The Three Delays

Some baby updates. The baby I resuscitated several nights ago and was then left with while everyone went to pray went home this evening, strong and healthy. The baby's mother and I, along with several midwives, spent a very long time working on breastfeeding, and last night it just clicked and by this morning he was feeding beautifully. The giant c-section baby and her mom are doing well also.

Unfortunately, the premature baby of the eclamptic mother I wrote about last time died last night about 5 am. We aren't sure what happened. Harrison and I were with the baby until about 1 am, and it wasn't doing great, but neither did it seem on the brink of death.

Though of course you can't ever really know what would have happened in other situations, this baby's death seems like a result of a pretty classic example of the "Three Delays" model of obstetric care. First, a delay in recognizing that medical attention is necessary (in this case, the mother being unwell for a number of hours before her family decided to seek medical treatment at Edna's). Second, a delay in reaching medical care (in this case, the long drive from the mother's home in a rural area to Hargeisa). Third, a delay in obtaining treatment once at the medical facility (here, the mother had several more seizures before she received medication to stop the seizures--despite preeclampsia/eclampsia being very common, it takes too long here to get treatment started for them, for a variety of reasons). Change any one of these variables, you might change the outcome for the better, which is why this is really one of the driving approaches to improving maternity care around the world.

After a pretty hectic morning downstairs, I went for a drive with Edna to get some water from her well in the country since the hospital's new water tanker could only bring one tankful today.


We drove south from Hargeisa into the country, with a storm rolling in from Ethiopia to meet us.


Saw the modern version of a traditional Somali home:


Went the long way home so Edna could show me a sweeping panoramic view from a hill above Hargeisa:


Went looking for where my meals of goat and rice were coming from. Found:


And found these lovely ladies as well. Apparently they've been making delicious Ramadan treats every afternoon since Ramadan started. This deliciousness is just gone by the time the non-fasters eat dinner an hour and a half after sunset. Fine, more goat for me then!

Unripened pomegranates:


Found this book on a bookshelf. Who knew?