Tuesday, March 13, 2012

A Non-Issue

One of my highlights of our recent trip to the USA was being able to attend the National Women's Health Consensus Conference which was held in Los Angeles.  In the past three years I have acquired a vision for women's health in rural Kenya.  The biggest and most immediate issue that has jumped out at me has been that of cervical cancer.  It is mind boggling that this is one of the leading causes of cancer-related deaths in Kenya when it is so preventable.

My friends who recently launched a hospice program in our area have already shared several sad stories of terminal patients they have or are currently caring for with advanced cervical cancer.

In the last two years I've been able to expand my training and skill set in the area of cervical cancer prevention and early intervention.  I've finished my training period and am ready to begin implementing what I have learned. 

So as I prepared to launch out it in this new area of providing women's healthcare at the village level, it seemed like a perfect time to attend a major conference addressing the latest in issues of women's health.  What surprised me when I received my conference agenda, was that cervical cancer would only comprise of one 30 minute session of this three day conference.

And then it hit me.  In the USA cervical cancer is a non-issue.  You rarely hear of someone dying of this disease.  We have such sophisticated yet simple screening methods that we pick it up before it becomes an issue.  We have the capabilities to do provide early intervention in the form of procedures and minor surgeries in simple office visits.  In-and-out.  Same-day!

There is not a lot of research and ground-breaking news in that area because quite simply, the West has it under control.  It is my hope and my prayer that the day will come in Kenya where we will be able to say "Cervical cancer, that one is a non-issue here!"

Tuesday, March 06, 2012

The Hand of God

This morning I saw the hand of God at work.  It was approaching 5AM and I had just gone back to sleep after feeding Ryan when I heard a knock on my window.  It was the nurse on-call at the clinic.  She quickly told me that she had a serious emergency at the clinic.  A mom who was 28 weeks pregnant was having a lot of bleeding, but baby had a strong heartbeat.

As I was getting dressed I was mentally reviewing possibilities.  None of them looked very positive.  I knew that I wanted to get an ultrasound quickly so that I could see if there was a problem with the placenta.  As I walked into the delivery room the nurse called out "the baby is here!".  It was one of those moments of sensory overload where my ER background kicked in.  You are thinking dozens of thoughts in a moment and trying to prioritize them all.  I saw a pile of blankets in our baby warmer which I assumed held the baby.  I saw a LOT of blood pretty much everywhere around the delivery table.  As I was pulling on a pair of gloves I heard a movement from the warmer.  Could it be?  Could a baby born at just 28 weeks without a highly specialized team to receive her actually be capable of making a noise?

A quick glance and I saw a little arm reaching up.  At that point I was pulling out all the stops.  The nurse was with the mom and a quick glance showed that she could do without me for a minute or two.  I immediately got on the phone to start working on emergency transportation even as I sorted out power cords to get our oxygen condenser up and running. 

With only one power socket on hand I had to choose between oxygen and warmth.  I opted for oxygen and got the machine up and running.  I put the baby's daddy to work holding the oxygen in front of the baby to provide what we call "blow-by" oxygen.  I then called William and asked him to bring the keys to my office so I could get a power strip out of my office to activate both oxygen and the warmer.  About the time the power strip arrived our stepdown machine (converts the power so that we can use the American oxygen condenser without blowing it up) started smoking and blew up.  William went to find me another stepdown while I got the warmer moving.  Unfortunately the second stepdown only accepted two-prongs and the machine had a three-prong cord.  So back up to the main building once more to raid the dental clinic for our last stepdown.  Finally we had both warm air and oxygen being supplied to the baby.

About that same time I got confirmation that miracle of miracles we were able to get transportation to take this mama and baby to the hospital.  The majority of the time it is next-to-impossible to get transportation for a case like this.  Many times we have put life-and-death cases in the backseat of our personal vehicle and taken them to the hospital at 3AM.  But praise God, transport was on the way.  AND the baby was not only pink, but was moving her arms and legs.  She looked to me to be more like 32 weeks along.  Still very early, but not as early as we had been told by the mom.

The nurse told me that shortly before the baby was born she had done a quick ultrasound and seen blood pooling behind the placenta.  This is what we call a placenta abruption where the placenta separates from the wall of the uterus before the baby is born.  This is an extremely life threatening emergency for both the mom and the baby.  It is nothing short of a miracle that both the mom and the baby walked away from this alive.  Mom lost about 1,500 mL of blood (that's 3/4 of a 2L soda bottle!).  She should be receiving a transfusions right now and baby should be in an incubator getting the neonatal intensive care she needs.

What a way to start my Tues morning!  And what an amazing reminder of God's power to intervene in situations that would seem hopeless.  When I first realized what was happening I felt fairly certain we would have two fatalities in our clinic today.  Thank you God for working a miracle!