Africa...nearing an end

Dear Friends,
Our trip is nearing an end. It has been an amazing experience. We have seen and done SO much and God has been very merciful. It is amazing to experience how others live on a day-to-day basis and what is “normal”. We have made many valuable friends and learned a lot. I think our presence has also been a blessing to them.


The stiff political conflict has ended as well. The OB “ran away” a week ago. That has been a relief. And after a few days the staff has settled into a calmer atmosphere. It has left a hole in some of what can be done. (There isn’t anyone to do ultrasounds for things like placental location. Linda and I are able to confirm fetal demise and presentation but that is about it.) There are three midwifes that can do vacuums and there is a general surgeon who will do the c-sections. There has also been some Gyn consults that aren’t being covered (like uterine prolapse). An OB from Denmark is coming mid Sept so that will be good!!

We are working mostly PM and night shifts, although we still spend much time during the day on the ward making rounds, discharging and writing orders for patients since the OB is gone. The prospective midwives had to take a test today and so we covered the ward during the test time. I delivered my 16th baby today. It wasn’t a happy occasion as no fetal heartbeat was found on admission. Culturally when someone dies there is an abundance of wailing that can be heard all over the compound. Today I asked about babies, because I haven’t seen any of this when a baby dies. I was told that there is no mourning until they are about 5 months old. Life is so tenuous until then and death so common that no one cries, there is no mourning. There isn’t a funeral or burial. The babies get taped up in an empty cardboard glove box, left in the hall and the guard comes and takes the boxes away. I’m in astonishment of how unaffected they are by babies dying.

There is an HIV patient who has been here since before we got here. Her husband brought her in because she was sick. She was diagnosed as end stage AIDS. He refused testing, packed up her stuff and left her here – abandoned her. She has no one to pay her bill or, more importantly, buy her medicine to relieve the pain. She has a 9 year old daughter who comes everyday to bring her food. We tested her today while she was visiting her mother. She is negative. That is really good news for her. She has a 6 year old sister at home that the father refuses to have tested. There is also a woman in cardiogenic shock. She has less than a week to live. Her lungs are full of fluid and you can feel her heart murmur by laying your hand gently on her chest. It feels like her heart is trying to surge through her chest wall. Linda and I went with Timesskin to do prayer rounds on all the patients in the hospital this last Tuesday. It was an amazing experience. They LOVE it – every one of them. They see you praying for someone else and come over and ask you to pray for their loved one. Timesskin always asks their name, where they are from, what the problem is and are they getting better (there really is no such thing as privacy). There are some tragic stories. They aren’t the usual heart disease, diabetes, and cancer like you see in the US. There is also a huge number with goiters - goiters as big as soft balls. These I haven’t seen in the hospital but out in the market or at church.

As usual, these trips always confirm to me that I am very grateful to live in the US. It has been so long since I have heard any “news”. Linda and I were talking about, “wow we wouldn’t even know if something terrible has happened”. It was brought up yesterday that the Olympics are happening. I didn’t even know that. Some of the medical students went to a “coffee shop” and it was right when the Ethiopians won a foot race (10,000 meter) and they were watching it in the shop. Everyone was very elated. I hope I get to see some of the gymnastics when I return but they may be over by then. Oh, well. Sigh…

I’ve also missed summer. We get an occasional sunny warm moment on an occasional day. I hope we have an Indian summer back home, so I can bask in the sun just a little before winter sets in. I’m also looking forward to fruit, any fruit other than bananas.

One medical student from the UK is following us around tonight. We had one 2 weeks ago who spent 10 min with the Ethiopian midwives and said no, he’d wait till we were on to get his OB experience. He couldn’t take it. Thankfully, he completely backed us during the political hoopla. I’ve really enjoyed the medical students. They also join us for our potlucks and social events. We’ve had a couple popcorn and movie nights. That has been fun. We have them at our house as we have the most comfortable furniture.

We haven’t had water for days and had to haul water from the hospital a couple of days ago. We haven’t had power for an equal amount of time. This translates into no showers. We smell just as ripe as the locals now. I have also taken to wearing a scarf like the locals. Oh the joys of living abroad!! This lack of power also translates into no bread. We had our cook buy njira from the hospital, today. It is like a giant crepe made from teff flour (This is not wheat but a local grain.) that is fermented to provide the leavening and then cooked on a very large griddle over a fire. It is a might sour depending on how long they fermented it. Njira is a staple and eaten at every meal. They usually eat it with shiro which is a bean power (I haven’t a clue what kind of bean) with spices that makes a sauce/paste/soup base. It is very good.

I’m sure I’ve rambled on long enough. It is 12:20 AM and all quiet in the Female Ward. Time to catch a few winks.

Blessings to each and every one of you,

Amber

ANT'S

ANTS!!! … WE’VE BEEN INVADED!!!!

Yes this is what we woke up to this morning. The kitchen counters were covered, the sinks were filled and I mean filled with ants! They were not only marching hundred by hundred but gathering thousand by thousand in our bowls and plates in the sink! Also the bathroom was being taken over by these marching creatures, and they were headed toward our bedrooms!!! Action must take place or we would be marched right out of our own house!! So Linda with some Korean bug killer we found in the house and me with my 29% deet bug spray started to fight back against the invading army. Slowly the invading army started to retreat or more like die in their tracts!!! Yes! Victory, the multitudes are dead, now we just pray that they don’t call in the reserves because we have now run out of ammo L But for now we are safe and have regained control of our house.


So you could say that we are kind of on administrative leave right now until further notice. The current Ethiopian OB hates us as well as the hospital in general and has stated that either we work or he works. So until we get the mess figured out we are off the ward and doing other projects. We actually heard today that the OB Dr. is quitting. So maybe we will get our job back sooner! But until then we will just serve God in ways other than in medical work.

Our first Job this morning after brutally fighting off the ants was to mark 108 sheets with the letters GAH (Gimbie Adventist Hospital). After completion of that job we met with Paul and he asked us to go around with the chaplain and pray with the pt’s on the different wards. The pt’s really like this and it encourages them tremendously. It took us about 2hrs to get through the almost the whole ward, the translator had an appt so we will be finishing the last part of the ward tomorrow. It was really neat to see how receptive the pt’s and families were. Some of them even cried as we prayed. Hearing about their medical cases was very interesting and gave us more of an idea of the kinds of sickness and injuries they acquire. Some of them are very interesting to say the least.

I have actually been writing this letter on and off today as we have down time between jobs. So as of now I have some new news on our “administrative leave” situation. While we were going around and praying with pt’s Paul came up to us to inform us that the Ethiopian OB who had been causing lots of problems just left and quit his job. We had heard of this possibility but because this Dr. usually makes a lot of threats we weren’t sure if he was really leaving or not. But he actually did. This is good and bad for the hospital. Good because he was the source of a lot of problems here and so hopefully those can now be resolved and good because he hated Linda and I and forbid us work, so now we can work again. But it is bad because we now have no OBGYN here at the hospital so we have to rely only on the General surgeon who is here and has little experience with OB cases. So please continue to pray for the OB situation as it is far from being completely fixed. Linda was informed that she is now the most experienced person in OB so she will now be doing a lot and in charge of much more. It seems funny how we have gone from being forbidden to work and now we are the most experienced and needed all the time. It is interesting how God works things out. So maybe we will get to do some more births now after a week of not working. I was beginning to get discouraged about not getting to work but Linda kept reminding me that God was in control and everything would work out and by Gods grace it did. Sometimes God has to remind us that He is the one who is in control and who is leading.

Just being here in Africa has been amazing. Seeing God work, learning how to adapt in non luxurious conditions, learning to work with the native nurses/midwifes/doctors and just being out of the busy American life style have all been great growing experiences. I am so glad God opened the doors for this trip it has defiantly been a blessing!


Blessing to all,

Amber

Will we ever have a normal birth???

Dear Friends and Family,

 

Well, I’m ready for some normal births.  It always seems that recently we have had a lot of problem births. Linda says whenever she has a student she has problem births because with the problems come great teaching opportunities.

 

Three things I have been learning and that Linda gets drug along with me are…  #1 Vacuums. Closely after the first smooth vacuum use came 2 more uses for first time mothers who were exhausted (they don’t eat in early labor so are completely wiped out when the end comes many hours later) with asynclitic (baby head in the pelvis crocked) babies and one with a very narrow pubic arch (i.e. poor fit).  Each of these vacuums was increasingly more difficult.  OK I’ve had enough of vacuums.  The last we didn’t do but we were present for the delivery.  And it was a good thing we were as this baby needed resuscitation. 

 

Which leads me to problem #2 Resuscitation  We discovered that they really DO NOT know how to do neonatal resuscitation even though there is a book with the how-to’s right there on the counter which lead me to believe they had been taught.  During our first resuscitation Linda and I were having to argue with 2 people, first off, as to the necessity of even resuscitating this baby who is limp, blue, not breathing, completely unresponsive and a heart rate of less than 100.  (For those of you who don’t know it should be about 120-160.)  And secondly, we had to argue with them as to how to resuscitate.  It wasn’t a very pretty scene as voices were a bit raised and they were pretty upset with us.  But we felt like we absolutely needed to advocate for this baby and do what needed to be done or it would die.  The baby recovered well and went home the next day.  The second resuscitation disaster was at a c-section that I attended.  We weren’t on shift but came in because we wanted to attend this birth (breech).  When it was decided to be a c-section Linda went home but I wanted to go in on the surgery. By the time I had gotten all gowned up and in the OR room the baby was being pulled from the womb and taken to the table. At once I knew that this baby was going to need resuscitation. After being placed on the table the other nurses started taking there time bulb suctioning this baby. I was trying to get my hand in there to start stimulating the baby because they did not seem to be doing anything but suctioning. After what seemed like forever but was really about a min they were still not starting to resuscitate. This baby had an apgar of 3 and looked terrible! The “midwife” finally got the bag and mask and started to use it. But as I looked I noticed that she had the mouth piece on the baby backwards the nose part was off the chin! I quickly informed her that it was backwards and she ignored me, I told her again and tried to reach in to fix it and she pushed me away. I was started to get very upset at this point because this baby had been so long without breathing and was still not being ventilated because the mask was not placed properly! I finally decided to be pushy and pushed my way into the baby picked up the mask and placed it properly. The “midwife” just glared at me. After the baby was finally getting ventilated I asked for a stethoscope to listen for a heart rate and they told me there was non here, and did not seem to think it was necessary. In looking at the condition of the baby I knew that it was a necessity. So I ran from the OR to the ward grabbed a stethoscope and ran back into the OR. Listening to the baby I had a heart rate of 90. Now remember we are at least 3 or more min after delivery. I listened again about 30 sec later and it did finally go up to 120. The baby was still not breathing on its own had no tone and was blue.  Fortunately the “midwife” kept PPV (positive pressure ventilation) going. After about 5min of bagging I suggested that we put a tube down into the baby’s stomach to relieve the air that was building up as a result of the PPV. But they again said no it was not needed and pushed me away.  After about 15 min of PPV the baby began to make a few gasps so in their book the baby is now breathing and is ok.  So stopping the PPV and putting the baby in the bassinette with just a nasal canula while mind you the baby still has no tone is still blue and is barely gasping. The only normal thing was her heart rate of 120. I tried to tell them the baby still need resuscitation but they ignored me and began to push the baby down the hall to the L&D/”nursery” room. I knew at this point that if something was not done the baby would die! I did not know what to do so all I could think of was to get Linda who was at the house.  So I raced down the walkway leaped down the stairs and bursting into the house yelling, “Lin, come quick!! The baby needs resuscitating and they won’t let me do it.  They keep pushing me away.  They are going to let this baby die.  Do something!!!”  So we hurried to the hospital.  Poor Linda did not really like being put in an adversarial position but she was able to reason calmly with the woman overseeing the baby and negotiate appropriate care, even though it was pretty late in the game.  Unfortunately, this baby has issues not related to the birth (several physical defects looking like some syndrome we are personally thinking maybe turners?). We were able to get her to breathe on her own with a rate of 36/min and then they insisted on now only using the nasal canula because the baby was now breathing fine. We knew that the outcome of the baby was very poor due to her physical defects and also such delayed resuscitation, so we just decided to back off and let them take over. It was not easy for me to do.  But she seemed to pull her own and continue to breath on her own. On shift later that night, she has to remain on O2 continuously or she turns grey and I’m sure she would die without it.  She was also having seizures, has no reflexes, hasn’t eaten or been given anything to eat (plus I’m not sure she even can swallow).  We finally took her out to see her mother and it was explained to her the situation.  The mother cried.  This was her first baby.  It is just not fair what this word gives and it makes me long all the more to be in a place where there will be no more suffering, pain or crying where everyone will be perfect. Oh how I long to go to heaven.

 

Problem #3  Malpresentations  The last 2 births were breech and brow.  Both ended in c-sections.  I was able to feel what those presentations feel like on exam and the ramifications of each so that was good experience.  They seem to have A LOT of malpresentations.  They have had 3 face presentations and 2 brow and 5+ breech just since we’ve been here.  That seems like an unbelievably high rate.  I can’t figure out why that would be except it is true that the hospital gets a higher rate of complications just because other clinics send us their complications and if it isn’t working at home they come to us.  But still???

 

So now you can see why I really want just some normal births !!!!

 

Friday was Becky’s birthday.  We had potluck supper at Paul and Petra’s house.  Linda and I had our cook make a cake.  Becky was so thrilled, as was everyone there.  Cakes just aren’t available (no quick mixes here).  Plus we were all ready for a treat having had pretty plain food and no sweets for many weeks.  It was so fun! 

 

To give you an insight into the “white” cast here:  there is Paul (25 administrator of the hospital, lawyer), Petra (22  his wife and helps in the office, Masters in Biblical languages), Becky (31, director of nursing staff, MSN, ARNP certified nurse midwife, spent a year in the Peace Corp in South America somewhere, wants to work with Doctors Without Boarders), John (18, Paul’s brother, brilliant kid who graduated from high school at 16, spent a year in the mission field in South America, will be starting his second year of pre-med at Southern this fall, David (21, accountant with several other interesting skills like tuning pianos, also brilliant).  Also in attendance are 2 medical students, one from Britain and the other Bermuda.  It is so neat to be amongst this group of  young people who are so bright and could be doing anything they want and making LOTS of money and yet they are committed to missions and the Lord.  It is amazing that this young group is leading this hospital.  All of them are also very musical.  Three of them have perfect pitch and a variety of instruments are played.  We have a really good time singing and hearing they play music.  Needless to say the fellowship and company is great.

 

In spite of a great many challenges and difficulties the mood is hopeful and positive.  The hospital is really in a pretty bleak situation.  Finances don’t look good.  They are trying to get grants and donations.  David prepared a financial statement that predicted the hospital will be broke in 6 weeks.  There are doctors who don’t show up for work or are fighting with other doctors or just plain nasty to the nurses.  The moral of the staff was very low prior to Paul and Petra coming.  But  has improved with there presence and work.  Also the relationship between the hospital and the local church was really bad and that has improved with the diligence of Paul and Petra.  Supplies are very limited and tt is difficult to get the staff to adopt current practices.  Unfortunately the teachers in the nursing/midwifery school aren’t well trained therefore passing on poor education.  The laundry is completely inadequate and archaic (you will be shocked at my pictures).  And yet this hospital serves a huge area and many people.  There isn’t another with surgical capabilities for many miles. 

Gimbie operates completely on faith and God has seen it through the tough times and I am sure He will continue to bless.  If any of you feels impressed to contribute it would be welcome.

 

The last 2 days we had no rain but, boy, is it ever lightning, thunder and pouring outside right now.  We are planning on pancakes this morning.  We usually have oatmeal for breakfast.  We have heard there is a “grocery store”.  I’m sure it isn’t at all like Safeway, but it is suppose to have things like peanut butter and chocolate, canned and packaged goods.  We’ll see.  I’d like to find it tomorrow.  We pay our cook/cleaner $8 a week and spend about $17-20 a week on food for the both of us.  Not a bad deal.

 

Well, I’m sure this email has consumed a good bit of your leisure (or perhaps work) time.  I think of you all and pray for you.  I do enjoy the short return emails you all send.  Even if I don’t respond to you individually I love the mail.  It makes me feel connected to home.  The internet is VERY slow (Ethiopian dial up) and we have to pay per minute.  I think they make it purposely slow so they can get more online minutes thus more $.  Given that, I type up my e-mails on my laptop and then store it on a flash drive so I can spend as little time as possible while on the internet.

 

Thank you for all your prayers.  We are well and of good courage.

 

In His Service,

Amber

 

Sleepless Nights and No Doctor

We again worked the night shift and had a good group of nurses (2) and a practical worker (1). I like working with ones that can speak some English and are willing to learn new things and teach us some things. There are defiantly some nurses and midwives that I don’t think like us to well. They have a big attitude toward us. They don’t seem to want to do anything more than they have to or anything that might be construed as beneath them.  But we try to be nice to them and model a willingness to do anything that needs to be done (like making gauze 4x4s and mopping) and maybe by the time we leave they will like us and see the bigger picture of service!

            Our shift started out with a woman who came in from a home delivery in which the baby had died.  She had a retained placenta. She stayed at home for several hrs with the retained placenta and then went to a nearby clinic for help. The clinic was not able to do anything but she stayed there for 7hrs before they referred her to the hospital.  So when she got to us she was around 15hr post delivery with a retained placenta. Fortunately, she was not hemorrhaging.  We got her up on the delivery table and Linda started to manually remove the placenta that was in shreds. Because she was so many hrs post delivery her cervix had already started closing down making it very difficult to reach into her uterus. We decided to call the Dr. because we did not know if we would be able to get it all and it takes the Dr. quite a while to come because they have to send a guard to go and look for him and then it takes a while for him to actually make an appearance.  Because we had no idea when he would actually show up, we kept trying to get out all the pieces of the placenta. Surprisingly the Dr. showed up about 20min later.  Right about the same time that Linda was getting out the last bit of the placenta. The Dr. came in and stood with his arms crossed and watched Linda for a minute and then left not even saying anything to us.  Linda didn’t even know he had showed up.  He didn’t give us any orders for antibiotics – nothing.  He just glared at us and then left. We were like “ok what was that all about?”.  (For the woman’s sake I was so glad that Linda was able to get the job done because the Dr. would have done a D&C right there and not given her anesthesia or pain meds.)  I think that the OB-GYN Dr. here has a huge pride issue.  When he comes and sees that someone else is doing the procedure when he was called, he is not too happy, even when he usually takes forever to come. Also when ever we have made suggestions for the good of the patient he comes unglued that we would even suggest something to him. I am not sure if it is just the culture of an Ethiopian Dr. or if he just has some issues. (Just as a side note, he randomly writes a note to the hospital and tells them that he will be gone for several days therefore leaving us with no OBGYN Dr.) The hospital is kind of frustrated with him also.  Evidently, he is very rude and nasty to the nurses, so we are not alone.  The administrator had to have a talk with him, which we hear didn’t go over so well.

After cleaning up the woman with the retained placenta and sending her to the ward, (I felt sorry we had to put her between two women with babies when she did not have one but we had no other choice) we decided she definitely needed antibiotics.  To call the Dr. just to get an order for that, was just asking to be chewed out. So we wrote our own orders for antibiotics.

I was horrified to find out when I asked the nurse how she gave the first dose of 2gm of ampicillin. She told me she just flushed it down her IV without even diluting it!!!!  And surprise surprise her vein blow (or probably melted) and the IV infiltrated just a little while later. Needless to say I showed them how to dilute and slowly push the meds over an extended period of time.

Several hrs later we got a new pt. She came in complete with a bulging bag of water.  The head was at about -2 station so we broke the bag to find thick mec, again.  Also because the head was kind of high she went back to an 8 when we broke her water. Her main problem was that she was going on 20hrs of labor and she was just exhausted and her contractions were petering out. After about 1 ½ hours and no really good contraction, we started an IV with pit to augment her labor and sure enough just a little while later her contractions we adequate. We let her labor for a while and then she finally made it again back to complete.  The baby was sounding great so that was reassuring with her having such a long labor. So she pushed and pushed and pushed making minimal progress. She was just so tired and not a good pusher. We also found out she hadn’t eaten for 15 hours and we asked for some Fanta (pop easily gotten in the middle of the night).  She drank about a cup – unwillingly.  After an hour of pushing and making little progress the nurses suggested that we use the vacuum.  Neither Linda nor I had ever used a vacuum but this woman did need to get her baby out soon!  She was fading.  So we decided to try it. It worked like a champ! With one push and Linda using the vacuum the baby’s head came right out.  The baby did not have a fit problem, the mom was just too tired and couldn’t push. We suctioned at the perineum and the baby had lots of mec in the mouth and we knew that this could be a problem. Once we’d suctioned, out came the baby along with an enormous amount of pea soup amniotic fluid.  ENORMOUS!  It created a huge lake on the floor and covered me and filled one of my shoes turning my sock green.  Needless to say I wasn’t very happy about this.  I did the best I could given that I was the NICU team and had no proper supplies for a mec aspiration. The baby’s lungs did not sound the greatest but after lots of percussion and bulbing and 02 for around an hour the baby was doing ok to go out to the mother. We found out that her first baby born at home, had died at birth. Both parents were so happy to have a living baby!! I think that the dad was worried about the baby when she did not come out with the mom so we asked him to come back and see the baby. We let him hold the baby while she was on 02 and we were observing her.

That next morning we asked the “charge nurse” to please keep them here longer than 12hrs so we could observe the baby for pneumonia or any problems relating to the mec aspiration.  They told us that they would, but when we checked in later that afternoon they had already D/C her home. So much for that, I just pray that the baby will be fine and not have any problems.  Oh I forgot to mention also that when we went out to check on the baby and the mother about 45min after birth (mind you all the nurses were sleeping at the nurses desk, some on the desk and some of the floor) we noticed that there was quite a bit of blood on the bed. After lifting up the covers we realized that she was hemorrhaging (dah, long long labor, pit augmentation, exhaustion). It was a good thing that we checked on her because otherwise she would have just bled out while the other nurses slept. So we fixed her up with some meds and monitored her for awhile. We think that she bled because her uterus was so tied from such a long labor that is was having a hard time staying contracted. But after some methergine and pit she did ok. 

            Once that whole ordeal was over we decided to get some rest ourselves. Linda and I were sharing one of the twin sized labor beds, and just as I was about to fall asleep (Linda had already fallen asleep) I heard some moaning and groaning sounds.  At first I just though I was dreaming and then I thought it was maybe just someone on the ward. But I noticed that it was coming from the other direction than the ward and kind of outside. So I got up to investigate. I went out the door to the OR waiting area where the outside door was located and there was a pregnant women squatting and trying to walk being supported by several men. I quickly told them to follow me.  They were lost and did not know where to go. We got the woman on the delivery bed lifted up her dress to find the babies head crowning. I yelled quick get me some gloves (by the way as I was guiding the woman to the delivery bed I yelled to Linda to get up because we had a patient!) I put on my gloves with one ripping just in time to catch the baby. This baby also had thick mec (it did not aspirate), was a girl and was the moms 2^ndbaby with the first being at home and having died.  This mom did fine and could not stop smiling because she was so happy to have a live baby!

            So that was our night, it was kind of crazy but a good night. We went home and sleep for a few hrs and then got up to go to the market with our cook. What an experience to go to market here. It is defiantly not your normal trip to the supermarket. The people are all lined up along the side of the road with their goods on burlap sacks on the ground. Everything is fresh grown, no processed foods here. So with our cook by our side we learned the different foods grown here and showed her the foods we wanted. Walking down the street and hearing the word foringe’ foringe’ has become a normal occurrence for us and watching all the little kids run to be able to get a better look at the funny looking white people. Also all the people in the market want the foringe’ to buy food from them. And of coarse they want to jack the price up for us.  Our cook made sure they didn’t do that.  It was a fun time and we got lots of pictures of the animals just wandering on the street and around the market and just the busy Gimbie market life. I was happy to return to our little hospital compound where I did not feel like everyone was staring and yelling at me.  It is weird to be in the minority and considered STRANGE.

 

Well it’s early to bed for us tonight with having only 4 hrs of sleep we are headed to hit the hay.

 

So until next time…

Meconium and Feet First

Well today is my half Birthday!! I am 22 ½ now. I know it is kind of funny but my family always like to have fun with it. You should figure out when you half birthday is too and have a ½ birthday celebration!

Today started out with cleaning a store room that has a whole bunch of medical supplies and I mean a lot lot of supplies. The problem is that they are all in bags and boxes and nothing is organized. Some if the stuff came back in the 90’s so you can imagine how much and long the stuff has been there. Our job is to organize all of it and separate it into useable things and unusable things. There are things like ventilator tubing, tracs, expired meds and other things that will never be used here but there is a lot of things that can be used such as IV’s and tubing, needles, caths dressings just to name a few. This room is such a mess that after working for a couple hrs you are exhausted and can’t stand the mess and dust any more. So we have been working a few hrs every morning on this big project.

After lunch and a short rest we were off to the hospital for our pm shift. When we arrived there was only one first time mom in L&D and she had just been started on pit because she had SROM’ed about 10hrs before and was not having any contractions. So the pit was started and we were to up it every 20 min until contractions started. So we had to sit and feel her tummy to feel if any contraction came and how long they were (there are no monitors here). It was very interesting to say the least to start a pit drip with no IV pump, we had to count out the drops, and with no electronic monitoring. So after upping it only once her contraction started J . A few hrs later another laboring woman came in she was on her 2nd baby and came in a 5cm. We got her all settled in the laboring bed and then let her labor down. About 1hr after that another woman, on her 4th baby came in in labor (when it rains it does poor). We only have 2 labor beds so she had to labor on the delivery table. After doing an assessment we discovered that the baby is breech with a foot presenting and bag intact. We had called the OB Dr. to consult and he came to evaluate the situation. He too confirmed that it was breech and one foot was slightly down. He decided that it the foot would go back up then we would attempt a breech delivery but if the foot continued to present then he would do a c/s. The woman was progressing very quickly she came in at 5 cm and about 1hr later she was 7-8 and then her water broke spontaneously. We quickly checked her and got heart tones and everything sounded and looked great. Things went very fast from here and with in minutes a foot was appearing. There was not time for a c/s so the Dr. would do the footling breech. It was very neat to watch and the Dr. did a good job except when it came time to deliver the head he starting pulling and pulling, I was horrified that he was pulling so hard I really though he might decapitate the baby. But my a miracle he didn’t and he had that baby out in less than one minute. (to bad there are not chiropractors here I think that baby might need one) The baby did well with apgars of 7/9 and the mom did not tear at all.

After we had that mom all cleaned up and out to the ward we went to evaluate the next laboring woman. She is the G2 P1 and was 5cm last check with a bulging bag. It had been several hrs since her last check so we decided to move her into the delivery room. Upon examination she was now a 7 with a very bulging bag. I broke her water to find thick +3 mec. We got everything ready to do suction if needed and resuscitation. It did not take her long to become complete and then the pushing started. She really did not push long at all and the head was out. I did some bulb suction at the perineum and then the body came out. With a little more bulb and some stimulation the baby had an 8/9 apgar. The mom had no lacerations so she was cleaned up and moved out to the ward.

It was now the G1 P0 woman’s time! Poor thing she was the first one to start laboring and she had to watch two other women labor beside her and deliver before her. I think she was very excited to be able to move to the delivery bed! I checked her again and she was now 8cm. It only took her around an hour to reach complete and then the pushing began. Because she was a first time mom it took her longer but she did very well. The baby came and had a cord around the neck but loose enough I was able to take it off at the perineum. Also when the baby was born we realized it also had thick mec. But a little suction with the bulb did the trick and the baby did great. This mom did have a laceration so I learned again how to stitch. It was much easier this time and everything made much more since. Linda is a great teacher! I will have to say the stitching job looked very pretty especially compared to the way the locals stitch!

Well I had prayed that we would get some births soon because it had been 3 days with no births, and well God answered out prayer and gave us 3 in 2 hrs! I am really enjoying helping the women here and learning so much. This experience is priceless.

Death and Life

Today we worked the pm shift 3:30 to 9pm. When I walked onto the unit I noticed that the family that had the preemie baby was gone. My heart sunk as I thought of what most likely had happened. I asked the nurse at the desk and she confirmed my fear. The baby had passed away. I had mixed feeling about what had happened, crushed that all of our efforts to do what we could to help the baby were not enough and my heart ached for the family as it was their first baby and all of them were so evolved in trying to save the baby. But I also felt at peace that the baby was no longer suffering and would not have to endure the very hard life of having to live with a lot of medical problems in a place were healthcare is very limited. But I cling to the fact that I will someday in heaven I will be able to meet this little girl again and tell her how much I tried to help her and how much I cared. Death here is something that is common but I thank God that I have not had to yet deal with it face to face. (I was glad that the baby went when I was not working.) The other day we were leaving the hospital and 2 men were carrying, actually they were running, a wrapped up body on a stretcher out of the hospital. I guess when the family finds out they all start whaling so they hurry them out before the noise begins and disturbs the other patients. He had died of HIV. I know that soon enough I will have to face this reality and see the death that is so common here. I just pray that God will help me to stay strong.

On a happier note, the nurses that we got to work with on our shift were so much fun. They knew some English so it was nice to be able to communicate some. They tried to teach us some of their language which is very hard and we all had a good time laughing at our inability to pronounce their words correctly. It was very slow with no laboring pt’s so Linda and I decided to clean and organize the nurses station. It was in much need!!! I am sure that the nurses think we were crazy because whenever it is slow we find things to clean and organize, and they just sit and talk and make gauze 4x4’s. Having things clean to them is not a priority by any means. After the nursing station was clean to our satisfaction (who knows how long it will stay that way), we all got to talking again.
Linda and I had wanted to ask someone about the female circumcision that is done here so frequently and we thought this would be a good time to ask. So we brought up the question to them and we were very shocked to hear what they told us. They do what is called level 1 circumcision. It appears they remove most of the labia minora and they say the clitoris as well. (I haven’t been able to tell that the clitoris is missing) They told us that it is done when the girl is 7 or 8 years old and it is a big celebration. They said they would have their girls done despite known efforts to get them to quit. The only reason they would give for doing it was – tradition and then laughingly to prevent them from running off with other men. Of all that I have seen and heard about, this isn’t as bad as most. At first I didn’t even notice the difference. There is evidently a village person who does the procedure and without anesthesia or antiseptics. They did say it was VERY painful and they all remembered it vividly. Yea, I bet!!!!
The culture is defiantly very different here but it is interesting to learn how other people live, even though some of the practices are well to put it softly are dreadful! This is for sure cultural experience!
Well no babies on this pm shift L maybe tomorrow though!

Until next time…

Hello Friends Again

Dear Friends and Family,

Rain, rain, rain. We are growing gills. Actually it isn’t that bad. There are a few days with no rain and everyday has some time with no rain. It just comes down in buckets and makes rivers and mud.

The work here is varied. Linda and I have been spending our mornings sorting through this huge storage room with medical supplies some of which date back to the 90’s. It is an amazing amount of stuff and very dirty work.

We had several days with no babies born. I mean there weren’t any even on other shifts. They say that when it rains the women don’t come to the hospital because it is too muddy.

The preterm baby we worked so hard to save, died after 4 days. Thankfully, it didn’t happen on our shift, because I was very attached to that baby. It is probably best since she had many bowel problems that would have made life miserable for her at best.

Yesterday Linda and I were going through serious birth withdrawal so we prayed for births. We had 3 in 2 hours last night. The first Dr Esayas delivered because it was a footling breech and he wouldn’t let us do it. I sure did learn how NOT to deliver a breech. He was actually very good about it until it came time to deliver the head and then he pulled so hard I thought he was going to pull the body off of the head. I was so worred that I was hopping up and down and even told the doctor to stop while he was pulling super hard on the babies body. It was frightening! The next 2 babies I caught. The first didn’t tear but the second did and I got to do my second suturing job! Both babies had thick mec and one a cord around the neck so I am just getting all kinds of good experience.

We observed 2 of the local midwives suture and their technique is ancient history. They use 2.0 chromic gut – rope. One used 3 packages of suture on one tear. Can you imagine how much rope was in her tissue? It was unbelievable. She also used only interrupted stitches with external knots. That poor woman is going to have a very pokey, sore bottom not to mention the risk of infection with all those suture holes externally. We went and spoke to the woman (a Kenyan midwife) who trains the midwives, about this. She said she had only once seen a UK doctor suture the way we do with all internal stitches and she wants to learn so she can teach them correctly. Ah ha! The source of the problem. It is good that she is willing to learn. The midwives that have watched Linda and I suture are amazed and watch carefully. I really hope they are getting it. After teaching the teacher, I hope we can have an in-service on suturing for the OB staff.

They also cut a lot of medial lateral episiotomies for these little babies and they do it before the head is even down on the perineum. The Kenyan midwife teacher says she teaches them to not cut but they seem to be afraid they will tear up if they don’t cut. They don’t document that they do it in the log book even though there is a line for that, so no one knows just what is going on.

Two nights ago when there were no births, Linda and I were cleaning up the nurses’ station. (The paper confusion and mess is atrocious.) After we were done, we were talking with the 4 nurses present. We asked them about female circumcision. We have been very curious. They do what is called level 1 circumcision. It appears they remove most of the labia minora and they say the clitoris as well. (I haven’t been able to tell that the clitoris is missing) They told us that it is done when the girl is 7 or 8 years old and it is a big celebration. They said they would have their girls done despite known efforts to get them to quit. The only reason they would give for doing it was – tradition and then laughingly to prevent them from running off with other men. Of all that I have seen and heard about, this isn’t as bad as most. At first I didn’t even notice the difference. There is evidently a village person who does the procedure and without anesthesia or antiseptics. They did say it was VERY painful and they all remembered it vividly. Yea, I bet!!!!

The other day we were leaving the hospital via the ramp in back when 2 men rushed by us carrying a stretcher between them with a dead man wrapped up in a sheet on it. He had died of HIV. They hurry any dead out quickly because the family starts wailing loudly and they don’t want them doing it in the hospital and disturbing the other patients. I thought he was going to bounce right off the stretcher, they were running so fast.

I got to inspect their bee hives here and make suggestions. They need to purchase a few things before we can get started. The gardener showed us 3 hives that were in local hives. They were very interesting. They are made of woven reeds/leaves into a huge pod that has an opening on one end. They are probably 2 ½ feet in diameter and 4 feet long. They were hanging in the rafters of a shed. The bees here are Africanized, which means they are vicious. I did bring my bee suit fortunately and will help them get going when Paul and Petra get back from Addis Ababa with the supplies.

There are 2 local conversation tools that we find fun once we figured them out. The first is when talking and the response is yes or an acknowledgement of understanding, they gasp with an eyebrow lift. The second is when they want to say OK they shhh. I thought they were shhh ing me but they were really saying OK. It is so much fun living in another culture and discovering other ways of doing things. J

Well Hope all is going well with everyone at home and I miss you all!

God is good. All the time.

Amber

Episitomies, Dilation, and Feeding Tubes

We got off work around 8:30am this morning and our laboring women were at 8cm and 6cm. We were bummed that they did not deliver because we labored with them all night. We told the African midwife on for the day shift that we would go home and eat and then come back to hopefully deliver the woman who was 8cm. We had developed a bond with her and wanted to deliver her. We got back to the hospital about 2hrs later and she was on the delivery table with the baby coming. It was not even the midwife delivering her it was one of the nurses. By the time we got there the nurse had already cut a large medial- lateral episiotomy without the head even showing. The baby soon came and it weighed only 2.4 kg. It seems that all the nurses and midwifes here give the woman episiotomies even when they don’t need one and then watching them stitch her up was a even more horrific experience. Mind you I have not seen many repairs but this just looked brutal. They used very little lidocane, we actually asked them to please use some more because the woman was in so much pain and squeezing the life out of Linda’s hand. They reluctantly gave her some more. Then the repair began. All of their stitches are interrupted and the knots they use are slip knots. They used 3 packs of suture which was 2.0 catgut (which was like rope!). Her bottom was so full of suture it was painful to look at! The stitches were all knotted externally leaving pokey ends and a great opportunity for infection. When the laceration was all repaired it was not approximated well at all and was all puckered, nothing near smooth. Linda is making plans to give some in-services to the midwifes/nurses on how to suture because their technique is so bad. Hopefully they will be receptive and willing to learn.

Before we had left for the end of our shift we had requested several things to be done with the preemie infant to help her such as change her IV dressing that was soaking wet and insert a feeding tube through her nose so she could be fed though it. She did not eat well for me the whole night, she was not swallowing well and she needed nourishment. When we came back for the one delivery we were happy to see that they had preformed the tasks we had asked. The baby was still hanging in there but still doing far from good.

After sleeping for several hrs we had all the Americans over for lunch after church and then visited in the afternoon for while and then took another nap in the afternoon. That evening after sundown Linda and I decided to have a movie night so we watched a movie on my laptop, we found one plug that works in our house and an adapter for US plugs!!! After our movie it was off to bed for tomorrow was another day of work. Here they have 6 day working weeks. Linda and I are really blessed for the accommodations we have, running water most of the time and electricity to power the lights and one plug-in. We are truly living in luxury!

Night Shift

Well tonight we are working the night shift. It is a bit busier tonight with two laboring first time moms, who were going very slow. Right now one is at 5cm and the other 2cm. I broke the water of the woman who was 5 because she had been about 4hrs with no change and had a bulging bag of water. We are hoping that this will speed things along. I am learning to do dilation checks by checking our two laboring women. I am hoping that they hurry up and dilate or they will most likely have a c/s tomorrow. We also have a preemie baby weighing only 1.8 kg the baby did not pass a stool for 48hrs and then it was decided that it had a bowel obstruction from an x-ray. The general surgeon here was going to do the surgery, that of which he had never done before and to make matters worse we don’t have an anesthesiologist so no one knew how to do the anesthesia on the baby. We did not think the baby would make it thought the surgery but by a miracle it did. (The only reason the surgery was attempted was because the parents had money to pay for the surgery and they insisted that everything be tried, so the surgery was done to create a colostomy) They baby was not doing so well after surgery, retracting, grunting and her color was awful. With no pulse ox there was no way to see what her 02 stats were so we put her on 02 and she did respond well. She started to improve and the nasal flaring and grunting stopped and the retracting we mild. I was starting to get encouraged about her survival rate. But then things started to take a turn for the worse. Her retractions worsened and the worse part is that her lungs are starting to fill up with fluid. I am not to sure how much longer she will be able to hang on. Please pray for this little baby that she will get better or go peacefully. It is so heartbreaking to see such a small baby suffering and there is nothing you can do. We don’t have the equipment or supplies to care for her like she should be. Being in the mission field is exciting and fun but you must also remember the harsh realities of limited healthcare. It truly makes me grateful for the healthcare we have in the US.

Clinic Survival

Well I survived being out in the middle of nowhere with only 1 native nurse, operating a clinic with which had nothing but some worm medicine and some pain meds and gloves. There was a very nice clinic in this town but it burned down last week. They really to open the clinic but did not have the nursing staff because the one nurse was in training. It was quite an experience being fully immersed into the culture here; it made me feel very grateful for how we live in the US and for what we have. We cooked over a fire and had running water and electricity for about 5% of the time and when we did have water it was very cold and at random times. So I did not have a shower for two days, so I fit right in with the local people! I actually got to come back this afternoon instead of tomorrow morning, and I was very excited to find that the water was on at our house when I got back so I got a shower!!! Well right know I it is about 2:00am and Linda and I are working the night shift. Just when I thought I would be done with working nights! Well already tonight we had a woman come in that delivered at home and still had not delivered the placenta. It came right out when we got her on the delivery table and after further examination we saw that she had a laceration. So Linda told me to glove up and I would be doing my first repair. So with much coaching and guidance I sewed her up, and it looked pretty good I should say! Other than that it is very slow, just keeping a good eye on a baby that will most likely die soon, it had a bowel obstruction no stool for 48hr and vomiting up mec. They did surgery because the parents are “wealthy” but the Dr. had never done this kind of surgery before and nobody new how to do the anesthesia on an infant. We thought the baby would die during surgery but she some how survived. They gave her a colostomy so we will see how she does. We started her on O2 and she responded well to that (we have no 02 stat monitor), but she is still having retracting and grunting and her color is not so good. So keep her in your prayers that she will either go quickly or get better soon. Then the other lady we are watching is C/S of earlier today, had general anesthesia (that’s what everyone gets) and gets no pain medicine but some NSAID type which does nothing. I feel so bad for her. All the other pt’s seem to be doing fine.
It is quite an experience to work here I am learning so much everyday and my present knowledge is being challenged everyday.

Well I do miss everyone and all the luxuries of the US but I am learning lots here and realizing how much we really have. I am also realizing how much I miss everything being clean!!! Everything is so very dirty and the smells are awful.
But with Gods help I will make a difference here and come back a stronger person.

Well until next time and with much love,
Amber

Challenges

We woke up today and there was still no water, so no shower today. We got ready and went to worship by 8:00 and then down to the ward by 8:30. When we walked in there was a woman on the delivery table. We asked what the situation was and found out she came in bleeding and they were waiting for the Dr. to come and do an ultrasound. The Dr. came and it was decided that she had placenta previa, so off to c/s we went. Linda and I went in to do take care of the baby when it came out. The baby did fine with apgars of 9/9. The mom had general anesthesia and it took them all of 10 min to get the baby out once the mom was out. What an experience to be in the OR here. Linda and I were trying to set up O2 incase we needed it for the baby but the O2 was on the other side of the room from where the baby was to be cared for. We tried to move the O2 closer but there was no other plug. We were running out of time, and they were started to cut so be bagged the O2 and hoped that we would not need it. Everything turned out good and the mother and baby are doing good. ( poor mother they have no pain meds for her)

At about noon we went back to the house to talk to our cook about the cooking and cleaning and ate a very good lunch that she had prepared for us. Potatoes, cooked greens and fresh baked bread. After lunch we took a quick nap and then had to be at the hospital about 3:45 to start our assigned shift from 4-9pm. We waked in and there was a woman on the table who was groaning and looking like she was pushing. But there was no one there. We went and got the nurse and asked about her and they said she came in about 1:30 with PIH and was 6cm. They gave her some diazepam and then let her labor. When we waked in she was pushing. So I quick put on some gloves and caught the baby. It was a small baby 2.4 kg but did well, lots of vernex!! She did have a 2 degree tare so I watched and learned from Linda how to repair it. After the repair back to the ward she went. Her BP was still high 180/90 so we decided to call the Dr. and get her stated on Mag. What and experience starting a mag drip here. There is no IV pump, so we had to calculate it all out and figure out how many drips a minute the IV should be at and then count it out to make sure it is the correct drops. Then trying to explain to the other nurses how often her V/S need to be taken and DTR checked was a joke. It seemed like nobody cared. So we kept and eye on her for the first 5/6hrs and then we had to go to bed and we really hoped that they would continue to take her V/S. The next morning the pt was still alive even though no DTR’s had been done and only a few V/S taken. Things are so different here it is hard to adjust. Having some previous knowledge in OB and all the meds has been a huge help, thank you LLUMC!!!

Please continue to keep us in your prayers as we face new challenges everyday, but by the grace of God we are being able to help the people here and train their medical staff to better care for the pts.

Heartbreak of Ethiopia

So the 20th was our first day in the hospital. We got a tour of the whole hospital and then a more detailed one later from one of the RN’s who does deliveries. The OB and woman’s ward are all in one large room with some small dividers. The RN who is in charge of the ward took us around and told us about all the cases and it was so sad to hear some of them. One woman had come in with a ruptured uterus and the baby dead and to have a hysterectomy. She was so depressed about it that she had psychosis and was refusing food and drink, so looked terrible. To make matters worse she was in a bed next to a woman with a baby. The woman did have one other child and I suggested that they bring the child to her to help her but they said that the child was to far away. They were able to more her to a private room on another ward to get her away from the other mothers an infants. But another mother who lost her baby at 3days old for reasons I was not able to gather was right between to mothers and infant, and often I would look over to her and she would be crying and just watching the mothers nurse there babies. I was just heart breaking.

Linda and I missed a birth during lunch because they were unable to get a hold of us, we are trying to fix that problem. But when we came back we helped her start breastfeeding. She had a 2kg infant and the RN who delivered her gave her a large episiotomy. So you can tell the people here need some training. Linda and I were put on the schedule for the 20th from 4-9pm because there was not midwife on and only 2 nurses for over 20 pts. The language barrier is very hard. One of the RN did speak very little English but it was still very hard. Because Linda and I did not really have anything to do because there was no laboring pt at the time we decided to clean, and boy did it need it. There was dried blood on the labor beds and delivery beds and dried mec on the scale and wall. So we scrubbed with rags and toothbrushes. We also organized the delivery room and all the supplies because you could not find anything and nobody new what supplies they even had. While Linda and I were organizing all of a sudden a woman was carried in by 4 or so men and put on the delivery table, she was complete and pushing. Linda told me to quick put on some gloves and she with me helping delivered the baby, in less than 10 min. The baby did have thick mec all over him but had agars of 8/9. The woman did well this was her 4th baby, and after about 15 after delivery she had to get up and walk to the ward to her bed, leaving bloody foot prints all the way. Then the nurse came in with mops made of rags and sticks and moped up the blood. Later we went out to check on the woman and ask if anyone a checked her fundus and no one had at it was almost 1 ½ hrs later. It was then checked and everything was good. There was blood everywhere because they just put a rag between their legs to catch the blood. I guess you use what every to got.

We also got a new admit to the med/surge ward of a middle aged woman with a compound fracture and both bones broken in her arm. The Dr. was called but he was in a he market and so we could not get a hold of him. So this woman already at 12hrs post the break just had to wait with her compound fracture for the Dr. to come at some time. He had still not come we left from our shift. So you can see the needs are great and I hope that as time goes on and the nurses let us do more and we will be able to make more of a difference and help more people. Please continue to pray for us and the people here that we will be able to use our supplies and skills to the best.
Well hope you enjoy this little peek into the life here at Gimbie and what we are doing.

Well everything is packed, my house, my car and my bags. I am now hoping that everything got done that needed to be done, and if it didn't then o'well because it's too late now!! My plane leaves from LA at 10:40am. I will be meeting up with the Midwife that I will be working with there in LA and our journey will begin! Please keep us in your prayers as we will be traveling for around 25-30 hrs. So until we are in Africa...

God Bless.

To AFRICA...

Well it's 100% official, I am going to ETHIOPIA AFRICA!! I received my visa today, have my plane ticket and now all I have to do is pack. But packing is not as easy as it sounds, for I must pack up my whole house and fit it into my car. If it won't fit it wont go! Then I have to also pack my bags to take to Africa. So yes it is a very big project!

I am really excited about this trip not only to go and help people with needed health care and to see new and exciting places, but to see God work in amazing and unthinkable ways. This trip was truly a miracle and Gods hands were all over it. Without Him it would never have been possible to pull this off in 2wks. Every day I have witnessed a new miracle making this trip possible and showing me that God is in control. So stay tuned to this blog if you want to see God work in crazy ways, because I can truly say that this is a God ordained trip!

So until Next time...
amber