This afternoon, I agreed to go the market in central Hargeisa with two other volunteers, the matron of the hospital and the head nurse from the medical side during our afternoon break. We left at 2 and spent several hours in the market (unfortunately my camera was out of batteries, so market pictures will have to wait until another visit). A bit before 4, we called the taxi driver to come and get us. The 5 of us squeezed into his taxi, and we started to drive home, via a supermarket that sells imported plain yogurt one of the other volunteers HAD. TO. HAVE. The supermarket was locked up tight, and moments later the late afternoon call to prayer began to sound out from mosques across the city. The driver did a crazy u-turn, avoiding a goat by only millimeters, and accelerated down the street, screeching to a halt in front of the main mosque. He leapt out of the car, and started gesturing to the proprietor of a menswear shop in a kind of tarp-covered lean-to across the alley from the mosque (an alley his vehicle was now thoroughly blocking). After a minute, he gestured for us to join him in the shop, at which point he and the head nurse promptly disappeared into the mosque to pray. So it came to be that we spent the almost half our of prayer time sitting on tiny stools, sweating through our headscarves in the sweltering back of a menswear shop. When prayer was over, the driver came to collect us with a big grin on his face, herded us back into his car, and drove us home (via the now open supermarket for the yogurt, of course.)
The other market highlight: the giant load of toe socks being delivered to the market. Apparently, they're quite the thing here because they allow you to wear flip-flops without showing any skin. No one seems to see any irony in this.
Tale of Woe #2
This morning, a woman came to the hospital, very early labor with her first baby. Early this evening, a combination of worsening preeclampsia and some signs of obstructed labor led to the decision to do a c-section. Preparations were made, and I decided to go back to the neonatal resuscitation room, just off the OR, to watch what a Somaliland-style c-section looks like, without having to scrub in.
The baby seemed to be in good shape heart-rate-wise and so though I spent a few minutes with the two community midwives (who have not yet learned neonatal resuscitation) and one post-basic midwife student (who has learned) reviewing the basics of resuscitation and Apgar scores, I wasn't too concerned. But I was watching when they pulled the baby out, and I could immediately see he was covered in meconium, limp and blue--the classic resuscitation scenario.
At this point, I must make a confession: though I have now taught 2 groups of students neonatal resuscitation, I have neither actually seen one performed nor performed one myself--I've never even seen a baby in particularly worrisome condition born. But I do know how to do one, theoretically at least. So I went for a modified version of see one, do one teach one: Teach two, do one. The scrub nurse brought the baby in and laid it down and we went to work on the limp, silent baby. Two students began to dry and stimulate the baby and suction his mouth and nose while I listened for the heart rate. Nothing. No respirations. A bit more stimulating (aggressive rubbing with the blanket), and I began to hear a faint heart rate, rising to about 60, but no respiration. I helped the student quickly situate the oxygen mask on the baby's face and kept time and helped her count while she gave squeezed the bag breath-two-three-breath-two-three for 30 seconds, then took the baby's heart rate again--110, beginning to breath on his own, but still silent.
Almost immediately, the call to prayer that signifies sunset and the time to break the day's fast sounded. And every. single. one. of the students disappeared to eat, leaving me alone with a 2-minute-old baby who moments ago had been at death's door (This is the tale of woe part. The rest of it is a tale of weal.)
What can you do but laugh? I dried him off a bit more, rubbing him hard on his back to dry to get him to cry to get some of the junk in his lungs out, listened to his heart rate and lungs a bit more and carried him out to meet his family and the world. I put him in the (hospital's single) incubator to keep him warm until his mother could put him skin-to-skin after the surgery, and to keep a bit of an extra eye on him, found a doctor to make sure he really was okay (he was) and breathed my first breath in about 20 minutes. Here he is, lucky little boy, big bright eyes looking around to see his new world:
Celebrated with a Coca-Cola Classic, in an attempt to stabilize my shaky legs:
Then went out for pizza with Lauren and Harrison at Hargeisa's finest, Fish and Steak. First non-goat meal I've had in a week along with the developing world's always-favorite, Fanta, at a plastic table in a lovely, fragrant garden in the aftermath of a rare August rainstorm.
A (probably final) update on the woman with puerperal sepsis. She continued to improve overnight and today, and when I went to check on her late this afternoon, her family had brought her the baby. I asked the student midwife if the mother was going to breastfeed, and the midwife laughed and said it was too late, all the mother's milk would be gone 12 days postpartum, the baby would keep getting formula. I asked if she had checked the mother's milk, and she admitted she had not. So we got the mother to try and express some milk, and lo and behold, she was producing a lot of milk. The baby, after being fed formula out of a wide flow nipple for more than a week was not sold just yet on the work that sucking milk from the breast was going to involve on her part, so we've still got some work to do there, but the mother is pumping and the baby is being cup-fed (no more bottle nipple for you, baby!) and will most likely come around to drinking straight from the breast in a couple of days. Can you believe this mother is breastfeeding? Two days ago she was comatose. I continue to be blown away by this story.
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