Dr Torbjørn Eggebø, who has travelled to an MSF clinic in Cerigaabo, Somaliland, with MSF representative Saskia Spijker, tells us about life in the field:
“On May 4th the rest of the ISUOG team returned home. I had promised to extend my stay in Somaliland for one week. I followed Saskia and Harriet from Médecins Sans Frontières (MSF) to a little town called Cerigaabo where they support the hospital. It is in the east of the country close to the border of Puntland. We travelled with a Cesna airplane and had a wonderful view of the country. Already the same afternoon, we started our work at the hospital. MSF is running a local hospital, but in two months the local government will take over responsibility of the hospital. The purpose of our visit is to educate the local staff before the handover.
Precise diagnoses are important in a labor ward, and that’s why ultrasound might be helpful. I have been training the local midwives, auxiliary midwives and nurses and the local physician in performing ultrasound. Many of them have never touched an ultrasound device before, and I really have to start from the beginning and focus on the simple and most important findings – presentation, is the fetus alive, are there twins, placental location and assessment of amniotic fluid. The measurements are difficult for the beginners and we focus primarily on the BPD. Many of them struggle with measuring HC, AC and femur length. But some of them improve very quickly and at least four of the midwives are now able to perform all the basic six steps including measurements.
I also have been able to demonstrate the use of ultrasound in clinical situations. First a primiparous woman at term arrived with suspected foot presentation. A breech presentation was confirmed with ultrasound, and we could see that the fetus was “sitting on the legs” and therefore safely could be delivered vaginally. Four hours later, she delivered a healthy boy and I had the opportunity to teach the midwife how to perform a breech delivery.
The next morning a woman arrived with polyhydramnios. Using ultrasound a “double bubble” was seen, and a duodenal atresia was diagnosed. Unfortunately no one can operate this condition in Somaliland, and the family cannot afford an admission to Kenya. The outcome for this baby is not good.
Last night a woman was admitted with severe antenatal bleeding. A placenta previa was suspected. The fetus was dead at arrival to the hospital. In these situations it is very important to differentiate between placenta previa, abruption of the placenta or uterine rupture. We performed a thorough ultrasound and were able to see the placenta on the posterior wall. I also showed them how to perform a transperineal scan and we were able to confirm that the placenta was not a previa. The woman safely delivered during our lunch break today and while she has lost her baby, she is so happy that she is alive and well. In this instance an unnecessary caesarean section was avoided.
We have also managed to scan successfully both with and without ultrasound gel. As we cannot guarantee a reliable supply of ultrasound gel to this community in the future, we have been practicing scanning by substituting gel with water. The image resolution is not compromised in any way and by using water there is no risk of damage to the probe by using oils. This has been an important message to communicate to the midwives here.. water works just as well!
The raining season has now started, and there have been some very heavy rain showers and the runway of the airport is also partly destroyed by the rain. We hope they will be able to fix the runway so we can start our return on Saturday.
It is a very great experience to be here. Everyone is friendly and I enjoy spending my time with MSF. I hope to be able to leave some of my knowledge to the local staff in the hospital here.”