By Lia Puggioni – Physician, Gynecologist, and Obstetrician, member of the Rotary Club Ogliastra, Italy
It was Saturday, 30 March 2019. I was awaiting the arrival of my fellow travelers at Fiumicino International Airport in Italy and reflecting on this new Rotary adventure on which I was about to leave to reach the Momè Katihoe clinic run by the Sisters of Our Lady of Compassion in Togo.
I felt great responsibility and, at the same time, great joy to be part of the Vocational Training Team (VTT) “INSIEME PER LA VITA” [Together for Life]. There were so many doubts in my mind. Would I be able to teach the midwives how to use the ultrasound scanner and convey the basics to be able to interpret the ultrasound images? Would I be able to help the women that came to the clinic? What problems would I have to deal with? Having already been to Africa, I was expecting emotional experiences in regions with limited resources and felt encouraged by the opportunity to empower a community to provide needed health services for years to come.
Finally, my traveling companions joined me, interrupting my train of thought, and making me feel part of a wonderful team. Besides me, the team was composed of team leader Dr. Sebastiano Fava of the Rotary Club of Civitavecchia, an ophthalmologist, Monica Spiridigliozzi, a non-Rotarian with expertise in the equipment we planned to use, Cristian Dragone, a non-Rotarian technician specializing in gynecological – obstetric and ophthalmological equipment, and my Rotarian friend Riccardo Angelini, a hydraulic engineer expert in environmental hygiene, and specifically in hygiene and safety of healthcare work environments.
Rotary’s value of service, passion, and a genuine interest had pushed us to look beyond our borders and to walk together. Upon our arrival in Lomé we met Sister Confort who came to pick us up with an affectionate welcome, grateful smile, and hugs. And we were all emotional when we finally arrived at the clinic! What a beautiful clinic: in the heart of the village of Momè Katihoe, well kept by Sister Elisabeth, Sister Marie Bosco, missionaries from Switzerland, founders and keepers of this precious structure and the young Togolese nuns, some of whom were already nurses or midwives, eager to learn to help the people of the village.
Each of us was assigned a small room with a bathroom. I was late to fall asleep thinking about the next day.
At 5:30 in the morning, the mission chapel bell invited us to go to mass at six. Afterwards, we ate breakfast together and were ready to begin our activities.
Sebastiano Fava, our talented team leader, was in the small operating room he previously helped establish, thanks to a global grant to operate on cataracts with state-of-the-art equipment and to teach surgical techniques to medical and paramedical personnel from other health facilities. I was with the midwives in the outpatient clinic for obstetrical visits or in the small labor room adjacent to the delivery room. The room was equipped with a delivery bed in precarious conditions. There was no directional lamp, but there was an outdated trolley with all the necessary clean and well-kept tools and a cabinet with bandages, medicines, and disinfectants.
With the help of Cristian Dragone and Riccardo Angelini, we assembled and started up the ultrasound scanner we had sent via airmail from Italy, a scanner suitable for obstetric and gynecological diagnoses. I started with theoretical lessons on the basics of embryology and fetal anatomy through ultrasound images to facilitate the interpretation and understanding of the fetal organs in the different stages of pregnancy.
It was a complex process but indispensable to learn how to use the ultrasound scanner and to be able to make at least basic obstetrical diagnoses, such as better understanding the position of the fetus and dating the pregnancy. In fact, the women of the village did not know how to report the date of their last menstruation. The midwives explained to me that they could not read or write, and there was no calendar in their homes.
Throughout the week we continued our commitment. I saw some women, who had not been able to get to the clinic in time, give birth in the courtyard on the ground and in the dark, with the help of the midwife on duty called by a family member.
One morning a young woman arrived, pregnant at full term and in labor. Unfortunately, despite strong and frequent contractions, she was not dilating and the fetal heartbeat was beginning to show signs of distress. I realized that an urgent cesarean section was necessary. However, the clinic did not have an operating room or an anesthesiologist. The patient had to be rushed to the nearest hospital an hour and a half away, and the only possible means of transportation turned out to be a scooter! I spent a sleepless night unable to communicate with the hospital in Afagnan. Finally, the next morning, the husband returned and informed us that the caesarean section had been performed immediately upon their arrival and that mother and child were safe.
Knowing that the hospital was so far away and difficult to reach, I asked the midwives to assess the risk factors of pregnancy and childbirth in the early stages and to send the women to the hospital earlier. The midwives told me that the women arrive at the clinic already in advanced labor and without prior medical visits. My heart tightened, and I understood that I could not apply our protocols of assistance to pregnancy and childbirth in such a reality. We would need to work together to adapt these protocols to a context that made sense locally. But I also better understood why the maternal, neonatal, and infant mortality rates are so high in more remote villages, and I understood the attitude of the midwives who have no choice but to roll up their sleeves and assist in a delivery under any conditions.
The days passed quickly and intensely. I remember with great emotion the joyful moments we spent with our local partners, the Rotarians of Lomè, and those spent with the hardworking nuns with whom we shared meals and evening chats about our experiences from the day.
I returned to Italy keeping in my heart the shy, grateful, and uncertain gazes of the women who were trying to understand who I was and what I could do for them, women and mothers to whom perhaps we gave one more glimmer of hope.
Unfortunately, the COVID-19 pandemic interrupted our Rotary mission in Togo. I am so nostalgic and aware of how much more there is to do. I hope it will be possible to return to the Momè Katihoe clinic together with my wonderful VTT team so that the story can continue.