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…