Tuesday, November 13, 2012

Baby Emily

Supposedly, I have numerous husbands roaming around Sierra Leone, as well as lots of little Emilys.     This is for the simple reason that when a baby is born in the OB ward and I have anything to do with it, all the women will start calling the baby my "man" (husband) if it's a boy, or my "namesake" if it's a girl.  Of course chances are high (I'd say REAL high) that I'm not going to marry any of these babies and that once they get to the village nobody really names their baby "Emily"....that weird white person name.  

About nine months ago my neighbor found out that she was pregnant.  I work with her husband and I really like him.  We've had some of those good conversations that make me think "ahhhh.....now THAT's why I moved here!"  When I was talking to his wife about my dilemma in bringing Kadiatu to come live with me, I told her one of my biggest fears.  I was afraid because I couldn't teach her to be a good African woman because I don't know how to be a good African woman.  She said "Just send her to me! I'll teach her to cook, I'll teach her to wash clothes....I'll help you!"  So they're good people.  

So when we found out she was pregnant I quickly did the dates and realized that the doctors would NOT be here when it came time for her to deliver.  Darnit.  I'm not sure......I may have mentioned it here before, but OB IS NOT MY THING!!!

As the time started getting closer, I started getting more and more nervous.  What if I was down there by myself when it came time for her to deliver????  My nervousness is pretty pronounced when I'm trying to deliver a strangers baby...but when it's my neighbor???  It goes up exponentially!!  Before every shift I'd stop by and say "Hey!!  Has your belly started hurting yet?  No?  Alrighty!" :)  My biggest fear was that I'd be down there by myself and something bad would happen!  I'd been following this "case" since the first question was asked..."is she or isn't she???"  I couldn't bear the thought that I might mess that up what she'd been "cooking" for 9 months!  

A couple weeks ago I got all excited because we thought the time might have arrived (and I wasn't working!!) but....false alarm.  Yesterday was my last day of work before I go to Freetown tomorrow......and fly home on Monday!!!  We were all joking that I'd been waiting and waiting and waiting, but the baby wasn't going to come until I left.  Last night the husband called me and the first question I asked was "does she want to give birth tonight!?!??!"  Negative.  Bummer.  

This morning I was up early as usual and about 5:30 heard some noises coming from their house.  An hour later I noticed that she'd come outside and as I watched her (yes, I have stalker tendencies) I noticed that when she started making her little noises, she would also grip the metal pole beside her.  Could this be?  The day before I'm supposed to leave? When I'm not working so wouldn't be the only one down there?  A little bit later she and her husband came to the door and said that she hadn't slept all night because her belly had been hurting so much.   

I had to go down to chapel this morning even though I wasn't working to say goodbye to everyone and give them their early Christmas presents....a pen.  I know, not very interesting but seriously people are always asking me for my pen!  Seemed appropriate.  I told them I would meet them in the OB ward when I was done.  

When she arrived there was another woman in the labor ward who was getting ready to go for an emergency c-section.  I took her to another little room and checked the baby's heart rate...fine. I did the vaginal exam and she was 5-6 cm.  Awesome!!!  She's going to have this baby today!!  I couldn't believe how awesome it was that after literally waiting for weeks, I was going to get to meet him/her before I left!!  I told her I needed to go up to the house for a little bit but would come back down. I figured I had a good 2 hours before things got too exciting and since I hadn't started packing or cleaning yet, I'd work on that for awhile.  

Fast forward several hours, past the oxytocin drip, past the rupturing of membranes, past the normal crying that would occur when trying to push something very large out of somewhere very small etc to being fully dilated and ready to push.  Wait.  Let me hit pause to tell you that my favorite thing she said through those hours of waiting was when she asked the nurse if all women experienced this kind of pain while giving birth?  When the nurse said "yes," she said "Why do these women have so many children?!?!??!!?"  Precious! :)  Also...good question!  

The delivery was not an easy one.  I called the doctor when she was ready to push.  Did I forget to mention that in addition to me not having to be the only one down there, we also have a great Sierra Leonean doctor here right now who was eager to help us?  I had told the doc that I was concerned about the baby having some decelerations (heart rate going down) so as soon as she was fully dilated we wanted to get the baby out.  We ended up having to use the vacuum and do an episiotomy to get the baby out.  It had some shoulder dystocia so we really had to work to get that baby out.  Because of the difficulty of the delivery, the doc told me to prepare to resuscitate.  NOT what I wanted to have to do!

After quite the struggle, the baby came out.  It's heart was beating strong, but it wasn't breathing.  We bagged it for awhile, the doc gave a medicine through the vein in the umbilicus and finally it started breathing on it's own.  It didn't have that strong, angry cry that we love to hear, but it was trying!  

Now for the gender. Oh the gender.  Part of the excitement of delivery here is revealing the gender. I often get in trouble because I'm always so excited to tell the mother and father the sex of the baby that I don't ask them for the kola (money) that is traditionally paid to the midwife before telling them the sex.  Since I'd feel weird asking for that anyway, if I don't really forget, I just pretend that I did.  :)  

A few months ago my friend had an ultrasound that said the baby was most likely a girl.  Later she had another one that also said it looked like a girl.  When I told one of my friends that my neighbor was going to have a girl he said, "Well, I will still pray for a boy."  So it became a thing.  Emily and the "machine" versus my friend.  When the baby was born and I got to say it was a GIRL....I won. :)

The most precious thing about this is that a couple months ago my neighbor started telling people that if it really was a girl, they were going to name it Emily.  Now, as I mentioned above, people tell me that quite frequently but I never really put much stock in it so when they would tell me that, I would just nod and smile.  As the time kept getting closer and closer though, both the husband and the wife kept talking about it.  Last week I was talking with the husband and he said that if it was a girl, Emily, but if it was a boy the were going to have some problems because so many men were vying for the baby to be named after them.  When this little one was born today, people started saying, "Yeah!! Baby Emily has come!"  

So here she is.  My first official "namesake."  Baby Emily.  

Reasons I'm thankful for today? 
1) This baby was born JUST in time.  Literally the day before I'm leaving.
2)  I wasn't working so I could just help and try to encourage...without all the stress of being "in charge."
3) We had a doctor there who is very knowledgeable
4) We have a vacuum and scissors to do episiotomies
5) After breathing for her for awhile, she started breathing all on her own and shows no sign of any kind of anoxic brain injury from the rough delivery
6)  I got to see the looks of delight on this daddy and tired mama as they posed for their first family photo :)  Thanks Jesus!!!
Don't worry, I took one without the crazy white lady in the picture too.....

Saturday, November 3, 2012

Can I See That Hand?

Last night I was in the OB ward, minding my own business listening to my IPOD when a pregnant woman had the audacity to walk in.  At first I thought she was just visiting someone until I saw her bend over in what seemed to be some kind of distress and I went over to investigate.  Oh yes, she’s come to give birth.  My stomach did the drop that it always does as my adrenaline starts pumping. I asked if she’d had an operation before (hoping it would be a clear case of “take her to the OR quick quick like a bunny”…shout out Alanna!)  But alas, no previous C/S. 

She came with an older lady who was a TBA (traditional birth attendant) so since the pregnant woman was in a wee bit of pain I directed my questions to her.  “When did the belly begin hurting?”  “An hour ago.”  Huh. An hour ago?  Something didn’t make sense.  TBA’s never bring patients that quickly to the hospital unless there is some major problem.  Also, the woman seemed to be in quite a bit of pain for the labor to have just started an hour ago.  I asked the TBA what it was that made her come and she said she just wanted to get the woman checked.  Ok………

I took her back to the labor ward to check her out.  When we got there I again asked when the pain had started and this time the patient responded that it had started at about ten that morning.  OK!! That makes a little more sense!!  I started with the exam and when I got to the vaginal exam realized…something was fishy.  At first I thought it was the cord that I was feeling and had a moment of panic. Last week I lost a baby with a prolapsed cord (when the cord comes first) and it really really really sucked.  I did NOT want to do that again.  But as I started feeling around, I realized it was the hand that I was feeling.  Instead of the head being the presenting part, the hand was.  Oh boy.  Something else I’ve never seen before.  Oh, have I mentioned that OB IS NOT MY THING yet in this blog?  In case someone forgot…..there you have it. 

So the hand is presenting first.  Now what? When I did the vaginal exam I noticed a meconium stain (when the baby starts pooping inside the belly) which is a sign that the baby’s in distress.  I listened to the fetal heart tones they were 186.  Too high.  Another sign that the baby was in distress.   I knew that our doctor was in surgery so there was no way we could take her for a C-section right now anyway. I ran down to the OR to see if they were almost done. They weren’t.  Shoot. Well, I told the doc that when he was done I needed him to come down to the OB ward. 

Ok. So I can’t take her for a C/S right now.  What next?  I decided to do an ultrasound.  If the baby was breech than I was pretty confident that only a c-section would save this baby.  But if the head was down, is there any way she could push it out?  This was her fifth time giving birth so shouldn’t she be pretty well…..expanded by now?  I did the ultrasound and sure enough, the head was down.  I grabbed my book to see if I would get any inspiration there, but all I could find was how to deliver the foot first.  Blast.  Ok Emily, think.  The hand is coming first, the baby is in distress, and the woman is not fully dilated yet.  We need to get this baby out, but surgery is not an option right now. 

So what do I do until surgery is an option?  I can’t just sit and do nothing!  Ok, here’s the plan.  I’m going to augment her labor to try and get her fully dilated to see if there’s ANY way this kiddo is just going to slide right out.  After I started the drip I tried to see if there was any way I could push that hand back up there so the head would come first.  Negative Ghost Rider

Fortunately just as I started the oxytocin, the doctor showed up.  Thanks Jesus!!!  I told him about my exam, what I’d done, and my concern for the baby.  C-section it is.  Since I’d been pretty sure that’s what we were going to end up doing I’d already started all the preparations so as soon as they closed the other woman up and cleaned the OR we could take the woman right to the OR to pull this kiddo.
Because of the distress of the baby we wanted to be quick about it so instead of doing an epidural we used local anesthetic.  That’s right.  We used lidocaine to numb the incision area and cut into the woman while she was wide awake.  Don’t you want to have surgery over here!??!!  Usually they will give a medicine to knock the patient out, but in cases of c-sections they try to wait until after they’ve pulled the baby out because any medicine they give the woman will affect the baby as well.
Unfortunately this woman didn’t appreciate being cut open like a fish and started fighting.  In cases like these they take the risk and go ahead and give the sleeping medicine because if the woman starts fighting than everyone is in danger. 

As they pushed the medicine my heart sank a little because I HATE it when they have to do that (which they have to do pretty frequently......turns out most women don’t like being cut open. Weird.)  I almost always have a harder time with the baby when this happens.  Since this baby was already in distress I knew that this wouldn’t make things any easier.  Sure enough, as they pulled the baby out he wasn’t breathing.  

I took him over to the little incubator and immediately started bagging him.  I listened to his heart and it was beating, but slowly.  I knew that the medicine they give during surgery usually wears off in about 15 minutes, but the 15 minutes of waiting is FOR. EV. ER.  Also, I wasn’t sure how much of his present situation was because of the medicine and how much was because of the prolonged, stressful labor.  So I kept bagging him and slapped him around a little bit to try and make him wake up and scream at me.  Finally, his color started looking better and he started moving around a bit more.  Eventually he started breathing on his own and I just put some oxygen on him to give him a little extra help. 

All of the sudden, all the power went off in the OR.  The solar was finished.  A few months ago we got solar power for the entire hospital.  There is generally enough to do two surgeries and if we have to do more than that we run the generator.  Unfortunately this time the solar decided to cut off right in the middle of surgery.  And the surgeon was in the middle of sewing this woman up.  So what did we do?  Well obviously, myself and another guy pulled out our cell phones that have lights on them and shined the light at the woman’s incision.  After about 30 seconds of this I just started busting up laughing.  Is this really my life right now?!?!  When a fly was attracted by the light and kept trying to land on the woman’s open belly I started laughing even harder.   Fortunately my co-workers weren’t offended and we all started laughing at the absurdity of the situation.  Ten minutes later the generator came on and there was light.

Like to remember these ones!!!
My little patient wasn’t doing so great off the oxygen so I took him back down to the ward so I could keep him on the oxygen.  His right hand was extremely swollen, bluish in color and cool because the circulation had been cut off for awhile while he was in the birth canal.  However, by the time we got down to the ward he was moving all his fingers and crying a little. I think he’ll be A-OK.   It’s always an adventure………

Wednesday, October 31, 2012


I’ve seen Kadiatu three times now since I dropped her off at her village.  I was a little nervous about seeing her the first time, having NO idea how she would react. I remembered the first time we went to see her family in the village after I’d started keeping her and she was screaming and crying for them.  But since she hadn’t seemed to mind me leaving when I dropped her off, I was hopeful that we would just get to have a good time and that would be that.  Well….it was awful.  She was a little shy at first but warmed up quickly and was just laughing and snuggling.  My roommate and I stayed there for a half hour or so and then I went to leave.  As I passed her off to her relatives she started screaming.  Not just crying, screaming….”EMILY!!!!  EMILY!!!! EMILY!!!! EMILY!!!!”  As I drove away, I wondered if my heart could be shattered into any more pieces. 

I decided that I did NOT want to do that again.  I would wait a LOT longer before I went and visited so that she would be used to her family again.  I didn’t want to put her, her mom, or myself through that again anytime soon.  Unfortunately, about a week later I had to travel to Freetown and therefore  pass right through her village.  It would be rude for me not to stop. I was dreading it.  When I stopped, they told me that she’d gone to the farm with her mom and started to send someone to get her. NO!!  That’s ok! We just stopped to greet.  See you next time! Saved!

I spent almost a week in Freetown and when I came back up I knew I would need to stop again.  When I stopped, she ran up to greet me and again, we were laughing and playing.  After a little while it was time to go but this time when I went to leave she just said goodbye and was fine.  THANK. YOU. LORD!!  This kind of goodbye I think we can both handle.  She’s adjusted.

Two days ago I got a call from her family that she was sick so yesterday I went to the village to check it out.  When I got there she was laughing and playing, glad to see my roommate and I.  She didn’t look sick.  I’m always a little afraid of being manipulated so I was leery but wanted to get her checked out at the hospital anyway.  She gladly came along and was just laughing all the way to the hospital (she loves riding in the car).

When we got to the hospital, although she was happy, it quickly became apparent that she wasn’t well. She was really clingy and just not her normal self. Sure enough. Darn malaria.  I got her medicine and then took her up to the house for awhile. I figured I’d take advantage of the opportunity to spend some time with her without 30 people standing and staring at us. 

As soon as we got to the house she walked in, looked around the living room and then went looking in our bedroom.  Yup….everything’s still the same.  We ate some lunch and played and then she started getting really fussy. Nap time for sure. Since I’d worked the night before I was really tired too so we went in my room to take a nap together. She did what she used to do when I’d put her down for sleep which was wrap her arms and her legs around me with her face touching mine until she fell asleep.  Melt. My. Heart. 

She asked to watch "Akoona Tata" which means the 10 min of the movie where they sing the song.  She loves to dance to it :)
When she woke up we went to go greet my neighbors who love her.  As soon as they saw her they started saying, “Emily. Please keep her.  Look how her body’s gone down in the village. Ok, when you go to America you can take her back put please keep her. You saved her life.  If it wasn’t for you she would be dead.”  No pressure.  I told them that I was praying about it.  But my words sounded hollow.  How can I not  take her??? 
Some girls stopped by on their way back from school and they were way more excited to see her than me! :)
I took her back to the village a little while later and when I started driving away she started crying again.  Not the screaming sobbing like the first time, but the sobs of someone who’s confused about why you’re leaving her there……again.

She wasn't all about the picture taking since she wasn't feeling great.....but she tried.  Love her fake smile :)
When I have experiences like that, I start to panic.  Emily. You have to make a decision. NOW!!  The knot comes into my stomach and my mind starts whirring!  Make a decision, Emily. For the love, just decide!!!  But I can’t yet. I just don’t know!!!  So the other day I went through the Bible and wrote down some of the numerous verses describing how God leads his people.  I don’t know if I’ve ever needed His direction more.  I don’t want to screw this one up!  But then I rest in the fact that He doesn’t want me to either.  He’ll tell me. In HIS time, not mine. So I’ll wait.  And he’ll renew my strength.  And I’ll rejoice in Him.  Thank You Lord. 

Thursday, October 25, 2012

Vote for Pedro!!!

Well, the political season is upon us in Sierra Leone!  As many of you may know, Sierra Leone isn’t what you’d call the most “stable” country in the world, having recently (within the last decade or so) emerged from a devastating civil war. 

Sierra Leone elects their President every 5 years.  Five years ago, the government successfully changed hands (meaning switched from one party to another) without any coups or military takeovers or leaders who just flat out refused to give up the power.  So….yeah!!!  Even so, tensions are still high here, as the election draws nearer.  People here know much better than I do, just how quickly things can turn sour.

For that reason, there is an understandable departure of a large number of ex-pats (“white people”).  I was down in Freetown the other day with my other WMTers and we were listing off all of our friends that are leaving.  The election is on November 17th.  Our conversation went a little something like this: “So and so are leaving the 12th, so and so already left, so and so are leaving the 10th, so and so are leaving the 14th.  And Emily’s leaving the 19th.”  That’s right. I’m leaving 2 days AFTER the election.  Cause I’m just that smart. 

To be fair, I specifically WANTED to stay for the election. I wanted to observe, to stand with my friends as we all prayed for peace.  I wasn’t really afraid for my safety because I was going to stay up in the village where the vast majority of people are all from the same political party, so there's very little conflict.  The hot spots are the bigger towns where different political parties are living together and don’t always play nice. 

Well, life happened (i.e. my sister started pressuring me to come home for Thanksgiving) so now I’m leaving on the 19th.  And my perfect plan to stay up country during the election is also foiled because I will need a couple days in Freetown before flying out so would need to be travelling on the actual day of the election or the day before.  Now, I think this blog has well established that I’m not always the sharpest tool in the chest, but even I know that I don’t want to be travelling long distances through major cities that close to the election.  Therefore, I'll actually be heading down to Freetown about a week before the election and staying with my friends down there.  Right in the thick of it!  

I went down to Freetown for a meeting last week. My plan was to Friday: drive down.  Sat: go to meeting. Sun: go to beach (because I don't know if you've seen the pictures I've posted of the beaches here but.....if I have a chance, I go!!)  Mon: go to town to stock up on supplies before heading back up country. Tues: go back up country.  Then we read the e-mail about the political rallies. See apparently, there’s a schedule of when the different political rallies are going to be, and in which towns.  They try to schedule the different parties for different days (smart!) so that things don’t get out of hand.  However, Monday was supposed to be BOTH political parties in Freetown.  Not somewhere I wanted to be. 

See, these political rallies can be really peaceful, people just being excited about their candidate, but they can also turn pretty quickly. We had some friends who had a soft-top jeep and during one of the rallies the crowd cut into the jeep and started stealing their stuff while they were sitting right there!  I’ve driven through a few of these rallies and there’s this sense of powerlessness as you’re forced to move at a snail’s pace and there’s just a HUGE group of people all chanting and being really excited, often beating on your car as you drive by.  One Sierra Leonean told us that political rally days are like free days. People act like there is no government, no police, etc.  It can be a little intimidating.  Throw in a little (or if you happen across them at the end of the day a LOT) of alcohol and marijuana and you’ve got yourself quite the party.  But not really a party I’d like to attend.  

So life in Freetown right now revolves around when these rallies are being held.  All your plans change depending on when and where they’re being held.  But that’s not the kicker. Yes, they have an official schedule, but that can change as well. For example, I changed my whole schedule to stay in town an extra day to NOT go into Freetown on Monday but then found out that the rally was postponed because the president was out of town and the other party wasn’t REALLY having their rally in Freetown but on the outskirts.  So all of the sudden, Monday is the perfect “in town” day.  Sheesh.  But such is life in Freetown now. 

Even though it can be a little intimidating, it's still fun to get to see people excited to exercise their right to vote.  They've been preparing for this all year and it's all coming to a culmination now!!!  And yes, we have to be wary of vandals, riots, ceremonial killings, etc. but if I had a tv and I was watching TV, I wouldn't be interrupted by a single political ad.  So there.  

I’ll be flying home after the elections but before the election results are in, so I won’t even be around during the highest tension time (when the loser has to admit defeat). And until that time I will leave all my red (APC) and green (SLPP) shirts in the closet so as not to accidentally affiliate with any team!  Blue’s really more my color anyway…

Tuesday, October 23, 2012

Blood has always been my favorite body fluid but......

The other day I was at home, NOT in the OB ward.  I was actually supposed to be there but it was really quiet and I’d been working a ton and my house was a mess so I told the nursing assistant to just call me if anything exciting came in.  I lasted at home about 20 minutes before I got the call that a pregnant lady had come in.  I headed down.

When I arrived I saw them helping the woman from a motorbike.  That’s right…in labor, riding a motorcycle.  Oh dear.  We helped her back to the labor ward and I started asking the normal questions.  First being, what’s going on?  They said that she had started laboring the night before, but had started bleeding almost as soon as the labor started.  I got the Doppler to check for fetal heart tones.  I got a rate of 160 but when I checked it against the mothers pulse I found that it was really the mothers pulse. Good grief!!! (That’s really fast!)  I am not at ALL an ultrasound guru but I took her back to the ultrasound room to see if I could confirm that there were no fetal hearts on the ultrasound.  Because Jesus loves me, I got a really clear picture of the chest wall (really clear pictures of….. well, anything are rare with me) and could see that the baby’s heart wasn’t beating. 

Ok, now to figure out why this woman is bleeding.  There are a few options.  Number one, the placenta is down too low and is causing bleeding.  Number two, the placenta has prematurely separated from the uterine wall and she’s bleeding.  Number three (and number scariest!) is that her uterus has ruptured.  But how the heck do I tell!??!?!?!?!  

I did a vaginal exam and felt….something squishy.  I tried to see where the head was on the ultrasound (usually one of the things I can actually find) but was having trouble being sure.  The squishy thing I felt on exam didn’t feel like a head.  I called one of my friends (shout out most wise and excellent CHO!!!) to come help me. I needed to bounce some ideas off someone.  We did a speculum exam and sure enough…it didn’t look like a head. It was kind of blueish….yeah.  So I figured it must be the placenta that is covering the opening of the cervix, which is now causing her bleeding.  But now what to do?  This woman was still bleeding and I wanted it to stop! We checked her hemoglobin and it was already low enough to need a transfusion.  The other problem was that her blood type was extremely rare. She came with someone who had her blood type so we were able to get her one unit, but we knew that the likelihood of getting any more was extremely rare.  Any bleeding she was doing would most likely not be able to be replaced. That’s scary!

I hit the books. I knew that if the baby was alive, and the birth wasn’t imminent we would take her for a c-section.  However, the baby was already gone.  So do I need to make her undergo a c-section if the baby isn’t alive? I wasn’t sure. I started reading about bleeding during labor and started reading about placentae abruption (premature separation of the placenta from the uterus).  In this section it said that if the baby was already dead, you could try a vaginal delivery. I figured that if that was true for a separation of the placenta, it could be true for placenta previa as well.  Let’s try it.
Her contractions weren’t very strong so I have her some medicine to get things going.  I went back to reading while I waited for the medications to kick in.  It wasn’t too long after that I went back in and checked her and she was fully dilated. I decided to let her push.  (NOTE:  IT MIGHT GET A LITTLE GRAPHIC HERE.  YOU WERE WARNED!) 

Ok.  So as she was pushing, there was this bulge coming out, but it was like it just wouldn’t come out.  I let her push a couple times and….nothing.  Then I started looking at it closer.  Hmmmm.  That looks really fluid..y.  Could it be that instead of the placenta those are her bulging membranes?  (Remember, I have mentioned this many times:  OB is NOT my thing!)  By George I think it might be her membranes.  Since we don’t have any of the fancy tools to rupture membranes I used my fingernail and sure enough, a fountain of fluid came out.  Nice!  Oh sheesh. And there’s the head.  One push and out came the head.  One more push and the baby shot out of the woman.  And I mean SHOT out of her.  But it wasn’t only the baby, the placenta came out with her.  As well as more blood than I have ever seen in one place!  I’m serious. Giant clots, a river of blood…wow. 

As I pushed on her uterus to get all the clots out, it was like there was an artery bleed. Every time I pushed on her uterus, blood squirted out.  Oh my gosh.  Is this a ruptured uterus?? Is she going to bleed to death in front of me???  The OR team is at lunch. I have yet to see everyone gather, scrub and open a woman up in less than an hour. Does she have an hour?  I started to get that cold ball of fear in the pit of my stomach as the panic started to creep in.  There was just so much blood! And I knew that because she came in with such a low blood count, she didn’t have much reserve.  We had lost too many mothers lately.  I did NOT want her to be another one!!

I pulled out my phone and started calling my CHO friend, the one I’d consulted earlier. As I did that I went into the hall and because Jesus loves me, the hospital administrator was in the hall (he’s also been a nurse forever and has seen just about everything).  I calmly said “Excuse me, but can you please come in here?  NOW? “  He got the gist.  We decided to take her to the OR so we could get a better look and see if we could see where all the blood was coming from.  Did she rupture her uterus?  Did she tear her cervix as the baby was coming out? (I did mention that it SHOT out of her right?  Did I also mention that this was her 9th pregnancy???  We couldn’t have kept that kid in there if we’d wanted to!)

We got her to the OR. We tried to do a speculum exam but there was just so much blood that it kept filling up the speculum and we couldn’t get a good view.  We decided to call the OR guy on call to see if he could come help us.  When he arrived he asked me about the placenta.  Was it intact? I told him that to be honest, I couldn’t really remember because it came out with the baby….and all the blood distracted me. I ran back to the delivery room to check.  I looked at the placenta.  Well, it looks like all the other placentas I’ve seen…..I guess it’s good?  I went back and told him it looked ok to me.  After digging around inside her uterus for a bit, he pulled out….pieces of placenta.  Jackpot!!

We figured that she had indeed had placenta abruption. That’s why her placenta had come out with the baby, instead of the 5-15 min. later that it usually comes out.  But part of the placenta had not detached, so was still attached to the uterus.  And that can make you bleed!!!  Yes, I checked her placenta but…..I didn’t do a very good job! I’ve never seen an incomplete placenta before and it looked like all the other ones I’d seen.  My bad.  Have I mentioned that OB IS NOT MY THING?!?!?! 

Once the OR guy removed the placenta, the bleeding slowed considerably!  She continued to bleed a little but not like before.  Thank you Lord!!  In addition, her family was able to find a second unit of blood for her…which was an absolute Christmas miracle!!  I’m just so thankful that in spite of all my inadequacies my God was so faithful and sent me people who could help!   A few days later the woman was ready to be discharged.  Yeah for happy endings!!  

Saturday, October 13, 2012

Dating Sierra Leone Style...

I’ve debated on whether or not to write this blog.  As you can see by the title, it could raise a lot of questions that, in an effort to be diplomatic to all sides, I can’t really answer well.  However, because the last few of my posts have been a bit… well, in the Debbie Downer category, I decided to go ahead and tell a story that wasn’t nearly as dramatic

As the title of the blog suggests, a couple weeks ago I went out on what would most likely be classified in our culture as a “date.”  With a Sierra Leonean guy.  I won’t go into the specifics of how or why I ended up going out with this guy but let’s just say that he is the close friend of one of my co-workers at the hospital who is also a big guy in the community in terms of his relation to the Paramount Chief. He is also very persistent.   And before you start marching me down the aisle I will say that he is a nice guy and will be a nice friend.  So there you go. 

He called to ask if I wanted to go watch a soccer game with him.  I told him that I have this little four year old that I can’t seem shake and wants to go everywhere with me.  He said it would be fine if she 
came with us.  Alrighty then.  Sounds like a hoot. 

Because I was afraid to put Kadi on his motorbike, we decided to meet at my co-workers house at the edge of town and he would show us how to get there.  When we met up with him we both took one of Kadi’s hands and began walking down the road into town.  Begin my nightmare.  Or if it’s not my nightmare, it’s at least one of those dreams where you wake up and you don’t really know what happened but you just don’t feel good about it.  Yeah. That starts now.  See, I do NOT love going into town.  (And by town I mean the four intersecting streets that have nearly identical booths selling nearly identical things).  That’s our “town.”  I pretty much do whatever I can to avoid going there because whenever I do I feel like I’m on a stage with the spotlight pointed directly at me.  As I walk down the street all the kids yell “White! White! White! Hello! Hello!”  All the people milling around their shops stop what they’re doing to watch me pass.  I feel like a freak of nature.  And I hate it.  In fact, I’ve come to realize that one of my absolute favorite parts about being home….even more than the delicious food, is the fact that I can walk into Target and absolutely No. One. Cares.  It’s awesome!

So here we are, walking down the street.  This time, instead of just me, it’s me....and a guy.  Let the rumor mill begin!  We were walking down one of the main streets when all of a sudden a man about 50 feet ahead of us coming towards us started shouting.  I strained to hear what he was saying and then realized he was pointing to me saying “I HAVE SEEN MY WIFE!!!  I HAVE SEEN MY WIFE!!!!”  He proceeded to grab onto my arm and tell me that he wanted me to stand there, talk to him, and then marry him.  Um….awkward.  I kept telling him sorry, I have to go but he was still holding on.  The guy I was with was also trying to talk to him, telling him that we needed to go but he wasn’t having it.  He’d definitely been knocking back the palm wine and it seemed to be impairing his reasoning abilities.  Fortunately I took a self -defense class when I was in high school and was able to do a quick release to escape.  His parting remark was “It’s ok. If you’re staying with my brother, you’re staying with me!!”  Whatever that means! Buddy, I’m staying with a 4 year old who often doesn’t quite make it to the potty and tries to steal my pillow every night! 

So anyway……..  We quickly reached the place where the game was being held.  As we walked through the door my friend handed him some money and I was faced what appears now to be the universally awkward dating question…who is paying?  I paused, not sure if I was supposed to pull out some money, not sure how much it should be even if I did pull out some money.  What about Kadi?  Did it cover her?  I stood there for a minute unsure and then just walked in.  They could come arrest me if they wanted. 

As we walked into the room, my heart sank.  The place was pitch black but with enough light for me to realize that it was full of men all yelling at the two TV’s at the front of the room.  There was not a single other girl in the entire room.  Well, aside from the four year old in a frilly dress that was clinging to me.  Lord give me strength. 

He found us some seats and as we sat down I started taking in my surroundings.  I realized that the place was so dark because all of the windows were shut so that the TV’s could be seen.  I don’t know if you’ve ever been to Africa, but it’s hot.  And Africa with zero air circulation is….really really hot.  Fortunately, as the sweat started pouring down my face, arms, back, etc. I had a four year old who was pointing it out to everyone.  “Emily! You’re sweating!!  You’re sweating a lot!!!”  Yes, thank you little one.  Perfect date attire.  Cute shirt, dressy capris, and buckets full of sweat. 
Shortly after we arrived it was half-time.  Everyone started standing up to go outside. Because did I mention how hot it was in there?  My friend offered to go get us some drinks so he left and we waited there.  I debated getting up and going to wait outside…..you know, so I could breathe for a second…. but couldn’t decide which was worse.  The suffocating heat staying of staying inside, or the curious stares and attempts at small talk with a large group of guys if I was to go outside.  We stayed put. 

My friend came back with our drinks and the second half began.  I was now faced with the question of how to keep a four year old entertained in a dark room that didn’t allow for a lot of movement. Oh, and how do you keep her from shouting and continually kicking the guy in front of us?  For awhile, she was content drinking her soda.  But as she was happily chugging away, I began worrying about what I was going to do when she inevitably told me in a little while “Emily! I need to PEE!!!!!!!!”  You see, even after having a child for two months, I have not yet mastered the whole “where is it appropriate to let kids pee” question.  How do you know which bush is appropriate and which will get you angry, condescending stares from your neighbors???  As I sat there mulling it over, Kadi started getting restless. She wanted up, she wanted down. She wanted to sit on my right side, on my left side, on my lap.  Apparently 4 year olds aren’t great at sitting still??  Finally she noticed some trash on the ground and started playing with it.  I let her.  She was happy.  I’m a horrible “mother”. 

She started playing the game we liked to play at the hospital which is “Making a Fire and Cooking Lots of Food and Yelling at Emily to Eat!!! Eat!! Eat!!”  As she was cooking, I was dividing my time between trying to pay attention to the game and then pretend blowing on her fire, eating her rice and drinking her water.  Oh. And still trying to keep her from kicking the guy in front of us.
How long do soccer games last?  I played when I was younger but since then have had little to zero interest in the sport and was wracking my brain to remember.  I got it in my head that it might be 90 minutes and started watching the clock more than I was even watching the game.  Please, please, please just let us make it through without something horrifically embarrassing happening.  As the time reached 90 minutes and kept going, I was distraught.  For The Love!!!   How long are these games?!?!?!?!   Fortunately, a few minutes later everyone started standing up.  Sweet relief it’s over!  And best of all, with minimal humiliation!

As soon as we walked out of the building, Kadi told me she had to pee. Shocker.  I was really unsure of what to do so I asked my friend. He pointed to the place we should go and she went fine. I didn’t notice anyone giving me a death glare, so I guess we were ok.  He said he wanted to take me up to show me his office and then we would loop back around to go to my house.  As we were walking up to his house, it turns out that he knows everyone.  Every single person in this town.  No flying under the radar with this guy. 

We reached his office which also turns out to double as his house.  We went inside and were chatting.  Kadi was wandering around, picking up stuff that wasn’t hers, interrupting our conversation, you know, generally just being a four year old.  At one point she came up to me and told me she needed to go toilet (that’s #2).  Oh dear. That’s even more of a dilemma than peeing!  I asked her to wait.  Fifteen minutes later she came up and asked me again.  Wait please.  She wouldn’t be put off though and kept coming to me, now with a look of pain on her face. Poor kid! Finally I just said, “Do you have somewhere she can go to the bathroom?”  He pointed me to the adjoining bathroom.  He did have a toilet but there was no seat so I stayed in there with her to make sure she didn’t fall in.  She proceeded to have the largest, longest bout of diarrhea that I have ever heard.  Very romantic.  As she was..ah hem, finishing, I started to think about my next quandary.  Toilet paper.  They don’t use it here. And while I am almost never without it for just such occasions, I was utterly unprepared. 

No toilet paper you might ask? What do they do?  Well, at the hospital whenever you see someone walking with a little plastic tea kettle you know that that tea kettle is filled with water and they are off to have a bowel movement and will use the water in said tea kettle to wet their hand and…clean themselves, splashing large amounts of water on their bums.  That’s just how it rolls here.
I really really didn’t want to do that.  Especially because I didn’t bring my hand sanitizer either and there’s all this cholera going around…..just NOT what I wanted to do!  Fortunately my friend came to the rescue and asked if I wanted water or tissues.  Tissues!! Tissues!!!  Thank you Jesus for tissues!!!   See how much Jesus loves me???

After her exhausting time on the toilet, Kadi promptly fell asleep (it was 7:30 after all!)  We chatted for a little while longer and then headed back to my house where we called it a night.  PHEW!!  I made it!  In closing I will say, “Thank you Lord for a new cultural experience. And please never make me do it again!”  

Friday, October 12, 2012

I don't know what to title this blog.

Two nights ago I was in the OB ward, working evening shift.  I started off the shift with a bang, as a woman needed a C/S as soon as I arrived.  No problem.  She was a breech baby and the woman’s belly was so big that we were suspecting twins.  When the surgeon cut into the uterus a literal fountain of fluid came out.  We all yelled “woah!!!”  The woman had polyhydramnios.  This is when there is more amniotic fluid than there should be. It hadn’t been a second baby in there, but just lots of fluid.  Unfortunately this is often associated with birth defects.  As soon as they handed the baby over to me, I knew this would be the case with this little one. 
Her head was too big and looked like a mushroom.  She had two clubbed feet, four fingers on her right hand and her eyes could not open.  She wasn’t breathing well so I worked at resuscitating her. Eventually she was breathing on her own, but her respirations were ragged.  As they finished sewing the woman up, I took the baby back to the ward, keeping her on oxygen.  All evening I kept her on oxygen and suctioned her over and over as she kept coughing up more fluid.  At 8:56pm became unable to continue her fight and passed away.  Her mom didn’t cry.  I’ve found that I am actually more surprised when the women do cry. So many children die in childbirth that it’s not wholly unexpected. 
About the time that I was pronouncing this baby, a woman walked in, obviously great with child.  She was being assisted to walk by two different men so I ushered them back to the labor room.  I began with my usual questions.  “What time did the belly begin to hurt?”  The husband told me that it wasn’t just the belly, but the whole body that’s hurting her.  Oh?  So she’s not having the kind of pain to give birth?  Nope. 
Ok, my train of thought moved to malaria.  I started to take her blood pressure but couldn’t hear it.  That’s weird.  I moved on to take her pulse and was surprised to see it was 200 beats per minute (normal is 60-100).  This was fast!!!  Sheesh, no wonder she could barely walk.  I took her to a bed and tried once again to get a blood pressure and got 90/?  Well, she was holding her own.
My first thought was that she was in SVT (supraventricular tachycardia) or some kind of rapid a-fib.  Since the doctors had left the hospital but were still in country I called one of them to see what kind of meds we could give her to bring the heart rate down.  Of course I have my list of things we’d do in the States but we couldn’t do any of them here, and since OB was never my thing, I wasn’t sure what meds would be safe in pregnancy.  After chatting with the doc I checked her hemoglobin (maybe she was anemic?) and started some IV fluids (maybe she was dehydrated?)  We gave her one medicine to try and bring her rate down.  I was told that we actually have an EKG machine that works. Perfect! Unfortunately the only guy that knows where all the parts are and how to work it turned his phone off and when I sent someone to his house he wasn’t there. There was nothing else I could do.  As I left her in the care of the night nurse, I just prayed that the fluids would bring the rate down. 
I went back down a little early the next day because I was so curious about how she was doing.  I saw her empty bed and immediately asked if she’d died.  The nurse laughed and said that no, she was over on the other side.  When I went to look at her, I could immediately see that her condition was worse.  Her lungs were now full of fluid and she was working a lot harder to breath. Her O2 sat was 69% (should be above 90).  I gave her some Lasix to get rid of the fluid on her lungs, put her on oxygen and gave her some dexamethasone in case the baby wasn’t full term.  The doctor had called a little earlier and said that if her condition wasn’t any better, we needed to go and get that baby. 
But how could we take her to surgery in this condition?  She couldn’t even lay down and her heart rate was still 200!!  Unfortunately there was another woman waiting for a C/S as well. We decided to take the non-critical woman first, in the hopes that the Lasix would continue to work and take off some of the fluid off her lungs and she would be more stable for surgery. 
I went and caught the baby from the first surgery and then was back to my critical patient.  She was continuing to go downhill.  At this point, we’d been hemming and hawing about whether or not to take her to surgery because we weren’t sure if she would survive.  Now I could see that she wasn’t going to survive if we continued to do nothing. My small hope was that somehow taking the baby would relieve some pressure on her heart and cause her rate to go down.  It was a thin hope. But it was all I had. 
Unfortunately the stable C/S turned out to be messy. It was her third c-section and during the last one the surgeon had inadvertently sutured her intestine to the abdominal wall (or somewhere it wasn’t supposed to be) so the whole thing had to be done with extreme caution and she bled a lot.  It was taking forever!!! 
While I was waiting for them to close the woman up, I went back to the woman in the ward.  We wanted to check for a fetal heart rate, even though at that point I thought we should probably go try for the baby even if it wasn’t alive.  As I stood there, with the Doppler on her belly, she was saying things like “Take me for the operation.  Anything that you need to do just do it. I will bear it!”  Then she took her final breath. And was gone. 
Of course I started going over and over things in my brain.  We’re very fortunate that it’s not too often that we lose a mother.  I had admitted her last night and she had lived all night, all day, and within two hours of me coming and messing with her, she was gone.  What could I have done differently?  In hindsight I should have taken her to the OR when she came the night before, as she’d only become more unstable as time progressed.  But I was afraid if I took her last night she would die on the table and we hadn’t tried everything yet.  Anyway, over and over in my brain.  She left four little ones at home.  Lord help them.
I’m really sorry that I’ve had so many downer blogs lately!!  I usually try to alternate so that a feeling of depression doesn’t come over my readers whenever they see I’ve posted something new.  Life is hard here, but our God is still alive and my hope is that someday Justice will reign!

Tuesday, October 9, 2012

Another Goodbye

Yesterday I took Kadi back to her village.  Today the two American doctors who have served this hospital for four years left, with plans not to return.  Bleh. 

The last few months here have been chalked full of drama!  And although my family will attest to the fact that I might be a little dramatic myself, this drama actually had nothing to do with me.  I won’t go into details because to be honest I’ve only heard one side of the story so I don’t feel free to comment but what it boiled down to was that the doctors felt that the leadership of one group of people that they’re working with was too corrupt and they could no longer morally work under him.  They feel that they’ve been lied to and manipulated too much and they’re just tired.   They were planning on leaving at this time to go home for their annual rest/fundraising effort, but a couple weeks ago they announced in our chapel service that when they leave, they will not be returning.  We are all devastated.

Needless to say, this place has erupted!!  These doctors have not only done so much medically for the hospital but they’ve made huge improvements in the hospital doing things like providing solar electricity 24 hours a day, bringing in tons of supplies, helping the schools , the churches…I could go on and on.  And the community knows what they’ve done.  There have been demonstrations, radio broadcasts….the other day my roommate and I had about 30 people show up at our door with signs chanting “Whites don’t go” and “No Whites, No Hospital!”  Most of them had been sucking down the palm wine for a while and were a little overzealous.  Although it’s always nice to know that your efforts are appreciated, we were REALLY uncomfortable and felt it was really disrespectful to the countless other people that AREN’T white and are working their hineys off at the hospital. 

So what do I do?  Do I stay?  Can I stay in a hospital that doesn’t have a doctor?  We always manage for a while if they leave for a few days.  Last year they went home for a couple months and we managed, but I literally saw people die that probably wouldn’t have if we’d had the expertise of a doctor.  It’s a lot of pressure to be one of the ones that has the most knowledge and not have that experience to tap.  This doesn’t even take into consideration the moral question of continuing to work for a man who is….well, just not good.  Could I do that?  But what about the hospital!?!?!?!  I love the people that work down there.  They’ve become my friends. Can I just abandon them?  What will they do? We’re already so short staffed….this would just make it worse!  A few days ago I had a meeting with one of the leaders of the hospital who informed me that if they do not send him another doctor (which there are none to send….so they won’t be able to), he will resign.  You just can’t run a hospital without a doctor.  I’ve decided that I agree with him.  I won’t be able to stay here without a doctor.  I just can’t do it. 

There is a meeting tomorrow in the capital city with the doctors, the man they have a problem with, the paramount chief from this area and a bunch of other people.  The doctors have essentially said it’s either them or him.   So while they’ve packed up their house, said goodbye to everyone and have stated over and over that they’re not coming back….we’re all still holding out a little hope.  What will happen at this meeting? 

A couple weeks ago I was in Freetown talking to one of my friends and teammates (shout out Kaysie). We listened to some podcasts by a woman who is REALLY into memorizing Scripture and we both got really excited about doing more of that together. (You can listen to her podcast here).  The woman gave us some strategies on how to do it so we each picked some verses that we’d memorized in the past and were going to go over them every day for 7 weeks.  One of the passages that I picked comes from Philippians.  “Rejoice in the Lord always.  I will say it again: Rejoice!  Let your gentleness be evident to all. The Lord is near. Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends understanding, will guard your hearts and your minds in Christ Jesus.”

Now I’ve known these verses for years and while they were tucked back in my brain somewhere, I’ve started meditating on them every day.  But I STINK at doing what it says.  Aside from the decision to move to Sierra Leone, I’m on the precipice of making perhaps some of the biggest decisions in my life up to this point. Whether or not to become a mom (see post from yesterday) and what to do next in my time here. 

I’ve stopped sleeping.  I wake up in the middle of the night and immediately start thinking about everything and can’t shut my brain off. I’ve stopped eating.  What? Stopped eating? Inconceivable! !!!  And while it is a great weight loss plan, I’ve now had two toenails fall off for mysterious reasons, which makes me wonder what kind of nutritional deficiency I’m suffering from. 
I was getting mad at myself.  Where was the peace which transcends understanding that Jesus promises there?  I didn’t have it.  Then I realized.  I wasn’t praying and petitioning. I was just thinking and worrying. Instead of drawing closer to my Jesus because of all the stress, I was just going inside my head, trying to find a solution. And what about the part about doing it with thanksgiving?  Thankful for what?  Really?  Am I supposed to be thankful that I have the ability to bring my requests to God?  Thankful that I’m in these situations where I have to bring things to God?  I wasn’t sure, but I knew I wasn’t doing either.  So I’ve decided to do both. 

My brain still wants to go into overdrive.  I have to literally force myself to change my thinking into praying.  To rejoice. To be thankful.  But that’s where my peace is!! Every time I remember that my God hasn’t forgotten me. That he knows what’s going to happen.  That He loves Kadi more than I do.  That I came here to do His ministry, not my own, so He’ll show me what He wants me to do.  There is peace.  To me, it feels like thinking about it, worrying about it will somehow help.  That somehow I’ll figure out a solution.  But it doesn’t. It just makes me really sleepy and my toenails fall off. 
I don’t often wax philosophical on my blog because…well, I just don’t.  But there you go. My inner most thoughts from today. J  Thank you all so so  much for your prayers and words of encouragement. I’ve been blown away with the kindness I’ve received and am really really grateful!  

Monday, October 8, 2012

I gave her back today.

I took Kadiatu back to her village today.  The original agreement was that I would keep her for two months and at the end of that time would return her to her parents.  Since I know there isn’t a huge emphasis on time here, I reminded her mom when we were at the half-way point.  Last week I reminded her that there was just one more week and told her that I would be bringing Marie to stay on Monday.  Today.
I’ve been preparing for today since the day I took her from the village, two months ago.  At the beginning she would often get really quite and sometimes her eyes would well up with tears…apparently for no reason.  After a while we realized that these were the times she was thinking about her mom.  The first few times we went back to the village it was torture as she cried and cried when we left.  But that gradually started to change.  After a few weeks we would spend time with her mom and brothers at the hospital and she wasn’t glued to their side like she was before.   She started getting really shy when she saw her mom and brothers and would hide behind me, sometimes starting to cry if I left her with them.
From the very beginning, I did everything I could to combat that.  For some reason people here love seeing a white girl with a Sierra Leonean child and were always asking if she was my child. My standard response was, no she’s not my child, she’s my friend.  They would always ask her who her mom was.  She started pointing to me.  She would often call me “mama.”  While of course this absolutely melted my heart, I always corrected her.  “Kadi, who’s your mom?”  “Aminata.”  “Yes!!  Are you going to stay in  your village again?  Are you going to go stay with Aminata and your brothers and your daddy again???”  “Yes!”  “Yeah!!”  Nearly every day we would have this conversation.  At night we would pray for her family and thank God that she was able to come stay with me for a short time and also thank Him that she got to go back there again.
As today grew closer and closer, my roommate and I started talking about how to handle this.  Do I just take her and leave her?  How best do you explain what’s going to happen?  We decided that honesty would just have to be best.  So last week we started telling her that we were going to her village (she always gets excited about that) but that this time I was going to leave her there with her family and I was going to come back to the hospital.  But I was going to come see her!!  At first her response was always “No, no no no no!”  Gradually though, she started becoming more agreeable.  In the last few days she would even bring it up.  “I’m going to the village?  You’re going to leave me there? You’re going to come see me?”  Yes yes yes! 
Although she seemed to be understanding, the fact was that she is still just 4 years old so I wasn’t sure how much she was really understanding, and there was still that darn language barrier!  As we set out this morning, I really had no idea how this was going to go.  When we were packing her things last night she’d been really excited and all morning she kept asking if we were going to her village. 
I was nervous about how I was going to handle things.  I’d been a bit of a wreck throughout the week and had been crying spontaneously. I prayed that I would be able to keep it together for her, because I knew that she would take her cues from me.  I packed on the excitement.
When we arrived at the village I got her out of the car and handed her a bag of her things.  She marched right off to see her mama.  When we reached her mom, there was no smile.  No “so happy to have you back!!”  I didn’t know what to think. 
Unfortunately Kadi started coughing on Friday. Since it only seemed to be getting worse over the weekend, I decided to start her on an antibiotic.  I pulled it out and started explaining to her mom how to give it to her.  After I finished explaining that, a man came up to me and said, “We don’t really understand why you’re coming back with this child.”  Oh dear.
A part of me had been expecting this.  Nearly every time someone asks if she’s my child and I explain that I’m just keeping her for a couple of months to get her healthy, they will ask me what I’ll say if her parents ask me to keep her.  I’ve been asked that countless, countless times.  My response has always been that she has a mother, she has a father, and I haven’t been asked to keep her.  But as the time grew closer, I was counseled to be prepared with an answer just in case they did ask.  To be honest, when I reminded her mom last week that the time was almost complete, I wondered if her husband would show up at my door.  Since no one did, I kind of put it out of my mind and just focused on getting ready to let her leave. 
Back to the situation at hand.  When the man told me that he didn’t understand why I was bringing the little girl back, I went over the agreement that we had signed that stated the time would be for two months.  To make a long story short, Kadi’s uncles, Kadi’s father and (although she doesn’t have a say I insisted that I wanted to know what she wanted ) Kadi’s mother, all asked me to keep her and raise her because they just couldn’t.  They told me that if I hadn’t come and taken her when I did, she would have died and that she’s just going to get this sickness again.  They also pointed out that her younger brother also has “the sickness “ (malnourishment) so how are they going to manage? I was blunt with them and told them that I’m going to America for two months in a couple weeks and when I come back I’m not sure if I’m going to be coming back to this area (another long story…blog about it to come).  They wouldn’t be able to see her as much then.  Her mom’s face dropped a little but was still adamant and said that I should take her. 
I’m very fortunate that God has placed wise people in my life.  First my friend, who advised me to be ready with an answer in case this came up, and then other people (in this case mostly my dad….Hi Dad!) who helped counsel me as to what that answer should be. 
You see the thing is, I would seriously consider it.  I love this little girl.  But there are SO SO SO SO SO many questions, problems, etc.   It would drastically change my life and it would drastically change hers.  My inclination at this point is that if I took her, I wouldn’t want to take her to America, but would want to raise her here.  That dramatically changes my time commitment to Sierra Leone. Now a lifetime?  If I stayed here and raised her as a Sierra Leonean, she’d be a horrible African woman because I can’t teach her all the things that African women need to know how to do!  I don’t know how to cook their food. I don’t know how to wash clothes, how to plant hair, etc.   I’m afraid she would always have an identity crisis, as she would be neither fully American or fully African.  Could I do that to her?  What about the fact that I’m single?  I know that there are millions of single parents in the world and my hat goes off to them because this is hard!!!  I can easily see why, although unfortunately things happen, God did design this to be done by two people.  What about my ministry here?  I didn’t come to Sierra Leone to be a mother.  I came to serve the people using my medical skills and to show people how awesome Jesus is and what it looks like to follow Him.  How would this change when I came here to do?  I couldn’t keep working 6-7 days a week at the hospital as I’ve been doing.  I’ve done that for the last two months while I had her and I’m just about at the end of my rope.  Something was going to have to give.  This is just a fraction of the things that I’ve been thinking about, but I won’t bore you with the rest. 
My roommate Erin and I right before I took her home
So what did I say?  I said I was going to need to think about this.  I told them that this was a big decision for me and one that I wasn’t going to take lightly.  I want to take a month and think and pray about it.  It’s just me. I don’t have other kids, I’m not married so I need to go talk to my people and ask their advice.  So I prayed with them, and then left Kadiatu there with her family.  As I kissed her goodbye, she didn’t look at me.  I got in my car and started sobbing.  I wasn’t sobbing because I was missing her, like I was expecting. I was sobbing because I have no idea what to do.  I have a month to decide. I have a month to get away from the situation, get some emotional space and seek my Jesus to see what He wants me to do.  So if you want, I sure would love you to pray for me!!  I’ll do whatever!!  I gave my life to Jesus a long time ago and if He wants me to give it to this child, I’ll do it.  If He wants me to let her go, I’ll do it.  I just want to know!!  J

Friday, October 5, 2012

Meet Valentina!

Meet Valentina.  

Valentina is Awesome!!

She is a nurse from Chile who came over to Sierra Leone in February to help with one of the medical teams.  One of our goals as a team here is to help mobilize the Chilean church in sending out their own missionaries.  After earnestly praying for this for several years, Valentina coming for that medical team was the first step we saw in that direction. Since that time we’ve had a family from Chile move here to join our team and several more Chileans are interested in coming over. 

Valentina is one of those people interested in serving here.  Her goal right now is to come for six months and get a feel for the ministry, what God’s doing over here, how her gifts and talents can best be used, etc.  I wish you all could meet her and spend an hour just talking with her.  She is one of those people with such a tender and compassionate heart that it makes me want to be like her when I grow up.  When she found out that she was going to be able to come over for the medical team she immediately started studying English and in just a couple months was doing so great that by the end of the week long medical clinic she was attempting to see patients without the English/Spanish translator.  Rock star!
Valentina helping with a mini surgery while she was here

As you might imagine, while the Chilean church is ready and excited to begin sending out their own missionaries, they are not in the financial place that the American church is.  This is where I’m making my appeal.  Valentina has raised a significant part of the support that she needs, but is still in need of some monthly support.  If God so moves on your heart, we’d love you to consider partnering with Valentina as she makes her plans to come over.  Thank you so so much!!  

Tuesday, October 2, 2012

Circle of Life

Last week I was in the OB ward, per usual.  A man came in and brought his wife, obviously great with child.  I asked them what the problem was and her husband said she was having some abdominal pain and was a previous c-section.  These are my favorite patients because they are no brainers.  Previous c/s?  Let’s tell the OR team we’re getting ready for another C/S.  No hemming and hawing about “can she give birth for herself?”  “Pros, cons, etc.” Nope. Easy capeesy. 

The husband left the ward and I went to tell the OR team that we were going to do a C/S.  I took the woman back to get her prepped. First I told her to go and wash well.  Then I started her IV, and gave her the pre-op antibiotic.  I had her lay down so I could insert the foley catheter (rubber tube that goes into the bladder…for those of you who haven’t had the pleasure).  She’d been perfectly cooperative up to this point, but when she saw what I was trying to do started balking, saying she didn’t want this done.  I explained that in order to do the surgery we have to put this catheter in…just like the last time she’d had it done.  That’s when she looked at me like I was crazy.  “Wait! I’m going to have the baby today??”  Then it was my turn to be surprised.  “Wait! Isn’t that why you came here in the first place???”  Turns out, nope.  She had complained of some belly pain (evidently not labor pain) and her husband was concerned and brought her here to get checked out since she’d had such a hard time with the last pregnancy.  She wasn’t even aware that because she had a c/section with her last baby, she should have one with this one too.  Oops! There’s a “lost in translation” moment for you. The poor woman had just come in because her tummy was hurting a little and I’d made her wash, started an IV and was trying to put in a foley.  She must have thought I was insane. 

Needless to say we had to put everything to a halt and sort this mess out. Her husband had left to go find some food so I told the OR guys we had to wait for the husband to come back.  When he came back I explained the situation.  The couple was from really far away so since the baby was term and I knew that if we sent her away she probably would not come back to us again, I told them we really should do the operation today. He was totally in favor of that and said that he’d come because he wanted to make sure they would be ok.  Surgeries here are not cheap (about $125 so….I guess it depends on your perspective) so the fact that he so readily agreed impressed me.  We took the woman to surgery and it turned out that the baby was breech so it would have been even more difficult for her to deliver for herself.  Mom and baby both came out doing great. 

When women in America have c-sections, I’ve heard that they stay in the hospital for 3 days. Here we keep our patients for 5-7 days. Part of the reason for that is because when they go home they will have to immediately start carrying heavy buckets of water and doing other strenuous work like washing clothes, cooking, and caring for the other children.  In reality most of the women end up staying longer than the 7 days because they’re not allowed to leave before the bill is paid and it usually takes the husbands longer than that to “find the money.” 

Over the next week the husband came every other day or so to check on his wife and baby.  During that time he always made a point to tease Kadiatu (my little roommate) and call her his wife and ask what she cooked for him that day.  One Saturday he came to talk to me about the bill (as a lot of the men do).  He had paid a significant amount but was having trouble coming up with the rest.  This is a common problem and whenever I’m approached with this I always refer them to the hospital administrator who is in charge of the fund that we have to help people who truly cannot pay. I told him to come back on Monday to talk with him about it.

On Monday I saw him talking to the hospital administrator. As I walked by I heard him say that he had a child who was sick.  Later I saw that the balance of his bill had been marked to the fund for people who couldn’t pay.  I was going up and down the halls that evening and saw him sitting on one of the benches. I started giving him a hard time because he’d been pestering me to have his wife discharged for so long and then was still hanging around.  He told me that his child was in having surgery.  I knew there was a kid with an acute abdomen that they’d decided to take to surgery that evening.  I put two and two together and realized it must be his son.  Poor guy!! His wife just had surgery a few days ago and now his son was in there. 

I was working a double shift that night so later that evening, around 9pm I saw him walking down the hall and asked how his son was doing.  He said he was doing better now.  Good!!  Literally 10 minutes later I heard wailing coming from the peds ward.  I went down there to see what was going on and found the man’s son dead.  I asked one of my friends, a nurse working down there, what had happened.  He said that the child had spiked a temp and she had given him the Tylenol as ordered.  She had called the doctor to let him know what was happening and by the time she got off the phone, the child was gone.  We honestly have no idea what happened.  As I passed him in the hall a little while later and told him how sorry I was, the phrase “circle of life” passed through my head.  But I don’t think it’s supposed to be one child entering a family and a second one leaving in the same week.  Oh Sierra Leone.  Ee no easy-o!!!

Wednesday, September 19, 2012

Love in the Time of Cholera

Sierra Leone has been in the news recently because of the cholera epidemic spreading throughout the country.  It started in Freetown but cases have now been documented in all the districts except one.  Our hospital has not been immune. 
A couple weeks ago I was down in the OB ward, getting ready to go home at about 9:30pm.  I was literally walking out the door when one of the nursing aids came and asked me to see a patient that had just come in. I walked down to the ER (ie the bench outside the nurses station) to see what was going on. 

The guy in front of me was a young, healthy looking guy, but was in rough shape.  He said he had just arrived from Freetown that day, and had been vomiting and having diarrhea since that evening.  As soon as he said he’d come from Freetown, a little light went off. I’d just come from Freetown myself and had seen all of the signs posted and heard the radio announcements about the cholera epidemic, what people should do to prevent it, when to go to the health center, etc, so it was higher on my radar than it usually would have been.

Of course I’ve seen plenty of diarrhea and vomiting cases….but this guy seemed a little different.  During the interview he had leave a couple different times to go vomit and or use the bathroom.  When the cholera episodes first started appearing, I took to ole’ Google and researched the signs as well as how to treat it.  It’s actually a simple treatment of IV fluids and/or oral re-hydration salts.  Oftentimes people will add an antibiotic because although it isn’t curative, it has been shown to decrease the duration of the diarrhea and vomiting. 
I admitted the guy and started him on IV fluids and the antibiotic and called one of the docs to let him know what I was suspecting.  He agreed with my plan so we put the guy in a private room and started his treatment.  I went down to see him the next afternoon and was doing much better. The day after that he was discharged.

We didn’t see much else that we suspected could be cholera until about a week or two ago.  At this point we’ve had four confirmed cases and others that were probable cases but we didn’t have the testing to confirm it.  We’ve made some changes to the hospital now and have moved all the women down to the OB ward so we can have the womens medical ward for the male cholera patients and the womens surgical ward for the female cholera patients. 
While cholera is relatively simple to treat, it can be extremely deadly. The fluid loss is just so extreme that if it’s left untreated for 24 hours, it can kill.  Since patients aren’t always quick to come to the hospital (see other bazillion posts about patients coming too late) it can easily kill. It’s also very easily transmitted (oral-fecal transmission….yum!) 

It turns out that trying to contain cholera isn’t easy!  Now me, I hear cholera and I think hmm…I don’t want to go anywhere near that!  When we realized that we were seeing multiple cases, we decided to limit visitors and only allow one visitor per patient.  We went up and down the wards kicking patients out, but they kept finding their way back in.  My friend explained that if you ask a family member to leave the patient, they automatically think that the patient is dying and so will do whatever they have to to be near the patient.  He had one family member that he had repeatedly asked to leave, but kept coming back.  Later when he asked this family member if the patient was drinking the ORS (oral re-hydration salts) like he was supposed to the family member said that yes, he was drinking it, but the family member had also started having diarrhea so was drinking some of it as well.  Frustrating!!!  We’re currently working on getting some better security and educating the community on the various dangers.  The WHO came a few days ago to see how we were handling things and the government is supplying free IV fluids to the hospital for all the cholera patients.  We’re very grateful that we haven’t seen any deaths (although we were fearful for one guy in particular!) and our patients are improving. 

Ironically, last week was a red letter week for me, as I received 3 different marriage proposals.  It had been awhile!  To be fair two of them were by one person who initially wanted me for his son but when I said he was too young offered to marry me himself.  This was of course after I’d already met his wife.  It must be true what they say.  Cholera is in the diarrhea….love is in the air. 

Wednesday, September 12, 2012

Spoke too soon....

The last post I did was about the successes that we had in the OB ward.  I’m sad to say, I spoke too soon.  One of the success stories I mentioned, the woman who’s baby was breech and had a c-section, died yesterday.

She was discharged.  She’d stayed her 7 days and was ready to go home.  But the bill wasn’t paid in full yet.  Her husband came to visit her almost daily, always promising to come with the money and always drunk.  On the patient’s last admission he threatened to beat one of the nurses because he was upset about the bill.  He is a policeman.  Yup.

So she was ready to go.  She had been having vague complaints throughout her stay.  Every day it was something different.  Her head hurt. Her back hurt, etc.  She spent a lot of time in bed and we had to keep encouraging her to walk.  Those of us in health care have had these kinds of patients before.  The best thing for them is to get out of the hospital, get back into their routine and they start feeling better. They forget to be sick. 

Such was this patient.  Needless to say, when we were doing rounds on this patient on her 3rd or 4th day after being officially discharged, I wasn’t overly impressed when she said, “I torment, I torment.”  What does that mean?  “I just don’t feel well.”  Well, we all said.  You need to get home, get back to your routine, etc.  Your blood pressure is fine, your incision looks good.  You’re on the mend. 
About an hour after this conversation, she said she was feeling cold so we took her temp.  102.6.  Huh. That’s weird.  Something really is going on.  I called the doc and we ordered some labs.  While the labs were cooking, she started becoming delirious, talking but not making any sense.  The family also said that she wasn’t moving her right hand very much. 
While we were waiting for the labs, we called another doc to come look at her and see if this was a complication from her surgery.  I’d listened to the abdomen and didn’t hear a whole lot in there, so it was possible.  The doc came, looked her over but decided that this wasn’t a surgical problem.  Darnit. Back to square one.

The labs came back and she was malaria positive.  Upon admission, she’d been negative but had been given the treatment anyway (we can only test for one strain of malaria so if they complain of symptoms we often treat even if the test is negative).  Ok, now it was starting to come into focus.  Cerebral malaria.  I’ve never really been with someone it came on so while it seemed pretty fast to me…maybe that’s what happens?

Now our dilemma.  We use quinine as our injectable anti-malarial for adults when patients aren’t conscious.  It’s not the best medicine because the malaria in this area has developed a resistance to it. It also has some pretty nasty side effects.  But it didn’t matter because we don’t have any.  We have recently discovered injectable artesunate.  This is the drug we use as first-line treatment for malaria.  Unfortunately our supply is limited so we’ve been using the artesunate in the kids, the quinine in adults.  But we don’t have any quinine. We have 30 vials of artesunate.  Kids, depending on their weight will use 1-2 vials. She would need 4 vials for every dose.  It would burn up our supply pretty quickly. 
We stood there…two doctors, three nurses, trying to figure out what to do…what decision to make.  We have plenty of oral anti-malarials.  Can we give that rectally?  Will it still work as well?  We have no idea.  No study to help us decide.  What if we gave a lower dose, didn’t use as much?  But then what’s the point if it’s not a therapeutic dosage?  Does she really need the injectable artesunate?  Her family said she seemed to be getting a little better, moving her right hand now.  Could we get away with saving it for the kids?  Finally one of the other nurses suggested putting in an NG tube (tube going through her nose into her stomach) and giving it orally.  Perfect.  The oral anti-malarial we have works really well…and this way she doesn’t have to be awake to take it.  Seemed like a good solution.  I had high hopes she’d turn around.

When I came in the next morning and asked the night nurse how the night had been, she told me it was very rough because the woman was “tormenting” all night.  She hadn’t come out of it.  When the doc came by for rounds she listened to her lungs and said she was full of fluid.  They were now suspecting that she threw a pulmonary embolus (little blood clot into the lung) and this put her into pulmonary edema.  We threw a whole slew of medicines at her…..although it was frustrating because we just don’t have the testing capabilities or monitoring capabilities to do everything we would in the states.  We continued on like this for the day.  When the doctor came by in the afternoon she was hopeful that if we just gave this lady one more day, she would probably turn around.
Over the next 2 days there was no improvement.  This woman lived nearby and was well liked so the family and friends started coming by.  The crying began.  She has three children.  Two girls, age 10 and 6, and this new little baby boy.  The older girl began to see that her mama wasn’t getting better and became hysterical.  Some other family members took her home.
Yesterday she started seizing.  The family had once again begun complaining that she wasn’t moving her right hand, so we thought she must have had a stroke. Again, no way to confirm.  We got the seizures under control but now her oxygen saturation was dropping. We put her on oxygen.  We tried to suction her lungs, but there was nothing to come out. 
The ward was full of people! The rumors had started that she’d died and the nursing assistant working with me was fielding the calls to find out if it was true.  Her family came and asked me if they could take her.  They wanted to take her to her home town about 6 hours away.  This town is the center of all things “magical” “occultic” whatever you want to call it.  They said that her sickness wasn’t a hospital sickness and that her twin brother had taken something from her that they needed to go to this town to get back. 

I didn’t see any reason to keep her.  She began doing the “guppy breathing” that people often do at the end of their life, and I knew there wasn’t anything else we could do for her.  It was heartbreaking to see her two daughters sitting by her bedside.  The older one knew that something was going on, but the little six year old had no idea that her life was about to change forever. 
I couldn’t do anything to stop this woman from dying.  For some reason, her little daughter just got to me. I wondered if she would remember her mom. I wondered if she would remember the week and a half that she spent in the hospital, only to leave with a new brother and no mother.  I wondered who she would live with.  What was her life going to be like?  I mentioned above that she and Kadiatu had become quite good little friends.  They often played with Kadi’s “baby” (a black baby doll that was sent over on the container).  People freak out over this doll because it’s pretty life-like. I’ve had tons of people stop to see if it was real, touch it, etc.   And I had another one.  The dolls came as a set of twins. I’d given the first one to Kadi on her first night with me but the other one was sitting in my closet. I’d been saving it for….something.  I ran up to the house to get it and had Kadi give it to this little girl.  She was so excited.  I felt like crap.  A baby doll?  Really? It was such a small thing to give when I knew what this girl was about to lose.  I knew, but she had no idea what was coming. 
I left that afternoon and she was still alive. I found out the next day that they had taken her that evening and she died three hours after leaving the hospital.  Leaving three beautiful children behind.

I wanted to remember the feeling I had, remember her, so I snapped she and Kadi with their babies.
 The faces are real. It is so common here to meet people who have lost their mother, their father or both parents.  While I always feel bad, I generally meet these people as adults and the wounds have had time to heal, at least a little bit.  This was the first time I watched it happen.  It sucked.