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.

I shouldn't post this.....

I usually strategically post my blogs so that everyone at home thinks that I'm over here thinks I'm just a suffering a way. I was hesitant to post this one because...well, it blows my cover out of the water.

A couple weeks ago we had a medical team that came over. One of the girls from that team wanted to stay a little longer (who wouldn't!?!?!) so she came up to the hospital with me. I treated her like royalty by letting her sleep in my buggy, spidery room, feeding her delicious food like copious amounts of peanut butter and jelly sandwiches (ants included for free.....she really loves bugs) and letting her participate in the comings and goings of the hospital like an 80 mile an hour ride in the ambulance down a road so bad it induced vomiting in 3/6 passengers.

I took the team to the beach at the end of their trip and decided that my friend and I definitely needed to return there before she left. She decided that instead of just visiting for the day, she wanted to spring for us to stay the night!! Oh. My. Gosh. Spending the night at the beach?!!? Yes please!!

We stayed in the upstairs of this house

The whole group (team members staying in Freetown) came out for the day and then my friend and I stayed the night. We were the only guests staying there that night. It was heaven.

We ate dinner at our balcony overlooking the beach. I did a lot of reading and relaxing. So thank you thank you thank you Friend for doing that for us!!!!!

Who wouldn't want to live here?!??!

We have solar!!

A couple years ago I was hanging out with a missionary couple who had been on the field for years. They told me that the most common reason for missionaries to leave the field....is other missionaries. Since that time I've repeated that statistic to multiple missionaries and more often than not get the response "oh, I believe that!!" Fortunately I have NO concept of that because the team members that God's given me over here are a.w.e.s.o.m.e! Allow me to give you an example.

Last year we were preparing to send a container over. On that container I included a solar fridge. That's right. I'm very trendy now!

Meet John, Kaysie, and their son Aden.

John is a solar engineer and despite the fact that I'm incredibly handy at installing and maintaining all sorts of things, I decided I'd let him mess with my fridge. John and Kaysie have been incredibly busy for the last couple of months so they decided they needed a little vacation.

They are such good friends that they used a good portion of their vacation to load up their car with my (and my neighbor's) solar fridge and make the brutal drive up to my village.

John then proceeded to spend the next 3 days on my very literal hot tin roof, rummaging around in my attic of 130 degrees and living in a fish bowl while all the kids within a 20 mile radius congregated on my front porch to watch all the action. Throw this in with the fact that

they accidentally forgot their suitcase so had no clothes of their own and....you've got some pretty good friends!!

John up on my neighbors roof (did I mention he installed a whole system for her too???)

After John put in many a long day, we were ready for the dedication by putting our first item in the fridge. A most important item!

It's a beautiful sight!

In the last week I have enjoyed magnificent cold water. It really does make all the difference. In fact, the cold water combined with delicious Crystal Light caused me to have to limit my liquids...for the first time ever! I'm also enjoying cold powdered milk which is much better than warm powdered milk, and am able to save my leftovers. Truly life changing! So thank you thank you thank you John and Kaysie!! You guys are amazing!

Night Shift

Weekends are always thrilling around the village. (Insert thinly veiled sarcasm here). However! On Saturday night I got a dinner invite for pizza over at the doctor couple's house. It was a big party with med students, doctors, nurses, teachers and maintenance people. We had a blast and I learned how much fun you can have with pizza, chocolate, a blow up globe and some people who have had to learn how to entertain themselves with no TV.

I tucked myself into bed at about 10:30 (pretty late for me....I was partying hard!) but was jolted awake about an hour later by my phone. It was one of the doctors who had just been called down to the hospital because one of the staff had collapsed outside his house. Apparently he was having chest pain and collapsed. Now, of course if he was in the States we'd have him back in the ER in minutes, running a hoard of tests. Here, we gave him some nitroglycerin (which did help his pain) and something to bring his blood pressure down a bit.

I got the call because while the doc was down there, he noticed that there was one, count them one person working for the whole hospital. And he was a nursing assistant. Granted, he's a stud (you can read more about him here) but still. (We were supposed to have 3 people on but the nurse that was supposed to be on was the one having the chest pain and the other guy had worked during the day because we were short staffed then.) The doc called to see if I could go down and work for a little bit to help him out.

I went down with one of the other nurses. Um, it was kind of crazy. There was our staff member who had collapsed from the chest pain as well as a lady who had a gastro-intestinal bleed and was receiving blood. Almost as soon as I got there I saw some people carrying a guy down the hall. That's almost never a good sign. I peeked in on the GI bleeder, sent the nursing assistant "Abdul" to go make sure our chest painer's blood pressure was ok and went to find our new unconscious guy a bed. There literally were no empty beds in either of the mens wards. What's happening to the men around here??? I went to the little storage area and fortunately there was a bed in there, so in he went.

I started getting a history from his friends. Apparently the day before he had been in the bush and was accused of throwing a lighter at a group of guys (which the friends vehemently denied). The group of guys did not appreciate having a lighter thrown at them and proceeded to beat the snot out of him. Apparently he had been unconscious since that time.

Ok, unconscious. Breathing? Check. The other nurse started getting his vitals and blood sugar. All was normal, except his heart rate, which was low. His blood pressure was fine though, so it was fast enough to keep his pressure up. I proceeded with his neuro exam.

The first thing I noticed was that for being jumped by a bunch of people, he didn't look too bad. In fact, I couldn't find any bruises, scrapes, nothing. I opened his eyes and he fought me a little bit and his eyes moved all around in his head. Pupils equal, with a brisk reaction. I did some stimulation to see if he responded, and he responded to my painful stimulation. Next I did my "faker test." I learned this one in the ER and I love it. When a patient is lying down I lift their arm over their head and drop it. I know it's not perfect, but the logic is that if someone is really unconscious they won't move their arm at all and it will hit them in the head. I did it on this guy and hit himself in the face a little. I did some other things and then went back to the "faker" test. I lifted his arm over his head and dropped it....probably about 10 times. Never once did it hit his face.

The rest of his exam was also essentially normal. His abdomen was soft, good bowel tones. No obvious broken ribs and his breath sounds were normal.

Hmmm. His vitals and exam were essentially normal. He failed the "faker test" but he did seem a little "off." It was possible that he had a concussion. It was possible that he had a big bleed in his head. Either way, there wasn't a whole lot I could do because we don't have any neuro surgeons around. Since his vitals were OK, when they came to get me to tell me there was a new patient who just came and was vomiting blood, I went to see him.

After getting the new guy settled I went back to "unconscious guy." He was snoring. I was kind of naughty and snuck into his room and startled him awake. He woke up and looked right at me, something he hadn't done before. I told him I needed to give him an injection for which I got a "are you serious?" look and then he rolled over so I could inject his bum. This reassured me that at least he was following commands now...... (The injection I gave him was something for pain).

While I was in the mens ward helping with the paperwork, I heard a guy working to breathe who had been admitted earlier in the evening. He sounded like he was drowning. I went and listened to his lungs and they definitely had some stuff in them! However, I wasn't sure if it was fluid overload, or pneumonia. He had a low grade fever and a non-productive cough. The person who had seen him originally had ordered fluids for him. I sat and hemmed and hawed. If it was pneumonia, he was probably dehydrated and could use the fluids. However, if he already had too much fluid on board, the fluids that were hanging would not be helpful.

After watching him be restless for a few minutes, really working to breathe, I pulled the trigger. I stopped the fluids he was getting, went and got him a medication to get rid of the extra fluid as well as a strong, injectible antibiotic. He really needed some oxygen but our oxygen concentrator was being used by the lady getting blood, and it was almost to the end of it's 2 hour battery. Darnit!

By this time it was about 2:00am. I was planning on sleeping down at the hospital so "Abdul" wouldn't be alone. However, since things had quieted down and I had to make a 6 hour drive the next day, I decided to go back up to my house and told him to call me if he had any problems.

At about 3am I got a call saying that my respiratory distress patient had passed away. Darnit. I laid there going over and over the things I'd done. After thinking about it for awhile, I'm not sure that I could have done anything differently. In America he would have had a tube stuck down his throat to breath for him and been shipped off to the ICU. Here, we couldn't even give him oxygen.

It can be tempting to be discouraged. There is too little staff, too few resources, and too much that I don't know. However, the last few weeks I've really been convicted (once again....I always need to relearn things) that my job is not to save everyone. My job is to show people here that they are loved. By me, but more importantly, by Christ. :) Thank God!!

Magnet.....

In the hospital we have a term for certain doctors. We call them......."poop" magnets, if you catch my drift. This means that for whatever reason, whenever they're on call or around, you know that you're going to have a rough night. The crazies seem to come out of the woodwork for these folks and you're going to be busy. I'm beginning to have that complex about myself. Yesterday someone made the comment that it seems like when I'm in the OB ward, things get crazy. It definitely felt that way yesterday.

I walked into the OB ward at about 8:15am and the nurse that had been on the night before called out from the labor ward "Emily, come and catch this baby!" So I went and caught the baby. Both mom and baby were doing fine....not a bad way to start the day! :)

About 20 minutes later we got a call for the ambulance. Then we got another call for the ambulance. Two places to go, only one ambulance. Since nobody seems to really like going on the ambulance runs and I still get a little adrenaline rush from it, I volunteered (along with a friend of mine that's visiting from Canada). They told us to go to the farthest place first. I asked how far it was and was told it's "far small". I've learned better than to try to get more specific but since they didn't tell me it was close, I knew we were looking at at least an hour.

Off we went.

Whenever I go in the ambulance, I always get the "Oh my gosh I can't believe this is my life" feeling. Traveling at breakneck speeds over some of the worst roads of my life with the siren going full blast and people in small villages jumping out of the way, will do that to a person. Toss in the fact that we're in the middle of nowhere and headed into who knows what kind of a situation where there may or may not be cell service.....and you can get a bit of a rush. That's what my friend and I were feeling as we were flying down the road.

After a little backtracking and about 1 hour, 20 minutes on the road, we found the village we were looking for. I got out our little maternity box and headed into the health center. When I got to the room I saw that the pregnant woman was walking around so phew....at least I know she's not almost dead. I laid her down to examine her and asked the nurse what the problem was. She told me that this was the woman's ninth pregnancy and she has eight living children. She had been in labor for 1-2 days but had just come to the health center that morning. She was concerned because the child was breech was afraid that her uterus would be more prone to rupture because it had been pregnant so many times. Valid concern.

I checked her for myself and sure enough, there was the little tooshie right there ready to come out. Ok, that's enough for me...let's go. I was afraid that she might drop that baby right then and really didn't want to try and deliver a breech baby by myself. I really, really didn't want to deliver a breech baby by myself, on that road!

As we turned to leave, the nurse told me that there was another woman who had come to the clinic complaining of severe headache and although she had been treated for malaria, continued to have the headache. Sure, throw her in too.

I told my friend that I wanted to sit in the back with the patient because I just wasn't convinced things weren't going to fall out. As they piled more and more people in the back, I began to question my choice. But at that point it was too late, so off we went.

I can't imagine being in labor and driving on that road. She couldn't brace herself very well because she was lying down and there was a metal box right by her head so I spent the trip trying to brace myself and trying to protect her from splitting her head open on the corner of the box. I had multiple arms grabbing onto my own as we were tossed about in the back. All of the sudden I hear someone heaving and....sure enough, the woman next to me is tossing her cookies. A few minutes later the grandmother lost her lunch in the back of the ambulance and another woman followed after that. Lord, please please please let us get there soon!!

After what seemed like an eternity we finally got back to the hospital with our two pregnant women, their families, their rice and the majority of their earthly possessions.

I wasn't feeling so hot after that ride so I delegated someone else to take the next ambulance run and went to check on the women we'd just brought. We checked the woman in labor first. No fetal heart tones. Crap. I hate that. We decided to try and augment to see if we could get her to push this baby out. If she failed to progress, we'd go ahead and do a c-section. We try to avoid that when we can.

About the time we finished with the first woman, the second ambulance returned with a young girl, about 17 who had been in labor for about a day and was failing to progress. We checked her and she was about 6 cm dilated with strong fetal heart tones!! Woo hoo! She was pretty small but it was her first baby so we wanted to give her a chance to birth the baby for herself.

After about 2 hours we decided that the breech lady just wasn't going to be able to deliver for herself so we took her to the OR. They pulled the baby out...and it was rough. You could tell it had been dead for awhile. The smell....ugh. It was a boy and he had been a big one. I cleaned him up and gave him to the family.

In between cases I checked on the woman who had come with the headache. She was about 32 weeks and said the last time she'd felt the baby move had been the day before. But maybe she had felt it that morning. We listened for fetal heart tones and didn't hear anything. Then we got out the ultrasound to see if we saw any little heart beating. Nothing. Darnit.

I moved on to prepare for the next c-section. Our smaller girl just wasn't going to be able to birth this one. I got everything ready with more adrenaline this time. This woman had been in labor for a while, but she still had fetal heart tones. The baby might not be doing well though, so I went through my mental checklist of what I could/would do if the baby came out in distress. The surgeon made the cut and I got my receiving blanket ready. As he pulled out the little kiddo he gave a good scream. Ah, I love it when that happens. I took him and got him all cleaned up and ready to show the family. There's always lots of onlookers and everyone gets so excited when there's a new baby. Some things just cross all cultures. :)

It was a long day with ups and downs....like a lot of days here. But two mamas got to go home with babies that they might not if they hadn't come so....we are trying, small small. :)