The Challenges of Childbirth in a Refugee Camp: A Day in the Life of Dr. Bryan:
On Feb 24th I had the opportunity to walk through almost the entire length of the main Rohingya refugee camp, from the NW corner to the SE corner. And I did many “spur road” journeys into the center of the camp, as far as the roads and trails would go to allow a small vehicle to pass. My guide was trying to map with GPS possible ambulance evacuation routes on Tom-Toms, which are small three-wheeled vehicles, for pregnant women to get to birth centers when they are in labor. It is not easy. The photos don't do justice to the scale and scope--imagine nearly 1,000,000 people living in places like these in the photo below, often more crowded than the photo of a Hope Fndn-UNFPA women's health clinic in foreground.
I have wondered why the % of women delivering at birth centers is so low. Around 80% of women still labor and deliver in their crowded tent homes in the refugee camps. But after seeing the lay of the land, and understanding the up and down nature of walking on these unstable hills, and then doing this at night without a torch with an insecure security situation, and being in painful labor I now understand better why women in labor don't make it to a relatively safe birth center. After my guide did his computer geospacing work it turns out that a high % of the narrow paths that might allow a small vehicle to pass currently are in regions expected to be under a meter or more of water when the annual monsoon season hits this Spring/Summer.
We visited a clinic where more than 200 pregnant Rohingya women were waiting to be seen for prenatal care. Three midwives worked at the clinic. Pregnant women waited for hours to be seen, standing most of the time in line.
We also saw big lines at food distribution centers. And heartbreaking sights of kids carrying food bags weighing nearly as much as they did. The picture above is of a kid who literally was wobbling under the load he was carrying. Look at his neck. Of note though is that people now safely and calmly queue up and there seems to be a good distribution system for rice, lentils and cooking oil. (At the beginning of arrivals in Bangladesh there were deaths from stampedes at the food distribution centers as people were so desperate to get food.)
The young kids continue somehow to find some joy in the camps. They are laughing, goofy, mischievous, playing dodge ball and badminton and a game that seems to be somewhat like horseshoes but is played with sandals.
During a rest break a deaf man come up to us and muttered in a guttural language something that sounded like “Burma". He then went into a long pantomime of violence including decapitation, amputation of limbs, rocket launcher fire and explosions, fire and homes burning down. He showed us what appeared to be a healed machete wound near his right wrist. This encounter still haunts my thoughts.
My wife Paula had a similar experience when a Rohingya women in the fistula ward of the hospital gave her a similar pantomime experience of the violence she had encountered.
Today I was surgeon on four cesareans. The indications were interesting and the medical decision-making process is certainly different than back at home, but for indications/reasons we never have to consider. And the starting Hemoglobin levels were 7.7 on two women.
Today another heartbreaking story of a young Rohingya mother had obstructed labor, stuck at 6 cm for a full day, transferred in from a birth center. Her husband had not been heard from since the chaos of leaving Myanmar in September (he is presumed dead). Her brother and sister were her advocates and very concerned that if she had a cesarean scar on her abdomen, she may then become "untouchable" in terms of meeting a new husband. Since she is likely have to have cesareans in the future, which are more expensive, she would be "tainted" or a financial liability. Another good reason for vaginal birth after cesarean! It has been quite a intense few days.
Editor's Note: This photo is of a Rohingya mother and newborn visiting Hope Foundation's Women's Health Field Hospital, and is not the women of Bryan's story.
Post submitted by Dr. Bryan, Maternal and Fetal Medicine Specialist, Ashland, OR volunteering for Hope Foundation for Women & Children of Bangladesh (www.hopeforbangladesh.org) in partnership with Global Force for Healing