Obstetrician-gynaecologist Dr Diana Wellby, from Perth, has completed five assignments with Médecins Sans Frontières. She reflects on the role of the obstetrician in field projects.
What led you to work with Médecins Sans Frontières?
I had always known about Médecins Sans Frontières from the news media, and admired the organisation, being particularly impressed by their objective of providing medical care across national boundaries and irrespective of race, religion, creed or political affiliation. Finally, in 2014, my time came! My first assignment was in Peshawar, Pakistan and since then I have been to Afghanistan, Nigeria and Yemen.
What does the role of obstetrician typically involve?
The international obstetrician is responsible for the overall efficient running of the clinical side of the maternity hospital. The role supports and mentors locally trained obstetricians and medical doctors, particularly with managing complicated cases. Another important aspect is teaching, mostly bedside, but also regular weekly tutorials and case discussions, for doctors and midwives. The best thing is the deep satisfaction of feeling that your presence (or that of someone in your role) has made a difference to, or even saved, many lives. In some places, there is just no other hospital for people to go to, or only expensive, unregulated private clinics.
"It is shameful that there is such disparity in health services in the world. It is unacceptable that any woman should be risking or giving her life to give birth"
Could you describe any patient stories?
In the first few days of my first assignment a woman was admitted who had been given oxytocin to induce labour, at another clinic. Unfortunately the dose was way over the recommended limit, which is very dangerous. She was already collapsed on arrival, with a rapid pulse and very low blood pressure. During emergency surgery we found that there was rupture of the uterus, with a dead baby expelled into the abdomen and a very large haemorrhage. It was her first pregnancy; fortunately it was possible to repair the uterus, and after many units of transfused blood and intensive post-operative care, she was discharged well a few days later.
What do you find most challenging?
In the developed world, because of excellent antenatal and readily available emergency obstetric care, we have now almost completely prevented complications including eclampsia, ruptured uterus, septic shock and fistula formation, but these are all daily occurrences in Médecins Sans Frontières projects. It is shameful that there is such disparity in health services in the world. It is unacceptable that any woman should be risking or giving her life to give birth.
On a day-to-day basis, the most difficult aspect is the frustration when a patient arrives too late at the hospital, either because of lack of transport, the great distance on poor roads, or because of a lack of awareness of when to seek help. It is distressing to see preventable loss of life, especially if it is a teenage girl, or a woman who leaves her children motherless.
Do you have any advice to other obstetricians considering this work?
Go with an open mind. Do not expect to make big changes, but rather support the work of the national staff as best you can. After all, they were there before you and will stay after you leave. You will be teaching and supporting them, but you will learn a lot from them, too. You will have the most personally rewarding experience of your medical career, I can assure you!
After five assignments, what keeps you coming back?
It is a thrill to know you have saved a life. It makes you feel so proud to have been part of such an admired and respected organisation, and the local people are so grateful for the free and quality care. My family and friends keep saying to me how wonderful I am to do this, but I tell them that I just feel so lucky to be able to do it. It’s a privilege to be able to contribute my time and skills.