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 2ndbaby 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…
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