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Treating Magda

Five days ago a 19 year old girl was admitted to our Cholera Treatment Center (CTC) with symptoms of severe cholera. She had been in another hospital but had been discharged and sent to our CTC.

I will call her Magda.

Magda had all the obvious signs and symptoms of cholera. She had severe vomiting and diarrhea, her eyes were sunk, she was barely responsive, and I could feel no pulses in her cold arms.

Her mother came with her and said that Magda was pregnant but everyone was unsure how far along and Magda was not able to help with history.

Magda received IV fluids full bore for the next few days, woke up, and she looked some better. But she was very weak as most people are who survive severe cholera.

Yesterday, on Sunday, when I was making rounds in her hot tent, Magda cried out complaining of severe pain in her pelvis. Shortly after, while lying on her cot, she screamed again, and a grey sack appeared at her birth canal. The sack, which was her gestational sack, burst open with the egress of blood and water.

Magda was obviously having a miscarriage.

As I assessed this situation, I saw that her IV catheter was no longer in the back of her hand but was lying wrapped in tape on the floor of the tent.

So I hustled out to the main supply area and got another IV catheter and a liter of fluid. When I got back, Magda was sitting on her cholera bucket in no apparent distress.

I bent down and was able to look between the upper rim of the bucket and her hips and saw a perfectly formed baby hanging straight down from the birth canal. I could only think of one thing with this horrible scene…a black lynching in the South.

The baby was a tiny little girl a little bit longer than the length of my hand.
Her mouth was gaped open and her eyes were also open and staring at the sides of her mother’s cholera bucket. The baby’s umbilical cord curved back up and ran back into the birth canal.

So I started an IV into the back of the Magda’s right hand as she sat on the bucket with her head down, and I opened up the infusion full bore. We then transferred Magda back to her cot.

Magda’s pain had diminished significantly and she seemed stable. I placed the aborted baby between her legs.

After half hour had passed, we were able to deliver the small placenta. The placenta and umbilical cord were dropped through the hole in the cholera cot, I quickly baptized the baby, and let it slip through the hole in the cot.

As the baby fell into the bucket with a thud, I asked myself if I realized that I just dropped a dead little human being into a filthy cholera bucket in a sweltering hot tent. I realized it but didn’t think this could hardly be happening in 2010.

The unborn little baby girl had her chance for about five months, safe in Magda’s womb, until cholera killed her.

Magda’s father showed up and watched all this from an adjacent cot. He was drunk on clarin and crying.

So I continued the fluids and added 20 units of Pitocin to stop the bleeding in the uterus.

Magda’s blood pressure was a remarkable 136/80 and she seemed fine for all she had just been through. Nineteen year olds can withstand a lot.

The nurses removed the baby from the cholera bucket and wrapped it in a plastic baggy and gave it to Magda’s mother to bury somewhere.

Will this baby be counted in the 2000 plus deaths that cholera has claimed in Haiti in less than two months? Probably not.

But she sure looked human to me.

John A. Carroll, M.D. is a physician working in Port-au-Prince.

 

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John A. Carroll, M.D. is a physician working in Port-au-Prince.

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