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