Welcome to Mansa: A journey of challenges and hope

Mansa is the provincial capital of Luapula province, which is in the north of Zambia, bordering the Democratic Republic of Congo.

In Mansa, we are 800 km south of the most unstable Eastern parts of Congo which are often in the news. You generally won’t hear about Zambia as it is largely peaceful and without border conflicts. However, it is a low-income country with all the health issues you would expect in Sub-Saharan Africa, such as HIV, malaria, and TB. The Zambian government has been fighting these problems along with international partners, including THET, for decades.

At the hospital maternity unit where I began my journey, we had more facilities than you might assume. We had a dialysis unit, adult and neonatal ICUs, and a dedicated team of well-trained specialists and interns undergoing their pre-registration rotations just like those in the UK.

But there are problems in providing the type of support and training that specialist trainees in higher income countries take for granted. So, that’s where my role came in.

Let’s look at Edinah’s story. Like most of our patients in the maternity unit, she was referred from a district clinic in her case due to high risk– this being her 5^th baby there were concerns about her low blood pressure and the baby’s heartbeat.

It was a long journey to our hospital and when Edinah arrived in advanced labour, the team in the labour ward faced a concerning situation. They were unable to detect the baby’s heartbeat and could feel the unborn baby through the abdominal wall, strongly suggesting a uterine rupture.

At that moment, I was assisting a specialist trainee in another surgery when the urgent message came from the labour ward. The other theatre was prepared (we had two), but we had no blood available for Edinah.

Sadly, the baby was outside the uterus in the abdominal cavity and was stillborn. A significant tear in the one side of the uterus was ragged and bleeding – it was clear that Edinah needed an urgent hysterectomy. Having no blood available made for decisive and prompt action.

The next day, I went to see Edinah. As I approached, she got up out of the bed. I was surprised – less than a day after major surgery, significant blood loss and having received only one unit of blood, she was mobile. Although sadness filled her eyes due to the loss of her baby, she was grateful to be alive.

Edinah’s story cannot be called a typical ‘good news story’ since she lost her baby. It shows the harsh reality of high mortality rates faced by many women in low-resource countries who struggle with transportation issues, delayed access to healthcare facilities, and a lack of equipment and expertise.

While we couldn’t save Edinah’s baby, the prompt transfer from the district paired with the immediate recognition of the severity of the problem by the labour ward staff and the collaborative efforts of the theatre team allowed her to survive, ensuring that her children still have their mother.