oath to do no harm, and most believe and practice to live up to this. I am not holding a brief for the entirety of doctors here. As we well know, every 12 has Judas or two.
There are myriads of factors mitigating against the sound medical practice in our country, most of them are well-intentioned ironically. This brings me to a significant experience I had and would love to share.
In the first year of my internship in South-Eastern Nigeria during my obstetrics and gynecology posting, I had come across a woman well advanced in her pregnancy who had come for her regular checkup. She was well above 6 feet tall, dark ebony skin, and was shining in pregnancy, her first. She had already had an ultrasound and knew she was having a baby boy. She was as happy as could be and as could be expected. While doing her preliminary checks, a very diligent female nurse noted that her legs were slightly swollen, proceeded to check her blood pressure which was quite high, about 220/130. The wise nurse took a urine sample, did a dipstick test which showed significant protein in her urine. She brought her findings and her concerns to me before I saw the patient. We had agreed to go ahead and admit this patient, with a plan to first try to bring down her blood pressure. If that fails, we would proceed to induce labor or go to cesarean section to get the baby out and save the mother from going into seizures that could be likely fatal to the baby and/or the mother. In all of these, our primary concern was the woman and her unborn child.
When I saw the woman, she complained of a pounding headache, and was visibly anxious. I tried the most I could to stay calm and explain to her the seriousness of the situation we found ourselves in. After explaining the medical implications of the situation to her, she requested that I talk to her husband as she alone could not make the decision as to whether she would be admitted and proceed with the plan as outlined. Her husband was a pastor in a local church, and we had to wait for him to get to the hospital after finishing his evening service. When he arrived, he requested to speak privately with his wife. After their discussion, he came back into the consulting room with his wife and told me that the God he serves did not decree that his wife should deliver their first child through a cesarean section. That it was decreed that she would deliver like Hebrew women. He explained the favor that God placed on the Hebrew women and all that follow His ways, that they would not suffer long in labor of childbirth. Something in that theological vicinity.
Hearing him say this one would assume that being Hebrew or Jewish gives you a biological advantage (somehow rooted in theology) in matters relating to childbirth and labor. The biological aspect of that argument I happen to know a bit about by virtue of my profession (suffice to say there’s not a lot in that argument biologically), so I decided for the sake of this presentation to do a little digging in theological and demographical angles. We will get back to the story and how it unfolded, if you don’t mind.
The biblical root of this belief can be found in the book of Exodus, chapter 1 from verse 18 onward. It was during the years of enslavement of the Israelites in Egypt. After taking office, the new Pharaoh had noticed that the Israelites were multiplying at a rate he considered alarming. His thinking was that if there was to be a war, the Israelites could side with their enemies and with their large numbers may defeat Egypt. They had the Jews living in camps doing all manners of hard labor for the state. He appointed two midwives, Shiphrah and Puah, to ‘supervise’ all Jewish deliveries. Their special instruction was to kill at birth every male Jewish offspring and let live all female offsprings. These women were full of human compassion and did no such evil. When the Pharaoh noticed that the boys were somehow making it out of the labor room alive, he summoned the midwives and asked them ‘why have you done this ? Why have you let the boys live?’ To which the midwives answered ‘The Hebrew women are not like the Egyptian women, for they are vigorous and give birth even before a midwife arrives’. The story goes on to say that God was good to the midwives and gave them families of their own. The Jews went on multiplying. In essence, the midwives lied to the Pharaoh to protect the Hebrew children.
Now to present day Israel. How are they faring regarding childbirth, viz a viz vaginal delivery versus use of C-section ? For the sake of fairness in debate, it would help to point out that amongst the 36 OECD nations (what we call Developed countries, the First World countries if you may) Israel ranks among the lowest in the utilization of Cesarean Section as a means of child delivery (34th). Turkey comes in at the top with about 50.4% of all their babies born by CS (that is 504 out of every 1000 deliveries). Out of every 1000 babies born in Israel, about 150 are by CS.
(Source:Jewishbusinessnews.com,jewishmom.com,thejewishwoman.org). To a aid drama here, let us all take a deep breath and acknowledge that Hebrew women actually deliver by Caesarean Section (ga gwazie ndi yard unu !!). I had to do that.
The use of CS is on the rise worldwide, and the reason is not far fetched. With the trend of general economic growth in many countries, women are more economically engaged. They are putting off raising a family to a later age. More women are having kids in their late thirties and forties today than used to be the case in the 1960s and 70s. These are called high risk pregnancies and are often resolved by CS (rightly so too). Secondly, as a result of better economics too, and better advances in reproductive science, assisted or enhanced conceptions (IVF, artificial insemination etc) are more within reach of many. These methods often lead to multiple pregnancies, requiring CS delivery.
It would help if Nigerian women, men, Pastors, mother-in-laws and all could realize that delivery by CS does not in any way mean a woman is weak, cursed, or less in status relative to her peers that delivered by SVD (spontaneous vaginal delivery). It will save us all a lot of psychological, physical and emotional pain.
So back to my patient. At this time I had brought in the Nurse that checked her in. My hope was that a maternal voice could get the message across better. We even tried to separate the couple and speak to them individually, but the answer remained the same.
We gave the pregnant woman some medication, knowing fully well she needed way more than that, and that she was in such grave danger. The pastor proceeded to take his wife home. He told of how he had prayed for a lot of women who were “condemned to delivering by cesarean section” by doctors like me, and they were saved. They had all delivered like Hebrew women.
Fast-forward to three days later, about 1:24 AM, I was on call, got a call about a woman who had been rushed to the emergency room in full tonic-clonic seizures. I’ll digress here a bit to say that seizure on its own could be quite an ugly sight, but seeing the 6-foot tall woman with a full pregnancy in the throes of a grand seizure, is a sight that would never leave your mind.
Nature is an awesome phenomenon when it is in full play. While in eclamptic seizures, this woman’s system had gone into AutoCorrect, she was in full labor at the same time. This is where I would stop and pay complete respect to every single Nurse, no matter their areas of specialization.
To make a long and ugly story short, we were able to save the mother’s life, but not the baby’s. The woman remained in a coma for another two days. Her mother came in from the village, was by her bedside every single second of the two days that her daughter was unconscious
She took charge, took part in the disposal of that stillborn baby. When her daughter opened her eyes on the third day, her mother had a courageous smile ready, with soothing words. The daughter was too weak to cry, but the ache in her soul could be read in every single line on her weary face.
Mother and daughter stayed in the hospital for a total of one week and four days. On one of those later days, I ran into the pastor husband along the hallways of the hospital. As was expected in such a situation, he was somber and quite subdued. He took me aside and told me how sorry he was. He apologized for a few choice words used to describe doctors during our earlier discussions prior to the incidence. Then he told me how he believed that God still had a plan, and how this was a test of their faith.
I had a few things in mind to tell him. My emotions were gradually getting the better of me. I wanted to tell him how the blood of his unborn child was on his hands. How the pain and suffering of his wife were clearly on his shoulders. I wanted to know where he was the first 3 days while his wife was unconscious. All these were playing in my head, but as a doctor, I needed to stay in my role.
Finally, I asked him what he would tell his congregation. Will he tell them the truth, or will he tell them whatever gets them through the day, and keeps them coming back time after time. If only he would tell them the truth. I begged him to please tell them how his son would be alive and well today, and how his wife would be a proud mother, with or without the scar of a blade had he adhered to medical advice. I told him to treat his wife and his mother-in-law with every kindness and respect he could possibly have. He promised to do better. We shook hands again. As he walked away, his heart was heavy. So was mine.
Written by Uzoma Chukwuocha.uzchuks2005@yahoo.com, @uzorcentric
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