Medicine in Third World Countries; Pregnancy; Unsuccessful Labor

By Larry Puls @Larrypulsauthor

Medicine in Third World Country; Pregnancy

The Jammu and Kashmir state in India are home to part of the Himalayan mountain range. Five doctors lived there and handled two hundred patient visits a day in this very remote and isolated area. When the story occurred, four of them left for their annual national meeting, leaving one physician behind to tend the flocks. At the same time, an American medical student arrived, enticed by an opportunity to gain an experience. And an experience is what he received. These events occurred before the birth of words like Internet, Google, or cell towers.

One physician, one American third-year student, a language barrier, and a sea of patients were brought together in place and time to make for a complicated month—and a test of resolve. Shortly after his colleagues had left for their meeting, the sole remaining physician recognized that the clinic was short of antibiotics. And in a world full of infection, that’s sets you up for failure. Grabbing his motorcycle, he made the jaunt over to the next village in hopes of securing the needed drugs. But life happens. Maybe it was a bump in the road, or a pothole. Something. The physician went tumbling down and sustained a compound fracture to his leg. Transporting him out left the student alone, and now responsible, for a foreign world full of the sick and broken—as a doctor—which he wasn’t.

Now one medical student. No doctors. No experience. No surgical skills. Two hundred patient visits a day. And no command of the Indian language. And cell towers were not even in existence.

He was now in charge of running a medical and trauma ward with little to no ability. Two hundred people were coming and going with infections, with wounds, with worms, with cholera, with things we don’t even want to describe. Every day he prayed that nothing serious would come over the tops of the remote mountains.

But how a prayer is answered is God’s domain. Six men on the side of the mountain, coming down, carrying the stretcher with an undefined human disaster. The student just knew that whoever, or whatever, was on that stretcher was in bad shape. And intuitively, he assumed he lacked the skills that would be needed.

But God can provide.

The men arrived carrying a gravid woman, by history laboring for some thirty-six hours. And there was no heartbeat in the child—at least not that he could find.

Normal management at this point would be simple, deliver her vaginally. But yet he knew logically, her laboring for a day and a half without results suggested little chance.

He made the decision to watch her for another twenty-four hours, in hopes of a miracle. And the miracle didn't come. No progress occurred over that time frame… And she was screaming in pain. The child simply was not going to deliver. Mulling over where to go, he found her fever unexpectedly at 103. Sepsis was kicking in. He weighed out the evidence: Dead child. Septic. Unable to deliver. The conclusion seemed undeniable, without intervention this would lead to her death. Expeditious delivery now became a non-negotiable. But delivery would need to be via cesarean section, and he had never done one. He had barely even seen one. And further more, he had never done any surgery at all by himself. And there was no backup plan. None. She was forcing his hand. Intervention would have to be done, and done soon, or she would die. It was really that simple.

So, armed with a scrub tech (who spoke no English), an anesthetist who knew a few token English words, a Grant’s anatomy textbook, and no experience, he set off. The prayers of a Godly man...

Four hours and a thousand studious glances at the textbook later, the deceased child was out and the patient was closed up...  End of story???

Not all good deeds go unpunished.

The next twenty-four hours proved to be the longest of his life. He watched to see if she would survive. And there was nothing certain about that. But one thing had become certain, and it was not good. In these hours after surgery, she had not made one single, itsy-bitsy, tiny drop of urine. None. The prayers of a Godly man now became more fervent. Without resolution of this fact, she would subsequently succumb to kidney failure. That was fact. His conclusion, based upon incomplete information, was that he had tied off the ureters, the tubes that drain urine from the kidneys. They sat anatomically next to the area where he had operated the previous day, and he surmised that he must have wrongly placed sutures around them... Oh, if only that hadn't happened... But it did. He would now have to fix his mistake. The second time in two days he had faced a scenario where he had to perform surgery on this same patient or she would leave this life.

Back to the OR. Chapter two. One student with no Indian-language skills, a scrub tech with no English skills, an anesthetist who knew a little English, and an anatomy textbook turned to the page on ureters. Those were his weapons. Oh yeah, and a lot of prayers. A life was in his hands. Truthfully.

Dig around. Stop the bleeding. Dig some more. Search. Stop more bleeding. Look at the book. Cut a few old sutures. Look at her catheter for urine. Dig some more. Think this out… And think it out, he did.

After several hours and a lot of sweat, and a lot of digging around, he thought maybe, just maybe, he had found the answer. Sutures were possibly in the wrong place, as he suspected. So, he cut them… And then he waited… And then he waited some more… Staring down at her catheter, he prayed for something to come out... Anything… But nothing came out for ten minutes… Another prayer… And then something. A drop. A simple drop. How glorious a sight. Then two. Then a trickle. Then a stream. Her kidneys began to spew forth urine. Life-saving urine... And so ends the story of a man who took an enormous step of faith. One that few of us would have ventured to do. But he did it to save a life.

And save a life, he did. And then he truly dropped to his knees.

Have you ever taken that step of faith you never thought you were capable of doing? Encourage us by commenting on it.

I will have a challenging Christmas story for you next week. 

Medicine in a third world country, Larry Puls, (Click to tweet)