The baby girl is born on a Thursday morning. Her heart is beating but she is not breathing.
The Jahun General Hospital in northern Nigeria has no incubator, so the girl is put on oxygen. If she cannot breathe on her own within 15 minutes, there is nothing more the doctors can do except let the baby rest, wrapped for warmth in a blanket, until her heart stops.
The 15 minutes passes and still the baby girl’s lungs are not working on their own. Attention moves elsewhere and, eventually, a nurse will have to tell the girl’s mother that her baby has died.
This is one morning in the Jahun General Hospital’s maternity ward, run by the aid organisation Medecins Sans Frontieres. It is where Munich paediatrician and neonatologist Sibylle Sang has chosen to spend her four weeks’ holiday from her regular job at a Munich hospital.
If the baby’s death underscores the grim statistics we are used to hearing about sub-Saharan Africa, Sang and her colleagues — both foreigners and Nigerians — represent a resilient hope for the world’s poorest continent.
MSF runs the maternity ward as an adjunct to its fistula ward, where it repairs the terrible injuries suffered during childbirth by many women who don’t have access to modern obstetric care such as emergency Caesarian sections.
Fistula, which causes a woman to leak urine uncontrollably, has long vanished in the west but remains a quiet scourge in Africa thanks to poor health care and infrastructure, early marriage and, often, the low status of women. An estimated 400,000 to 800,000 women in Nigeria alone suffer the condition. They are often divorced by their husbands and shunned by their communities, forcing many to hide at home for months or years.
To prevent fistulas happening in the first place, the doctors’ group urges local women to come to the hospital to give birth. Sang’s job as a paediatrician is to care for the babies when they arrive.
Altruism and adventure
When I meet 37-year-old Sang at the MSF compound a short and dusty walk from the hospital, it’s hard not to gush with admiration for someone whose vacation dilemma is not Santorini or Sardinia but rather the Ivory Coast or the Democratic Republic of Congo.
But she’s quick to dismiss the idea that she and her colleagues are driven by boundless idealism and altruism.
“I love my job at home but … medicine in a first world country is often reduced to writing a lot of notes and trying not to get sued,” she said. “Here, you get a lot more down to basics and it’s an adventure and you get to see places you could not travel to otherwise. A big part of it is for yourself.”
The daughter of teachers who travelled a lot, Sang, who grew up near Freiburg in Baden-Württemberg, says she studied medicine partly because she’d always wanted to work in exotic places. (Her other early passion was archaeology.)
This is Sang’s sixth mission with the aid group, having previously been to the Ivory Coast and the DRC twice each, and once to Chad. The first mission is always the eye-opener, she says. For her it was the Ivory Coast, in 2003, after a disputed presidential election led to civil war – as it has again recently.
MSF took over an empty hospital in the middle of the country between the opposing forces, just 20 kilometres from the border with Liberia, whose own civil war was spilling into the Ivory Coast, bringing child soldiers and violent rebels into the territory.
“Every morning I had 50 to 100 people waiting there (in the hospital), mostly with malnourishment because they had fled into the bushes. Everybody started cheering when you walked into the room.
“There is a great group feeling. You get back home (to the compound) at the end of a day and everybody is okay and it’s such an incredible feeling. And you’re looking for that same feeling but you won’t get it again.”
That can be addictive, she says, and there are dangers to chasing a repeat of the first-mission thrill like a drug addict trying to relive the memory of their first hit. People’s emotions harden, they become harder to shock, and also less empathetic.
“Some people get hardened and lose everything else. They can be a bit scary. I don’t want to end up like that,” she said.
Coming back to earth
There are readjustment issues too, she says. After her first mission, Sang took a walk around Munich feeling quite disconnected from the city and its people. It was impossible not to draw comparisons between the money spent on health care in Africa and Europe.
“You get annoyed because you take these standards home and you think, ‘Some of these people don’t need to be in hospital’.”
“After the first DRC mission I went back to paediatric cardiology — I couldn’t believe the amount of money you spend on one child in paediatric cardiology in Germany.”
But dwelling on such inequities will bring frustration, she adds.
“None of this is perfect, but we are making a difference.”
It has certainly made a difference to Sadiya Annas, 16. She was in labour two days in her home village, being told by older to women to take herbs and keep pushing, even though her baby was stuck.
Luckily for Annas, a local health centre referred her to Jahun maternity ward, where staff gave her oxytocin and used vacuum extraction to deliver the baby. Her daughter survived and Annas probably won’t suffer fistula.
“I would have suffered much more,” she said when asked what might have happened had she not come to hospital. “The end result would have been death — for both of us.”