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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