Tuesday, May 14, 2013

Oh the Familiar Feeling...

Yesterday I was working in the OB ward. It was quiet so I was reading a book when I watched some people carry a woman down the hall on a stretcher.  It was Saturday which meant it was a half day and since it was almost noon, I figured that the outpatient department had closed a little early and they were bringing the woman to our “ER” when the outpatient department is closed. It’s a very sophisticated ER……a green bench in the hallway outside the nurse’s station.  I turned my attention back to my book. Until I heard….”Emily!  It’s a pregnant woman!”  Commence stomach dropping and palms sweating. 
She was able to get up from the stretcher pretty easily, which was comforting to me.  As I led her back to the labor room I asked her how many times she’d been pregnant and if she’d ever had a c-section. She said this was her fifth pregnancy and she’d never had a c-section.  (Small “darnit” in my head.  If she’d had a c-section before it would be a simple matter of calling the OR staff and doing another one).  This meant I was going to have to think and try and problem solve.  Double darnit!

We got to the labor room and I started doing the check in things like vitals, listening to the fetal heart tones, etc.  Everything looked ok. The baby’s heart rate was strong.  Ok, so why was this woman here? She said that she’d been in labor since yesterday (which is always a slight help…..but lots of women like to fudge a little on the time because they don’t want to get yelled at for staying in the house so long).  The information that it does give me, is that she’s been in labor longer than usual and it’s been so long that the traditional birth attendant or whoever was trying to help her deliver, became concerned and sent her here.

So why isn’t she delivering?  It’s her fifth pregnancy. By now it should be like a slip n’ slide and the kid should just shoot out of there right?  I did a vaginal exam and she was fully dilated. The head was the presenting part, but it was still a little high.  Her bladder looked a little distended so the first thing I did was put a foley catheter in to drain the urine.  Ok, she didn’t produce a lot so that probably wasn’t what was holding things up.  Next option.  Five pregnancies.  I’ve learned in the past that sometimes these women who have delivered quite a few times (especially if they do it in a short time) will have uteruses that just get tired.  So I started an IV with some oxytocin to see if that could get things moving a bit.  After I started the IV I decided to check things down there again.  Although the woman had said that her water had come out, as I was feeling around, I thought things felt a little too squishy and that her membranes were still intact. Since we don’t have any of the fancy tools to break someone’s water, I pinched and used my fingernail until I could finally make a little hole.  Sure enough, more water came out. 

And then things moved fast! In the next five minutes I saw the head had moved down quickly!  But wait, what was that squishy thing? Was that the cord?  Did the cord come down with the head???  I’ve had that happen before and the baby died when it did, so I’m always afraid of that happening!!  I listened to the baby’s heart rate again and it was much slower.  Shoot. It’s a half day. Who else is around?  I ran down to the outpatient department to see if there was anyone there. Fortunately, my friend who frequently saves my butt was there, even though it was his day off.  I told him what I suspected and he and I ran back down to the OB.  I saw the anesthesiologist from the OR team so I asked him not to leave yet, as we might have a c-section to do.  As I entered the OB ward again I saw one of the midwives who has been doing this whole baby borning thing forever!  As we all headed into the labor room I remarked to my friend…..”See how much Jesus loves me?!?!   I was all by myself and now look at all the help I have!”  J  My friend did a vaginal exam and said that he didn’t feel any cord.  Good!!  (And bad, as I once again proved that I didn’t really know what I was doing!)  Two pushes later the head was out. The cord was wrapped around the baby’s head so I clamped it and cut it. One more push and a bouncing baby boy was born.  8 pounds!! I told them that was an American sized baby!! 

The placenta was delivered just fine and mom had no complications.  I was talking with my friend later about prolapsed or presenting cord (when the cord comes down in front of or in conjunction with the presenting part, thus putting pressure on the cord and essentially cutting off the blood supply and oxygen to the baby).  He gave me some tips on things you can do if you have that problem. In the States they will immediately go for a c-section but here, it takes an hour to get everyone into the OR so the outcomes are also not great.  But praise God this woman delivered just fine!! I think it was probably the combination of a tired uterus and intact membranes that slowed things down. I was a little bummed at the end because if I hadn’t suspected the cord issue, I totally would have delivered her by myself!!!  But I thank God that even though I had to eat some humble pie, the woman and baby did fine and I got to learn some more.  

Friday, May 10, 2013

Happy Mothers Day....to me! Yikes!

Marie’s been living with me for several months now, but until recently nothing was done legally. I hadn’t been sitting down in one place long enough to begin pursuing it. However, I began the journey last week. After talking to a friend of mine who’s undergoing the same process but is much farther along, I knew I needed to start at the Social Welfare Office for the district in which we live.  Fortunately, a friend of mine know a guy that works in the office. As sad as it is, it seems to be easier to get things done here if you “know somebody who knows somebody.”  We saddled up “The Colonel” (my car) and made the 3 hour journey on the horrific road to talk to the people in Social Welfare.  They gave us the list of things we needed to do. 

After getting her birth certificate (very few people actually get one at birth) I went to her village to discuss the issue with the town chief.  This is where Sierra Leone is different from America.  Well, maybe one of the 5, 428 ways.  America is so much more individualistic than Sierra Leone. When I initially went to the Social Welfare office, I explained that since taking Marie, her dad had left the village to go do some mining in the eastern part of the country and her mother had moved to Freetown. To get us all together would be difficult. Not impossible, but it would take some finagling. That's where it got interesting. The man in the office told me that as long as I had a representative from both the mothers and fathers side of the family, that would be good enough.  Really?!?  It wasn’t the first time I’d run into this kind of thing. When we do a c-section in the hospital we will offer to do a tubal ligation (“tie the tubes”) but we have to have the consent of the husband.  However, if the husband isn’t there but a member of his side of the family is willing to sign, we can still go ahead. SO SO different from America!!! J

So after meeting with Social Welfare we went to Marie’s village to talk to the town chief. The town chief happens to be a relative of both sides so he could represent both Marie’s mother and her father. How convenient!!  (And a little scary to be honest…).   I got a call about a week later from the man in the Social Welfare office. He said that they had prepared all the documents and were just waiting for me to come with Marie’s birth certificate and the parents’ representative.  I went to Marie’s village and the town chief told me that Marie’s father had come, so he would be able to come with us. Good!! I felt better having at least one of her parents involved. (Incidentally, I was just trying to get temporary custody at this point. When things move to a more permanent holding, both of her parents will be there and everything will be explained in their tribal tongue and their replies will be videoed.  I really don’t want to end up in prison for child stealing!!!)  So a few days later we headed BACK down the road that has tried but failed to dislocate every joint in my body, to the Social Welfare office with Marie, the friend of mine who knows the guy in Social Welfare (“John”) Marie’s dad and her mother’s representative, and the town chief. 
When we got to the office three hours and 6 Ibuprofens worth of muscle pain later, I was nervous.  What was going to happen here?  They welcomed us warmly and we all went and sat down in the office.  The head man called Marie over to him and asked her a couple questions. He asked her where her Papa was and she pointed to her dad. He asked her who bought her dress and she pointed to me. He asked her who bought her shoes, earrings, etc. and she pointed to me. Then he turned his attention to Marie’s dad.  He asked him what we’d come for and he said he’d come to do the papers to give Marie to me.  Then the man went on to explain the difference between giving her to me to KEEP or to MEND.  See, giving children to other people to mend is VERY common here.  Most houses in the village I live in have at least one or two kids that aren’t their own because it’s a bigger village and there are several schools here.  So parents from smaller villages will send their children here to live with relatives and go to school. 

I was nervous for the response.  I absolutely do NOT want to take a child whose parents don’t want me to take her. Obviously.  And I want to make SURE that both parents fully understand what they’re doing.  Giving up the parental rights.  That’s NOT very common here.  So as the man was explaining everything, I was waiting with baited breath. I want the best for Marie. If her parents don’t really want to give her to me, then I would never want to take her.  But I love her. I’ve grown so attached that to give her up would be…..painful. To say the least.  I’ve explained the permanence of this situation many times, but sometimes I’m just not sure how much I’m understood.

So I’m sitting there listening to the man talk and just as he gets to the part where her dad is supposed to respond, Marie comes up to me and says, “Mama.  I need to toilet!! (Poop).”  Oh come on. Now?? I tried to put her off but got the fussiness with the legs crossing. I figured it probably wouldn’t look very good for me to deny a basic need of my child, so just as her dad was about to answer this most important question, Marie and I went off to find a toilet. IE. Little rubber bowl that kids poop in and then….I don’t know what usually happens to it. When I got back I waited for a break in the conversation and then interrupted.  “Excuse me sir. I really need to know how Marie’s dad answered that question.”  “He said he wants to give her to you to keep.”  Exhale.  Ok.
Next was the paperwork.  The Social Welfare guy drafted a letter that handed custody over to me for six months.  Temporary custody is the first step in the adoption process here. (It is possible to adopt if you don’t live here. Adoption just became legal again in this country last year, so I think the rules are still a little flexible while they are working everything out). I signed. Marie’s dad signed. The town chief representing her mom signed.  It was done.

 Next were the photocopies.  They didn’t have a photocopier at the office (I know….)  so my friend John got on a motorcycle and went to make enough copies for everyone.  Next were the photos.  We weren’t really sure where to go to get photos taken but fortunately Marie’s town chief knew someone in the area so he gave him a ring and told him to come to the office QUICK!!!  They took a picture of Marie by herself and then one with the two of us.  But after waiting a half an hour or so we found out the that photo shop’s generator wasn’t working so they weren’t sure when they’d be able to print the pictures.  John got on the phone and started calling some people and found somewhere they could print them. This guy knows everybody.

While we were waiting for the pictures to develop we went and got some food. Then we split up and I went to go shopping for some “American food” and Marie’s family went to go run a couple errands. While we were separate from them, Marie kept asking “Where’s my Papa? Where’s my Papa?”  It was a little bit heartbreaking.  It struck me that no matter how much her dad wasn’t able to take care of her, wasn’t able to provide for her basic needs, she still loved him. She still wanted him.  She was still a little girl who wanted her Daddy.  Heart. Breaking. 

After our errands were done we met back up at the Social Welfare office and they gave me the documents. It was finished.  They said I will be able to travel with her with these documents. I’m a little suspicious so will pay a visit to the US embassy when I go to Freetown next week. Next on the list of things to do will be to get her a passport so she can meet her cousins in November!! Je askeHe as


Saturday, May 4, 2013


There are a lot of really awesome things about living here!!  There are some challenges to living here as well. One of the things that I struggle with the most, is people asking me for money.  It happens all the time. It happens at the house, at the hospital, in my car, on the street…basically everywhere.  One morning I was awakened by a strange man knocking on my door.  When I asked him what he needed he told me that he’d run out of gas for his motorbike and wanted me to give him money to fill his tank.  Seriously? You don’t even live here and someone directed you to the white person’s house for gas money?  Sometimes it feels like I have “Sucker” painted on my forehead. 

In the last couple of years I’ve developed slightly thicker skin.  I’ve learned to say no.  I have to say it a lot.  One of my friends lived in Africa for several years and when I moved over here, her advice was to start off saying “no” but then to pray about it and see which people God leads you to help.  I want to help! But I also don’t want people to look at the “white man” as the solution to their problems.  So I’ve gotten pretty good at saying no.  I’m mean.

A couple weeks ago a kid (we’ll call him Musa)  came to my door asking for Emily.  Since it was me who answered the door and I didn’t recognize him, I figured that I didn’t know him.  My guard started going up.  He wants something.  I’ve been here before.  I took him outside and we sat down and he started talking.  He told me that he was from an area far in the east but that he and his family had come here about a year ago to try country medicine for a problem in his abdomen.  His abdomen would “swell up” (become distended) and he would have alternating vomiting and diarrhea.  He couldn’t eat much.  He’d had to quit school because of the problem and had been trying country medicine (various herbs, leaves, God only knows what else) for the last year but wasn’t getting any better.  This problem had been going on for five years, and he didn’t know what else to do.

I don’t know what it was about this kid that turned my stone cold heart to mush. Maybe it was the fact that he came by himself.  He was a young kid, 14 years old but he was determined to find a solution for this problem.  Long story short, I told him to meet me down at the hospital the next day to talk with a friend of mine who sees the outpatients. 

The next morning he and his mother were at my door by 7am.  Yikes. I told them I’d meet them down at the hospital by 8:30 and we’d meet with my friend.  My friend and I talked to him and did an exam. He definitely had something going on in his belly, and the distension was worse on the right side.  He did an ultrasound and decided that the kid needed an exploratory laparotomy to find out just what was going on.  We explained this to his family.  Unfortunately our primary surgeon had lost his son the week before so no one was really sure when he was going to come back to work.  I explained this as well and told them we’d alert them when we were ready to do the surgery.  They came to my friend and I’s house just about every day. One day Musa came to my house and when I told him to go down to the hospital a little later and talk to my friend, he said, “Oh yes. I already went to his house, but he was taking his bath.”  Boundaries are just a little different here…. J 

Finally the day of the surgery arrived. I made sure I was in on that one, as I was really curious to see what was going on. As I was talking to the surgeon beforehand, he said that he suspected it was a cyst.  Sure enough, when he opened the kid up there was a giant, fluid filled cyst there.  He pulled over 3 liters of fluid out of that abdomen. Impressive!!  No wonder he was having so much pain and vomiting!  He removed the cavity of the cyst and was confident that it wouldn’t grow back.  As he was closing up I turned to my friend (American) and said, “I really hope he does ok!”)  She remarked later that she'd been surprised I’d said that because the surgery had been a success!  They’d removed what they’d hoped to remove, etc.  But I've lived here a while now.  Here…you just never know.
We ran out of OR caps for the surgery, but I didn't let that keep me out of the OR. The anesthesiologist tied this for me. When I got out of surgery though and was explaining what we'd found Musa's mother asked to see the picture of the fluid we'd drained. W hen I told her I hadn't taken a picture of it she said, "But I saw your friend go in with a camera!"  Oh no. That wasn't to take a picture of the surgery. That was to take a picture.....of myself.  Awkward. :) 

The next couple of days were painful for him as you would expect them to be (especially when your only post op medicine is Tylenol).  But gradually he started doing better and after about a week they said they were ready to discharge him.  I was so happy! Musa is seriously one of the sweetest kids ever. SO thankful for anything you do for him and very determined.  There are a lot of things that we can’t do here.  I’m often frustrated by our lack of resources and just want the things we have in America.  But that day I was happy! For a mere $125 this kid’s life was changed forever. 
The day he was discharged he asked me if I’d go to his house with him.  As we walked down there, he was obviously tired and weak. We had to stop a couple times to let him rest. But it’s Africa. It’s ridiculously hot. And he’d just had surgery. So I wasn’t overly concerned. 
Musa and I documenting his discharge.  He was glad to be going home!!
On the way to his house I got the usual silly comments…”Musa! So this is your wife!  Musa! So you’ve married now!”  When we arrived, the Imam for the nearby mosque came to extend his greetings and say thank you.  There were a few more speeches and then they told me that they wanted him to come stay with me. Say what?!  I said, well….thank you very much, but I think he should keep staying with his parents.  They bid me adieu with the Imam’s umbrella “because the sun is hot!” 

The next night I was at home when one of the nursing assistants called me. He told me that Musa had been throwing up all night and was in a lot of pain.  He said his family wanted to take him to a “doctor” in town but the nursing assistant told them they shouldn’t do that without talking to me first.  He said he didn’t feel like he needed to be admitted so I told him I would go see him at the house the next morning.  At 7 am his mom was at my door. He wasn’t doing well.  We agreed to meet at the hospital. 

As soon as I saw him, I knew something wasn’t right. He was really tender on the right side of his abdomen, where the cyst had been. He also had a fever and not many bowel tones.  I was scared for him. I was afraid they would have to open him up again, and he wasn’t strong enough for that.  Since I’M NOT A DOCTOR I went to my handy dandy books and looked up what kinds of antibiotics I could give him.  It’s always a little discouraging doing that because we have so few of the ones that they suggest. But I found a few that we actually had, two of them even in IV form.  I threw everything I could at him.  For 2 days.  Usually they’ll just do a couple doses of IV antibiotics because they’re so expensive, but I was too scared for this kid.  I had to laugh at my own shock when I saw that the bill was close to $100.  How could it be that expensive!?!!?!?  Oh how my perspectives have changed since coming here. J

I checked on him frequently over the next couple of days.  By day 3 I was so excited! He was doing SO much better. He was stronger, he was smiling more, and I actually saw him JUMP up from sitting down on the ground. Like he hadn’t just recently had his belly cut open.  Awesome!

Today I went to check on him again.  He was complaining that his belly was hurting again. NO!!!!!!!!  But when I pushed on his belly he wasn’t tender and guarding like he had been before.  A friend that was with me asked him about his diet and he told us that yesterday he’d eaten some mangos. A LOT of mangos.  He said he was having diarrhea and that his stool just looked like mangos.  Gross.  I told him to lay off the mangos and will hopefully see some improvement tomorrow.  Things are rarely simple here, but I’m praying and hopeful that this kid will be alright!