Thursday, January 19, 2012

Having a baby....Sierra Leonean Style!

Wow! Today was an adventure!! The other day I was talking with one of the doctors here and we were discussing the potential problems we’re going to have because several people from the OB ward are leaving. We are already short staffed and it will most likely only get worse in the near future. That being said, I volunteered to orient to the OB so I can figure out what the heck is going on in there. As an ER/ICU nurse, I have always run (very fast) in the opposite direction of the OB patients (no offense moms...but you're scary!!) So I was definitely getting out of my comfort zone…..but I was/am so excited to learn!!

I’d only been in the OB ward for about 30 minutes when they came and told us there was an ambulance call. I asked if I could go, so a nursing assistant and I jumped in the ambulance and off we went. During the very fast and very bumpy road, I was reviewing the possible things I might find there and how I could stabilize them until I got to the hospital. Bleeding patient? Septic patient? Seizing patient? Who knows? One of my old roommates had a really bad experience where a woman actually died in the ambulance on the way to the hospital, so I was trying to prepare myself for anything!

The patient was being referred from a health center so we rode with our siren on the whole way (keep in mind I think we passed exactly 2 cars the whole way). But the siren’s there so...might as well use it! However, we did turn the siren off about 5 minutes before we got to the health center because apparently the siren scares the nurse there. Alrighty.

After arriving at the health center, I walked into the labor room to see the patient walking around. Well that’s a good sign!! At least she’s not on death’s door! The nurse came in and told me that they were referring her to the hospital because she is just not cooperating. OK? I began to see what they meant when she refused to sit down, would yell if you even attempted to touch her and kept walking away from you. It took me forever to get her to settle down enough to just take a blood pressure! I wasn’t sure how we would make her cooperate more at the hospital but…ok, we can give you a lift.

At this point there is a huge crowd around, all yelling at the patient and her mother. Then the mother started to cry because she didn’t want to go to the hospital because she doesn’t have any money. She wants her daughter to deliver at the health center. I’m not sure ethical guidelines were exactly followed as the crowd pretty much bullied them both into the ambulance. We turned on the siren (guess it only scares the nurse on the way in) and away we went. For about 5 minutes. Then the ambulance driver remembered he didn’t get the ambulance fee paid yet so he stopped in the middle of the road and went to the back to ask for the money. They didn’t have it. But the nursing assistant who was with me convinced him to go ahead. So we did.

We got to the hospital and went to check the patient. Wow. That was difficult!! The midwife and I tried first, but we couldn’t keep her down. Every time we went near her she would scoot all over the table, throw her legs together and try to turn over. She was really strong! We called her family in to see if they could talk to her and convince her to let us check her. They tried and tried and ended up slapping her on the legs and arms. Multiple times. As hard as they could. They kept asking her if she wanted to kill her baby and making slightly inappropriate innuendos about her not being this afraid 9 months ago. Yikes! I could understand their frustration because she literally did not want us to do anything but……I tried to picture any of this going on in the States and I had to chuckle a little. Could. Not. Happen.

Anyway, it didn’t take long to decide that unfortunately, she would not be able to deliver vaginally. She just wasn’t cooperating. So they went to do a c-section. I wish that they could have waited, but I could see their point. Might as well take the baby now when he’s nice and strong instead of waiting until she’s been laboring for hours, the baby starts to decompensate and she still refuses to push. But I always think it's a bummer to have to go the c-section route (although of course better than the alternative).

So I was down in the OR waiting for the anesthesiologist when I got a call from the midwife. There was another lady who was laboring and was ready to start pushing. I ran down to the OB ward and sure enough…there was the head! The midwife tried to let me deliver it and I started to…but I got so scared! I was afraid I was going to pull the head off! I watched really closely and the midwife gave me some pointers for next time. I want to deliver one SO bad!!! The miracle of life and all that.

Anyway, it was my first day back…and what a day it was!! I love my job. 

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