MATERNAL HEALTH: #CelebratingDru - Daily Nation

Dru, woman who made the ultimate sacrifice


MATERNAL HEALTH: #CelebratingDru

Here is the latest anecdote in Kenya’s maternal mortality story.

On May 23, 2017, at exactly 1.05am, a young woman breathed her last at a hospital in Mombasa. Her name was Druscillah Walowe Mngoda, but many knew her simply — and affectionately — as Dru.

Two days earlier, she had been rushed to hospital as a result of pregnancy complications, and even though doctors managed to save the life of the baby, they couldn’t save Dru. Darrel, the baby, will now never know his mother, but he has the loving duo of his three-year-old brother Djibril and his 34-year-old father, Dan Kinyanjui, to keep him going.

This is the story of a mother’s ultimate sacrifice to bring forth a new life, a man’s heartbreaking tributes to his wife, and a nation gripped by a love story so tragically ended.

Dan, a theatre and film actor, says the final week of his wife’s life was the darkest of his life. By the time the cloud over his head started to disappear, he had lost a “friend, a lover, a soulmate, a confidante, a home maker, a manager, a prayer partner, a pillar of strength, a mother, and a companion”.

“On Saturday night, May 20, we arrived home at 10pm after an awesome evening at our pal’s, Michael Otieno, popularly known as DJ Lenium. We went to bed, but at 1am she woke up complaining of heartburn,” remembers Dan.

“She wanted to brush it off, but when she threw up I immediately rushed her to Nyali Healthcare in Nyali, where we were ably assisted by Dr Kevin Kinyua, who then referred us to Aga Khan Hospital for admission.

She was okay when they arrived at Aga Khan, and even got out of the car unassisted. She sat on the wheelchair and was wheeled to the maternity wing as Dan sorted out the admissions paperwork.

While at admissions, Dan heard the four words that would forever change the course of his life and that of his two sons.

Maternity Wing, Code Purple! someone bellowed from down the corridor.

“I rushed there to find my Babe convulsing,” he says, using the affectionate name, Babe, to refer to his wife of six years. “She was in a fit and foaming, and once she was stabilised I signed the consent forms for her to go for emergency Caesarian section.”

Doctors told him the fit was indicative of high blood pressure complications during pregnancy, referred to in medical terms as eclampsia. If unmanaged, it could destroy the liver, kidneys and even the brain.

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Druscillah Walowe Mngoda, also known as Dru, who died of pregnancy complications in Mombasa in May 2017, with her husband Dan Kinyanjui and their son. PHOTO | COURTESY

SERIOUS CONDITION

What Dru was going through was a severe complication of pre-eclampsia, a condition that affects some pregnant women, usually after the 20th week or the second half of pregnancy, or soon after their baby is delivered.

Gynaecologist John Ong’ech explains that the signs, which are not easily recognised, include high blood pressure (hypertension) and high levels of protein in your urine (proteinuria), which is a hint that one’s kidney functions are compromised.

Other symptoms include swelling of the feet, ankles, face and hands, caused by fluid retention (oedema), severe headache, vision problems, and pain just below the ribs. It is common in women who are pregnant for the first time, but its frequency drops significantly in subsequent pregnancies.

It affects women who have pre-existing hypertension, diabetes, and autoimmune diseases such as lupus, and kidney complications. Women with a family history of pre-eclampsia, weight problems, or those carrying more than one baby, are at a heightened risk.

Eclampsia, which follows pre-eclampsia, is a rare but serious condition where high blood pressure, like in the case of Dru, results in seizures, loss of consciousness, agitation, headaches or muscle pain, and upper right abdominal pain.

Dan, a biker and celebrated Master of Ceremony in Mombasa, was now reeling in shock at how quickly the tables were turning. He did not understand the severity of what had befallen his wife, but he could sense that all was not well. Worse of all, while he had been used to being ‘the man’ to his wife, there was nothing he could do now. Everything was in the hands of doctors now.

Dru, who had celebrated her 34th birthday on May 13, and who had just walked into the hospital unassisted, was now motionless after a series of convulsions and violent shaking. Doctors surgically removed the baby — Dan named him Darrell — and, as they wheeled the little chap out of theatre, another team wheeled the mother into the Intensive Care Unit of the hospital. She had slipped into a coma.

In the morning the hospital made an O+ blood donation request. Dru required fresh platelets — the blood cells that aid in clotting — as her body was not producing any. This is because at this point the pre-eclampsia was progressing to a life-threatening syndrome called Hemolysis, Elevated Liver Enzymes and Low Platelets (HELLP).

This is a liver disorder characterised by the destruction of red blood cells, elevated liver enzymes and low blood platelet count. Its symptoms are sometimes mistaken for heartburn, flu, acute hepatitis, and gall bladder disease. Women with a history of HELLP syndrome are at increased risk of all forms of pre-eclampsia in subsequent pregnancies.

Despite the worsening situation, Dan remained hopeful. Miracles, he believed, happen. His friend, DJ Lenium, wrote a post on Facebook on his behalf:

“Dru has been fighting for her life for the last 48 hours,” read the post that would soon go viral. “Her complexion is back and the swelling has reduced, but she is still in critical condition. Her body isn’t creating any platelets. The signal from the brain to the organs is weak, making her situation hard.”

Dru had suffered a brain aneurism — a bulging, weak area in the wall of an artery that supplies blood to the brain — due to the high blood pressure. That means the blood pressure was so high that it exerted a force against the walls of her arteries that was high enough to damage them and other blood vessels.

This damage restricted blood flow, leading to a swelling in the blood vessels in Dru’s brain and interfered with its ability to function, which explains the seizures.

Dan says the blood in his wife’s brain caused coning — the squeezing of the brain and brain stem through the foramen magnum (the hole in the base of the skull through which the spinal cord passes) as a result of swelling — which led to brain death. Eventually, Dru’s heart stopped.

VITAL CLINIC VISITS

The news of her death spread a wave of tears, pain and shock on social media. Dan and Dru’s friends had been following the story with bated breath, hoping that she would walk out of the hospital.

Hashtags such as #GodHealDru had united people in prayer for her and her family, but these quickly changed to #RIPDru and #CelebratingDru.

Dru, who until her death ran a family events management company in Mombasa, was laid to rest at the Mbaraki Cemetery, Mombasa, on May 27, exactly two weeks after celebrating her birthday. “Every day is now a struggle,” Dan told HealthyNation last week, “but my boys get me going. I loved my wife unconditionally, I showed her off, and I pampered her constantly. Everyone who knows me, knows this. I think and reminisce on the full life I managed to give her. She was happy. I am dealing with so much at the moment but trusting in God and taking it one day at a time.”

Eclampsia is one of the leading causes of maternal mortality among women of reproductive age, and also a leading cause of disability of mothers and their babies worldwide. It affects five to nine per cent of all pregnancies after the 32nd week.

“Ante-natal clinic visits are very critical for picking out some of these complications because during such visits an expectant mother’s family medical history and previous pregnancies are used to assess risk,” says Dr Ong’ech.

National statistics on maternal mortality, defined as the death of a woman while pregnant, during delivery, within 42 days of delivery, or during the termination of a pregnancy, paint a grim picture.

The 2014 Kenya Demographic and Health Survey estimates that 5,000 to 6,000 women die while giving birth every year in Kenya, while 22 out of 1,000 babies die at birth. And, according to the 2014 report, A Price too High to Bear, one woman in developing countries such as Kenya dies every two minutes from complications of pregnancy and childbirth.

The survey, conducted between 2011 and 2013 in the Rarieda, Gem and Siaya sub-counties, captures the emotional as well as the financial costs and impacts of maternal mortality to households, such as the wellbeing of families left behind, the survival of newborns, and the health and opportunities of surviving children.

 It also deepens household poverty, disrupts the life of her family, and devastates her loved ones with grief.