‘Save My Wife’ [A Snapshot of Cameroon's Health System]

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.”

Comments

[Nico]

As I read through to the end, I felt a tear run down my cheek. This is exactly the health system that our government has nurtured. Doctors seem to forget that they swore a hippocratic oath to try to keep death away from us. We need some relevant change that would impact not only the Health System in Cameroon, but the socio-economic and political atmosphere. It is sad and that is all one can say.
It really is sad.

[Bill]

This is very sad andI can attest to thisbecausethishappens too manya time especially in the rural areas where the Doctor has no one who he/she can give accountability to. Thank goodness this is happening in front of the very eyes of foreign journalists and I hope that they can write on this and appear on major news agencies to make the case for the poor people of cameroon who have no voice. We need a change in the government. In short thesystem has failed and it is time for us to try out some thing else.
Bill,USA

[WestCameroonian]

A good doctor can give account to self. There should be a way to stock these poor hospitals through gifts, but knowing that state, materials will be appropriated and sold by those who are supposed to care of the people.

These kinds of nightmare situations used to be described to us when we were growing up in West Cameroon, as being commonplace in East Cameroon, even in the big cities. Now they are part of our people's reality too.

[Dyna Ngoy]

My mother fell seriously ill, was rushed to a mission hospital in the South West Province of Cameroon at 4:00 p.m. (30 minutes after regular closing time) and just when the Doctor who stays less than 50 metres away from the hospital, had left. I went to the Doctor’s house and pleaded with him to attend to my very ill mother. The Doctor, in an emotionless manner told me he was closed for the day and he will only see my mother the following day at 8:00 a.m. The following day he came in at 9:00 a.m. and attended to my mother at 10:00 a.m. 18 hours after my mother was rushed to the hospital. It was already too late. My mother passed away a few days later.

If this Doctor could have attended to my mother when she was brought to the hospital, may be she could still have been alive today.

The Health System in Cameroon needs a complete overhaul!!!

[Emah]

Dyna Ngoy,

Accept my sympathy on the eventual death of your beloved mother, may her sould RIP. This tragedy befalls many many more Cameroonians everyday and it will continue to do so unfortunate for a long time to come.

The 'brave' conclusion you gave was'The Health System in Cameroon needs a complete overhaul!!!'.

You didn't heap blames on the doctor as many of us would have done, but this is not to say the doctor doesn't have a share of the blame, what this shows is a society in total state of decay and in dare need of some kind of a miracle.

What Cameroon needs, is a COMPRHENSIVE HEALTH POLICY, anything short of this, then we shall continue to see things like this for generations to come.

So unfortunate indeed.

[Dyna Ngoy]

Very unfortunate indeed. Thanks Emah.