Nyna Amin

Ruptured subcapsular hematoma of the liver due to pre‑eclampsia presenting as interstitial pregnancy and the role of intra‑abdominal packing

Ruptured subcapsular hematoma of the liver (RSHL) can mimic ruptured interstitial pregnancy because each of these conditions occasionally presents at the same gestational period and both do manifest hemodynamic instability. The similarities between the two conditions pose a diagnostic challenge, especially in an un-booked patient. We report a case of an un-booked primigravida, at 21 weeks of gestation, who arrived at a regional hospital with evidence of intra-abdominal bleeding and hypovolemic shock. She was diagnosed as potentially having a ruptured interstitial pregnancy. During the ensuing emergency laparotomy, RSHL was discovered, the area around the ruptured liver capsule was packed with large abdominal swabs, and the patient recovered. This case report illustrates the need to consider RSHL in patients presenting with features of ruptured interstitial pregnancy, as this will assist in the planning of intraoperative care. We also describe abdominal packing and highlight the need for this essential surgical intervention to be taught to doctors practising in low-resource settings.

Autobiographies, biographies and writing lives

This special edition of Agenda invited writings of women’s lives from perspectives that capture the multiple and subjective realities of women as one way to counter dominant male depictions of life, of history, of culture, of politics and lived experiences – depictions which not only marginalised women but rendered them invisible. It has sought to correct androcentric and mono-dimensional views of theworld, by speaking back to narratives which erased women’s voices. The stories are in some ways about women’s stolen lives, retrieved histories, agentic incursions and evolutionary shifts in the 20th and 21st centuries.

Undoing Cognitive Damage

The great topmost sheet of the mass, where hardly a light had twinkled or moved, becomes now a sparkling field of rhythmic flashing points with trains of traveling sparks hurrying hither and thither. The brain is waking and with it the mind is returning. It is as if the Milky Way entered upon some cosmic dance. Swiftly the head mass becomes an enchanted loom where millions of flashing shuttles weave a dissolving pattern, always a meaningful pattern though never an abiding one, a shifting harmony of subpatterns.

Curriculum Without Borders

In the early seventies, a band of highly trained doctors decided to provide medical care to deprived, dispossessed and marginalised groups of individuals ravaged by war, poverty, political strife and inadequate health provisioning. Calling themselves Medicins Sans Frontiers/Doctors Without Borders, they took their medical craft to the forgotten parts of the world, to the frontlines of war and into the midst of havoc caused by natural or human disasters.

Dilemmas of telling bad news: Paediatric palliative care providers’ experiences in rural KwaZulu-Natal, South Africa

Background. In general, the principles of palliative care suggest that, at some stage, patients should be given ‘bad news’ about poor illness prognosis. The information is often important for care planning, especially when it involves disclosure to children. Although there are ongoing debates about whether to tell or not to tell children bad news, these debates have largely been informed by patients who live in a developed-world context. In contrast, this paper focuses on telling bad news to children and their families from a rural, developing-world context. Objective. The objective was to analyse the experiences of providers of palliative care to children when they attempted to fulfil one of their roles as palliative caregivers, i.e. to prepare patients and families for a child’s poor illness prognosis. Method. This was an exploratory study that was approached qualitatively. Five nurses and eight home-based care workers who provided palliative care for children in rural areas of South Africa formed a purposive, information-rich, self-selected sample. Data were produced through discussions with participants, using photographs taken by the caregivers to stimulate and contextualise the discussions. Results. Participants experienced four dilemmas with regard to telling bad news: when families did not want to be told any bad news; when participants felt uncomfortable about telling bad news; when participants and patients shared dissimilar values about telling bad news; and when participants were unsure about when to tell bad news. Conclusion. In the rural areas where the study was conducted, children are not usually given bad news about their illness. Disclosing poor prognosis led to the dilemmas faced by caregivers. The result was that the emotionally charged work of caring for children reaching the end of their lives became more challenging for the caregivers because they were not prepared for cultural complexities. In view of the findings of this study, there is a need for ongoing research into paediatric palliative caregiving in context.

“She doesn't look like she is both mother and father”: Disrupting the child/parent binary

abstract This focus interrogates the parent/child binary within a context of poverty, more specifically in a case where a girl lives with her parents. The protagonist is a young South African girl of Indian origin living in a suburb close to the city of Durban in South Africa. Leela and her family live in a wood and iron shack without running water and electricity. She was born when her parents were children (her mother 12 and her father 15 years old). Now aged 13, she has taken over the running of the household and care of her siblings since her mother is unwell and her abusive father is unemployed. Leelas story reveals the hardships of living in an intergenerational family structure, and highlights the fragility of the categories of ‘child’ and ‘parent’ when parent and child roles are reversed and subverted.