Friday, December 16, 2011
Well, I'll come right out with it. I have a hidden motive for writing this blog. Well, I guess it was hidden until I just told you it was hidden...so I guess it's not hidden anymore. Wait. I'm confused. Anyway, the other day I was talking to a friend of mine (shout out MAS, you'll know who you are). She was asking me about what kinds of things we'll need at the hospital in Sierra Leone, and how she could help. Since I've had multiple people ask me this, I thought I'd throw out a few ideas if there are any of you who feel the same.
Number One: D50. In the time I've spent at the hospital, I think one of the easiest but most important things we do for our kiddos who are sick is check their blood sugar. You can read about two of these instances here http://emilyinsierraleone.blogspot.com/2011/10/so-proud.html and http://emilyinsierraleone.blogspot.com/2011/08/bleh.html
Kids with malaria often have low blood sugar and the thing that saves their lives (I've seen it many many times) is a medicine called D50. When we have it, it's like gold. :) Unfortunately we haven't been able to find it in country so the only way we can get it is to bring it in. I did some research today and found out that a vial of 50ml is $1.40. We usually give a kid 5-10ml, so one vial can be used on quite a few kids!! Awesome deal! :)
Number 2: Glucose monitoring strips. Although the D50 is pretty cheap, the strips that we use to check the blood sugars are pretty expensive....about $1.25 per strip. Since we have to use them to find out if the blood sugar is low before we can give the D50, they're pretty important.
Number 3: RhoGam. We have two pregnant women who have recently come to the hospital who are RH -. This means that they can safely deliver one child, but the way the antigens and antibodies work (might want to Wikipedia it)she won't be able to have a second baby unless she gets a shot of RhoGam. It's $90 a dose. I need two doses.
Anyway, those are a few practical ways you can help if you want to. :)
Checks can be made out to
Willamette Medical Teams
PO Box 772 Albany, OR 97322
Thanks guys! Merry Christmas!
Tuesday, November 22, 2011
Tuesday, November 1, 2011
Another thing that makes me a bit of an oddity is the fact that I drive. I drive all over the country and people are always commenting about it. A couple months ago I had one of the nurses at the hospital ask me to teach her to drive. The next week I had another woman ask me. Then another. Ha! Well, I may have to give up my whistling, but teaching these women to drive will be a good substitute for my “girl power” that I’m giving up by my whistle cessation.
So last week we had our driving lesson. It ended up being two girls and the father of one of the girls. (When he found out I was going to teach his daughter to drive he begged me to teach him too.) All the roads in our town are dirt, so I was just going to teach them on one of the roads, but they suggested we go to an empty field. Boy am I glad I took their suggestion!
I underestimated how bad they were going to be. Since the lesson I’ve tried to remember learning to drive myself. Since I grew up on a mini-farm, I learned when I was pretty young. The day I got my learners permit I drove home from the DMV (which included some freeway time). I’m sure there was a learning curve but in my own hindsight, I of course, was perfect.
These new drivers….were not perfect. “Joseph” was first up. He has a motorcycle so he was definitely the best. After he the circles around the field, “Aminata” was up. Joseph got out of the car and refused to stay in while she was driving. He was too scared. Ha! Around and around we went. Although it was a big field, while we were there a soccer game started so we had to keep our circles pretty tight. There was a big cement block of some kind in the middle of our circle. Of course, for some reason there seemed to be a magnet that drew us to the cement block.
Joseph, standing on the infamous cement block, giving lots of advice, but refusing to ride with us :)
While Aminata was driving, we started heading straight towards the cement block. I didn’t really say anything, assuming she’d correct. You know what they say about assuming. As we got closer and closer I said “ok, slow down, turn to the right….” I’m pretty sure she meant to hit the brake but slammed on the gas. And we ran straight into the cement block. She was horrified. I started cracking up. Aminata, concentrating so hard.....right before we ran into the cement
If my car (Boris) was really nice, I probably would have been a little bummed, but one glance at the front of my car and I knew no one would even notice. I’m thanking God that no internal damage was done, but also thanking God for the great memory and the dirt that I can now hold over her head for years to come!! The good news is that by the end of the lesson, they were all doing much better and were becoming more confident. I’m sure (ok…maybe 70% sure) that our next lesson will not include any accidents!
On another note, today is November 1, which means that I’ll be home THIS MONTH!! Woo hoo!!
Saturday, October 22, 2011
I put it on my bucket list of things to do before I leave this year. My roommate will be leaving about a week after me and we have a midwife friend from Nigeria who will be leaving in December. We decided to make it a girls trip and invite my Sierra Leonean friend Kadiatu too because she’d never been before.
As I started asking people about this game park, I started getting nervous for a couple of reasons. Number one. In order to get to the game park, we have to cross ariver, in a "ferry". And this ferry is super sketchy. It’s pretty much just a bunch of planks put together…somehow. They have a big cable that stretches across the river and 3 guys literally pull the “ferry” across the river by hand. In the dry season, this isn’t really a problem, but in the rainy season, when the river is high and fast well….you catch my drift. Rainy season is still upon us, so this was almost a deal breaker for me. But not quite. Oftentimes, when I'm contemplating doing something I will ask myself, "Emily, if you die doing this, when people come to your funeral will they be crying on the outside but thinking on the inside that you were really an idiot for doing that?" This one was on the line....and in tennis, lines are IN!!! The "ferry!!"
The second thing that made me nervous was the fact that because the ferry was so sketchy, we were strongly encouraged NOT to take a car on it (although one could theoretically squeeze on). This meant that we needed to hire motorbike drivers to take us up there and back. Motorbikes are one of my other fears. I’ve seen too many accidents firsthand and have taken care of too many accident victims in the hospital. However, I didn’t want to let irrational (or slightly rational in my point of view) fears keep me from doing something awesome. So this morning the four of us headed with our rent-a-bike drivers up to the game park.
The trip started off great with some beautiful scenery. However, I was quickly faced with a dilemna. I wasn’t sure where to put my hands. I didn’t want to wrap my arms around this guy….but where do I hold on? I had my fingertips lightly resting on his jacket ( I didn’t think he could even feel me!) but after a little while he swatted my hand away. Oops….must have broken some motorbike etiquette there. My bad. Then I remembered that I’d seen people hold onto a little pole in the back so I leaned back a little bit and grabbed on there. With both hands. Perfect! In hindsight, I think this is where the trouble began.
Since I was holding onto the back, I tended to lean back, putting my weight to the back. I also had a pretty heavy backpack on because the other way Africa tries to kill me every day is through the painfully slow process of dehydration. So we brought a lot of water! Every time we went up a hill my backpack tried to pull me off the back. Abu told me I needed to scoot closer to him. I tried, but if I scooted too forward, I couldn’t hold onto my lifeline at the back.
Then it happened. We started up the hill. It was rocky so Abu (my driver) had to slow way down. Way way down. As we slowed down I started to feel the pull of my backpack try to pull me off the back. And off I went. Right off the back of the motorcycle.....while it was still moving. As I slid off, I’m not sure exactly what happened but the next thing I knew, the motorcycle was on top of me. I don’t think Abu really knew what happened either because it took him a few seconds to turn around and when he did and saw me on the ground with the motorcycle on top of me he said, “Oh $*&#!!!!!” But then just stood there. I laid there long enough for the thought to cross my mind…. “Ok, this motorcycle is kind of heavy….and it’s getting hot!” Then he sprang into action and helped me get it off.
I felt bad for the guy because he looked just horrified….even though if it was anyone’s fault, it was mine for hanging on the back and having the heavy backpack on. I started laughing and everyone kept asking “are you ok? Are you ok?” I thank God that my friend’s dad made us all wear helmets because I did smack my head on a rock on the way down, but aside from some scratches and a sore back, I’m no worse for the wear. Also, since I didn’t actually get to see how it happened, I only have the mental picture for myself…and I’m cracking myself up on the replay!
After that little drama, our adventure continued and we got to the game park. It was deserted. It was at that moment we thought…hey, we should have called ahead. But alas, no phone service so we couldn’t have even if we’d have thought of it. Eventually somebody found somebody who found somebody who could help us. Since they told us the monkeys had just been there but had left to go eat, we decided to go see the hippos first and come back for the monkeys.
Our hippo hunt meant that two of us went in a canoe with one of the “park rangers” who would take us to where we could find them. They told us we needed to go one guy, one girl but I didn’t come all that way to hang out with my motorbike driver so I told them I wanted to go with my Sierra Leonean friend. They handed me a paddle. Ohhhhhh…THAT’s why it was one guy, one girl. Cause one of us is paddling. No problem. I’ve been in my share of canoes. Granted, never on a river with hippos….but still. So we paddled down, down, down the river. Apparently there was a monkey but I didn’t see it. We kept paddling and paddling, but no hippos. The further down river we went, the more I was thinking “shoot man, we have to go all this way UP the river on the way back.” Eventually, my friend in the other boat made the call to turn back because her boat captain kept saying “they’re running down, down, down” and she said “well why are we chasing them??? Let’s turn around.” So back we went. As we were paddling, I noticed little blood spots on my legs. At first I thought they were from my accident but then realized that I was being bitten. A lot! I was being bitten by these flies that cause elephantiasis (where one appendage (usually the leg) gets REALLY swollen! I am sitting here now and lost count after 55 bites…on one leg. So I guess I did see SOME animals! (Yes mom, I’m taking the medicine to prevent the disease when the pharmacy opens on Wednesday!)
The next group got in the canoes and headed up the river. When my roommate got back she reported that while she hadn’t seen any animals either, she had seen some elephant poop. So that’s something.
We walked around the game park a little, saw the little huts that people can stay in if they want to….but didn’t see any monkeys. And then we decided to call it a day. And nary an animal did we see.
On the way back Abu saw a big snake on the side of the road but didn’t tell me about it until we’d passed it because he didn’t want me to jump and scream and make us both fall off….again.
When we got to the “ferry” and were waiting for it to come across and pick us up, one of the motorbikes started hissing from the tire. They got someone to come look at it and started to fix it on that side but everyone yelled at him to bring it across to the other side. So they hauled it onto the ferry. As we were crossing the ferry (which takes about 10 min. to cross) the mechanic started working on the bike….and dropped a really important piece into the river. Seriously? So when we got back to the other side, the hunt was on to find the right piece so we could go back. When I asked them what plan B was if we couldn’t find the part (keep in mind we’re in the middle of nowhere) they said we were going to put 3 people on the bike. Say what? When my Nigerian friend heard that plan she said, “But we’re all fat! How will we fit??” Abu said, “Yes, that is the problem.” Yes!! Quite a problem!
Fortunately they were able to patch the bike back together and we all made it back in one piece. Although I never did see one animal at the animal game park, it was a really fun trip with some good memories that I’ll have to take back with me when I go home next month. I’m going to miss this place and these people!!
Wednesday, October 12, 2011
My friend said that in his class the answers from the ex-pats were either spouse or child. Every single Sierra Leonean chose their mother…..because you can get another wife, have more children, but you only have one mother. I was kind of floored.
Since this conversation 2 days ago, I’ve been conducting my own non-scientific experiment by asking all my Sierra Leonean and ex-pat friends the same question. All my ex-pat friends have chosen either their spouse or child…..BUT so have all my Sierra Leonean friends! Interesting. So far, not a single choice for mother (sorry to all the mothers out there….no offense intended).
When my friends tell me their answer, I follow it up with "why? THIS has been the interesting part. I will give you a sampling of the conversations.
Me: “Ok, you’re on a boat….blah blah blah….Who do you choose to save?”
Sierra Leonean friend: “My child.”
SLF: “Well, I only have one child. I need someone to go on after I die and this is my only child. So I will save my child.”
Me: “Ok, on a boat…blah blah blah.”
SLF: (After thinking about it for awhile) “I would save my wife.”
SLF: “Well, she came from somewhere else. From a different family. Her family gave her to me. I am responsible for her. If anything happens to her, her family will be very angry with me.”
SLF: “I would choose my daughter”
SLF: “My mother is getting old. She will soon be a dependent. My daughter is a dependent right now but I am thinking ahead to when I am old and will need someone to take care of me.”
*We then ended up having about an hour long conversation about how his wife left him for another guy and he tried to get her back for a year but she wouldn’t come back and now she’s not even taking care of their child but has given her to someone else. He ended the conversation by saying that he would probably push his wife out of the boat, even if it wasn’t sinking.
So our answers were mostly the same….but I feel like the reasoning behind the answers showed our cultural differences. Instead of the answers being about taking care of the most vulnerable ones, or the ones we are closest too, my friends’ answers tended more towards survival. This isn’t surprising at all when considering the recent civil war and the survival instincts that that would hone.
Anyway, I’m not sure how good I feel about asking my friends to choose the most important person in their life…..but I did enjoy picking their brain and trying to understand them a little better!
Monday, October 3, 2011
One of the areas that I’ve been trying to work on with the staff is assessment- picking out those kids that are really sick. This week it was myself and a junior staff person taking care of 34 kids, so being able to figure out which ones are the really sick ones is really important. Unfortunately I’ve done rounds before and been in the ward for an hour before stumbling upon a kid that was barely breathing—but nobody who had been working in the ward for hours before had bothered to tell anyone. So assessment is key.
I try really really hard not to be preachy, so the way I tend to try to teach is that when I decide to do something (give a certain med, add an extension to the IV etc) I explain to the person I’m working with what I’m doing and why.
Two days ago I was working the evening shift, so that morning I was lounging around, reading. At 8:30am one of the junior staff at the hospital called me at home. The conversation went like this.
Junior Staff: “Emily, I have a child here who is very sick. I checked his blood sugar and it just says “low.” (Note: This made me proud in itself because we’d been practicing taking blood sugars all that week. The quinine that we give the critically ill kids tends to drop the sugar and since they usually haven’t been eating much in a few days when they come in, their blood sugar is often critically low. So the fact that he’d checked it made me really excited!)
Me: “Ok, that means it’s too low for the meter to read. Has the child been breastfeeding?”
JS: I don’t know. The mother has left, said that the child is dead already.
Me: Ok, does the kid have an IV?
Me: Ok, we want to give some D50 through his IV. Do you know where it is?
JS: Yes, I’m looking at the D50 right now, I just don’t know what to do with it.
Me: Ok, give him 5ml’s of the D50 and then check his blood sugar again in 15 minutes.
15 min later he called me back
JS: Emily, the blood sugar is now 101.
Me: That’s good! Ok, check it again in 30 minutes.
About 30 minutes later I went down to the hospital to check on the kiddo myself. When I went to the bed, the kid was wide awake and was eating. I went and got the junior staff and clarified, “Is this the kid you called me about?” He was beaming. Yup, that’s the one. I jumped up and down and gave him a HUGE hug and said, DUDE (I really said his name) YOU SAVED THIS KID’S LIFE!!! He got a huge smile on his face and just nodded.
I found out later that the child’s father came back a couple hours later and asked for the child’s body. The Junior Staff said, “Look, there is your child in the bed.” The father had already gone and dug the grave and prepared everything for the funeral. The junior staffer started explaining all about how the blood sugar works, etc. Not sure if the father understood but he got a lesson anyway. J Love it!
Wednesday, September 21, 2011
I took my Benadryl at 9:03pm. I tucked myself into bed at 9:40pm. And I turned. And I turned. Back. Left side. Stomach. Right side. And repeat. What's wrong with me? Why am I so restless? After 2 hours of this, I decided to get up and take another Benadryl. Really knock myself out. I also took some Tylenol because...well, it was my new best friend and I remembered from grad school that sometimes if old people are having trouble sleeping it's because they're in pain and Tylenol can help. Well, I am almost 30 so if it works for them, maybe it will work for me. Also, my legs felt really weird. They were tingling and would occasionally have little bursts of pain that would sometimes make my leg shoot out almost involuntarily. Eh?
I laid in bed for the next hour, it all of the sudden struck me. Mosquito repellent. Because I was planning on working that evening, and because I am now terrified of mosquitoes, I'd doused myself in the stuff before going down to the hospital. Maybe a little TOO much. So at about 12:30 I got up to take a shower and scrubbed scrubbed scrubbed my legs to try and get all the DEET off. There, I thought. That should be better.
After another hour and a half, it hadn't changed. But I'd began to notice something. The pains only came when my legs were still. As soon as I moved them they'd be better for about 5 seconds or so, and then the pain/tingling would come back. So as long as I kept moving my feet every five seconds, I was good. But that isn't all that conducive to a good REM cycle. I tried to do a little tap tap of my feet to see if that would be good enough to keep the pains away...not so much. As I was telling this story to my friends in the hospital, we were all laughing at the thought of my legs shooting out involuntarily from pain and trying to sleep while still moving my feet.....but I'll be honest, at 2am I wasn't laughing.
Although I've never had this problem before, I thought this sounded like Restless Leg Syndrome.....because that's exactly what it felt like. My legs were annoyingly restless! Google time. The Internet is AWESOME here at 2am by the way! (And by awesome I mean it takes 2 minutes to download a page instead of 8). Anyway, as I as reading, some of the causes that stood out to me were
1. New illness (check).
2. New medication (check).
3 Stress (check).
4. Iron deficiency anemia. I went into the bathroom to look at my conjunctiva. Nope, pink as ever. Ok, so it's probably not that one.
Then I went to the cures.
1. Lots of drugs that I don't have here.
2. Massage- I started rubbing my legs.
3. Stretching- I went back to my cheerleading days and started doing all these leg stretches, while still continuing to massage them at the same time....all on my bed....under the safety of my mosquito net.
3. Walking- By 4am with no improvement, I decided it was time for a walk. I walked down to the hospital (although I didn't go in because I didn't want to answer the questions about why I was creepily walking around at 4am). Was that enough walking? The Internet didn't specify the distance I needed to walk for a cure.
4. Warm baths- I don't have a bathtub so when I got back from my walk I heated up some water and just kind of poured it over my legs. As good as I'm going to get.
Hopeful, I headed back to bed. None of my remedies worked. I laid there until 7 and decided it was late enough and went over to the doctor's house to say "What the heck is wrong with me?????" and "Is this going to last forever?????"
After talking with them, we decided that it might have been caused by toxic DEET exposure (he knew of someone who was admitted into the ICU after putting mosquito repellent on in July when it was really hot, causing her pores to be open and absorb a lot). Another possible cause was the fact that the day before I had taken
a. Artusunate for my malaria
b. Keflex for my knee infection
c. Bactrim for my ear infection
d. Benadryl to knock me out and
e. Tylenol for my aches and pains. Since I usually take NO medicines, it might have just been too much for my body to handle.
Anyway, I am SOOO happy to report that last night my legs stayed right where they were supposed to and nary a tingle was felt. I am now considering myself officially cured from malaria (I know, I know, it's with me for life) and am back to normal!! Thank you Jesus!
Sunday, September 18, 2011
This led me to think about the medicines I've had to take while here. I had a whole blog written in my head about how the medicine I've had to here hasn't been for the crazy things like malaria, dysentery, typhoid, etc. but for things like an infected scratched cornea, a perforated eardrum (twice) and now for a silly little fall.
So I had the blog written in my head and was getting ready to post it when I go it. IT. Mal. Aaaaaaaria!!! (Earlier this year I went to a lecture on malaria by a malariaologist?? and that's how he said it. In the scary ghost stories by the campfire voice.)
I stopped taking my malaria medicne a couple months after arriving in the country. Before you go postal on me (Aunt Berta), let me explain. I really really really like my liver and kidneys. And I couldn't find any studies that showed the long term effects of taking an antimalarial. Since I could potentially be here for lots of years, I was leery about taking them for so long. I've heard some horror stories about patients on dialysis who SWEAR it was because of the malaria med they took. Anyway, upon the advice of some friends, I went and picked up a bunch of malaria test kits and anytime I feel weird...even if it's just a headache, I do a quick test. My plan was to most likely get malaria eventually but catch it early so it doesn't kill me.
On Saturday I wasn't feeling too bright. But I could account for all of my symptoms.
1. Every muscle in my body aching.- On Friday evening I returned from a road trip which had me on the worst roads I've ever been on here....for 7 hours. Of course I'm achy.
2. Headache.-The last three times I've gone on a road trip I've gotten a really bad headache. I think it's because I don't drink a lot (not a lot of rest stops in Sierra Leone) so I get dehydrated.
3. Lightheaded/nauseated.- I hadn't slept well the last two nights so I knew I was tired. And my symptoms weren't that bad so it could totally be attributed to fatigue.
4. Fever. I checked my temp and it was 101.2. This would normally be a dead giveaway since I don't remember having a fever....ever. BUT I have this dang infection in my knee so....
Anyway, I did my little test and sure enough, positive. But BARELY!! I think I did catch it pretty early.
I took some Tylenol and started my malaria treatment. About 40 minutes later I started sweating profusely when my fever broke. But I felt a TON better! The fever was gone, the aches were gone. In fact, I went back down to the hospital because they were swamped and I told my friend I'd come help if I could. However, after a couple of hours I started to feel not so awesome again so I went home.
Tylenol is my new best friend. It was incredible to see the difference that it made. By that evening, I could tell exactly when my four hours were up because at about 3 hours 45 min. my fever would start going up, the achyness would come back and I'd want to throw up again. But after I popped a pill, I'd start feeling better soon! As I went to sleep, I thought "Hey, this malaria isn't too bad...."
That night was a rough one. Even though I've been giving Tylenol to my patients for years, all of the sudden I couldn't remember if the max dose for 24 hours was 2 grams or 4. I knew my spleen was already taking a hit from this malaria so I didn't want to mess up my liver too so I didn't take my Tylenol when I probaby should have. I didn't really sleep that night.
I also discovered that I'm not a very good patient. At one point I was shivering so bad and figured I had a temperature but instead of doing what I always tell my kiddo's moms to do (tepid sponging, take the winter hat off, etc.) I went and got my sweatshirt, blanket and socks on. I was sooo cold! Temp: 103.3. Oops. I didn't care. Definitely time for some Tylenol....liver damage...who cares? An hour later I was drenched. Tylenol, you're awesome.
In the morning, I was tired but feeling better. I was able to stop my Every 4 hour Tylenol schedule. I did "call in sick" for the first time in my life, but I don't think people would have known I was sick if they hadn't announced it in church. :) I had lots of visitors come to say "Osh ya?" (It means.....I'm sorry for you! I've said that to hundreds of patients...my first time having it said to me!) :)
Anyway, it's now almost 4am and I've been up for a couple hours. I couldn't really sleep and my fever went back up again but not nearly as bad as last night. All in all I'm thanking God so much for his protection! I know malaria is nothing to take lightly but I'm thankful I didn't get too sick and now have some antibodies! So thanks so much for your thoughts and prayers! In terms of getting a disease that I've seen kill so many, I'm very very blessed!
Tuesday, August 30, 2011
I was working an evening shift. Since one of my co-workers was sick, I’d worked a double shift that day and was just dead tired. I was counting the minutes until 10pm so I could go crawl into bed. Fortunately it was raining pretty hard that day which is awesome for a couple reasons. First, I love rain. Always have. Second, people here do NOT love rain, so if it’s raining, they tend to stay in their houses…..and not come to the hospital. It had been really slow that day and evening.
At about 8pm I was in the peds ward checking on my kiddos when they told me there was a patient to be seen. When I walked down to our “ER” (the bench in front of the nurses station) I saw a kid about 4 or 5 years old that did NOT look good. When I asked what happened, they told me it had been a motorbike accident. Shoot. I’ve seen how these motorbike drivers drive! They. Are. Crazy. So right away I knew that most likely they had been traveling pretty fast and of course...... no helmet.
So I was pretty sure he had a head trauma of some kind. Mild concussion or big brain bleed….who’s to know. As I started looking closer, I noticed that he was bleeding from his nose as well. He started coughing and coughed up some bright red blood. His lungs sounded horrible….probably full of blood after seeing what he coughed up. His abdomen was distended but was it distended because everyone here as worms and distended bellies or because he’d perforated some abdominal organ and was bleeding internally.
We have an OR team here. Some of them have been here forever. They’ve been trained by lots of different people so do a lot of different surgeries, skin grafts, etc. They’re very talented. If it wasn’t for the fact that if I had surgery here I would a) have to lay naked as a jay bird in front of all the people I work with. B) have my arms tied down like I’m being hung on a cross to keep from putting my hands where they shouldn’t go c) have to settle for Tylenol for any post-op pain and d) have a HUGE scar because laproscopes haven’t made it here yet…..I would totally let them operate on me.
Anyway, I digress. Since I am confident in our OR team, I called the CHO (community health officer) who works here to see what they would be able to do. The conversation went like this.
Me: Hey buddy. I have this kid here who flew off a motorbike, most likely has head trauma, is coughing up blood and may or may not have a lacerated spleen and/or liver. I’m wondering if it would be possible for the OR team to open up this kid, take a look at his liver and spleen, see if it’s bleeding at all, and put in a chest tube if necessary. I’m not sure if he needs all of that….I’m just wondering if they can do any of that.
Him: No. They don’t do any of that.
End of conversation. Ok. At home, this kid would have kept me running for a few hours…x-ray, CT, meds, consults. Here? I sutured up his head lac and admitted him for observation. I did call the lab man in to check his hemoglobin. At least we could give him blood if he needed it.
Honestly? My pediatric trauma assessment skills aren’t finely tuned, but I didn’t have a lot of confidence this kid would make it. I was most concerned that he had a big head bleed that was just going to continue to get worse. His mother came to see him and the wailing started. As I left to go home, I expected to be awakened by more wailing as he passed away.
It’s been 3 days now and the kiddo is doing great!! MUCH better than I hoped for! He’s started eating a little and today was walking all around. Not quite up to smiling yet but patiently stood still while I took a picture. :)
Note: I put 7 stitches in this kid’s head. It took me a painfully long time. Two guys were there to “help” me and I think by the end of it they were uber frustrated and just glad it was over. Apparently I need to keep practicing. :)
Thanking God for a great outcome in what seemed to be a hopeless situation!!
Tuesday, August 23, 2011
Every morning I do rounds in the peds ward. Malaria season is upon us which means that the peds ward is SUPER busy! Last week we had a record (at least since I've been here) of 31 patients. There were mattresses everywhere and they were labeled things like P2/3 (the matress between bed 2 and 3) and Private Room 1A, 1B, 1C. And there is usually just one nursing assistant for the whole ward. B.U.S.Y.
Since I do rounds in the morning, I generally have a good idea who the semi sick patients are and who are the ones I need to keep an eye on. However, about 10am the admisisons start rolling in. Since they've already been seen by a provider and been given their blood and medicines, unless the nursing assistant or one of the parents comes to get me, I wait to see them on rounds the next morning.
However, since it's been SO crowded recently, I've started doing some more rounds in the afternoon. This set of rounds is abbreviated and just involves me going around the room, physically looking at the kiddo and giving the parents the opportunity to tell me if they've noticed something wrong. I especially like to do this after a child dies because all the other parents get really anxious and need some reassurance.
Today at about 1:30 pm. I was down in the OB ward when I heard the familiar wailing coming from the peds ward. Never a good sign. I went down to check it out. Sure enough, one of the kiddos had passed away. I did what I hate doing, which is listen for the respirations and heartbeat and then tell the mother or father "ee don go." (He's passed away.) When a person dies, they always pull the sheet up over the head but I haven't had the courage to do that yet. I just can't cover their precious little faces.
So after that kiddo died (he'd been a new admission so I hadn't seen him that morning), I started doing the rounds of the ward, reassuring parents and looking to see if there were other super sick kiddos. Ding...found one.
This kiddo had come in a little bit ago with a hemoglobin of 2.6. For those of you who aren't medically inclined.....it's low. Really low. Incompatible with life kind of low. He was getting blood, but he was getting it through his umbilicus. Also not a good sign. Anytime I get a kid who is getting blood through his umbilicus, it means that the OR guys had tried and tried but couldn't get an IV in the scalp. It also means that the blood is going into the abdomen which means it takes a lot longer to raise the hemoglobin level....like days instead of hours. Bad.
The child was not breathing well (not suprising with no oxygen due to no blood....think back to your high school biology lesson). As I stood there for a second, collecting my thoughts, he started seizing on and off. I asked the mother if the child had been breastfeeding well and she said he had been until today. I checked the blood sugar- 46. Really low. Incompatible with life, low.
D50 is a medicine (dextrose- 50%) that we give to patients with low blood sugar. It brings the blood sugar back up really fast. I knew we had had one vial of this but also knew that last time I'd seen it, it was really low. I ran down to the OR to see if it was there. Didn't see it anywhere. I called my boss to see if we had any more. Nope. Then I called another co-worker to see if he knew of any secret D50 storage places. Negative. The only option I have is to give this child D5 (dextrose 5%...clearly not as strong as 50%) which we usually give as IV fluid so the it comes in 500ml. However, I only have on "IV" line...and that's not even going into a vein! He desperately needs blood, and desperately needs sugar.
I knew the OR team had tried multiple multiple times to get an IV in the scalp because it's the only reason they ever put one in the umbilicus, but sometimes they don't try the arms. IV catheters are precious here so they are kept under lock and key. I ran down to the storage to grab a cannula. I wanted to see if I could get an IV in the arm. Maybe they hadn't tried there.
I looked...and looked...and looked. This kid literally had no blood. I think I poked that kid 25 times. I poked him so many times that the needle became so dull it would barely puncture the skin. As I was poking him (he was essentially unconscious at this time so he didn't cry or pull away) his breathing started becoming easier. I also realized, as I was trying again on his other arm, that my elbow was now sitting in a puddle of his urine.....he'd become incontinent. This commonly occurs right before death. I knew as I sat there poking this kiddo that he was not going to make it. But I couldn't seem to stop. I couldn't just sit there and watch this child die. I'm not sure why. I've done it before. For some reason, this time I knew I would keep trying until he took his last breath. I wanted his family to know that we had done everything....tried everything. In a last ditch effort, I grabbed a bottle of D5, the biggest syringe I had (which was 5 ml) and put some sugar water into his peritoneal "IV." As I pushed it in, he took his last breath.
His mother had already left the room to begin grieving outside. The crowd that had gathered began to disperse. The show was over. We'd given it our best shot.....but we'd lost. "ee don go." Malaria wins again. Bleh.
Sunday, August 21, 2011
I have a bunch of boys that live nearby so I called them to come help us eat it. After dinner I taught them to play "slap jack" which was hilarious to watch. However, I discovered that these kiddos are the biggest cheaters I have ever seen!!! Every time we slapped the cards they would all try to sneak some into their hand. Stinkers!
Although they liked "Slap jack," Jenga is really their game. We have a piece of paper on my wall that is keeping track of who loses each time. (Note: I'm the only one who hasn't lost so they were all trying to "set a trap" so that I would lose). Not going to happen......steady as a rock.
Since we have no lights, we play by candlelight. I have a cinnamon candle that my sister and brother-in-law gave me before I left. I love it because it reminds me of home. One of the boys wanted to drink it. Ouch.
Fatu and I representing the girls in the Jenga game
The next morning my neighbor commented on the loud noise coming from my house. When I told her about the kids that were over she said, "well, it wasn't really them that I heard the most...it was you." Oops! Quietness has never been my forte. And during a high stakes game of Jenga and Slap Jack how are you supposed to keep from screaming??? Impossible.
Let the good times roll......
Wednesday, August 3, 2011
I've learned something about doing rounds on the ward. The first thing I look at is the kid....do they look sick or not? The second thing I look at is the date of admission. I've found that our routine kids with malaria associated anemia can usually be in and out in about 3 days. So if the date of admission is more than 3 days, I know I'm going to have to think harder about what's going on. There were 22 kids in the ward and my first 8 or so were easy! Mostly new admissions who had received blood and were waiting for their post transfusion hemoglobin to be drawn that morning. Then I got to P9. Admitted July 29. Rats. I looked at the girl and she looked sick. She's older than most of our kids-probably around 7 or so. And she was skin and bones--clearly malnourished. Mom's complaint was that she didn't want to eat and that she was still vomiting up everything she ate. She'd been diagnosed with malaria, transfused and her post-hemoglobin was 8.....which is pretty good for these kids. Her malaria medicine was finished but since she'd been vomiting, I decided to give her something for nausea, start her on a different malaria medicine, and recheck her hemoglobin.
I got the results a couple hours later and her hemoglobin had dropped from 8 to 6. I kind of hate it when kids have a hemoglobin in the 6's because it's kind of boarderline as to whether or not we should transfuse. Since I have now seen one adult and one kiddo who did NOT do well after a transfusion, I am always a little nervous. But with this kid, it was an obvious choice because she looked sick and since she was so malnourished she was going to need all the help she could get. I sent her down to the lab to get her blood.
No donor. The kiddo was A+ and mom was B+. This happens sometimes and we may have a small supply in stock but we transfused so many kids today that we didn't have any extra blood. Never fear! I am A+. Woo hoo! I've been trying to donate since I got here but they kept telling me to keep it and they'll call me when they need it. Score!
I haven't been able to donate blood in America for years because I've been coming to Sierra Leone every year. Because it is endemic with malaria, they make you wait a year after you're back before they'll let you give. I remember the time I found that out. I'd been waiting for an hour or so and had filled out the questionnaire when they sent me back to the lady who checks your iron and clarifies any of the "bad" answers on the questionnaire. It's all sectioned off so it's very confidential. When she saw that I'd been to Sierra Leone she told me that I couldn't give. I had to do the walk of shame back to the door without giving and wanted to shout to the waiting room "Just in case any of you are curious, NO! I did not use IV drugs or trade sex for money! It's just......Africa!!!" But I didn't. Social filter. I'm learning.
Anyway, I digress! Again. I told them that I wanted to give some blood for this kiddo. It's not good enough in America but in Africa I think it's prime real estate because it's malaria free!! We don't check for malaria so I know sometimes we infuse kids with blood that has even more malaria. You win some.....
I went to the lab and told them I wanted to give this kid some blood. Lab Man said we should go to the OR. That's weird. They always do it in the lab. I always get nervous when I have to poke someone I know so I thought, maybe he's just a little nervous and wants to make sure he gets it right in. I'm ok with that! I've been told I don't have great veins but I've never been stuck more than once so....shouldn't be a problem. Well, small problem. Fourth time was the charm. At one point I was feeling around myself and felt what I thought was a pretty decent one. I tried to think if there was any way I could poke myself. That would have been tricky.
As soon as he got it in I started worrying. They always do a screening for HIV, hepatitis and maybe a couple other things. They hadn't done that with me. As far as I know I don't have any of those diseases but I've stuck myself with dirty needles a couple times and I'm always playing in blood over here so....well, you never know. I definitely didn't want this kiddo getting sick but felt kind of weird saying "Hey, by the way....can you check me for HIV?" But that's pretty much what I did. No problem, they checked me when they checked my blood type. Good.
After I was finished I called the little girl into the OR room to start her IV and give her....my blood. I've been giving blood for years and it was kind of weird to see the blood hanging up, knowing that 5 minutes earlier it had been in my body.....pumping through my heart, lungs, etc. Weird.
After she went back to the ward I looked outside and had a line of kiddos waiting to get blood. The IV's are usually put in by the OR staff but Wed. and Sat's are half days so they leave at 12. It was just me and a couple other nursing assistants who don't put IV's in very often. Crap. It wouldn't be a big deal if I could use catheters and put them in the arms....but those are in such short supply that I knew I needed to at least try the scalp first. Dangit. I hate those things. And I really stink at putting them in. 0 for 5 so far. I can always hit the vein but then I blow them. BUT!!! Today was my lucky day!! I put in my first successful scalp IV!!! And may or may not have done a little dance in the OR. I've been trying for weeks!!! It's the little things, you know?
So all in all, it was a good day! Got to give blood, got to successfully put a needle into a child's head........I was made for this! :)
Friday, July 29, 2011
Last month I bought a car. His name is Boris. Boris is what you might call... a fixer upper. I've been up country for the last month so one of my friends has been working on fixing some things so that it will be ready for me to take back with me. I drove it the other day and noticed some things that weren't working so well. Yesterday I had an errand to run in Freetown so I decided to take Boris along to see if there was anything else that needed fixing. Also, Freetown is a ridiculous place to drive and I've always been afraid that I'm going to get in an accident and damage the car that my friend is letting me borrow. If someone ran into Boris....I doubt anyone would notice.
ANYWAY, Boris and I started out at about 9:30 yesterday morning. It takes about 45 min. or so to get to Freetown and I go over a very rugged mountain road to get there. Since it's rainy season, the dirt turns to mud and some places start to feel like you're driving on an ice rink. I noticed that I was sliding a TON so slipped him into 4 wheel drive and got some better control. One of the things that Boris needs is new tires. Definitely. Since I'm going to be driving up country a lot where the roads are less than ideal, I decided that if I'm going to invest in anything, it should be a good set of tires. (The vanity in me wanted a paint job but....tires it is). They're coming on Monday. Yesterday was Friday.
I made it over the mountain road with only two heart catching moments in which I started sliding toward the edge of the mountain uncontrollably, but arrived to the paved roads of Freetown without incident. I had one objective in coming to Freetown and that was to return to the internet office for the third time to see if they can please get my internet to work. After two weeks without it, I was going through withdrawls! That's half of my new niece's life in which I haven't been able to stalk her via pictures!
As I was driving towards the internet office I suddenly remembered that I left my wallet on my dresser at home. Dangit. Since I have been pulled over frequently for them to just inspect my license I knew this could be a problem. Shoot! "Well," I thought. "I was here all day yesterday and didn't get pulled over. I'll just hope it happens again today." No sooner had I thought those words than a female police officer waved me to the side of the road. Dangit. Double dangit.
She was very friendly and asked to see my drivers license which I explained to her that I'd forgotten. Then she told me that my tires were "smoot." Smoot? What the heck does that mean? Are they flat? Smoking? Not sure. I got out to take a look (keep in mind this is in the middle of a very busy area and it's a white girl in trouble so there were no shortage of onlookers!) She pointed at my very, very bald tires. The were smoot....ie smooth....ie bald. Ah ha!
"You have two great offenses" she said.
"I understand! You're absolutely right. What do I do now?"
She proceeded to get into the front seat of my car and we started driving. I asked her if she was taking me to jail. She laughed and said, "No. I don't want to take you to jail. I don't want to waste your time. We will work this out between us. You are my friend. I don't like to cause trouble for women especially"
"Ok, that sounds good. I totally understand that I broke the law. In America sometimes the police officers will give you a warning and let you go, but if I need to pay a fine I can do that. I'm just going to need a receipt for any money I give you."
"You need a receipt? I can't give you a receipt."
"Well yes, I need a receipt because I have to account for where all my money goes. Otherwise my bosses will think I've stolen the money! You don't want me to lose my job do you???"
We had this conversation about 5 times. Round and round we went as we drove around Freetown. Finally she said, "Ok, I'm not arresting you. Forget about that. You are just my friend."
"Ok," I said laughing. "You are my friend. Next time I'm in town I'll take you to lunch."
And that my friends, is where I think I made my fatal mistake.
She said "Ok, let's go back and you'll give me some money for lunch and you'll go your way and I'll go mine."
"No, I can't do that because you've already arrested me. I can't give you anything today!"
Of course, the point was not that I needed a receipt. The point is that these police officers constantly pull people over and ask for a little something to keep them from being arrested. The injustice of it drives me insane. Abuse of power to the max. I put my crusader hat on. Maybe I should have left that one at home.
At this point we'd pulled up to the police station. She got out of the car and just stood there....seemed to be debating what to do. Then she told me to come with her. Until this point I'd been hoping that she'd just give up and let me go with a warning. Negative.
She took me into one of the rooms in the police station where she told another officer what my offenses were. There were three.
1. 2 smoot tires
2. Inconsideration for other drivers on the road (because of my smoot tires).
3. Failure to produce my license
As the new officer started taking my statement, the arresting officer stood up and left. Not even a goodbye! Some friend. If she keeps this up I'm going to revoke the lunch we were going to have next time I'm in Freetown!
After he wrote down my offenses he had me read it and see if I agreed. I read the statement, told him that I did agree but asked if I should add that the policewoman told me she would let me go if I gave her some money. He gave me a little half smile and said no, we didn't need to put that in the statement but I could talk with the magistrate about it. In hindsight I wish I would have written it down. Next time!
At this point I'm having a delightful time. As I mentioned before, I didn't have a lot to do that day, so I had the time to spare. Plus it was my first time being arrested in any country, so it was an adventure!
After they took my statement they sent me upstairs to one of the bosses. When I got up there I waited for a few minutes and eventually the bossman came out. He looked at me and then asked another officer in Krio why they brought me to him. Then he turned to me and asked if I was a diplomat. What? A diplomat? Ummm...no. Just a volunteer. I told him what happened and that my friend was coming with my license. Then he told me to sit down here with a couple other girls....NOT over there with the guys. Okey doke.
So I sat there chatting with the girls and the other officers for the next hour while I waited for my friend. One of the benefits to working upline is that a lot fewer people speak English so my Krio is slowly but surely getting decent. When I started chatting with them in Krio everyone got really excited. "Eh, yu wan tok di Krio?" "Ah de try, Ah de try." Another benefit of having worked in multiple different areas in Sierra Leone I've picked up a few phrases from several of the different tribal languages. People always like it when I bust that out. :) The downside to this is that my fraud quickly becomes apparent when they continue the conversation in their tribal language and I stare at them blankly. Anyway, the next hour or so were spent rehashing what happened over and over again as people kept asking what the white girl was in for. But no problem. I was having fun. The officers, the other two girls and I were all laughing together, drinking sodas and eating cucumbers. Couldn't imagine a better time being detained. :)
One of the officers decided to make it her mission to get the offense for not producing my license dropped. I think it was because when one of the male officers started yelling at her I told him he needed to stop yelling and be nice to her. I said it with jest....but I think he got the point. She whispered "thank you" to me. :) Ha!
I was "arrested" at 10:30am and it was now almost noon. They told me that the magistrate court wouldn't start until 2:30 but that they were going to try and get me in early. One of the officers (the one who wanted to help me get one offense dropped) and I got in my car to drive to the courtroom. I would like to mention that this officer told me to go the wrong way up a one way street right in front of the courthouse and when I mentioned that maybe I could go up the neighboring street and then come back down she said, "Oh, yeah that's a good idea. How long have you been driving? You're a very good driver." Thank you!! I've been trying to tell people this for years!!
Wow, this post is really long. I'll try to speed things along. As I mentioned above, the next step was to go to the courthouse where I would speak with the magistrate. I got there at about 12:30 but he was eating lunch. They told me it would be about 5 minutes. An hour and a half later he was ready for me. I would also like to point out that while we were waiting, the officer who was wanting to help me said that since she had left her work, and came over here just to help me, when this was over she hoped I wouldn't tell her I needed a receipt for anything I gave her. Really??????? Are. You. Kidding. Me? Don't you realize that I'm mostly here on principle??????? I thought it was obvious, but now I think maybe I was the only one who realized that.....I told her I definitely would need a receipt or they would think I stole the money blah blah blah and told her that I appreciated that she wanted to help me but she really didn't need to and she could totally go. She stayed.
The magistrate finished eating lunch and I was led to his chambers. Outside the door the officer stopped me and told me that when they read the offenses I was to say "guilty." When we walked in the magistrate's assistant (who incidentally had been super cranky since I'd walked in 1 1/2 hours ago) pointed to a chair and told me to put my bag down. When I went to sit down where she had pointed she said "No! Stand up!" Oops. Party foul.
They read my offenses again one by one and I admitted my guilt to each one of them. The judge started writing a bunch of stuff down while I waited. I put my hands in my pocket and cranky lady said "Take your hands out of your pocket!!" Oops. Strike two.
After the magistrate finished writing everything down he gave me my sentence. He dropped the offense of not producing my license because I had produced it. My sentence was 200,000 leones (about 45 bucks) or 2 months in Pandemba prison. I'll be honest and say the thought crossed my mind to say that I'd take the 2 months in prison please. I wonder what kind of ruckus THAT would have caused. Ha! I giggle to myself just thinking about it. Probably wouldn't be giggling after day 1 though.
It's now almost 2:30. I need to pay my fine, get my receipt and get the heck out of there. I pay the fine to cranky lady and she tells me they will come with my receipt shortly or maybe I can wait until Monday. Sorry lady. I've spent 4 hours in this funhouse already. I am NOT leaving without my receipt. So I told her I'd wait. I start chatting with some of the officers who are waiting for the various court cases to start and text my friends and family to tell them I'm in the slammer. :) Sorry for the heart attack Mom. :)
At about 2:45 they send me to wait in the peanut gallery. As I'm waiting the magistrate comes out and the first case begins. Husband vs. wife in a "failure to support the wife and children since leaving 7 months ago." FYI per the magistrate, the wife cannot demand spousal or child support while she is still married. She needs to file for divorce first. Just in case you were wondering.
As interesting as it was to watch the legal proceedings, I had been waiting for my receipt for about 45 min. and was afraid they were going to forget about me. This is the first time that I start to feel frustrated. I mean....45 minutes to write out a receipt???
I noticed that cranky lady was leaving the courtroom periodically so I snuck out so I could ask her about my receipt the next time she left. She told me I needed to wait a little longer. They were coming with it. 15 minutes later they came with the receipts (there were a bunch of us waiting for them) but wouldn't give me mine because she needed to make a copy. I let her know I was frustrated. It had been 5 hours. I still needed to go to the internet place before it closed or I wouldn't be able to pay the WMT employees tomorrow, which I'm sure they wouldn't appreciate it.
Looking back, my biggest regret is that I let her see that I was frustrated. How cool would it have been if I never showed any anger at all the whole time??? Darn. Maybe next time.
Anyway, during this time I was chatting with the people around me. One guy came up to me and said, "Hey, you like justice."
"They told me what happened. That the officer wanted money and you told them you had to have a receipt. You really like justice."
"Ha, yeah," I said. But inside I thought, "Why yes, yes I do really like justice. And thank you for noticing!"
Thirty minutes later I had my receipt in hand. V.I.C.T.O.R.Y!!!!! (Incidentally I spent those 30 minutes trying to convince a 23 year old kid that if he is farsighted, he really does need to wear his glasses.....even if his friends call him "Harry Potter."
Left the courthouse, got my internet fixed and picked up some material to make some curtains for my house. All in all, not a bad day. :)
My day was fine though, because I had the 45 bucks to pay the fine. This experience gave me insight into why taxi drivers always pay the little bribes to the officers when pulled over (which they are pulled over all the time!) There's no way they could afford this fine which means they'd have to spend months in prison...not earning any money for their families. It just made me madder at the whole system! My little personal crusade was something I could afford to do, while others couldn't. I'm not saying it justifies the corruption, but my experience has helped me to understand the complexities. Maybe we could get all the taxi drivers together, collectively decide NOT to pay any more bribes....hhmmm....interesting. Taxi drivers of Sierra Leone Unite!!!
Anyway, it was an experience. Not one that I'd necessarily like to repeat but I don't regret having it. At least I got a good Facebook shock and awe comment out of it. :)
Friday, July 15, 2011
Instead, the father went to pull away the lapa (big piece of material) the child was wrapped in....and I couldn't believe it. HUGE chunks of this child's right leg were missing. From mid calf up to the child's buttocks there were huge craters covered with dead skin. The leg was covered in gingin violet which is a common thing to place on wounds here. It actually has bacteriostatic properties (can kill bacteria) so we often prescribe it because it's not going to hurt, it might help, and most importantly it will hopefully prevent any other potentially harmful substance from being applied. The leg also had dried gauze that had adhered to the dead tissue. As soon as I saw all of this, I was immediately angry. One of the most frustrating things about working here is when parents bring their children in so so so so late! When I asked what happened and how long this had been going on, the father told me that he had a "swelling" 2 weeks ago and then this happened.
When I worked in the ER, one of the questions we often had to ask was "how much have you been drinking tonight." An experienced nurse once told me that you have to at least double the amount that the patient tells you. Here, one of the nurses told me that if you ask how long someone has been sick you have to triple it. There's no way that what I was looking at happened in two weeks. So I was angry.
Then as I continued to interview the father, I found that he had actually taken his son to the health center in the area and they had been treating him. Ok, now I'm not so angry at the father....he tried to do the right thing. Now I'm angry at the health center. Clearly, they didn't know what they were doing but didn't refer to a higher level of care. In their defense, health centers are often poorly equipped with supplies and often aren't able to treat what comes to them. However, in this case I got no letter of referral so I can only assume that they were going to continue trying to treat the patient (which CLEARLY wasn't working!) but the father decided it was time to take him somewhere else. Frustrating.
The kiddo had a temp of 103 and was slightly delirious.
My diagnosis for the patient was WTH (what the heck!!!); probable sepsis from wound
What's the diagnosis for the majority of someones leg being rotted off? Seriously, if someone knows what it is, it would be helpful. I've come to recognize the scent of rotting flesh as this is not the first time I've seen something like this here.
Anyway, I admitted the patient, started antibiotics, Tylenol and IV fluids. I debated on trying to get the gauze off but decided to wait until the OR team came in in the morning. This kid needed to be knocked out for what they were going to have to do to debride the wound.
Yesterday as I came into work the OR team was doing the debridement. They had to cut off the majority of the skin on his leg. Aside from a miracle from God, I don't see how this kid is going to make it. We were talking about skin grafts yesterday but weren't sure where to get the skin from. (I wanted to donate myself because A: I have plenty and B: he'd look kind of cool!) but unfortunately it doesn't work that way.
Last night I went in to replace his IV which he'd accidentally pulled out and he was awake and the most lucid that I've seen him. He was acting like a normal, scared 10 year old kid. It broke my heart to think of the painful road he has ahead of him....and whether or not he'll still be alive on the other side. Bleh.
Side note: Since the kiddo was asleep I did take some pictures but have decided that if I posted them my sister would say "Emily!! Social filter!!!" So I'm filtering them but will have copies available for my nursing/friends who like gross stuff when I come home in Dec. :)
If you think about it, pray for this kiddo and his family. Pray that the hospital staff will have wisdom in how best to treat him and that I will know how best to love on he and his family! Thanks!
Monday, July 11, 2011
The neighborhood boys have discovered my fear/loathing of snakes. So now they bring me every snake they find after they've killed it.....just to torture me. I kind of like it. :)
A few weeks ago the pump that pumps our water was struck by lightening and destroyed. This week we ran out of water. We have a big tank in front of our house but couldn't find anyone with the key to open it. Fortunately, the top of the tank blew off in a storm so we got some neighbor boys to climb up and give us water from the top.
Wednesday, July 6, 2011
The morning after that rough day (this would have been Monday morning) I decided to go for a walk before work. Psych myself up. :) As I was walking I started thinking. As I was thinking I started praying. As I was praying I started crying. I started telling God that it was too much. That in case He hadn't noticed, I'd reached my breaking point and something needed to give. I'm tired.
There are two things that I believe are true. (Well of course more than two, but these two principles are what I belive have allowed me to stay here up to this point and make me think that I can stay here as long as God calls me.) Number one is that "I don't have to act the way I feel." There have been many a mornings when I've been tired and cranky as I walk down to the hospital. However, whenever I feel this way I start telling myself that just because I'm cranky does NOT mean that I have to act cranky. So I put on a smile and make it a point to be chipper. It's pretty incredible how acting this way...even when I do NOT feel like it makes my day so so so much better! I forget that I'm supposed to be cranky! I know myself and I know that if I wallowed in my crankiness and made sure everyone knew how I was feeling that I would ruin my day. I've done it too many times not to know this. :)
The second thing that I'm slowly learning to be true is that God is the giver of joy and it is not dependent on my circumstances. This one has been HUGE to learn here! I can't tell you how many times I've thought something like "if only these kids wouldn't die" "if only I lived nearer my friends" "if only my family was here" "if only it wasn't so. stinkin. hot!" THEN everything would be so much better and I'd be happy. I've heard that God is the giver of joy for years. I've read the verses in my Bible to back it up. But I've never really tested that theory like I have here. When I arrived at the hospital it didn't take me long to see that this might be a little harder than I was anticipating. I wanted to pout. But shortly after I arrived I listened to a sermon (shout out Pastor Dee) that kicked my butt and I made a decision. I decided that I would focus on God being the giver of my joy and would try not to complain but to rejoice always. It wasn't easy. After 29 years my family can tell you that I've perfected the art of complaining! :) But I was FLOORED at the amazing freedom I felt when I said "God, some of theses circumstances are absolutely not what I would have chosen. But I know that you know me best and You've placed me here so I will trust that this is what is best for me so thank you. I don't see how some of these circumstances can make me happy so I'm going to trust you to keep up your end of the bargain and give me joy." I'm not kidding you about a week after I started doing this I couldn't believe how happy I was! No change in my circumstances....just God being God, doing His thing! It was incredible. Of course then I thought I had the whole "rejoice always" thing nailed down and I fell flat on my face and had to "relearn" everything all over but....well, that's just me. Slow learner.
So these are the thoughts I was thinking the other morning as I was walking...and thinking....and praying....and crying. And as I kept praying and just pouring out my heart telling my Friend that I was tired of rejoicing and I just wanted to whine and complain I heard Him tell me that it was ok. He knew. Then I started thinking about Jesus' life on earth. And the verse "Jesus wept" popped into my head. And I was struck with the fact that Jesus' heart was broken too. He knew exactly what it was like to be tired and to deal with death. Besides that, He knows me better than anyone so he not only knows how He felt but how I was feeling as well. And it was ok to cry!! It was ok for me to say that death really sucks!! And that it's hard to deal with it a lot! And that it's ok if sometimes I need to cry about it! He tells me that I don't have to act the way I feel and that I need to rejoice always because He is the giver of joy because that's what's best for me..... which I know is true becasue I've seen the results! But it doesn't mean that it's easy or that he's unsympathetic. He knows it's not easy. This led me to think about the verse in Hebrews that says, "For we do not have a high priest who cannot sympathize with our weaknesses, but One who has been tempted in all things as we are, yet without sin. Therefore let us draw near with confidence to the throne of grace, so that we may receive mercy and find grace to help in time of need." So. Awesome. That's what He did on our walk. He once again showered me with His grace and I was refreshed.
I'm not meaning to sound preachy at all and I know this is not one of my most exciting posts, but the last couple of days I have been so unbelievable encouraged and excited! I wouldn't have got to have these intimate moments with Jesus if I hadn't been brought to my knees. And that's just exciting!
Thank you so much to my friends and family as well!!! You have no idea how much your thoughts, prayers and words of encouragement have lifted my spirit!! So thank you thank you thank you! Today on my walk I was very excited that this is my life!!!
Sunday, July 3, 2011
Today was supposed to be my day off. However, when I looked at the schedule, I noticed that the guys who was supposed to work today was going to have to work two weeks in a row without a day off. Since I’d just come from having 10 days away from the hospital in Freetown and he’d had to pick up the slack with some crazy busy days, I offered to work in the morning for him so he could go to church.
Since it was a Sunday and weekends tend to be low key (in America at least) I took my IPOD and a book, planning on listening to a sermon when I had time. I arrived to the hospital at 8am and all was quiet. They’d had a pretty quiet night with only a couple of admissions. They had one guy who came in vomiting blood and with diarrhea with blood clots in it. Ok, I thought. He’s definitely sick. His hemoglobin was 8 when he came in last evening so I went and asked the lab man if he could draw another hemoglobin this morning since he was still having bloody diarrhea. (Sorry if that’s too graphic….I tried to warn you…these are my inner thoughts!)
While I waited for the lab to come back I went to check on him and checked his blood pressure. It was 70/50. Low. Very low. He had some fluids running but I knew what he was really going to need was blood! Since we don’t have a way to give packed red blood cells but give whole blood here, it’s a lot of volume that we give. I didn’t want to overload him so decided that when that fluid finished I would wait to give him the blood. So I started to wait.
At 8:30 they started coming. The outpatient department (kind of like the ER or Urgent Care) isn’t open on Sundays so all the patients that come to the hospital are seen by the senior person (in this case me). Praise the Lord we had the lab open today so as the sick kiddos started coming, I took the history (almost always the same….fever, vomiting, with maybe diarrhea or a cough) and sent them down to have their blood checked for malaria and hemoglobin. After the first two cases we ran out of malaria tests so I just started treating for malaria (since 98% of them are positive). Two out of the first 4 had a low hemoglobin so they needed blood. No problem. I sent them down to the OR and one of the nursing assistants (there were two of them and I to cover the hospital today) put the IV in and started the blood.
An odd phenomenon kept happening though. Even though I kept seeing patients, the line of patients waiting to be seen kept getting longer, not shorter. In addition to seeing the outpatients, I still needed to do rounds on the inpatients. While I try to round on everyone, I could see after 2 ½ hours of seeing outpatients that today only the “critical” patients were going to get seen. This included new admissions from last night and patients with fevers. At about 10:00am the peds nursing assistant started coming and asking me to go to the Peds ward and see some patients. Some wanted to go home and some needed to be seen. I still had a line of patients waiting to be seen. Whenever I start to get a little overwhelmed I have a thing that I do. I literally stop whatever I’m doing and I think about what’s the most important thing I need to do. Seeing the sick peds was pretty high on the list. So was my guy who needed blood. I looked at the outpatient and the cases that were there didn’t look emergent so I decided they could wait. I went to check on my guy who needed blood (M2). They had found a donor for him and were looking for the adult blood bags. We didn’t have any. We only had pediatric blood bags. This meant that the donor would have to get poked twice to fill up two pediatric bags. She did not want to do that. Are you kidding me? You’re not going to donate because it means you have to get poked twice?? Now, maybe I’m being judgmental because while I don’t enjoy getting poked, I am not deathly afraid of it. Maybe she was. Well, I had to be frank with her and tell her that if she didn’t donate, her uncle would probably die. She went back to the lab.
Next, I went to round on the kids. There were about 5 who had high fevers. Most of them had come in last night and started the malaria treatment. I wasn’t too concerned because the medicine hadn’t really had time to work yet and they all looked stable. There were two kids that still had fevers but their parents were requesting to go. They both looked sick. One of them had started the treatment for malaria yesterday but hadn’t started to perk up yet. I wanted to keep her but her mother was adamant to go. I knew that if I kept her here when she didn’t want to be here, she would either A) leave in the middle of the night and not take any of her medicine with her and/or B) not come to the hospital next time her child was sick. So I sent her home with some malaria treatment and Tylenol. The second kid that wanted to go home had come in 2 days ago super super sick. He was really febrile, seizing, very sick. Well, He had started to turn around and was looking better but the family was tired of waiting and wanted to leave to go try herbal medicine. Ill admit this frustrates me a little. Sometimes I feel like people expect miracles here and if their kids aren’t better in a day, then they give up and want to go. This kid was almost dead! It’s going to take more than 2 days of medicine for this kid to perk up! Frustrating! Fortunately she still had some money on her bill and they won’t let her go until her bill is paid. Since they kid now had bad sounds in his lungs, I started him on an antibiotic and asked them to please wait. They were kind of held captive.
I went back to my little bench where I see patients and started seeing patients again. A kid came in with a crush injury to his hand from his hand getting caught in a rice machine. The OR guy was still around so he took him to the OR to do what he could to patch him up. Then a super sick kid came in. I could tell right away that she needed to be part of the critical patient protocol so before I sent her to the lab I gave her two shots of Quinine to treat malaria and sent her to the lab to have her blood drawn. I went to get all of the supplies I was going to need as soon as she got checked so I could start her IV and give her the antibiotic that’s part of the protocol while we waited for her family to donate the blood. While I was waiting on her, I went to see if M2 had his blood hanging yet. He didn’t. I hurryidly told the outpatients waiting that I’d be back and went down to the lab to find out what was going on. When I got down there they told me that the girl was still afraid to donate but they had some 0+ blood in the refrigerator. We would give this guy that blood and his niece would come back the next day and replace it when we had the adult blood bags again. Fine. Awesome. I grabbed the blood and ran down to the mens ward. He actually wasn’t looking too bad. He was talking to me and asking questions. I paused to wonder if I really should give him this blood. Because we can’t screen the blood as well as they do back home, I only give blood here if I think the patient will die without it because a reaction could kill him. He looked pretty good. But when I asked him if he was still having diarrhea he said he was and that there was blood in it. So I decided to go ahead with the blood. His pressure was still in the tank and blood would really help. I started it slowly and was going to come back and check in a few minutes.
I went back out to my outpatient bench and saw another patient. After about 10 minutes the wife of M2 came to get me. He was not looking good. He started breathing rapidly and with difficulty. Crap. This looks like a reaction. Crap. I immediately stopped the blood. When I went to give him some IV fluids his IV had infiltrated. And we have no more IV canulas. At this moment my critical peds patient who I had sent to the lab came back. I ran to get some steroids from the cabinet to give to M2 while the nursing assistant worked on starting an IV using a blood collection device. I told him to keep working on that while I ran down to the OR to put an IV in this kid to get his blood going. As we were going down to the OR I looked down at the blood result. His hemoglobin was 2.6. I’ve never seen that compatible with life. Shoot. I started to run. We got him down to the OR and I spiked the blood bag and got ready to start the IV. As I did that his mother told me to look at him. He was gone. Died on the OR table.
I wanted to be compassionate and caring. I told them I was very sorry. They started wailing. I wanted to stay in the room with them for awhile, but I knew that I had the guy in M2 who was NOT doing well. So I left them in their grief and ran down to M2. (They technically needed to pay their bill because I’d given some medicine and they’d had labs etc. but I just didn’t have the heart to make them pay before they took the body. I can settle up with the hospital later if I need to). M2 was still not doing well, but he was looking a little better. Please GOD let him live! Abraham (the nursing assistant) wasn’t having any luck getting the IV in. Dangit we needed an IV catheter. This way just wasn’t working. I had been trying not to bug the guy who I was working for and was expecting him at any time but so far he hadn’t come. He’s the one with the keys to get things like IV caths so I finally decided I had to call him. As I stepped out of the ward to call him I saw an unconscious woman being carried down the hall. They went to stop at the OPD bench but I just waved them down further down the hall towards the womens ward. They were going to need a bed anyways so might as well see them there instead of on a bench. I called my friend as I followed this patient down the hall and told him that now we were really desperate for IV catheters. He told me he was coming. When I asked the nursing assistant to check a blood pressure, she said it was 40 and that she needed fluid. 40? Either it was REALLY low and/or she wasn’t really sure what it was. Either way I knew it was low and she needed fluid so I took of to get the stuff we’d need. Her family said she’d started having diarrhea and vomiting the night before (time is very relative here) so I knew she was probably super dehydrated. Just then my friend arrived so I gave him the low down on this new patient while I grabbed a couple IV catheters and ran towards M2. Sorry OPD patients. You’re going to have to wait a bit longer.
I tried multiple multiple times to get an IV in this guy but just could not do it. I’m not a horrible stick so I wasn’t sure what my deal was, but I finally went down to get my friend and have him try. Neither the nursing assistant or I could get it. After a couple tries, my friend got the IV in and we started his fluids. There was really nothing else we could do (at least that I know of and that they usually do here) but wait and see.
I went out to see some more outpatients and was seeing my first one when M2’s family came and got me to go check M2. He was gone. I don’t even know what to say. In hindsight, I wouldn’t have given the blood. I think I might have killed him. But with what I knew at the time, I don’t think I necessarily made the wrong decision, but now knowing what happened, I would have made a different one. I still feel like I killed a patient. It sucks. I’ve never heard so much wailing as I watched his wife and especially his daughter in their pain. Their daughter was probably about 16. What would I have done if I’d lost my father at 16? It really stinks.
Things settled down a little after that. The evening shift started arriving so we had a little more help in terms of staff. I went down to check on the woman we’d admitted and she was coming around while she was getting her second liter of fluid. I think she might be ok….hopefully! I went to tie up some loose ends, gave report to the nurse coming on and headed home.
I’m not a drinker. Today I was glad because I think it was the kind of day that might have driven me to the bottle. But since I can’t stand the taste and don’t think that would have been the best idea anyway, I went home and made up a big ole’ thing of Raspberry Crystal Light and drank a quart of it. (I forgot to drink anything all day so I figured I could handle it). Then I grabbed my Bible, my computer, my journal and my keys and hit the road. I didn’t really know where to go, but I just needed to get away. My days at this point consist of going to the hospital and then going home. And repeat. I needed a change of scenery so I took my car and went for a little drive…..up the road. Right now I’m parked on the side of a deserted jungle road putting all my thoughts on a computer.
So that was my day. Sorry it was so long and jumbled. I know some days are just like this. I had rough days at work in America and I have them here. The one downside here is that in America God blessed me HUGELY with awesome roommates who would listen to my rants, nod encouragingly and help me process things. Here, death is just such a part of things that when I try to talk to Sierra Leoneans about days like this I get “well, yeah, they died. We did everything we could. That’s all.” Not quite what I’m looking for. J I had too many counseling majors as roommates….I got spoiled!
But praise God for today huh? It was hard, but He was there. And I know He won’t give me more than I can handle!