Sunday, September 23, 2012

A God Moment


This post is a little on the longer side, but I just couldn’t figure out how to cut it down. It was a powerful experience that I believe is worthy of the details.  We recently had a visiting team of nurses and nursing students from UCLA volunteering with us. The team members were anxious to help deliver a baby and were thrilled when late one afternoon a mother came in, in active labor. I wasn’t on call that night and William wasn't expected to arrive until supper. I needed to get home to relieve my babysitter

Right as William was pulling in I got a text from the clinic saying that the patient was pushing. So I headed over to join in. Something just didn’t feel right about the situation. As the patient progressed I decided to do an exam. During the exam I had a hard time knowing just what I was feeling. Was it a baby’s face? Then I felt little digits. I looked at everyone in the room and said “I think I just shook hands with the baby!” Any time it’s not the head coming first, things get a little complicated. So I called in our most experienced midwifery nurse from home to please join our delivery team. I asked if an ultrasound had been performed. The on-call nurse that night happens to be new to the clinic and hadn’t been trained on the machine yet. (As a side note, the mom was 8cm when she arrived so realistically there wouldn’t really have been time to refer her to the hospital anyway.) We pulled out the machine and could not find the head. Doing an ultrasound on a woman in active labor who is pushing is NOT easy. We were not sure if the head was already in the birth canal or up under the ribs somewhere.

So our experienced nurse, Triza, did a manual exam. She looked up and our eyes locked. “Michelle, that was not a hand you shook. It was a foot…” In that moment I believe the same memory washed over both of us. Two summers ago we worked together on what is my most horrific medical experience to date. It was a breech delivery where we lost the baby and almost lost the mom. You can read about it here.

From that point things got pretty wild. I knew that there was a HUGE chance that we were going to need to do resuscitation on the baby when we finally got him or her out. So we put the visiting team into action setting up all of the equipment we might possibly need. Triza and I began talking through that case from two years ago. What could/should we have done differently? What can we do now? We came up with a game plan. It was a HUGE blessing having so many skilled hands in the room. The patient was a young mom who was not cooperative at all. She began kicking and thrashing quite a bit as things progressed. One of the student nurses actually wound up at the head of the bed just trying to prevent her from kicking us in the face.

I sent a few nurses to my office to search my textbooks for any instructions on a footling breech delivery. Every book they looked in advised an immediate C-section. I’ll spare you the details, but thanks to God’s grace and past experience we were able to get the baby out much faster than I was expecting. At one point things were looking a little grim and I asked the visiting team that if anyone felt that they couldn’t handle what was to come they should please leave now. Everyone stood strong!

As I was guiding the baby’s body out, I could feel a slow but strong heartbeat. I knew there was hope! The baby was born blue, motionless, no crying, and no breathing. But her heart was beating, just too slowly. We immediately began team CPR. Part of the resuscitation process involves keeping the baby warm and pumping oxygen directly into the lungs with something called an ambu bag.  Because of the third world electrical wiring we can’t run both the oxygen condenser and heater at the same time. So we had this system going. I would yell out OXYGEN and the nurse in charge of that machine would switch it on, while the nurse at the warmer switched it off, then shortly after we would switch again. I was alternating between doing the respiratory resuscitation and using a special devise to suction out the babies airway while another nurse did the chest compressions. It was a beautiful dynamic. Within a few minutes the heartbeat picked up and the baby began to breathe independently.

Once it was clear that the baby was in the clear, we continued to provide support with blow-by oxygen and heat. It is extremely rare (as in I’ve never had it happen before!) to get an action photo while a situation like this is going on. But once we knew the baby was in the clear one of the American nurses got some pictures. 
Suctioning the Baby's Lungs

Providing Blow-By Oxygen

More Suctioning and Oxygen
 Just after the above picture was taken the power went out in the room. We were all overwhelmed by the fact that the power had stayed on through the entire resuscitation process! One of the team members said it best, “It was a God moment.”

Just this last week the mom brought her daughter in for a well-baby visit. They both looked great. I hardly even recognized the mom. And the baby girl, well she is doing fantastic! She is eating well, moving well, and her reflexes are intact. Here she is!

Thursday, September 20, 2012

To Hurt that We Might Heal....

One of the hardest things for me as a medical provider is inflicting pain to help bring healing.  This summer I became aware of a slum on the outskirts of a small community center just a 20 minute drive from our home.  This slum has over 600 family units living there.  One of the challenges faced in this community is that of chiggers or jiggers.  They are extremely small bugs that imbed themselves in skin and lay eggs there.  They create itching, pain, inflammation and infection that can destroy the tissues in the feet. Because they imbed so deeply in the skin they must be removed using needles and scalpels.  It is a tedious and painful process; but necessary in order to treat the patient. 

This hurting to heal makes me stop and contemplate a bit.  Just as in the medical profession it often takes pain to bring healing, so it is in our spiritual walks.  There are times when we endure emotional pain that actually leads to growth and health.  The key is in sitting still while we allow God to use the scalpel and needles to dig out the root of the problem.  It’s in remembering that He also has the soothing salve and dressings to help heal the wounds so that we might be better off in the long run.

 But let me get back to the main subject of this blog, the community with the chiggers!  Since the discovery of this need, we have been able to make a few trips to do chigger care clinics.  The first time we were joined by a few ELI interns who helped sponsor the outreach.  Click here if you would like to see some pictures from that outreach.  This most recent trip was made possible by a team of nurses and nursing students from UCLA who also helped us with the treatment of the patients.  Our next chigger outreach will take place on October 10th with a few team members from Water of Life Church joining us.  They have also raised funds to help purchase shoes and socks for the patients being treated. 

Walking through the slum with supplies
Tools of the Trade
Setting up the Work Stations

The feet needed to soak before beginning treatment

This little Girl kept screaming at the nurse that she was going to call the police and report the nurse

Making the incision to remove the chigger

And there is the chigger with larva

Bandaged feet and waiting for socks and shoes

We were also able to distribute de-worming medication to the community

At the end of the day I climbed up on the rock behind the church to get a shot of the team with some of the patients and the local pastor