Wednesday, June 16, 2010

Been There. Done That.

Getting better at it. But still hate it...

Tonight I was starting to turn my thoughts toward bed when my phone rang. The caller ID showed that it was the new clinical officer (CO) at the clinic and I knew he wouldn't call me at night unless he needed backup.

"Michelle, we have a poisoning, can you come?"

I HATE poisonings. It is how people try (and often succeed) to commit suicide here. There are very strong pesticides and poisons available here that are not so easy to access in America. So when someone wants to kill himself or herself they will often drink poison.

Three years ago I didn't have a clue what to do when someone drank a glass of concentrated pesticides. Now the protocol is becoming second nature.

This case was a 19-year-old young man. The CO and myself were pretty aggressive in his treatment. And thankfully his family had found him and got him to treatment quickly. It didn't take long for him to turn the corner and start improving. This is the second crisis I've worked on with the new CO. And I must say we worked well together. William actually came in the treatment room to give an extra hand. I told him he has no idea what he just got himself into. Cause now I'm taking my hubby with me on future emergency calls!

As I was starting an IV I was pondering differences in practice here. There are the obvious ones, like lack of hospital gadgets, that make life easier. Or the fact that my dog comes with me and I often have to chase him out of the treatment room multiple times during a night encounter. But there are social issues too. Treating a suicide attempt in our little clinic is very different for me than treating one in the ER in southern California. It's somehow more personal, more dramatic. We are in a village setting where everyone is involved in everyone's lives. There is no anonymity. The people I am treating know me and look at me with hope in their eyes. I don't think I'm doing a great job of putting words to it, but it is definitely very different.

The young man I took care of tonight will be fine physically. But the spiritual and emotional injuries will still be there. Please pray for him as his family come around him and hopefully are supportive during this time.

As for me, well I'm gonna wrap a few things up and hit that pillow I was picturing before the phone call came!

Special Patient

Sometimes in the clinic we have patients who we treat on an ongoing basis for a chronic condition. This patient is one of those. I've been treating him for several months for a wound on his ankle. He told me it was a snake bite from the 1950's that never fully healed properly. He has been to various hospitals for multiple treatments without success in the past. Here at our clinic we have been blessed to have some specialty wound care items that were donated by generous medical professionals in the USA. I've started using some of those products on this old grandfather and they have been working miracles. It also helps that he is a model patient. He came in this afternoon for a dressing change and I asked him if we could snap a photo while he was here. I'm trying to be better about carrying my camera in my purse to capture those little special moments in the day.

Wednesday, June 09, 2010

Rough Day

*This is a very detailed and graphic post with material that is inappropriate for children.

Well this is one of those nights where my body wants to fall in bed but my mind just can't stop. And I know if I don't share the day now it won't happen.

Today we lost a baby. Today was the most horrific delivery I have ever assisted in. Really, really horrific. I just can't post all of the details here because it is to horrible. But we had a breech delivery. We didn't know that it was breech until the delivery was way too far gone for us to do anything about it.

As the mom was pushing I kept having doubts about the presentation (which part of the baby is delivering first) but my colleagues kept assuring me they felt confident it was the head. When we could finally see something, I felt confident that it was in fact, not a head. It was a little boy who came boy parts first. He got stuck. Really, really stuck. We did everything we possible could to get him out. Did I mention it was horrible?

There finally came this point where I was 95% sure that the baby wouldn't make it if we hadn't lost him already. The point when I had to fix my mindset on saving the mom because it was coming to the point where her life could be in danger. It takes more than an hour to get to the hospital from our clinic. So once a woman starts pushing it's pretty much impossible for us to refer. But the thought went through my head that maybe we would have to send her even in her current state because we wouldn't have another choice.

Then I had this thought that we needed to use gravity. So I asked everybody to help me get her off the delivery table. We put sheets on the floor and had her squat. Okay, I'm getting a more detailed than I planned. But let me just say that after much work we finally got the baby out. I was already mentally prepared for him to be gone. But I told the staff we would do ten minutes of CPR so that we all knew that we had tried.

After the first cycle of CPR I checked and found a strong heart beat. Since we had a heartbeat we all felt that we needed to do our best. We did two hours of support resuscitation. At one point I actually came very close to passing out. (I passed out on my very first day of nursing school and felt that same feeling washing over me.) I hadn't eaten or been able to use the restroom in over eight hours. I was overheated working over the baby who had the warmer blowing hot air on him. I broke out in a sweat and saw the room spin. Yet it occurred to me that everyone in the room was looking to me. So I asked someone to bring me some water, took a deep breath, pulled up a chair next to the warmer, and pulled it together.

Every time we got close to giving up, the baby would take a few gasping breaths and we would start up again. Finally after the two hours I told the family that we had done everything we possibly could. It was now in God's hands. We wrapped the baby skin-to-skin with his mom while he struggled to breathe. It didn't take long before the gasping stopped. Within fifteen minutes his heart stopped beating.

I laid my hands on his little body and prayed that the Lord would receive his spirit and comfort, love and care for him until his mom would one day join him. It was a horrible, yet somehow holy, moment.

Obviously I'm still processing the day. I would appreciate your prayers for the mama as she has to endure the physical pain of recovering from a traumatic delivery at the same time as she goes through the emotional agony of empty arms.

And I'm frustrated. Extremely, extremely, frustrated. Because you see, we have an ultrasound machine at the clinic. But we have had a terrible time trying to use. We desperately need a professional to come and train our staff on it. It seems like it should be easy, but every time we try, we feel lucky when we find the heartbeat. We have yet to be able to figure out the position of any baby we have tried to ultrasound. If only we knew how to use it! We could do a sixty second ultrasound on every mom who was admitted in labor. Then we would know immediately that a referral to the hospital for a C-section needed to be made. Maybe this baby we delivered today would be happily breast-feeding instead of wrapped in blankets in preparation for his burial in his mother's yard tomorrow morning.

Friday, June 04, 2010

Snapshots from Today

A few posts back I blogged about debrieding a burn on a sweet little girl. She came back to see me again today for another treatment. She got a pre-treatment sticker that she promptly stuck on her forehead. She is improving with each dressing change and soon won't need to come see me anymore.

The water project is going strong. The clinic has been filled with the sound of holes being pounded through our walls in preparation for the pipes that will thread through them bringing us clean water. We are hoping to have running water by the end of this month! Below you can see that fresh water being pumped into a big bucket for the construction use.

It seems we very well may have the most deluxe waiting room for a rural-clinic in Africa. Today we got fish! One of our nurses has a brother who builds fish tanks. He wanted to show his support for the work we do by donating a fish-tank and fish to the clinic! It was installed today and is sure to make the wait to see a provider just a bit more interesting!

Tuesday, June 01, 2010

What Was I Thinking???

So I have lived in Africa for going on three-years now. It's been a year and a half since our last trip to the USA. And on top of all of that I'm a medical professional. You would think that I of all people wouldn't slip up and use unsafe water. For goodness sakes, I battled worms and bacterial infections most of my first year here!

But this morning I was deep in thought as I was brushing my teeth. I had my glass of pure water at the sink right next to me. But for some crazy reason I flipped on the faucet and splashed water in my mouth to rinse. By the second splash I suddenly realized what I was doing. This was followed by a lot of rinsing with the pure water. And the rinsing with pure water was followed by a good gargle with Listerine. Considering I didn't swallow and I quickly washed away the "icky" water I'm hoping I'll be okay. But as I go about my morning I keep having flashbacks to my gastrointestinal issues from my first year.

So note to future visitors, do not drink the water unless it is bottled, comes from the deep borehole, or has been boiled! And I wouldn't mind if you say a little prayer that any buggers that made it to my system die a quick and painful death!