Dr Adekola is a consultant cardiothoracic anaesthetist and intensivist at the Lagos University Teaching Hospital, Nigeria.  She has led Lifebox training and oximeter distribution across Lagos State.

Why is safe surgery so essential for women?

It has been said that if a woman is educated, then so is the whole family.  It’s vital for her to have education, to have safe delivery – to be present for her family.

And many women are breadwinners in Africa – they are doctors, nurses, teachers, traders – petty traders and big time business women! – and especially in the rural settings, they do a lot of farm work to support their families and communities in general.

When you don’t get proper obstetric care – surgical, medical and family planning – the loss is to the family, the community, the nation in general.

How does life-saving surgery become unsafe surgery?

Surgery can be dangerous if it’s poorly managed, or in the wrong hands.  A woman in labour in Africa – most of them are afraid of surgery.  They’ll go to traditional birth attendants, and choose unorthodox medication to prevent them from having a C-section.  But if they can become aware that safe C-section is possible – that you can have this operation without losing your life – then more will come.

Can you tell us about a good or bad outcome you’ve seen recently?

I’m a cardiothoracic anaesthetist, but I do see obstetrics in an emergency situation, when I’m on call.  Recently we had a very sad case – a 26-year-old woman, a mother of three children, who developed post-partum haemorrhage following a C-section.  She didn’t do very well, and we couldn’t get to the cause of the bleeding.  We put her on a ventilator but we had no blood products to give her.  Because of Ebola post-mortems are suspended – 

But then just recently we had a woman, aged 30, with twins.  No critical incidents.  The mother and babies are well.

You’ve led a Lifebox workshop and oximeter distribution – what difference is it making?

A few weeks ago we were monitoring a patient with a Lifebox pulse oximeter and suddenly her oxygen levels dropped to 70 per cent.  She had an airway obstruction, and we needed to put in a tracheostomy [a tube into her neck, to help her breathe] – we were able to intervene in time to prevent cardiac arrest.   The pulse oximeter certainly makes a difference to surgery.

Without oximetry monitoring in surgery the reality is hypoxia, cardiac arrest – which should have been avoided.

It’s hard to understand what that feels like.

It’s traumatic.  When a patient dies who you know should have survived – you turn to your colleagues – you counsel each other – it’s not about apportioning blame, it’s about trying to avert the situation in future.  But still it’s devastating.  Often people need time off just to recover from the pain and trauma.  And then you come back to work – often knowing nothing has changed.

Is there a tradition of ‘baby showers’ to celebrate pregnancy?

On the 8th day after birth you have a naming ceremony.  A big party, with everyone you know, the family, the neighbourhood.  They come with gifts, baby clothes, and cash to set up an account for the baby.  A baby is a celebration – always.

But you wouldn’t have a party before the baby was born – no, no, definitely after.  Because the party is to celebrate a safe delivery – before that, you don’t know what will come.

And when there isn’t a good outcome?

No celebration, of course.  No celebration at all, not even if the baby survives.  The grandmother will take the child home.

There’s a huge responsibility on the women in the community. 

I think women can do all these things – take care of the family, the husband, the extended family – I think we can cope, psychologically and mentally.  We need support: from the family, the community, the government.  But we’ve been doing it since the beginning of the world.