Alison LaFrence, M.D., ’88, Family Medicine

Testing

Despite enduring seizures and incapacitating migraines which are the residual of contracting encephalitis in 1995, Dr. LaFrence, a family physician, has traveled to Cameroon, Africa just about every year doing medical missionary work with her husband, an obstetrician/gynecologist since 2000. The couple assists with a program established by Dr. LaFrence's mother-in-law, to train women and men how to perform prenatal care and low risk deliveries in rural villages; the Trained Birth Attendant (TBA) course. She also grades the course’s written exams, which is a challenge because English, Pidgin (a verbal and not written language of Cameroon) and French are all spoken in Cameroon.

Dr. LaFrence and her husband also drive to other villages and visit TBA graduates. Visiting villages is always a wonderful experience as it is an opportunity to meet old friends, see their “clinic” (delivery area) and review their medical records. They also make sure that they have the appropriate amount of medical supplies. If they do not, they give their clinic a “gift” of the needed supplies (gloves, stethoscope, BP cuff, pregnancy wheel, etc.).

These month-long visits have become her favorite part of the year. Reuniting with their Cameroonian friends, enjoying the countryside as well as the “change of pace” (decreasing demands on one’s life) all make our time in this country very special. They are currently on their eighth trip and are very thankful for the opportunity, means and the passion to continue doing missionary work.

Dr. LaFrence writes, “An additional part of the TBA training are all those “special” experiences, at least one of which seems to happen every year. These experiences are under the heading of “DON’T EVER DO THIS IN YOUR VILLAGE.” One of the most memorable ones was from a few years ago. A teenager, VERY pregnant, and in labor, came into their clinic one morning. An exam quickly showed a very large FOOT sticking out of her vagina. An ultrasound a month ago showed TWINS and she was told to deliver in the hospital. The pregnant teenager’s mother-in-law convinced her to wait until the last minute and come to Drs. LaFrence's hole-in-the-wall clinic. They could not send her to the hospital – it was over an hour away on a very bumpy road. No medical supplies were available for putting in an IV, much less for doing a C-section. They listened for both baby’s heartbeats with a fetoscope. They were pretty sure that the bottom/breach twin was doing well because he/she was moving his/her toes (good sign!). They heard three different heart rates, one of which was the mothers. Of the other two, one was 140 and the other was in the 70 range. Though it was a VERY small room (made smaller with the addition of 10 TBA students), they quickly divided responsibilities and prepared for the deliveries. The TBA students were responsible for praying for the mother and two babies. Alison's husband delivered a very large breach baby. This male newborn cried immediately. Alison quickly wrapped him up in a blanket and put him under a warmer as she watched her Cameroonian midwife friend deliver the second twin. This newborn was significantly smaller than the first. He had a weak rapid pulse but was not breathing. It seemed that it took forever before he started to gasp for breath and then weakly cry. Once both his weak cries and the louder screams of his “older” brother were heard, the room and outer hallway was filled with laughter and clapping. The birth of twins (especially MALE twins) in Africa are a time for celebration. Around 30-45 minutes later, both twins were stable. The delivery was not yet complete. The placenta was still attached. Finally, the placenta delivered; however, the mother continued to have post-partum bleeding. Dr. LaFrence's husband performed the usual techniques to control bleeding without success (no medications or IV access were available). Dr. LaFrence turned around to pick up one of the twins to put to the mother’s breast, only to find that both of the twins were gone! She quickly ran out of the clinic and finally found the family with the twins. With little explanation, she took one of the twins and brought him to the mother and put him on her breast where he began to feed quite vigorously. The bleeding significantly slowed down. That afternoon the TBA class had a review of this delivery and learned why they should not deliver TWINS or BREACH presentation in their villages. They also learned about post-partum bleeding and how to treat this condition.”