Not again, I thought, as I felt for a pulse on Sarah, lying unresponsive on the ground. She and her newborn baby had been through so much already and we were almost ready to discharge her. I started CPR knowing the futility (in our setting) of what we were attempting to do.
Sarah had originally come to Kudjip at eight months pregnant with her third child and seizing. With high blood pressure, swelling in her legs, and no history of seizures in the past, Sarah had one of the most common causes of maternal death in Papua New Guinea—eclampsia. With frequent screening and prenatal checkups, eclampsia (and particularly death due to eclampsia) has become incredibly rare in the U.S. Like many women in Papua New Guinea, Sarah had no prenatal care because she lived a long way from any health care facility. Originally from two provinces to the east of us, she was the first of two wives of a man from our province. Sarah was lucky to be alive as she traveled for many hours through the bush and was very ill by the time she finally reached us.
We gave her medicines to lower her blood pressure and stop the seizures. A quick ultrasound showed the baby to be preterm and breech, necessitating an emergent c-section. After stabilizing mom, a PNG visiting resident and I delivered a baby boy weighing 1.8 kg (4 pounds). The small baby needed some extra oxygen, but otherwise, he was doing well.
Over the next few days, things were tenuous for Sarah. She remained confused, somewhat combative, and ill. A woman from her husband’s family came to help look after her and the baby. We diagnosed Sarah with syphilis (likely from her husband) and started a series of three shots of penicillin to treat her. Over the next 10 days, Sarah slowly improved and her baby was growing more each day. She was close to being discharged when she had a sudden decline.
I was in a delivery room attempting a vacuum delivery when I heard a call for help from the nearest room. I ran in to see Sarah on the floor unconscious, barely breathing after having just received her second shot of penicillin. She didn’t have a pulse. We lifted her lifeless body onto the bed and began CPR. I felt her ribs pop as I pressed hard on her chest knowing that this was her only chance of survival. I have seldom had success with CPR here with our limited resources and knew this was likely futile. Our team did a great job giving her epinephrine and assisted breaths. Finally, after five minutes, we got a pulse back! We gave her more epinephrine, and she started breathing on her own. The list of possibilities for sudden cardiac arrest post-partum is long, but after an ultrasound and chest x-ray, my highest suspicion was anaphylaxis. We put her on a makeshift ventilator and mixed our own epinephrine drip (without a pump to tell me how much she was getting). Then, we prayed.
For several hours we did not see any change, and then we saw slow and steady improvements. She was still confused and short of breath, but we were able to remove the tube from her trachea and she started waking up. When I checked on her the next morning, she was on minimal oxygen and her only complaint was that her chest hurt.
The woman who had come to help her suddenly left. Sarah was now alone. Over the next two weeks, we watched as she slowly improved and her baby grew. I knew she was recovering when she started making a bilum (a handmade bag unique to PNG). After a while, her father and mother came to take her back home to her birthplace. It eventually became clear that her husband’s family had disowned her. Sarah would have to go back to her birthplace, leaving her two other children to be cared for by her ex-husband’s family.
While I was saying goodbye to Sarah, her father, mother, and her baby, we had a time of prayer and gratitude for what God had done in helping her survive two near death experiences. Then she handed me my first bilum, beautifully made and even more cherished due to the events it commemorated.
Papua New Guinea is a very difficult place to be a woman. I am daily impressed with the strength women here possess to overcome the trials they face. Taking care of Sarah was both painful and joyous. Painful – because of the inequalities in this world that put her in this circumstance and sin in our society that forced her to leave her two children. Joyous – because I was able to participate in and watch God’s healing two times to make sure this new baby was not motherless and to see the tender care of her Christian birth parents who have taken her back home after she was abandoned by her husband.
We see this pain mingled with joy on a daily basis at Kudjip. Many times, there are no easy fixes for the pain people like Sarah bear. The truth is that inequalities in the world and sin in PNG society are often targeted against the most vulnerable. The weight of this sin in our society makes me long for what the New Testament calls our “adoption as sons or daughters, the full redemption of our bodies” (Rom. 8:23). However, even in desperate situations (like Sarah’s) we also encounter joy. Ultimately, hope-filled joy comes from a relationship with Christ, but we can also find joy in the ways that God works in others’ lives – like watching an amazingly resilient woman endure two near-death experiences and walk out of Kudjip alive, with a healthy baby in her arms.