by Dr Shannon Petersen,
Obstetrician at the Good News Hospital
We recently celebrated Mother’s Day here in Madagascar and it reminded me of a story that I would like to share from Mother’s Day last year. It concerns a woman I will call Lala.
Lala was full term in her pregnancy and had suddenly started having back-to-back seizures the day before in her village, before becoming unconscious and unresponsive. She arrived on the maternity ward about 9am Sunday morning, seriously unwell, having been brought from her village partly being carried by family members, and then making the rest of the journey strapped on to the back of a motor bike. The on-call medical doctor had been notified and had started the initial treatment before being called elsewhere for another sick person. I happened to pass through the maternity ward on the way to do some printing, and the midwives – visibly worried – asked me to check on her.
Since working here, Brendan and I have seen the sickest of the sick that we could have only dreamed of in fear or read about in textbooks when we worked in Australia. Seizures in pregnancy (eclampsia) is an all- out obstetric emergency in high resource countries, but here it’s just another day. I’ve seen more cases than I can remember, and normally these cases do very well with our well-practised protocol. However, I could tell immediately that this case was different. She was still fitting relentlessly despite treatment, unresponsive in between seizures and we were struggling to get her oxygen levels to an acceptable level.
Sadly, the baby hadn’t survived and had no heartbeat when she arrived. It took hours to stabilise her for delivery, with every medication we could try, and even then, she wasn’t at all ‘stable’. The seizures continued, but had become less frequent and shorter, so she was taken to the operating theatre for a Caesarean Section.
During the Caesarean her heart stopped beating. She was successfully resuscitated, but she was now even sicker than before. By now I had called in another doctor and a critical care nurse (on their day off) to help and we began thinking how on earth we were going to transfer her out of the operating theatre to the recovery area. Meanwhile, Brendan was at home with the kids on Mother’s Day wondering how it is that I’ve been gone for so long just to do some printing! By now Lala’s seizures had mostly stopped, but her lungs were in terrible condition – filled with fluid and infection, and her heart wasn’t able to keep up. She was receiving the maximum oxygen therapy we have and still her levels were awful (60-70%). Eventually we were able to transfer her to our intensive care area and onto some breathing support, but her breathing only seemed to worsen.
We made countless calls to an anaesthetist in the UK who supports us with cases like these, but no matter what we tried nothing seemed to help. By now I had spent hours in the hospital and she wasn’t showing any signs of improvement. Unconscious, unresponsive, and working so hard to breathe I couldn’t imagine her body could continue much longer. Multiple times through the afternoon and evening she stopped breathing and her saturations would drop down towards zero, or her heart beat would plunge, but she would somehow pick up again.
To be honest, I had nearly no hope for her. I’ve seen way too many like her, even those less sick than her, not survive. But the doctor I was working with – newer to Madagascar and still full of hope and enthusiasm - kept saying over and over again, with every setback or turn for the worse, “we’re not giving up”. And for me, on Mother’s Day, I couldn’t stop imagining the faces of her young kids (5 and 2) waiting for mum to come home to them. Two little ones who saw mum carried away so unwell, who would have seen many like her leave in the same way and not return alive. Who probably already know the realities of death and loss and grief way too well. And naturally I couldn’t help but think of my own young kids, also waiting for me at home, but without any fear or anxiety that I won’t come back. Children who have never known anything even close to such realities, only the privilege of good health and resources.
So even though I felt guilty being away from home, especially on Mother’s Day, I was resolved that I wasn’t giving up either. I ducked home quickly in the afternoon, as Brendan was leading “kids’ church,” and took my little girl, Summer, back in with me (she was such a champ!). Mostly we stood at the end of the bed staring at Lala’s monitor and making little adjustments or trying another medication, only to see her worsen. After a brief break for dinner and putting the kids to bed, we all met together (three doctors, one critical care nurse, and another doctor on the phone from England!) and discussed what we would do for the night. We had one last breathing support machine to try and although we didn’t say it out loud, we knew this was the last shot for her. We went in together to set it up and handover the plan for the night to the nursing staff and went home around 10pm (after more than 10 hours in the hospital with her) having finally exhausted every single option. She was still hanging on but with a clinical situation that seemed incompatible with survival. We went home with heavy hearts, expecting her to die overnight, but knowing we had done absolutely everything we could. We were called a couple of times for more seizures and her horrible oxygen levels, but she held steady. And somehow, she survived that night. When I went to see her the next morning, she had turned a corner. She was still unconscious but as my eyes locked in on her monitor I could see her lungs and heart were starting to recover a bit. Very slowly and cautiously we were able to wean down her breathing support and wide array of medications, and over the next couple of days she woke up. After 5 days she was completely off oxygen and free from seizures, eating, drinking, walking and talking.
Once she was fully alert and orientated, I sat down with her and her mum and talked through everything that had happened. I said to her with my most serious eyes that she very nearly died and only a miracle can explain her recovery. And in fact, she did ‘die’ but came back, and sat right next to death for hours on end.
And that we did absolutely everything we could and it wasn’t enough, AND STILL – she lived. I have been so very privileged to have given this little talk many times during my years here, and it never gets less special. And whilst we don’t know every detail of her spiritual background, she and her mother said that yes they prayed, and accepted it with joy when we explained that it was God who had saved her.
She and her family were so very grateful for all the team had done. Brendan saw her six months later for follow up and she was well, normal even, with no brain injury or any physical evidence of the whole ordeal.
I never got to meet her kids, but imagining their little faces seeing mum again is the kind of joy that fuels us in our work here. Too often it is so discouraging, crushing even, but these wins keep us going.
This year, Mother’s Day was much quieter, thankfully!
PLEASE PRAY:
- For Lala and her family specifically to know not just that God miraculously saved her on this occasion through the care of the hospital, but that Jesus died to save them from death itself, and that He is the only one who can carry them safely to Heaven when the day (we pray many decades from now!) comes when death comes calling again. Pray if they know this already that this miracle would inspire them to tell everyone they know of His goodness and mercy and that if they’re understanding it for the first time they would truly put their faith in Him.
- For mothers across the town and district of Mandritsara, so many of whom face so many trials and suffering – pray that they would know God’s deep compassion and love (Hosea 11:3-4) and that when marriage and parenthood is hard, they would turn to the One who will never leave or forsake them. The One who is always faithful (2 Timothy 2:13).
- For the team in the maternity department: they have been wonderfully busy since the opening of the new maternity unit, but pray for strength and compassion, for wisdom and grace. Pray for the head midwife, Lamintsoa, and for Shannon as they lead the team, and that they would grow not just in their management of pregnant women but in the love they show and the skill with which they share the gospel.