Episode: "Borders and Babies"

SIERRA LEONE | AFGHANISTAN

In this episode, Amir Hussein was initially turned away from the hospital in Chaman, on the Pakistan/Afghanistan border. The Afghan government doctor did not want to treat Amir because the hospital's U.N. contract had expired. What does this mean and why wouldn't they treat him?

U.N. agencies often provide funds to government hospitals for refugee patient care. In these cases, medical services will be reimbursed according to an agreed fee scale. The U.N. had allowed its contract with the Chaman hospital to expire. Even though MSF offered to pay for Amir's surgery, the doctor was concerned that he would need follow-up care and the hospital would have to absorb the cost. In this case, the doctor was eventually satisfied and admitted Amir.

In the Sierra Leone segment of this episode, a sick boy (Osman) must have his leg amputated. Would he have received the same medical treatment in the U.S.? What happens to the boy?

According to Dr. David Friend, the MSF doctor who treated Osman, even in a western country this child likely would have required surgery, including possibly an even more extensive amputation, because of the size and fast-growing nature of the tumor in the child's leg. After about six months, Osman returned to the MSF clinic. He was quite thin and the stump of the amputated leg was a bit swollen. MSF was able to get x-rays at a UN field hospital that showed recurrence of the tumor in the stump with extensive deposits in the lungs, which is a common site for the cancer to spread. Because chemotherapy is not available in the region and the cancer had spread rapidly and extensively, it is likely Osman died shortly after this last visit to the MSF clinic.

In this episode, a mother dies of preeclampsia during child birth. The MSF team cannot save the child. What is preeclampsia? Why couldn't they save mother and child?

Preeclampsia is high blood pressure that occurs during pregnancy. It most often affects women in their first pregnancy, teenagers, or women over 35. Women who have high blood pressure before pregnancy are also at increased risk. Preeclampsia usually develops in the third trimester and doctors often prescribe bed rest and medication.

Severe preeclampsia, characterized by a widespread constriction of the mother's blood vessels, can cause liver and kidney damage, seizures, coma, and death. It can also interfere with blood and oxygen flow through the placenta and affect a baby’s development. Women in developing countries who do not have access to adequate prenatal care are more adversely affected by the condition. Sometimes labor must be induced prematurely or a c-section performed to save the mother and child. In this case, the mother showed up at the hospital with a severe case during the last days of her pregnancy. Like most pregnant Sierra Leonean women living in rural areas, she had no access to the prenatal care that might have prevented a tragic outcome.

Please send us your questions and comments on this show or the series in general. We may not be able to respond in person, but relevent questions - and answers - will be added to this site.