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
No comments:
Post a Comment