Evelyn is 28 years old, pregnant for the third time. When she goes into labor, she decides to deliver at the nearby Health Center. The previous two deliveries were uncomplicated and this third one was also proceeding regularly.

But this time things aren’t going well. After the birth of the child, the placenta is not expelled, Evelyn is losing a lot of blood, the young midwife struggles removing it manually. She finally succeeds but it is immediately clear that the patient needs blood. An ambulance picks Evelyn and her baby up and take them to Kalongo hospital. She arrives at the Out Patient Department unconscious, she has no blood pressure. The staff rushes to perform resuscitation maneuvers while the baby is sent to Neonatal Intensive Care Unit. Finally the patient regains consciousness, is stable, and is transferred to the ward. In the following days comes the diagnosis of malaria, which worsens her anaemia. However, Evelyn seems to go through all her misfortunes with an enviable strength.

Unfortunately after a few days in which she seemed to have recovered, Evelyn has high fever again, her stomach is swollen, she is coughing and has difficulty breathing. We think of a puerperal fever, probably induced by obstetric maneuvers. We start the antibiotics, but Evelyn is finding it harder and harder to breath. We have no doubt, we do the rapid test for Covid-19. To everyone’s dismay the test is positive.

They call me, it’s already Sunday evening, we cannot refer the patient to Gulu, where the isolation center is. We then arrange the transfer to our isolation area.

We prepare the oxygen, make some infusions. To our relief, her saturation seems to hold up well. We are optimistic.

But if her breathing maintains normal parameters, the abdominal situation doesn’t improve. Perhaps a surgery will be necessary. We explain that to the patient and her relatives, they are desperate. We contact Gulu again who inform us that they have no possibility of performing surgery, nor the suitable material to protect the ventilator.

I feel lonely, we all feel lonely. I think about our intensive care therapies, the beeps of the monitors resound in my head, I see again the team of doctors consulting.

I look around in the room where Evelyn is now asleep, the drip, the oxygen concentrator on standby, the pulse oximeter. I think about this young life that is facing such a great battle, against obstetric complications and against Covid. I say to myself “Come on Evelyn, we have to do this!”

 

Dr. Carmen Orlotti

Surgeon at Kalongo Hospital