Hidden tales behind unwanted pregnancies and botched abortions

Nairobi; Kenya: During my recent tour of Nairobi City’s maternity facilities in support of the Beyond Zero campaign aimed at preventing mothers from dying while giving life, I bumped into a colleague, a senior midwife, who I will call Nasimiyu for ease of reference.

I first met Nasimiyu in 2001 at Kenyatta National Hospital during my final year for my Master of Medicine degree in obstetrics and gynaecology.

It was a cold Thursday morning in July and I was on duty in the acute gynaecology ward covering the procedure room. This room is where all patients presenting with bleeding usually from threatened or incomplete abortion are evaluated and treated or referred for an operation depending on the findings.

I walked in at 7.45am and saw a long queue of patients waiting to be seen.

I hurriedly reviewed all the case notes and arranged the order in accordance with the most serious. I had 12 patients ranging from 14 to 39 years and more were expected.
I had hardly completed the procedure on the fourth patient when I heard commotion and wailing outside the room.
I continued for another five minutes and cleared with the patient who was on the table.

My assistant told me that my patients had run away. As I stepped out to find out what was going on, I came face to face with the detached head of a foetus of mixed race. I did not remember seeing a non-African on the queue.

I was told the head had dropped from one of the patients waiting to be seen. This had scared off all the others who took off in different directions, including the one whom the head had dropped from.

The place looked messy with trails of blood following each direction taken by the fleeing patients.
The nurses managed to gather the patients and bring them back.

The patient who had delivered the head was Nasimiyu, then a 16-year-old, who was in Form One at a city day school.

She lived with her parents who were domestic workers for an Asian family in Parklands. She had been born there and the family still lived there.

I attended to her, and realised she had multiple lacerations on her cervix and possible uterine perforation.

She was too devastated to talk. We arranged to take her to theatre for exploration.

Being a minor in an emergency, I signed the consent for her since none of her relatives was nearby.
In theatre we found and repaired a uterine perforation as well as other minor tears on the cervix.

She recovered and was discharged.

—To be continued next week