Korima* was scared, very scared. At barely 18 years of age, she was about to be a mother.
Korima’s childhood as she knew it was officially over. Her dismal attempt at acquiring a secondary school education had long faded away.
She could not recall a single day when her parents had been sober in the past 10 years. They lived their lives for illegal brew.
The illegal chang’aa dens dotting the wildly beautiful North Rift landscape were an open secret.
Lack of fees forced her to drop out of school at Form Three. She stayed at home parenting her two younger siblings with the support of her grandmother while their parents drank their lives away.
In a desperate attempt to get away from it all, she got pregnant. The man responsible was only 21 and had dropped out of school three years earlier to farm.
Korima attended only two antenatal care clinics in her entire pregnancy.
No one advised her on their importance and she only showed up to get a free mosquito net for her smoky hut.
Though the pregnancy was largely uneventful, everyone commented on how big her baby would turn out to be due to her large abdomen.
Her last two weeks were difficult and she struggled to breathe comfortably.
When labour set in, Korima and her mother-in-law, walked to the health centre.
The nurse saw how tiny Korima was and how disproportionately huge her abdomen appeared and referred her to the district hospital as the health centre did not have the capacity to handle any possible complications.
Her husband caught up with them as the district hospital ambulance pulled in to the parking lot to collect her.
The receiving doctor did not waste any time. The hospital’s only anaesthetist was sick. He quickly instructed that Korima be referred to our teaching hospital.
The circuitous journey ended up in the operating room with Korima requiring a caesarean section because her baby appeared rather large and was in breech position (the feet were coming first).
I was excited to witness the procedure as a junior medical student.
Nothing prepared me for the delivered baby.
Out came a large 4.3kg baby girl who had been enveloped in lots of amniotic fluid that made Korima’s abdomen distended and led to her breathing difficulty.
Though she was perfect in every other way, something important was amiss. She had no skull or brain tissue.
Despite having read about anencephaly since my first year of medical school, nothing prepared an overly enthusiastic and totally inexperienced fourth year medical student for this.
I gasped rather loudly alongside the rest of the team. Thankfully, Korima was under general anaesthesia and was oblivious to the reactions.
The baby was born with a generally lethal congenital abnormality.
Her baby’s brain development was interfered with, resulting in failure of the tissue and the skull to develop.
As a result of the absence of the vital tissue responsible for the function of every other body organ, the baby did not survive.
She could not breathe spontaneously and neither could her heart maintain spontaneous activity.
The little one was wrapped up and kept warm in the resuscitare where she only lasted an hour before she left us. Her mother was not even awake hence never even got to meet her. It was excruciatingly painful to witness the situation.
Korima’s husband was brought into the theatre bay. He sat there unresponsive even after being shown the lifeless little body of his daughter. Not even the grief counsellor could get through to him.
The situation was even worse for Korima. Since she was still in a drug-induced haze, the news had to be delayed until much later in the evening when she was fully awake. She lost it.
She would not stop screaming, demanding to see her baby, who by then had gone cold and stiff. She spent half the night cuddling her baby until the doctor sedated her to allow her to rest.
The pain the young couple experienced has never left my mind. Lack of access to quality ante-natal care led to failure to pick out this gross abnormality earlier in pregnancy through an antenatal ultrasound. This meant that the couple were completely unprepared for the terrible outcome of the pregnancy.
There was no prior counselling to help them confront and deal with the diagnosis and the poor prognosis. Further, they lacked an opportunity to consider the option of terminating the pregnancy earlier on, should they have wanted to.
Thankfully, they received quality education and counselling about the condition, the possibility of its recurrence in a subsequent pregnancy and how to prevent it.
Korima went home empty handed, but more empowered. She understood the need for antenatal care, importance of folic acid supplementation to prevent abnormalities of the brain and spinal cord such as this, the availability of tests for early diagnosis and the options available to her.
She had a choice to carry the baby to term, with the full support of her medical care team; or to terminate the pregnancy and start the path to recovery.