Friday, March 21, 2014

Teams, teams and more teams.....

It's that time again....time for the medical team to come!!! I was super excited about this year's team because it had some really special people on it! My parents, 2 uncles, an aunt, a friend from college and another from high well as some really other great people!  We went back to the village that we went to last year which meant.....camping again!  Woo hoo!!

Last year we had some teammates go ahead and get things set up at the campsite, which was a HUGE help. I didn’t know how much of a help it was, until we didn’t have it this year! We arrived at the campsite with about an hour and a half before the sun went down.  All I could think was “eat” and “sleep.”  We had to set up the tents so we could sleep, and find the stuff we were supposed to eat.  It was pretty chaotic.  Then in the middle of the mayhem, my dad pulled out this little number.  

It was a camping chair.  Converted into a toilet.  Crazy you might ask? Yes, that’s what we were all thinking too.  He bought them and then took them to the company that makes our canvas bags and had them reinforced.  Reinforced, camping chair toilets.  Complete with cup holders.  That’s right. We camp in style!  (Unfortunate mishap of the camping toilet occurred when I took my camera with me to take a picture of the toilet and put it in the cup holder while I was doing my business.  When I stood up my camera fell OUT of the cup holder, and down the 10 feet to the bottom of the disgusting pit.  After about an hour of weighing the pros and cons, we decided we’d just leave it down there.  Note to self: it may look handy and luxurious, but do NOT use the cup holders in toilets). 

She was all smiles until we all just kept taking pictures and not helping her out......
In addition to the awesome team we had, I think this trip will also stand out because of the patients we saw.  On Friday morning we were finishing up breakfast and getting ready to start the clinic when someone called me over to look at a kiddo who was probably about 2 years old.  He had the typical malaria symptoms, fever, not eating, diarrhea.   He didn’t strike me as super sick, but as I looked him over, he looked really really pale to me.  Now, I’m going to confess something.  I’ve been here for three years, but I’m still not super great at detecting the subtle nuances of paleness in my distinctly darker African population.  But in this case, even I could tell that this kiddo was pale!!  He needed blood.  At least I thought he did.  I called around to find the closest clinic or hospital that could check his hemoglobin and give him blood if he needed it.  It was about 3 1/2 hours away.  We decided to start giving him malaria treatment and see how he looked later that afternoon. A couple hours later we saw another little girl that didn’t look as pale, but looked clinically more unstable with a high respiratory and heart rate. 

At the end of the day they both looked about the same so we decided that we’d take them to the hospital early the next morning.  We brought the kids with their respective caregivers and explained what we wanted to do.  They were all in agreement that they would come to the camp as soon as the sun was up the next morning. 

I got up early the next morning to take the two kiddos in with their guardians. I waited around for an hour or so when a pastor we work with came and said that he had some good news and some bad news.  Apparently, one of the mothers ran away with her child in the middle of the night. Literally ran away into the jungle.  Guess she didn’t really want to take her kiddo to the hospital. She could have just said something!!  After some convincing, the pastor persuaded the other mother to take her child. So off to the hospital we went. 

We arrived at the hospital about 3 hours later….and I totally started second guessing myself. On the way, the kid had been talking, he’d asked for something to eat….all signs of an UNcritically ill child!  As we sat there waiting to see the provider I was preparing myself to be very humbled when the kid's blood was just fine and he was stable and we turned right around and took him home. I’m embarrassed to admit that when his hemoglobin came back at 4.3 (very low…needing blood) I was a little relieved.  It's just nice to know you're not an idiot sometimes......

It took a couple hours to get everything settled but he got all set up with his meds and blood and we headed back to the village.  I arrived in the village at about 7pm.  When I arrived, I met a woman who had been there for a while and was clearly very sick.  The story those in the clinic had received was that she’d been sick for a week with a fever, nausea and vomiting but then that day had a mental status change and her abdomen became really distended. I talked with our doc and with the other nurses and we decided that really, she needed to go to the hospital.  We were suspecting typhoid with a probable ileus to her bowel, possible perforation.  She at least needed an ultrasound to know what was going on inside her belly.  She was a mother of four children and her husband had died last year.  Her mother and father-in-law were by her bedside all day. 

We decided that I would take her to the hospital that night. I didn’t want to wait for her condition to get worse.  So we told her family what we wanted to do, I got a different navigator for this trip and we all loaded inside the car.  It was another 3 hours on the road so I reached the hospital around 11pm. 
As soon as I turned off the car and heard the patient breathing, my heart sank.  My car is so loud that I hadn’t been able to hear the changes as they were occurring, but as I listened to her, I could tell that her condition had worsened considerably during the car ride.  If she’d looked like that when I’d seen her in the village, I probably wouldn’t have suggested we bring her, because there was really nothing I could think of that a hospital could do that we couldn’t do.  In her present condition, she was no longer a surgical candidate.  But what could I do? I couldn’t tell these poor people that their daughter was too far gone and pack them back up into the car to take them right back.  So I alerted the hospital that we were there and we went to get her checked in. 

It was a bit of a mess. The hospital was pretty full, so after giving her a diagnosis (without ever physically touching her) the doctor told me that I needed to take her to a hospital in Freetown. At 12:30 at night. After I’d been driving all day.  I basically said I wouldn’t go.  Oops.  I’m a nurse. I know all about full hospitals. I know all about having to transfer patients because there’s no beds.  But there WAS an empty bed, they didn’t want to use it because that’s where the nurses liked to sleep.  That’s when I put my foot down.   I know the nurses were aggravated with me for basically refusing to leave but I was really concerned that if I tried to drive another three hours I would die.  Literally. And probably kill everyone else in the car with me.  I helped the nurses to get her settled (trying to show that I wasn’t REALLY the beast that I knew they thought I was) and then set out to find a guesthouse for my navigator and myself. 

A few short hours later (I got a 6am wake- up call by the caretaker letting me know he’d warmed up some water for my shower. It was very thoughtful, but the thought of that happening at a hotel in America made me laugh out loud) we were back up and back at the hospital. 

It wasn’t time for visiting hours, but when I explained to the guard that I just wanted to go check inside to see if a patient was still alive, he let me in.  I went in and greeted her in-laws who had refused the guesthouse that night because they wanted to stay by her side.  There was no change in her condition. My heart broke for them.  At that point, I had a decision to make. I was fairly confident that this woman wasn’t going to make it.  But did I just leave them there? After working in a hospital over here, I’ve come to know that getting a dead body back to the village for burial can be much more difficult than getting a patient to the hospital. I decided that the best thing for me to do would be to settle in and do the vigil. The death vigil.  It’s something I’ve become all too accustomed to doing here.  It just means that I stay near the bedside to let the family know that I care about what’s happening to them.  They didn’t speak any Krio and I don’t speak Temne, so I couldn’t even talk to them to sympathize with them. But I believed my presence would say it in some small way. 

I called Peter to let him know what my plans were and he decided to come down to sit with me.  Twenty  minutes later I called to tell him not to come.  The doctor had seen the patient that morning and written for some labs.  The nurses gave me the paper to go pay for them but I decided to stop quickly to see the patient again.   As I stood looking at her with her mother-in-law, I noticed that she didn't appear to be breathing.  She’d passed away.  I went and called one of the nurses to verify and as I started crying while I was standing there, her mother-in-law understood my tears.  She started crying as well. 

As I sat there crying with this elderly woman, I started thinking about she and her family.  The patient had four children who were now orphans.  The burden of their care would now fall to this woman and her elderly husband.  Most likely, these kids won’t find adults who will be able to love and provide for them like their parents did.  It’s common here for children to be given to other people to be raised, but the majority are not treated like children, more like servants.  It was a devastating blow to this family.  And we wept.

When we got back to the village, the team and I cried again.  I was sad that this happened and that the team had to witness this tragedy.  But at the same time, this is the reality of working in Sierra Leone. Sometimes you do everything you possibly can, but it’s still not enough. Tragedy prevails.  So you cry and you mourn. And then you get up and do it again tomorrow because…….sometimes the outcomes are different. Sometimes we win.  And because we’re serving Jesus, we work hard, love well, and leave the results up to Him. 

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