Oh. My. Gosh.

The last week or so has been slow in the OB ward.  Our ambulance was broken which I think contributed to the slowness, but this hospital is no different than others with the ebb and flow of patients.  Anyway, I was bored.  I complained about how slow it was to someone, which any person working in a hospital will tell you that is a big no no.  But I did it. Oh dear.

Yesterday I was working an evening shift, so I arrived to the ward at 3pm.  I was informed by the nurse that we had a woman laboring who was a previous c-section so would need another one for this baby.  The c/s was scheduled for 4pm.  Yeah!! Something to do.  I bustled around getting everything ready for the surgery and by 5pm we were in the OR.  I’m in a race with some guys from the OR to see who can guess the sex of the baby more frequently and was in high spirits when I took the lead by correctly guessing the sex of the bouncing baby boy that was born.  The last c-section this woman had had, produced a baby that was already dead so we were all excited about this beautiful healthy baby. 

Two hours later at 7pm I was sitting at the nurses station when I heard the ambulance siren.  Wait, I thought the ambulance was broken.  I couldn’t tell if the siren was coming or going so I went out to investigate.  When I got outside the driver told me he had brought two women in labor.  Yikes, 2! And one of me.  Ok, show time!

One of them was able to walk and one wasn’t. I took the one that could walk and guided her into the labor ward.  The thing about the ambulance, and the thing about giving birth here in general, is that they usually will not come to the hospital for a normal delivery.  So you know, especially when they come by ambulance, that something is wrong.  I started talking to the woman in Krio but she wasn’t understanding me so I went and grabbed one of the nursing students to help me translate (something for which I would be extremely grateful for later!) 

The history for the first woman is this.  This was her fourth pregnancy and she has been in labor since the night before.  She started bleeding but the bleeding has stopped.  The TBA (traditional birth attendant) who was attending her birth became nervous when she started bleeding so decided to refer.  **** A million gold stars to this woman for recognizing a danger sign and referring her somewhere else!!!****  I checked to see if she was bleeding and she wasn’t. I called the lab to come check her hemoglobin to make sure it hadn’t dropped too much.  Then I called one of the doctors to see if she could come down and do an ultrasound to check for placenta previa.  (Placenta previa is when the placenta gets too low and can go over the cervix.  When the woman tries to push the baby out she puts too much pressure on the placenta and she will start to bleed.  She can hemorrhage and die from this, so it’s pretty serious.  The treatment option is to do a c-section).  The woman’s vital signs were fine and the baby’s heart rate was fine.  Since the woman wasn’t bleeding and it wasn’t an immediate emergency, the doctor said she’d finish her dinner and be right down. Perfect!

By this time they had brought in the woman who was unable to walk by herself.  This was this woman’s 8^th (yes 8^th!) pregnancy.  She has four living children.  She too had been in labor since last night and although she was fully dilated, stated she didn’t have the strength to push.  Vitals signs?  Good.  Baby’s heart rate?  Good.  Ok, I did a vaginal exam and sure enough, she was fully dilated and the baby was right there.  I tried to pass a foley catheter to see if I drained her bladder if it would help the baby come, but I couldn’t get it in.  Next, I decided to give her a medicine that would help strengthen her contractions.  I’ve been told here that women who have given birth a lot have uterus’ that are just tired and need a little help.  I started the IV and sure enough, about 15 min. later her contractions were stronger and she really started to push.  

At this point the people in the room were myself, the nursing student I’d called for translating, and the TBA who came with the patient.  Although I’ve been working in OB for awhile, up to this point, for one reason or another, I’ve always had someone else with me when it was time to push the baby out.  This time, I was the most experienced in the room. Oh dear.

Push Push Push Push Push Push Push.  Little by little, the head came down.  Finally, out it came.  I reached up a little and felt the cord wrapped around the neck.  I yelled for the hemostats and clamped the cord and then cut it.  I expected the body to come out with one more push (as had happened with every delivery I’ve seen) but it didn’t come.  Crap.  I gently pulled, but nothing.  I started getting a little panicky at this point.  I tried to call the doctor but the call didn’t go through.  I know that even if help comes, it will be too late, as I just have a couple minutes to get this baby out. Now I’d been praying ever since the woman came in, but at this point it was more a guttural cry of desperation to my God! I’d listened to the heart tones of this baby just a few minutes before and it had been strong. Now, if I don’t get this baby out quickly, the last 9 months will be wasted in the last five minutes. 

The only case of shoulder dystocia (when the shoulder gets stuck on the way out) I’d seen  was when one of the doctors delivered a baby that was just about 30 weeks.  The baby had died inside the uterus.  He had had to really tug and pull hard, dislocating the arm etc., but it didn’t matter because the baby was already gone. I was really afraid of doing something to harm the baby.  Finally (and I’m still not sure how I knew to do this) I reached up and grabbed one of the shoulders and pulled it down.  When I did that, it came out. Then I lifted up and the second shoulder came out. 

The baby was not crying, not breathing, and very floppy.  I glanced down at the woman and saw that she wasn’t hemorrhaging then literally scooped the baby up and took off running.  Because Jesus loves me, the generator had randomly been turned on about 5 minutes before so I knew there was oxygen and suction in the OR.  As I glanced down the hall to the OR doors, I saw they were locked so yelled to the nursing assistant to grab the keys.  She flew past me and had the OR unlocked by the time I got down there. I ran to the main OR doors and saw that they too were locked. These doors don’t have a padlock and the lock that locks them is pretty flimsy. I knew I couldn’t waste time going to find the hidden key so I literally used my shoulder as a battering ram and opened one of the doors. 

Now we were in the OR but I didn’t know where the lights were.  Fortunately though, because we’d done a c-section earlier that night I knew the oxygen and suction were still set up.  I yelled for light and the nursing student and one of the other OB patient’s mothers (who had followed us down) brought out their cell phones that have flashlights on them.  I started giving the baby oxygen, bagging him, sucking out all the goop and slapping him around a bit trying to wake him up.  It was so dark that I couldn’t see if his color was getting any better. 

I yelled, “I need Marie!!”

“Marie?”
”That other white woman.  Someone go get the other white girl!”  Somebody took off running.

I thought Marie might know how to turn the lights on.  When she got to the OR she didn’t know how to turn the lights on, but I dispatched her to go check on the woman I’d just left when I took off running with her baby. 

All this time I’m continuing to bag, give oxygen and suction.  Finally, our little man opens his eyes and gives us a cry.  We all started cheering.  His color started getting better and he started crying more and more.  I was pretty close to crying myself. 

We left the oxygen on for a little while until I felt we were out of the woods and then got him weighed and dressed.  He was 8 ½ pounds.  In a country where the average weight is about 6 pounds, this was a BIG baby!

I took him back to the OB ward to check on his mom.  Marie had delivered the placenta for me started to help get her cleaned up.  A few minutes later the doctor arrived and I told her about my adventure. She went to check the baby and said everything looked ok.  Thank you Jesus!!!!  The night OB nurse also showed up at this time (she’d heard the ambulance and thought I might need some help). 

Now that the chaos was controlled, we turned our attention to patient number two.  The ultrasound showed that there was marginal placenta previa so we could try a vaginal delivery but it would be risky. Since she’d been laboring for so long but had very little cervical dilation, we decided to just go for the c/s.  I got everything ready and helped bring in the third baby for that day.  Three live babies for three deliveries!!

I’m so thankful for all the help that I had that night. If that nursing student and patient’s mom hadn’t been there, I would have been scre…in big trouble.  I’m also thankful that my God breathed life back into that baby when there was none.  He doesn’t always do that, and I am confident that He is still good when things don’t happen the way I wish they would.  But I’m very thankful for the happy ending in this case!

Evolution of a Plant

There's a common phenomenon among the Apotos (white girls) that come here, and it usually occurs about a week or two after their arrival, or right before they're getting ready to leave.  They decide that they should "plant" their hair like the Sierra Leonean girls do.  The women here can do some awesome things with their hair and it looks.....well, awesome.  However, when the white girls do it?  Not so awesome.  Since I have a rather large head and therefore lots of room for a blazing white scalp to show through, I have put off jumping on the plant your hair bandwagon.

I have enjoyed however, standing by and watching lots of Apoto's get their hair planted while here. A lot of them are really cool!  Some of them are....different.  My all time favorite was a plant one of my friends got called the "snake."  Imagine a spiral braid that starts on the top of the head and and spirals inward until the remaining end of the hair sticks straight out of the middle of the circle.  Then imagine that you have one of these spirals on the top of your head, one on each side, and one in the back.  All with that piece of hair sticking out of the middle of the circle.  I still literally laugh out loud when I think about it.  But the girl was a trooper and left it in for 2 days!! I called her Cindy Loo Hoo.

People (my Sierra Leonean friends) have been telling me to do it for over a year.  Every time someone does it it's "Emily, do it. Do it. DO IT!!!"  But I stood strong and my scalp remained covered.  Well, last week I hurled caution to the wind and said, "Sun! Prepare to meet and burn my scalp!"  

I had a friend that was getting ready to leave and wanted to get her hair planted before she left.  I went to keep her company.  Now this girl has GORGEOUS hair....and a TON of it!  I asked how long it would take to plant and they said about 4 hours.  Yikes.  I sat there for about an hour watching them work on my friend and listening to them all tell me I should get mine done. And I caved.  They went and bought some extensions for me (red and black....why not?) and three girls started working on me.  And it hurt.  A lot.  At times I would have all three of them pulling as hard as they could on my head in different directions.  But alas, 3 hours later I was finished.  

This was what my face looked like for the majority of the time.  

I looked like I should have been part of a reggae band. Or at least a roadie.  The toughest part was that every time I moved my head, a bunch of little hairs would get pulled out.  My sister had this done when she was in Nigeria and she lasted 5 days.  So of course my goal was to keep it in for 6. I wasn't sure I was going to make it.  It was so heavy.   And so hot!!!

The girls and I after they finished.  They were proud!

After 2 days though, it started feeling better! I figured that all of the little hairs that were getting pulled have all just come out now so there's no more hair to pull. I didn't care. I was pain free. 

My favorite part of the whole experience was when I got back to the hospital. People freaked out.  I have never had so many people get so excited about one of my hair-do's before!  It was hilarious. When I complained about how much it hurt they just laughed and said "You have to bear. You have to bear" (which means suck it up).  

Since I got such a great response, I decided to make my goal 2 weeks.  Then on Saturday night I had a dream that I took it out and when I woke up on Sunday morning and it was still there....I was sad.  So I quit.  A couple girls came over and the three of us plus my roommate went to task taking out all of the tiny braids. After two hours I had air circulation to my head once again, and a giant pile of fake hair.  As Mr. Gibson would say....Freeeeeeeeeeeeeeeeeeeeeeeedoooooooooommmmmm!   

I was afraid it was going to take as long to pull it out as it did to put it in

Apparently you can use it again, but I don't see it in my near future. So I gave it to the girls as a "thank you."  I would have been there for 3 days without them!

Tonight I was down at the hospital and an adorable 3 year old asked if she could plant my hair.  How could I say no?  Fortunately her idea of planting was twisting my hair around for about 15 minutes until she got bored.  My kind of plant!

When I grow up

Working at the hospital means that I am around people all day, every day. I'm constantly meeting new patients, families of patients, friends of patients, etc.  Every once in a while, someone will stick out of the crowd and really just "get to me."  It happened this week.

I spent the last couple weeks in Freetown and up country doing the medical clinic, so when I arrived back in the OB ward on Tuesday, I didn't know any of the patients.  I started reading through some charts and saw that one of the patients blood pressure was really high.  Like 260/140 high.  The patient had eclampsia, and as we learned in nursing school, the treatment for eclampsia is delivering of the baby within 24 hours.  I asked one of the nurses if the plan was to go ahead and section her, but she told me that she was only about 26-28 weeks.  In the US, with all the advanced technology, babies at this age rarely make it. Here, where our resuscitation efforts include bagging and using oxygen if the generator happens to be on or until all our battery packs die....there's just no way baby would survive. Since we couldn't deliver, the plan was to try and keep her blood pressure down for as long as we could, ideally until at least 32 weeks.  

The next day the doctor called me to the patients bedside while she was doing rounds.  She couldn't find a fetal heartbeat with the doppler or the ultrasound and wanted someone else to check.  I looked and looked, but didn't hear anything.  Mom said that she had felt the baby move earlier that morning, but we weren't finding any heartbeat now.  We told mom, and she started to cry.  This was her first baby.  

We decided to wait one more day, and readdress things in the morning.  The next day I got to the hospital at 3pm for my evening shift.  They had given her some medicine to help start her labor so she could deliver the baby (although it had been confirmed once again that it wasn't alive), but she wasn't progressing very fast.  A couple hours later I started her on an oxytocin drip to help speed things along.  This made her contractions start coming faster and stronger.  It was so hard because the labor was so painful....just like when you're delivering a live baby, but we all already knew what the outcome would be.  She kept repeating "I'm done, I can't do this.  I can't do this. Jesus, please help me.  Help me, help me."  I tried to encourage her as much as I could.  I prayed with her, told her to get in whatever position was most comfortable for her, held her hand.  It was hard to watch.

About 8 hours after the initial medicine was given to start labor, the baby started crowning and she was pushing hard. The head came partially out, but then it was just stuck.  Because Jesus loves me, the doctor just happened to be down in the OB ward, so he came in to help.  Her pelvis was very small and he had to pull hard to get that baby out.  When it was over, she just kept saying "thank you, thank you, thank you."  Her family came in and one of them started crying.  In her very soft way, the patient said, "Don't cry.  You're supposed to be encouraging me...don't cry. It's ok."  She was an absolute pillar of strength.  I was blown away.

She asked if it was a boy or girl and I told her it was a little boy.  I asked if she wanted to see him and she hesitated for a second and then said yes.  I washed him off and covered up the signs of the difficult delivery and showed her to mom.  She said he looked like his dad.  

I've been a part of two deliveries now, in which we knew that the little baby wasn't alive.  It's not fun for anyone.  This woman, a young girl probably around 18 or 19 years old exemplified such calm acceptance and determination in such a hard situation....I want to be like her when I grow up. 

One positive outcome was that we discovered that she does have a really small pelvis, so we told her that she really needs to make sure to come to the hospital for her next delivery, just in case she needs the help of a vacuum or a c-section.  Hopefully now she'll come early and will give birth to a healthy baby boy....or girl.

Oh, Caaaannnaadaaaaa....my home and native land.......

Long time no chat!!  I've been "up country" (which is code for anywhere outside of Freetown) for the last week and a half with a medical team from Canada.  We had a team of nurses and docs and boy...can those Canadians see some patients!! We kicked butt and took names (and by that of course I mean compassionately treated more than a thousand patients who came to see us).  Since the week was packed full, I'll give you the low down bullet point style.

1. I love getting to meet new people and see Sierra Leone through the eyes of first timers.  This was no exception.  Team Canada was great and I loved getting to know them and introduce them to the country I love.  Also, I learned the Canadian anthem while they were here so...I'm practically Canadian.  Just call me Amersalonian.  Definitely.

2. I love spending time with the Sierra Leoneans that always help me on these trips.  One of my favorite pastors here is...a little bit crazy...but awesome! I couldn't do these teams without him and I love hanging out with he and his wife!  He spends about 30% of the week going around snapping photos with his camera or ipod.  I spend 30% of the time trying to ruin whatever picture he's attempting to take.  It's a beautiful partnership....really.

3.  This year we had a doctor from Peru come join us.  Now, my dad has been building up this lady for....years.  "Emily, you need to meet this girl."  "Emily, you're really going to love this girl."  "Emily, she's like you....(which I interpreted to mean a little bit crazy).  Well, I spent the week with her and....well played Dad, well played.  She was great!!  We shared a room for a week and may or may not have literally spent hours giggling in the middle of the night.  Sorry third roommate!!  You didn't realize you were rooming with 2  ten year olds!

4.  There is a large population of Lebanese people living and working in Sierra Leone.  The hotel that we stayed at was run by a Lebanese woman and her son.  She and I hit it off and one day I was looking at pictures of her family and she was showing me pictures of hers in Lebanon.  It started to rain so I grabbed all my stuff from the table and took it to my room. A little while later she was looking all around and told me that she lost her key, and that her other key was locked in her room. I helped them look around some and then the maintenance man came to talk about breaking into her room.  All of the sudden I though, "Hmmm Emily, you wouldn't have taken her key would you?" Now, the only reason this even popped into my head is because....I'd already taken someone else's key earlier in the week.  I went to check in my room on the VERY unlikely chance that I'd taken it and...sure enough. There it was sitting on my bed with my camera, phone, etc.  Oops!! I tried to blame it on my roommate but....couldn't do it. It was my fault.  Fortunately she forgave me. :)  And REALLY fortunately, they didn't break into the room to get it.  Thank you Jesus!!

(Note: This is my Lebanese friend and I.  Apparently I took zero pictures this week, and the few pictures I did take wouldn't load....darn internet. So sorry for the essentially pictureless blog!!)

5.  I am constantly learning and re-learning things here.  One of the things that I've learned, is that the last day of the clinic is just....not easy.  All week when we see people outside and they beg to be seen, we can say "come tomorrow, come tomorrow, come tomorrow."  But the last day...no more tomorrow.  And since I am the keeper of the cards (the ticket into the clinic), the buck essentially stops with me.  I hate being the bad guy that says no.  Yuck.  I was sensing that I was a little emotional as soon as we pulled up to the clinic, but I started off the day doing pretty good!!  One of my biggest fears was that I would get frustrated by not being able to see everyone and by everyone asking for their mother/sister/uncle/great, great, grandmother to be seen that I would get irritated and snap at someone.  I needed to balance firmness with gentleness.  Not my forte.   But I was doing ok.  We knew approximately how many patients we'd be able to see that day so we handed out a certain number of cards and then just kept handing them out 5 at a time, so we would keep good control on how many we could see.  Then I was brought a list of 16 elders in the community who hadn't been around all week, but wanted to be seen now.  Ugggghhhh.  I lost it a little bit and started crying.
One thing that I have a hard time with here are the power plays.  I've grown up in a culture that teaches that the best kinds of leaders are servants....placing those they're leading ahead of themselves.  But that is traditionally not the way it is here.  If you're a leader or have power, it means you get the best seat, you are served first, etc.  So the fact that the people who had been waiting outside in the hot sun all day, every day, for the last five days were going to be pushed aside so these men could waltz in and be seen....frustrating.  I expressed my frustration to my Sierra Leonean friend who I trust to help me navigate through the political things that I don't understand here, and he was empathetic.  He told me that he understood my frustration, but the fact is, we are leaving tomorrow and there is a church and a school that will remain behind and these leaders have the ability to make things very difficult for them if we disrespect them right now.  
I could see some of the community members standing around me, wondering if I was about to make their lives a lot harder, so I swallowed my indignation and gave them the cards.  I still don't like it. I don't think it's right.  But when I get frustrated by things like that, I remind myself that I CHOOSE to live here.  So suck it up Emily.  Suck it up.

6.  Beach day.  Of course beach day was awesome. It always it.  What a beautiful display of God's creation and creativity!  I love going to the beach! :)

The season of medical teams is done now, and I'm planning on heading back up to the hospital tomorrow (providing Boris (my car) is done getting his face lift by tonight).  Bring on the baby borning!

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."

"Emrlksdjfee?"

"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 segregated....men 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 you....you'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 gates....it 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.  

I've got the whole baby....in 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 hospital...so 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!!

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.