Unfortunately, I didn't get a picture of my favorite, Tangle of Nurses. I did however, find two to help me figure out a career path:
It's clear to me from these that as long as I continue nursing overseas, a debonair and wealthy man prone to standing over my left shoulder looking into the distance will sweep my white-heeled feet off the African ground.Also, if I don't post any more blogs from Somaliland, it's because I'm holed up in my room finishing this stack off.
Speaking of surprises, a whole group of the hospital staff went to dinner last night to celebrate Hargeisa University officially approving a B.Sc. in Midwifery in conjunction with Edna's hospital, a long-time dream of hers. It's set to begin next year and is intended to produce a group of midwives capable of teaching other midwives at quite a high level. I was sitting back, drinking my Fanta when out of the corner of my eye I see a gazelle wander over and curl up behind my chair for a little nap. No one else seemed impressed by this, so I tried to pretend that I too am worldly and sophisticated enough to regularly eat at restaurants with free-roaming gazelles.
It's nice to find some things amusing, because there is lots here that isn't. I have been frustrated this week in particular by the mother of the most beautiful babies I've ever seen. I was at her birth on Sunday night, an emergency c-section at which it took much longer than usual to get the baby out for some reason (usually once the uterus has been cut, it takes less than a minute for the baby to be out, but it took upwards of 3 minutes to get this baby out). The baby ended up getting some oxygen, but just wouldn't cry for almost an hour and a half after her birth, which we didn't like. The next morning, I was looking her over in her mother's room and realized she was having seizures. I called Harrison (a med student) and then we got the doctor to give Valium (very short acting anti-seizure) to the baby to try to stop the seizures. It didn't work so the baby also ended up getting phenobarbital (longer acting anti-seizure) as well. The seizures stopped about 24 hours later and both drugs have now been stopped, but Valium lasts a while in a baby's system. I don't know if you've ever seen a baby on a hardcore relaxant, but the effect is about what you'd expect.But on Wednesday morning, the baby was still profoundly lethargic when I went in. Since the baby hasn't been breastfeeding and the mother was refusing to pump because it "hurt", I suggested that we weigh the baby to see if maybe being hungry was at play in her continued lethargy. It's normal for babies to lose up to 10% of their birth weight in the days immediately following birth. This baby had lost 25% of her birthweight. In other words, this was a baby at very real risk of starving to death, which the midwives had totally missed.
The midwives excel at writing things down, even as what they are writing suggests serious problem and when you look back over the feedings sheet, it's pretty clear that the baby was at risk. Not to mention, the previous morning I had gotten downstairs and glanced at the monitoring sheet of a baby in an incubator to discover that the midwife had cheerfully recorded 3 full hours of temperatures greater than 104 degrees without doing anything about it. Sadly but unsurprisingly, the baby died about an hour later. The baby had been born elsewhere and brought in because it wasn't doing well (cephalohematoma) and probably would not have survived anyway, but there were things that could have been done to make the end of his life more comfortable. I was infuriated, but all you can really do is make sure the midwife knows for next time. So I set out on my mission, now entitled KNOW FOR NEXT TIME: LETHARGIC BABIES.
I proceeded to spend several more hours with the midwives and the mother of the baby who was at risk of starvation, trying to get her to pump and trying to get the midwives to understand that this was a rare baby that needed formula supplementation NOT OTHER BABIES JUST THIS BABY. Nuances are largely lost on this crowd.
But the mother won't pump, won't hold the baby, won't do anything. Eventually it comes out that this baby is her 9th child and one of her older children is very ill with a heart defect. She's one of 4 wives, and her husband has a total of 18 children. She can't be bothered with this baby because she's already got her hands full. Well, it's a little late for that, don't you think? This is an ongoing battle, and I've rallied the midwives round. This is a gorgeous, very healthy for the most part baby, and there's no reason she should die of her mother's apathy.
On the other hand, yesterday I went down to labor and delivery and there was a woman in the late stages of active labor. There's no epidurals here, so she was obviously feeling some pain. I decided to get my doula on and started massaging her back and helping her find more comfortable positions that were still aiding the descent of the head. Possibly I was really helping, but also quite possibly I was just further antagonizing her. We weren't able to communicate, my Somali not yet being up to par. I took it as a good sign that her female relatives started to imitate me after a while. Eventually she went off to the delivery room where I held her hand and spoke inevitably indecipherable words to her in my best soothing tone. Still no idea what she thinks of me. A healthy baby boy was born after a few pushes, and a few minutes later she was all cleaned up and ready to go out to the postpartum unit when all of a sudden she grabs my hand as I'm about to help her into the wheelchair and kisses it and gives me a big grin. I took this to mean thanks for all the labor support. Best feeling ever, and more than worth the trip here.
Speaking of wheelchairs:
Yes, that is a garden chair and two bike tires!
No comments:
Post a Comment