Thursday, April 19, 2012

No Comprendo!

The title of this post is a shout out to the Peruvian doctor who will be coming on the medical team with us (and is staying with us right now) as well as Chilean family who will be joining our team in a couple weeks.  Time to bone up on my Spanish.  Oh, and my Krio. And I should probably start learning some Limba too.  Too many languages, too little time....and brain.  I digress.

I've been in Sierra Leone for over a year now, but I'm afraid that for every new thing that I start to understand, I become confused by 2 more.  I don't understand why, with all the white people running around here, I still cannot go outside my bedroom (my place of solace) without hearing "White Girl! White Girl!"  My standard reply is "Hey, my name isn't White Girl! Is your name black man????"  I usually get a chuckle to that and then

"Ok, what is your name?"

"It's Emily."


"Yup, Emllskjfee"

"Emrlksdjfee.........give me money."

Oi Vey

Oh! I should say Oio Veyo.....Bring it on Espanol!

One of the things that I really don't understand, are the secret societies that are here.  Literally. I don't understand them. I've asked lots of people about them and always get very veiled, mysterious answers.  This is what I know.
They are in one, women in another.
They like to drum at night.  Oftentimes, all night long.
The female societies are the ones responsible for the female circumcision.
They are very secretive.
If certain societies are out during the day, the other gender needs to go inside when they march past.  Otherwise, you will die.  They won't kill'll just die.  I'm not sure how you know which societies you need to do this for.....but I haven't really had to deal with that before.

Well, before yesterday.

I'm in Freetown right now, getting the final preparations for the medical team coming on Sunday.  The house that I stay at while in Freetown is on a hill and has a balcony that looks down over the street. Every once in a while we'll get to see some cool things.  A few weeks ago we saw a huge number of Sierra Leonean soldiers doing their drills while marching past the house.

Yesterday we were in the house when we heard some yelling and drumming.  We went out to the balcony and saw a "devil dancer" (that's what they call them) walking by with a big group of guys.  We were just watching them (as I feel is pretty normal when a big group of people is making a lot of noise).  They noticed that we were watching them and kind of stopped in front of the house but they didn't appear to be angry.....just stopped to watch the white people watch them.

One of our visitors pulled out her camera to take a picture and that's when they freaked out.  They all started yelling and I quickly told her to put the camera away.  They threw a big rock that hit a pillar right where we were standing.  The visitor didn't get a picture.

Our daytime security guard started yelling at them and then went outside to yell at them.  They took that opportunity to come inside our gate and continue yelling.  We told them that she didn't get a picture but they wanted to see the camera to make sure that she didn't get one.

Two of the men of the houses went down to talk to them. I don't know exactly what was said, but we gave them the camera and they flipped through a couple pictures, didn't see a picture of their "devil dancer" so they left.

I was mad.  I felt very bullied.  THEY were the ones that went down the street doing things to draw attention to themselves in the first place!! Yes, I understand if they don't want us to take pictures (although there were no signs posted so I'm not sure how we were supposed to know).  That's their prerogative. We're guests in their country.  But the way they went about it, throwing big rocks, yelling and storming our just didn't seem nice.

Like I said before, I don't understand these societies...especially the male societies.  I talked to a friend of mine who is in one and asked  him what they do. What is their purpose? I don't understand. He smiled at me and said, "Even if you give me 5 million leones, I will not tell you."  I offered him 10 million (as a joke) but he just laughed and said No!  He said that "yes, they do some bad things...I don't do those things, but yes, some do."  I have no idea what he meant by that.  Bad things? Are we talking tax evasion or human sacrifice?  Both are known to occur here......

It was my first real interaction with a society.  There is so much fear associated with them here, and now I have a little glimpse as to why.  I was a little afraid myself.  

Wednesday, April 11, 2012

I've got the whole my hands

I hope that song is now stuck in your head as it was in mine for the last several hours.

Last week I was in the OB ward when a pregnant lady sauntered in (it's known to happen from time to time). I asked her what was going on and she said that she had a lot of water come out "down there." After this last disaster I decided to make sure that I did things in the right order this time. I took her back to the labor ward to get checked out.

First I checked the fetal heart tones. They were there and they were good. Next I measured the height of the fundus to see about how far along she is. (Time is very relative here, so getting an accurate history of things...such as date of conception...can be difficult). When I measured her, she measured about 24-26 weeks. It was too early. THEN I did a vaginal exam and her cervix wasn't dilated. I decided to admit her, give her some antibiotics and treat her for malaria. My primary reason for admitting her was that I knew she needed bed rest and since she told me she had some other kids at home....I knew that wouldn't happen at home. She asked if she could go home and come back. When I asked the other nurse about that, she said that if she leaves she might not come back, so we need to keep her here. The problem was that she literally had no one with her. Nobody knew where she was! I asked if she knew her husband's phone number and she didn't. I was leaning towards letting her go home...surely she'll come back. But the nurse was adamant and said that if a pregnant woman is missing, they should come look for her at the someone will come. Oh dear.

The next morning I came in and when I asked how she was doing she said that more fluid was leaking out and now she was having some mild contractions. I re checked the fetal heart tones and they were still ok, but lower than the day before. I figured this kiddo was on his/her way out and there was nothing I could do to stop it.

The next day I was working evenings so I came in after the doctor had finished rounds. Apparently they did an ultrasound during the day and thought that the baby was farther along and might have a fighting chance. They gave some medicine to help the lungs mature and a few hours later, out she came. She was a whopping 1.7 kg. Her color was not great and after the last couple days in which I'd lost 3 different premature babies who weighed more than her, I was not hopeful. I put her on oxygen and hoped for the best.

A little while later I walked by the bed and noticed that her dad was just sitting there watching her. We don't see a lot of dad's hanging out at the OB ward so I took advantage of this guys' interest. Since it would be good for her to stay really warm I showed him how to hold her so his body would help keep her warm. He looked really uncomfortable but every time I walked by I tried applauded him and told him he was being a really good dad! All the other women would just laugh and he just smiled. :)

I had been really surprised that this kid was doing as well as she was so when I walked into the ward the next day, I had a feeling of dread. But she was doing awesome! Her mom on the other hand...was looking a little rough. The husband was gone and she had her other daughter with her who was about 2 1/2. At one point in the afternoon the little girl was just crying, crying crying and her mom was staring out the window. When I asked why she was crying she shrugged her shoulders and said "well, she's just crying...." I went over and picked her up even though I knew she'd probably be afraid of me. But when I picked her up she immediately stopped crying and fell asleep.

I wondered about the mom....wondering if she might have a little bit of post-partum depression. It would totally make sense because I couldn't imagine the emotional roller coaster she'd been on over the last few days. Usually when a woman comes to give birth, she comes with her entourage. This woman had no one. I wasn't really sure what I could do to help. Her little girl who had fallen asleep in my arms....smelled really bad so I decided that one thing I could do was help clean her up. I took her up to my house, gave her a bath and changed her clothes. I wasn't sure how her mom would take it but when I came back and her daughter reached for her right away, she got a big smile on her face. Phew. :)

The next day when I came in in the morning, the whole family was there. And baby was still doing great!!! The mom and dad were all smiles. When one of the med students asked what the name was the dad pointed to me and said that I was to choose the name. Precious!! Unfortunately the ambulance was called out and I was gone for a few hours. When I got back they were gone.

I'm so thankful that I get to see success stories like theirs!! I have no idea why this baby made it when I've seen several others who seem like they would have had a better chance not make it....but I "tell God tanki" for this little one! So Tanki!!

Friday, April 6, 2012

Still hate it!

When I was working in the pediatric part of the hospital, I saw the devastating effects of malaria just about every day. Since I've been working in OB, I haven't been confronted with it much.
Until now.

We are currently really short staffed with just 2-3 of us manning the ward 24/7. Therefore, although OB hasn't really "been my thing" in the past, it is quickly becoming "my thing" because there's no one else who's "thing" it can be. I digress. So yesterday I was in the ward and it was really busy. I was in the middle of helping deliver a baby when I heard the ambulance go out again for another pregnant woman. They were gone for several hours and when they got back I discovered that the woman they came with had actually given birth at home and delivered twins. They were premature.

I got the bed ready for her and the twins. When they got to the bed I started asking the mom questions about bleeding and felt her uterus which was normal. Ok, mom's good. I went to look at the kiddos. One, breathing ok. The second one, already gone. Somewhere along the way the baby died and no one had noticed yet. I got to be the one to deliver that news.

The second twin was breathing but was struggling so I went and got our little oxygen concentrator and gave him some oxygen. I called the doc to see if there was anything else we could do and she suggested keeping him warm using hot water bottles so one of the med students brought one down.

I started focusing a little more on mom and when I went to take her vital signs found her to be raging hot!! She said that she'd had the fever for about 4 days. Malaria. The anemia from her malaria made her go into labor prematurely and deliver her twins too soon. I gave the mom some Tylenol and medicine for malaria and went to check on the kiddo again. He was now barely breathing. Although I knew it would probably be a moot point, I went and got the bag and bagged him for a little while, trying to see if it would stimulate him to breath on his own. Nothing. He died in about 15 minutes. Later I found out that the woman had just completed the funeral for one of her other children. She has now delivered 6 children and has one living. Malaria!

Later a woman came in with her husband, complaining of side pains that had started after riding a motorbike. I assumed it was probably just some muscle pain but went through the motions and got her checked out. Her blood pressure was fine but when I went to touch her, her skin was on fire! Her heart rate was also really high. Baby's heart rate was high too and the estimated gestational age was about 8- 8.5 months. I decided I would admit her, give her some fluids and start treating her for malaria. As I left that night, she was doing fine.

This morning I went in to work and found out that she'd delivered her baby in the middle of the night. Yikes! I did NOT see that coming! I was really glad I hadn't sent her home! (Thanks Jesus!) The baby was doing ok but wasn't breathing great. I left the ward for a few hours to rest because I was coming back in the evening and when I came back, the baby had been placed on oxygen. She lying on an empty bed next to the nurse's desk.

After the nurse told me about the ward, I went to get a closer look at the baby. She was not breathing very well at all and her color was...bad. I knew the doctor had mentioned keeping her warm so I picked her up and held her really close to my body. I got my oxygen saturation monitor and checked. 38-40%. Very, very bad. As I held her, the oxygen machine started beeping, letting me know it was going to die soon. I took the oxygen off and her saturation stayed about the same but her heart rate started dropping. And dropping. She wasn't breathing anymore, her skin was mottled, and her heart was barely beating. All of the sudden I felt her body just completely relax. At that moment I realized that although I've sat by countless beds and watched children die, this was the first time I'd actually held one in my arms as she passed away. I was staring into her little face when all of the sudden she took one more breath and shot her first up into the air. I jumped out of my skin!

I wasn't really sure what the culturally appropriate thing was to do in this situation. The people here do not like to deliver bad news. They will almost never tell a patient when they have a fatal disease and more than once I've seen them take a dead baby via c-section and not tell the mother that the child didn't make it. They just left them to figure it out when they didn't bring a child into the room.

Anyway, I took the child who was essentially dead, to the mother. As I think back, I wonder if I should have taken her there a little sooner so she could have held her. But would she have wanted to be the one to feel the life go out of her little girl? I'm not sure. The baby was still taking a few reflexive breaths so I asked the mom if she wanted to hold her but she wouldn't take her. I honestly didn't know what to do. When the mother I told the mother that her child had died, she just looked at me. She looked sad but didn't shed a tear. I started bawling. Some other women crowded around us and eventually one of the older grannies took the child from me, placed her on the bed and covered it with a sheet. They kept telling the mother to be strong, be strong.

I really hate malaria.