Case Spotlight

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In May 2019, the specialty of OB/GYN was utilized almost 20 times over the course of the month, making it our 3rd highest needed medical specialty this month. This is almost four times as many OB/GYN consultations than we facilitated in April. When we receive this type of case, we work hard to get it to a qualified physician as quickly as possible because we know that the health of the mother and fetus heavily depend on receiving quality care. In Kenya, the country from which the majority of these cases originate, the maternal mortality ratio is 510 deaths per 100,000 live births, compared to the world ratio which is 216 per 100,000 live births and world’s lowest ratios in Scandinavian countries that are 3/100,000. Often many of the women presenting to our partner clinics are very ill and do not receive regular prenatal care and monitoring. With a very small cohort of 4 OB/GYN trained physician volunteers available to us, this group of specialists goes above and beyond normal “volunteer” duties to get answers to referring clinicians and their patients as soon as possible.

One such case came in earlier in May, when a clinical officer in Kenya encountered a woman who was 26 weeks pregnant and reported feeling ill, which included complaints of headaches, fatigue, and vaginal itching. This experienced clinician knew to do some initial evaluation and performed a urinalysis, fasting blood glucose test, and confirmed fetal heart rate and movement. Upon analyzing the results of the testing, the clinician quickly understood that something was amiss. The patient’s urinalysis showed high levels of sugar, while her blood sugar reading was well above normal at 305. Unsure with how to proceed, he submitted an OB/GYN Referral to The Addis Clinic.

Understanding that this patient needed intervention and oversight by a clinician experienced in managing complicated pregnancies, we allocated this patient’s case to one of our OB/GYN volunteers who is also certified in Maternal Fetal Medicine. She was gracious to take the case very quickly and responded that her initial assessment was that the patient has either gestational diabetes or overt diabetes mellitus that was undiagnosed before pregnancy. The vaginal itching was probably symptomatic for a yeast infection that is common in diabetics, especially in pregnancy. The specialist also noted the patient’s elevated blood pressure. and laid out a plan of care to address all concerns.

She first recommended the start of a diabetic diet, checking glucose four times a day along with instructions, and directed the start of insulin with detailed guidance on what kind, when, and how much. She also recommended the treatment of the yeast infection with a topical cream and oral medication, and careful monitoring of the patient’s blood pressure. This was just the type of systematic, specific and appropriate guidance our clinical partner needed to start his patient on the correct treatment regimen. We are hopeful that by following this advice, the referring clinician will preserve the health of his patient and her baby throughout the pregnancy.