- © 2008 Canadian Medical Association
A dizzying number of women lie weakly in the hospital wards with incomplete abortions. As abortion is illegal in Kenya, many women seek out dubiously trained sources for the procedure. A Kenyan doctor tells me razors and blades are commonly used, resulting frequently in infection or death.
The botched jobs on survivors who seek hospital help are completed with an extremely painful procedure: a manual vacuum aspiration. I recall most women receiving no analgesic before vaginal suction scraped products of conception from the uterus.
In the manual vacuum aspiration room, I have held the hands of countless women pounding the examination table in agony. Images of women writhing in pain, some with tears streaming from their eyes, and sounds of their wails … these are seared into my memory.
![Figure](https://www.cmaj.ca/content/cmaj/178/7/822/F1.medium.gif)
The rundown wards, prevalence of death and gaping health inequities come as an ontological shock. Image by: Alice Han
Rounding on patients, the attending flips through a chart, irritated: Nurse, this patient needs this antibiotic 3 times a day. Why is she getting it only once? The nurse tugs at her uniform, flustered: Doctor, we don't have enough of it in the hospital. We need to save it, give little by little. Both sigh heavily, frustrated.
The atmosphere is sombre here in the hospital. Unlike in Canadian hospitals, death arrives unceremoniously, often in hand with futility as physicians look on wearily, unable to curb its steady march.
After just 5 minutes in the wards, a newborn baby dies in front of her devastated mother's eyes. To my left, 2 lifeless bodies are wheeled to the mortuary.
I have acclimatized to the stench of urine that heavily hangs in the air, I no longer feel shivers when meeting the hollow gazes of the patients packed 2 or 3 to a bed. The casual reactions of the hospital staff to the frequent deaths are no longer strange for me.
I see tired looks in the eyes of the physicians. They work tirelessly but poverty and inadequate resources render them impotent. I see the gaping chasm between resources available in Canada and in Kenya. I feel powerless and small, and incredulous at the grossly gaping health inequities that mock human dignity.
Footnotes
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CMAJ invites contributions to Dispatches from the medical front, in which physicians and other health care providers offer eyewitness glimpses of medical frontiers, whether defined by location or intervention. The frequency of the section will be conditional on submissions, which must run a maximum 350 words or be subject to our ruthless editorial pencils. Forward submissions to: wayne.kondro{at}cma.ca