a maternal death from anemia

today is february 13th. before i tell the story i want to tell, let me just say that in general , my life here is going really well, and that blada and i are so happy together and really appreciating eachother. running the household, interacting with volunteers, managing everything here, has sometimes been really stressful and hard. there is a woman named lara who has been here for a month, here for 2 more, who is very helpful with house and especially volunteer stuff. nevertheless, it gets stressful. but all the work we are doing is good and important and is paving the way for things to get easier.

blada and i had our 8 month anniversary yesterday. it was lovely; we kept getting wrapped up in house stuff, and then reminding ourselves that "this is our day". oh yeah, try not to talk about the house stuff. we had a beautiful day though. really sweet.

a woman died several nights ago at the hospital. she was pregnant and had 2 kids at home. i will call her marlene. marlene had come in 3 weeks ago having difficulty breathing (air hungry) and feeling really bad and unable to stand up. she was 10 weeks pregnant at this time. her hemoglobin was 4.6. (hgb measures the ability of our red blood cells to carry oxygen around the body--normal levels are 12-16; in pregnancy 10-12 is still considered normal; under 10 in pregnancy is considered anemic). her hgb was 4.6--we made a requisition for blood from the red cross, and the blood didn't come that day. perhaps the next day, she got the blood--only one bag--which is about 1 cup--250ml. i had written about her on my last blog entry.
so, marlene got the one bag of blood and was sent home. supposedly her hgb was around 9, but that's impossible if you had a 4.6 and got one bag of blood. anyway, she went home, and then presented to teh emergency room 3 weeks later, in really bad shape. once again, having a hard time breathing--breathing fast, shallow, sweating, uncomfortable, groaning...so, she was admitted to the hospital. the NEXT DAY, her labs were drawn to see how anemic she was. there is no way to get someone's labs done at night--the hospital lab closes at like 4pm. well, this next day, and i was there--the result of her hemoglobin was 2.3. her hematocrit (percentage of red blood cells in blood) was 7. (normal ahct is 30-40 something). she was really doing bad. when the nurses saw this result, everyone started working fast to get a blood transfusion for her. i looked for oxygen in the ICU--there was no oxygen to give her.

well, one bag of blood arrived. i didn't return in the afternoon as normal, so i heard from the volunteer midwives when they returned after the afternoon shift, about how marlene was doing. they said that she was dying. her body was shutting down. her oxygen levels were so low, that her organs were literally shutting down. you could already see from when i was there in the morning, that her brain was being affected by the lack of oxygen, because of the way she was behaving.
apparantly, in the evening, marlene wasw moved into the ICU, given an IV, put on oxygen (they found some), and given 2 more bags of blood. but she died at 2:30 in the morning. she left 2 children at home without a mother.
she had tried to save her own life by coming into the hospital when she felt bad, but the hospital was unable to save her life because there was not enough blood to transfuse her and there was not access to oxygen to give her. those were the 2 things she needed the most, besides all of the other interventions that would have been done noramally, in a hospital, to treat someone this sick.
marlene had sickle cell disease. this condition causes the red blood cells to assume a crescent moon shape, which causes them to not circulate well and actually get stuck at certain points in the body--mainly the joints--and apparantly this is an extrememly painful event. this is called sickle cell crisis. when more of the RBC's assume this abnormal shape, and then can't circulate around the body--causing destruction of the RBC's (leading to anemia), causing oxygen deprivation to the tissues and organs, and causing pain where the abnormally-shaped RBC's conglomerate.
i don't know if marlene's 2.3 hgb was precipitated by a crisis. but her condition, sickle cell disease, definetly played a role in her severe anemia. this condition is not uncommon here. also, the night that marlene had come into the hospital, to the emergency room, she had witnessed her cousin being shot and killed before her eyes.

i share her story because it makes me so sad that she died--knowing that in pther places in the world, someone like her would have been treated correctly and saved. this death is an example of the capacity of the healthcare system here.
i have seen people here with like 3.4 hgb's who have survived. imagine seeing someone this anemic and them surviving. peoples' lives here are so hard.