By Nicholas D. Kristof [New York Times]
YOKADOUMA, Cameroon: Prudence Lemokouno was lying motionless on a bed in the bleak hospital here, her stomach swelled with a fetus that had just died, her eyes occasionally flickering with fright but mostly dull and empty.
Prudence at the Yokadouma hospital (c) N. Kristof
Dr. Pascal Pipi, the lone doctor in the public hospital, said she had a few more hours to live, and then she would join the half-million women a year who die around the world in pregnancy and childbirth.
Her husband, Alain Awona, was beside himself. “Save my wife,” he pleaded. “My baby is dead. Save my wife.”
In the spring, I held a contest to choose a student to take with me on a reporting trip to Africa, and now I’m on that trip with the winner, Casey Parks of Mississippi. I had wanted to introduce Casey to the catastrophic problem of maternal mortality in the developing world, because it should be an international scandal that the number of women dying in pregnancy worldwide has been stuck at a half-million for a quarter-century.
Indeed, here in Cameroon the maternal mortality rate has risen since 1998, and over all an African woman now has one chance in 20 of dying in pregnancy. In much of the world, the most dangerous thing a woman can do is to become pregnant.
When we arrived on Friday at the hospital here in the remote southeastern corner of Cameroon, we found Prudence dying for the reason that usually accounts for maternal death — a complicated childbirth with no emergency obstetric service available.
Prudence, a 24-year-old who has three children, went into labor on Monday. A village midwife assisted her, and after three days she was hoisted onto the back of a motorcycle and carried to this hospital.
And then nothing happened. The hospital demanded $100 worth of surgical supplies for a Caesarian section, and family members said they could raise only $20. I asked the chief nurse, Emilienne Mouassa, how often a woman dies in the hospital because the family can’t pay. She hesitated. “Not often,” she replied.
She said that when patients like Prudence are at death’s door, the hospital sometimes prefers not to operate. It is easier to explain a pregnant woman who has not been treated at all and died than one who has undergone an emergency Caesarian and then died.
Dr. Pipi, a bit embarrassed that a patient was dying in front of foreign journalists, said that he could find a way to operate without the money. But in addition Prudence had lost so much blood that she needed a transfusion.
“We don’t have a blood bank here,” he explained, “so we sent someone off to bring in other relatives to see if they are compatible. But the village is far, 120 kilometers away, and it takes a long time to bring them here.” A few more hours, he estimated, and she would be dead.
These women die because they are poor and female and rural — the most overlooked and disposable people throughout the developing world.
Politics also complicates Western efforts to help. The United Nations Population Fund has helped lead the effort to reduce maternal deaths — yet the Bush administration has cut off all U.S. funding for the agency because of (false) accusations that it supports abortions in China.
We inquired what Prudence’s blood type was. The nurse checked and reported that it was A positive. We looked at each other.
I’m also A positive. Casey’s blood did not seem to be compatible. But Naka Nathaniel, the Times multimedia maven who often travels with me, is O positive and thus compatible.
Would Dr. Pipi really operate if he could obtain blood? He said he would.
So Naka and I each gave blood, after a nurse went into town to find a plastic bag to put it in. It was promptly pumped into Prudence, and she began to look a bit better. Dr. Pipi promised to operate on her shortly.
Her husband cried with joy, but begged us not to leave. “If you go,” he warned, “Prudence will die.”
We waited, and six hours passed. The hospital began shaking down Prudence’s family for more money before the surgery could begin. The husband had nothing, so we chipped in.
Then when everything seemed to be ready, Dr. Pipi simply vanished. “Oh, he’s gone home,” a nurse explained. “He’ll operate tomorrow.”
We cajoled, pleaded and threatened, but the hospital staff was unmoved. “What if Prudence dies in the night?” I asked.
The nurse shrugged and said: “That would be God’s will.”