Back in the saddle again.....

I’ve been back in my village for exactly one week now.  When I came, I talked with the administrator of the hospital and we agreed that I’d only work 3 days in the hospital instead of the 6-7 that I was doing last year.  This little girl is hanging around a lot and needs things like food, schooling, etc so it takes up a bit of time.  I'm also really interested in doing some outreach in some of the smaller villages, so it seemed like a perfect plan.  The OB ward got 2 new midwives while I was gone so they’re doing pretty good in terms of staffing.  I have a nurse from Chile staying with me until July (shout out Valentina) so she and I will be taking over rounds in Peds three days a week and then hopefully doing some work in the villages as well. 

I was a little nervous since it’s been about a year since I’ve been in the Peds ward.  On Thursday Valentina and I headed down to the ward.  It was eerily quiet with only 4 kiddos there (as opposed to the 31 that had been typical when I worked there 2 years ago).  So we went through the ward….malaria, malaria, malaria….snake bite! (African version of duck duck goose).

The kiddo had come in the night before after being bitten by a snake on his left hand. As I watched him, he was breathing pretty well but his arm was very swollen, up to his left chest.  Of course he had the stone wrapped around his hand designed to pull the poison out (while also providing a great vehicle for infection to enter).  I looked at his card, saw that he had had the “snake bite protocol” done and was now receiving antibiotics.  I decided that most likely he had been bitten by a cobra, as opposed a mamba.  Mambas are the more dangerous of the two, as they cause neurologic problems leading to things like respiratory depression, etc.  So I was encouraged by this kid.  It’s true, his breathing wasn’t great, but when people have been bitten by a mamba, their affected appendage doesn’t usually look too bad….it’s the neuro signs that make you know this isn’t going to turn out well.  So I told the father that I wasn’t surprised that the swelling was continuing and it still might get worse before it gets better. Then I left. The next day I was thinking about the kid and called a friend of mine to make sure I wasn’t missing anything. He went and saw him and put him on a stronger antibiotic.

On Sunday Valentina, Mari and I went for a little stroll and decided to stroll to the hospital to check on the snakebite kid.  We stopped in at the OB ward and I asked about the ambulance I’d heard that morning.  They told me that the woman had come and delivered but the baby was already dead at delivery.

Now before I go on, I need to tell you a little bit about my friend Valentina.  Valentina is one of those people with the soft, gentle, compassionate heart that I want to have when I grow up!!  As soon as she heard that the woman lost her baby, she was sitting by her with her arm wrapped around her.  She’s one of THOSE kinds of people. J

Next we headed to the peds ward.  As soon as we entered, I saw that the bed was empty. I knew it!!! I’d told Valentina the day before that I suspected the family would get tired of the slow progress of the kids healing and would take him to go try country medicine. (Experience is a great teacher).  His empty bed proved my theory correct.  Until the nursing assistant told me that no, in fact the child died a few hours ago. Wait. Say what!?! He died???  I did NOT see that one coming!  And that yucky feeling settled into the pit of my stomach. I’d told the father I wasn’t worried.  I'd been wrong.  Bleh. 

Next we headed to the Alpha Ward (the ward for malnourished kids) to check on a little 7 month baby that Valentina had befriended.  This is him. He looks like he’s 3 months or so. 

And he wasn’t doing well. His work of breathing was really high and he had a temperature again.  They had ordered nebulizers for him (breathing treatments) which he hadn’t received and there was some question as to whether or not he’d received his antibiotic the last 2 days.  I was annoyed.  This kid was sick!  The baby’s mother and father were both dead so he’d been brought by his grandmother, but she was so discouraged that he kept vomiting and having diarrhea, that she wanted to leave.  Valentina and I talked to her and convinced her to stay so we could do everything possible for the baby.  Valentina fed the baby his milk with a spoon without any vomiting (yeah!) and an hour later we left.  I didn’t have a good feeling about that kid. Valentina’s tears told me she didn’t either.

Yesterday was Monday.  The little baby was looking better! We went to the market and Valentina bought him some diapers and a few other little things he needed.  She spent most of the afternoon down there with him, making sure he got all his meds and his breathing treatments.

This morning I got up early to have my “Jesus time.”  At about 6:20am I was sitting by the window, when I heard a woman saying “Why. Why. Why.”  This is what they say when something hurts.  Then I heard another woman tell they “Whying woman” to sit down by my house.  “Oh great,” I thought. “Somebody is sick and was directed to the white person’s house cause they know I’m a sucker. Can’t they see that I just want to spend time with Jesus and don’t want to be bothered!??!?!”  I know right? Awesome attitude to have. What can I say? God’s still working on me!  A lot! J

I turned around and saw that it was the little malnourished baby’s grandmother. And she was crying. This isn’t good.  She told me that the baby had died and asked where Valentina was, “the one that really loved that baby.”  No!!  I cannot go wake her up and tell her that he’s died!!  But I did.  We went down to the hospital and Valentina helped the grandmother pack everything up and wrap up the body. The day before I’d heard the grandmother say that if she had 5,000 Leones ($1.25) she would just take a motorbike and leave. I ran back up to the house to get the money to give her.  When I got back down, a man came to inform us that in fact, it was going to cost 70,000 Leones ($16) because nobody likes carrying a corpse. I quickly did some math (probably poorly) in my head and decided it would be cheaper for me to take them back to their village than to give her the money.  So my car became a hearse and we all went to the village.

When we got back Valentina and I went to the Peds ward to see if rounds had been done yet.  As soon as I walked into the ward, I saw a big group of people crowded around one of the beds. Never a good sign.  We went over to the kid and he looked rough. He’d come in at 6am that morning (it was now 10am). His blood had been drawn but the results weren’t back yet so I ran down to the lab to find the results.  His hemoglobin was 6.6 which is low, but definitely not as low as we often see. Based on how bad the kid looked though, of course we needed to transfuse. I went to the family who was crowded around the bed and asked them all to go down and be checked for possible donation. We went through all the other possible causes.  He'd gotten his antibiotic, although we could give it again, so we did. His blood sugar was stable but dropping significantly so I switched his IV fluids around to try and keep his blood sugar up. Since we only had one IV, I talked with the nursing assistants about checking it frequently when we had to stop the fluid to give blood so it wouldn't drop too low.  Infection covered, blood coming, blood sugar stabilized, kiddo on oxygen.  Everything that I could think of was being done.

Valentina stayed at the bedside while I took Mari up to the house to get some lunch. I called a little bit later and the kids oxygen sats were down to 60%. (We want more than 90%). I ran down to the hospital to see if there was anything else we could do. He was getting his blood, they’d stayed on top of his blood sugar, giving him D50% when needed.  I listened to his lungs and there was all sorts of sounds going on in there, but he’d come in with that. I gave him some Lasix (a medicine to get rid of extra fluid you have in your body) just in case he was overloaded with fluid.  I also ran down to the OR to see if I could find a mask to deliver the oxygen instead of just the nasal cannula.  I found one with part of the hose cut off but thought I could jimmy rig it to make it work. 

When I came down, I saw the boy’s mother and realized it was someone I knew. I didn’t know her well, but when she saw me she stretched out her hands to me and said, “Emily, my child. Emily, my child.” She kept repeating it over and over.  I sat down with her for a minute and said, “We’re really trying for him!!”

The boy’s oxygen stabilized a bit and although I still suspected that this child wasn’t going to make it, I thought it would be a couple hours. I had made plans with someone to go look at a sick child in a nearby village and knew he was waiting on the side of the road to direct me to the house.  I told Valentina I would go see this child quickly and come back (in my mind to do the death vigil with the boy’s family). 

After going to see a boy who was 14 years old and was smaller than Mari, (EXTREME malnutrition) I came back to the hospital where Valentina told me the child had died shortly after I’d left.  Darnit! I thought I’d had more time. I asked if the boy’s mother was still around and went to her. She was lying on the ground crying and when she saw me she said, “Emily my child died! What am I going to do now? Emily. He’s dead. What am I going to do??” She repeated this over and over. Then she said, I need to go to the village, but the sun is warm.  I told her that I would take her family and her sons’ body back to the village in my car. Since they don’t allow the family to take the body unless they pay their bill, I paid the few remaining dollars and for the second time that day loaded a dead child into my car and headed to the village.

Today sucked. Am I allowed to say that as a missionary?  Maybe not. But it’s true.  It was a no good, very bad day.  Not all days are like this, but when Valentina and I got back to the house we realized that in less than a week we’d lost 5 kids.  Sometimes it feels like the death is suffocating.  It’s everywhere you turn. You can’t get away from it. But as we debriefed about the last couple days, we rejoiced. We were thankful that we got to be there with these women in their darkest moments.  We couldn’t do anything to take away their pain, but they saw our tears and knew that someone else was hurting with them.  So through the pain, we “tell God Tenki.”