Here is a true story about a young doctor, a colleague of mine, that took place in 2004. This colleague, just out of medical school in an industrialised country, was in an African country to discuss the possibility of doing a study on maternal health, as maternal mortality is increasing in that country. This young doctor had previously spent three months in a hospital in another African country, and this had triggered his interest in the topic. In preparing for the study, he arranged to visit a teaching hospital in the capital that had a maternity ward, to meet with some of the obstetrician–gynaecologists working there. He did not have an appointment, but they were supposed to be there.
During his visit, he failed to find the doctors he wanted to see. In fact, he failed to find any other staff either. He went into the maternity ward, where he found some five women about to deliver their babies, but no staff whatsoever. Thus, he assisted first one, then another woman, to deliver their babies. In both cases it went well.
After a short while, a medical student came running in and asked: “Are you a doctor?” Yes, admitted my young colleague. “Can you do a caesarean section?” was the next question. I think so, said the young doctor, because he had assisted in two c-sections and done one himself. “So, let's go,” said the student. He had been looking for a doctor for more than three hours in order to save the life of a woman who had prolonged labour. That operation too was successful.
Thus, within one hour of being in the hospital, this young visiting doctor had successfully delivered three women. What if the women or their babies had not survived? He did not have a licence to practise in that particular country. It would have been up to me to bail him out, which I assured him I would be willing to do if he did it again.
The country concerned has a serious staff shortage, including doctors. Some of them are working abroad, some are in the private sector, some are just not there. That's one reason why maternal mortality is not decreasing.
Caesarean section, Médécins sans Frontières doctors assisting, Makeni, Sierra Leone, 2005
Name withheld
31 July 2005