Tuesday, June 4, 2013

A trip to the Boonies

We are extremely blessed to be able to offer free tubal ligations and vasectomies to our patients this year through partnerships with two organizations: one to pay the $100/patient charge and the other to provide the operations. The results have been astounding as many older moms (as in, over 27y/o) are coming to our clinic for the first time, hoping they can get their tubes tied after they deliver.

Getting ready to go home from the hospital with a 3.5lb baby
2 week visit
One such mom is Divine. She is the one who caught me in the halls of a government hospital while I was visiting another patient. She had come to our clinic with signs of premature labor at 28 weeks. After confirming her baby was indeed only 28 weeks gestational age and that her body was indeed preparing to give birth like a roaring train barreling down a hill, I sent her to the hospital, praying they could help her. After 10 days, she saw me as she was on her way out the door to head home. Wow!

Home visit at 3 weeks old
Nervous that a 3.5lb baby was going home, I asked her to bring baby Jasmine to Shalom every week so we could take her weight and assess her. We saw her for two weeks, then they seemingly dropped off the face of the earth and my heart became heavy for them. After numerous texts, I finally received one back after 10 days...her husband had no work and they could not afford the $1 to take public transportation to our clinic.

Family centered care is the only (wonderful!) option
So I grabbed our staff nurse and my intern and off we went. Quite the adventure as we piled in a motorcycle with a side car, then a jeep, got off at the wrong place and then walked about an hour to get to Divine's humble home. Praise God, Jasmine was doing great! While we were there, Divine asked again about ligation. Jasmine is her sixth and they cannot afford more kids. We got her on the schedule.

Cleaning Divine's infected incision in their home by flashflight
I was out of the country on the day she was ligated, but as soon as I got back I sent her a text asking for an update. "Jasmine is fine, but I'm not! My incision from the ligation is infected!" This time I drove to her house to assess her wound and switch her antibiotics.

I saw her again yesterday and she is doing much better. Please pray for Jasmine, Divine, and her whole family as they strive to make ends meet and provide for their family!

Friday, May 17, 2013

Baby Jen

She was born one week overdue, but baby Jennifer weighed only 4lbs, 10oz. Her skin was stained a deep yellow from stress-induced mec intrauterus, her lungs were filled with goopy yellowish-brown mucous and every breath was a struggle. The text on my phone read, "newborn baby in distress, can you come help?"
I hate these texts. If it were easy to assess the baby, give the first dose of antibiotics if necessary and transport them to the nearest hospital, it would be easy enough, but that rarely happens. You see, the week before, a baby was born at just 30 weeks gestational age, or 2.5 months early, after the mom appeared at our door fully dilated. The baby had an excellent cry and had a good suck for breastfeeding. We hooked the baby up to oxygen and heart monitors and checked her blood sugar after wrapping her up snugly on her mother's chest. She was doing "ok," but she needed more help than we are able to give. She was transported in kangaroo care by nursing students to the national children's hospital and refused because they had no free incubators. Mom and dad went by public transport to NINE other hospitals and were refused at each one because there were either no incubators available or they didn't have the money to make a down payment on the hospital charges. Discouraged and exhausted after spending 12 hours on the road going from hospital to hospital, they went back home where the baby died shortly after. Our hearts broke because this little one had a great chance of survival.
Now came baby Jen. Do we even try to transport her? Can we attempt to manage her care at our facility? Is it legal for us to attempt to provide higher level care, even if we know she'll most likely be refused at hospitals or her family flat out won't go because they think/know it is too expensive?
After hooking her up to the pulse oximetry machine, her saturation was running in the 80s and her heart rate was low at 90-110 beats per minute. A visiting pediatrician answered my call and came over to assess the baby. Together we decided to try to take care of tiny Jen on our own...
After pulling over the oxygen machine, finding an infant nasal cannula buried among our random donated supplies, and figuring out how to rig up some CPAP, Jen's heart and oxygen rates went up. We later started her on antibiotic injections due to a fever. Whenever we tried to take her off the oxygen, her vital signs would fall, so the doctor and I took turns visiting her nearly hourly and taught the midwives how to take and chart her vital signs. My phone was by my ear all night long, but with the exception of one 2am call, God brought her through the night with no problems.

At 5am, the following morning, the oxygen tank ran dry. Miraculously, her oxygen and heart rate stayed within acceptable limits. She gradually improved and ate voraciously. Mom and baby stayed with us for 3 days (normally they are sent home after 6hours!). It was three exhausting days for all of us -- mom/ baby, midwives, the doctor, and me -- as we carefully monitored the baby whose only incubator was her mama's bare chest. She continued to come back to us twice a day for injections and a month later is doing great! Praise God! In this instance, caring for the sick baby ourselves was the right decision.
But, we rarely have a visiting doctor. Our equipment and resources are limited. And we have minimal staff. It is exhausting on everyone, including me. Please pray for wisdom as we consider each and every case... These life and death decisions take an emotional toll, but every saved life makes it worth it.
(Pictured: pediatrician, escaping little sis, mama and Jen, and me)

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Sunday, October 28, 2012

Maraming Salamat, Ate Pami!

Stenciling in our main delivery room
I've just had a marathon of a week, beginning with sitting through horrific traffic for over 4 hours on Monday to pick up a team from my home church from the airport during their 10 hour layover back to the US, show them Shalom, and take them back to the airport to catch their flight. One of the team members, Jane, stayed to stencil Tagalog Bible verses on the wall of our new clinic. It's GORGEOUS! I dropped her off at the airport last night.

Touching up in our alternative delivery room
But one of the things short term visitors like to do is take a walk through one of the local communities we serve. You see, Shalom is actually located in a rather quiet area. We have a cock-fighting farm on one side, a farm/overgrown jungle on another side, and a subdivision on the other sides. Looking around, you really don't see too much poverty if you don't look too closely. However, just a 3 minute walk up the hill leads you to a very densely populated squatter community.

So, when Jane asked if we could go, off we went! As soon as we stepped off the road, we were inundated with children following us, asking for us to take their picture so they could see it on the digital camera. We stopped and bought a P1 (2c) miniscule bag of chips for a snack and continued on. When we stepped into a new area, a group of 8 kids went running up to me, "Ate," ("ah-tay," which means "big sister"), they cried, "I was born at Shalom!" All the other kids parroted the first kid. Of course, I had to get a picture with them...these kids, our legacy. These beautiful laughing children.

The awesome, photo-loving kids, doing our "wacky" shot
Later on during our walk after dozens of high-fives and spontaneous hugs, a young lady with a baby in her arms came running (literally, running!) up to me, "Maraming salamat, Ate Pami!" (thank you, Pami), "My baby was born at Shalom!" The little dude is 10 months old and an adorable chub. The mom was beaming and so excited to show off her son.

 And this folks, is why I love my job.

Because no trip to the barrio is complete without pop-in-a-bag

Saturday, October 20, 2012

Nurse, interior designer, and....ambulance driver?

I was already in a grumpy mood on Saturday morning. I found out on Friday night that we were going to have a meeting with our cabinet maker the following morning at 8am to discuss the plans. Now for most people this is no problem, the day's practically half over for them. But for me who needs one morning a week to sleep until my body naturally wakes up (nope, no kids yet!), I grudgingly agreed...

I woke up at 7:45, skipped the shower and make-up routine, threw on some clothes, and walked over to the clinic sans breakfast and coffee. I wanted to be able to go back to bed when I got back. Shortly after I arrived, Mavis finds me and says, "Did you get my text? I need you to take a post-partum patient with a large hematoma to the hospital." I was later disappointed in myself with how UNexcited I was to be able to serve in this way, but I knew that the other nurse had a volleyball tournament to go to (which her daughter was a player for)...

I walked back home to get my SUV and cracked a few yawns in the process. I pulled up to Shalom and saw the young mom, her mother, and two younger brothers, along with the sweet baby boy. The mom was obviously uncomfortable and very unhappy. Normally they are very grateful, but this mom was sullen and clearly miserable. We all piled in my car and after getting directions to the nearest public hospital that could help her, took off.

As we cruised down the road (I was so thankful this was not an emergency!), I started talking with the grandmother who was holding the baby. This was the first baby for the 19 year-old mom. She was worried about getting home, because her older daughter was there with her two little ones. The father of this other daughter was unemployed and out with his "barkada," or group of guy friends, drinking. He had left her and now her older daughter was a single mom with no source of income. She was worried the same was going to happen to the daughter laying on my back seat. The boyfriend was a lazy bum with no trade and frequently drunk. I glanced back at the daughter and she just glared at me.

We arrived at the hospital about 30 minutes later and I stayed in the car while the family helped get the patient out of the car. (Note - I would have liked to have helped, but as soon as they see a foreigner, the prices sky-rocket as the foreigner usually equals money)

My heart breaks for this new little baby. When I mentioned her attitude to the other midwives, they all agreed that she was very "suplada," Tagalog for snobbish or stuck-up. I have a feeling the grandmother will be raising this little boy, along with his two older cousins. Please pray for Nene, that her hematoma will resolve with no problems, that she will wake up and mature into an amazing mother, and for the new little one born into such tough circumstances.

Monday, September 24, 2012

A Trip to the Bowels of the Earth

Ever since I was a little girl, I can remember taking trips to one of the world's largest open-air markets. I have no proof to support this statement other than I cannot imagine there being a larger market than Divisoria. When you step off of the jeepney (public transportation vehicle), you step onto a never-ending conveyor belt of humanity moving every which direction. The smells of raw, open sewage singe your nose hairs, you constantly have to watch where you step for fear of an open man-hole or banana peel, you clutch your bag tightly to your chest to keep all your possessions yours, and you hold your bladder for as long as you can, all day if possible.
My 2010 Christmas card was taken in Divisoria

This truck was trying to navigate the narrow streets.
The guy with the stick is lifting up rope that vendors
string across the street in order for the truck to
pass under it
But, if you want to find cheap school supplies, just about any type of fabric, upholstery or pleather, China-made kitchen doo-dad, buttons, wedding gowns, wedding favors, Christmas decor, shoes, backpacks, suitcases, towels, blankets, ribbons, netting, fishing wire, autoparts, or just about any other item you can think of, the best place to go is Divisoria. So you brave the stench, the crowds, the sweat, and even the abject poverty and descend into the bowels of the earth and just hope and pray you come out alive.

Cindy perusing some of the options
Today it was curtain fabric. Cindy (the other American RN) and I needed 50-some-odd yards of different material to "treat" our windows. We were armed with our most comfortable shoes, big bags (back-pack worn in front for me), color samples, water bottles, and money and set off. It was driving my vehicle to some random subdivision to park then walk to the start of the Metro Rail Transit system, a 30 minute ride to the other end of the line, and then a 10 minute jeepney ride. We arrived just as shops were opening.

At first we were kind of disappointed...we were not looking for polyester Christmas material, school uniforms, or wedding dress material. Just plain cotton will do. After shooting down numerous rat holes in condemned buildings, we stumbled across several vendors. Slowly our bags filled and our backs began to ache. By this time my shirt was mostly soaked. While looking for our last few yards, we stumbled back into the light of day and onto a busy street. We found a vendor with a huge tarp on the ground and bolts and bolts of random fabric.
Diving into the middle to find what we like
What caught our eye was beautiful Christmas tablecloth material which we both decided to grab for the upcoming holidays...While the vendors were busy cutting up some pretty Christmas plaid fabric I spotted, I suddenly hear Cindy gasp and yell, "Oh-my-goodness-they-have-Thanksgiving-too!" That just might have been the most excited I've ever seen this woman! I might have spotted a tear of overwhelming delight spring from her eye. Then Cindy literally (!!!) dove into the mass of fabric and found some perfect damask for our green-themed alternative delivery room.

After the fabric was cut, packaged, and our bags filmed to the brim, we treked to the corner McDonald's (that didn't use to be there when I was a kid!) for some sustenance before beginning the homeward journey. Wanna see what fabric we got? You'll have to wait until it's in the windows! :)

Exhausted after a successful trip!

Saturday, September 22, 2012

Update on the wee one, Google

Whew! We've finished 10 days of antibiotics for the little guy, and at 3 injections a day, no one can be happier than him! He's been turned into a veritable pin cushion.

I cannot tell you how much better Google looks since his birthday. He's gained nearly a pound (birth weight 4.12lbs, today 5.9lbs) and he's smiling, cooing, and eating like a champ. His mom is doing great, too, praise God!

It doesn't always have such a wonderful ending like this, but when it does, we sure do celebrate!

Tuesday, September 18, 2012

and he shall be called, "Google."

This is the story of a little boy named, "Google."

Last Wednesday started out normal enough. Drag myself out of bed, blindly prepare my first cup of coffee, start to feel halfway human and get ready for Wednesday morning prenatals. It was normal until about break-time at 10am. We've had a slew of tricky deliveries and preemies and had just prayed for all these circumstances and kiddos during our Tuesday prayer time. One of the midwives mentioned that it happened again this morning...a thick meconium stained baby that had to be resuscitated for a good while. He was a week overdue and looked to be malnourished, barely five pounds. He was stabilized and resting with his mom. The midwife asked if I would assess him. Would I? Hmmm...let me think about that. ;)

Mavis lovingly pokes the cute cheek of Google
I grabbed our infant stethoscope and headed back to our overflow room where four moms and babies were recovering. Daisy and her little boy were on the only bed. I noticed this little guy seemed lethargic and had slow reflexes. His heart and respiratory rates were normal and his lungs were clear but I couldn't tell if he was super sleepy (normal at 3 hours of life) or if it was something ominous. I helped Daisy get situated to feed him so I could assess the process. It was mostly a failure as he was too sleepy. I admonished that when they were discharged to not pass go, do not collect P200, but go straight to the pediatrician for further assessment.

As I finished up prenatals, I got to think and feel more unsettled about this newborn. I went back in and took his temp, which had dropped to the danger zone (cue theme song). I got him bundled up skin to skin with his mama to raise his temp and contacted a pediatrician friend and asked if I could bring him by for assessment. At 1:30, I loaded Daisy, her neighbor who had come to help and be her companion (it's a cultural thing), and the baby into my car and off we went. Dra Glo was concerned enough to give us a prescription for some antibiotic injections and an order for a CBC. We picked up the meds and went back to Shalom. I administered the first dose and gave orders for strict breastfeeding and antibiotic compliance. The midwives were going to bathe the little tyke and send them to the lab, then home.

Daisy, Google, and me...before the injection.
Next morning I showed up at 0700 to give the next round of meds and found out the mom's blood pressure had spiked just before discharge and she'd been sent off to the hospital...baby went home with dad. At 8:45am Dad and baby showed up. Mom was doing ok but baby was supposedly not allowed to stay with mom (!!!!). I pleaded with the dad to try to take the baby to the mom so he could get the important antibodies and immune protection from his mom's breastmilk and he promised to try. Baby boy looked 100% better. Praise God! Strong reflexes and good temp. The dad later texted that baby was with mom in the hospital and the nurses there would continue the injections. yay!

Yesterday, Daisy and her baby came back. Daisy was fine, blood pressure normal, and baby looked great. (Though he's not a fan of the injections...don't blame him!) He was 100% exclusively breastfeeding! yay!

 Saw them again this morning. Praise God he keeps getting stronger and stronger! Oh, and his name? Kenneth, but dad has nicknamed him, "Google." No joke.

10:45 pm update - got a text from Daisy. The neighbor nurse who was supposed to give him his pm injection got extended at work and can't give him his injection. After calling her, we decided to meet at the town square. I mixed the med, assessed Google, and gave him his pm injection in the backseat of my SUV using the dome light and a flashlight. A day in the life of a missionary nurse. :)