INSANE 24 Hours

WOW! The last 24 hours have been absolutely insane! If I hadn't put up two posts yesterday I wouldn't even know where to start. We've had a few major events since the last post. Here are the highlights and then I'll go into details below:

1. My sister Danielle Buckland gave birth to her firstborn a little before 6PM on Feb 4th. Baby boy Lex had some complications and may have to spend some time in the Neonatal Intensive Care Unit (NICU)
2. Right around closing time at the clinic here in Kenya, we had a twin delivery. The second baby had complications and we provided support resuscitation for over an hour before she perked up.

Now for the details! If you read my posts from yesterday you will know that it was a rough morning and our staff were already wiped out by mid-afternoon. It's been over a year since we had a patient die at our clinic. So our staff took it pretty hard. Especially because we all thought that this little girl was going to make a full recovery. We were able to get her body transported to her home where she would be buried.

Late in the afternoon we had a mother in labor arrive. She was already dilated to 7-8 cm so she was too far into labor to refer out. On assessment Kiptoo found she was carrying twins. Baby girl #1 delivered just fine. The problem was that part of baby girl #2's umbilical cord came out with baby #1. The danger of a prolapsed cord is that it will be compressed as the baby delivers. Basically the cord gets squeezed during the delivery process. That squeezing cuts off circulation to the baby thus depriving her of oxygen.

As soon as we saw the cord, the power went out and the room went completely dark. Thank God we had some awesome donations of head-flashlights by some teams last year. We now keep one in each department. So I fumbled around finding the maternity headlamp as someone else ran to get a second one. In less than a minute I was gowned and gloved and reaching in with my fingers to decompress the cord. I could go into a lot of graphic details here but I've probably already gone a bit to far....

So finally the baby was delivered in the dark and was pretty much non-responsive. No breathing, but she had a strong heartbeat. So we initiated support breathing with a resuscitation bag. After a few minutes the heartbeat dropped below 100 so we began support compressions. We were now doing CPR for the second time in one day. A pretty big deal for our little clinic!

We continued with supportive resuscitation and suctioning for well over an hour. I kept doing spot checks and kept finding a decent heartbeat. Our team decided that as long as we had a heartbeat we would keep going. And we were thrilled with the fact that the baby never turned blue. About thirty minutes in she started trying to gasp every few minutes. As her gasps got closer and closer together our faith grew. Her sister start crying and we told baby #2 "Can you hear your sis cheering for you? Come on breathe little one!". Then as I would suction her she would make an effort to suck on the tube I was placing in her mouth. Soon enough she started breathing steadily on her own. Within a few hours she had a hearty cry and was breast-feeding. Mom and both babies were doing great when they discharged this morning.

It was late by the time I got home. After assisting with a delivery I always want a hot shower. Our shower uses electricity to heat the water and since the power was out I heated water on the stove to get washed up. We had scrambled eggs for dinner. Sometimes I wish we had take-out or could call for a pizza!

About 20 minutes after I went to bed I got a call from my sister Danielle that her water and broken and she was in labor. She delivered a baby boy a little before 6PM CA time. Baby Lex had a double nuchal cord which means that the cord was wrapped around his neck twice. He was born almost three weeks early and was 6lbs 5oz I believe. My sister had gestational diabetes and when Lex was born his blood sugars were extremely low. There was talk about sending him to the NICU but they are trying to bring his blood sugars up while he is with Danielle and Brett.

They are closely monitoring the situation and will take him to the NICU if it becomes necessary. Danielle went totally natural for the childbirth and has already advised me that when it is my turn I should come to the USA and get hooked up with an epidural! I've asked them to text me if he gets admitted to the NICU. Otherwise I'll just call them in the morning (my evening) to check on things.

As you can probably imagine, I'm hoping for a calm, slow day today!

From Hope to Tragedy

Well I don't often blog twice on the same day but I feel obligated to follow through on what happened to the girl in my previous post.

As I mentioned in the last post, she came in with malaria this morning and was treated. She quickly improved and was looking close to being ready to discharge home.

I was getting ready to wrap up some paperwork when I got a call from William that there was a group of wazungu (white people) headed my way. He said he met them on the road and they wanted a tour of the clinic. They arrived just a few minutes later.

I was starting the tour with them when our receptionist came and told me that Kiptoo (our most experienced nurse) needed me NOW. I knew that there was no way Kiptoo would have interrupted a clinic tour for something minor. I rushed to the observation room and found him with emergency resuscitation equipment and our little girl. In medical terms she had crashed.

I gave myself about two seconds to get over the shock and then started in with CPR. We worked on her for a good half hour doing CPR and giving resuscitation drugs before acknowledging that she was gone and there was nothing more we could do.

Her mother told us that right before she got really sick and became unresponsive she told her mom that she had fallen out of a tree that morning but hadn't told anyone at the time. She said that her chest had been hurting since but she didn't say anything because she thought she would be in trouble.

Our staff all came to the conclusion that she must have had internal injuries from the fall. Because her malaria was turning around and we thought things were looking great before she suddenly crashed.

Talk about a rough day! We then had to go out in the hallway and break the news to mom. We took her in my office. It took a while for the fact that her daughter had just died to really settle in. The moment it really hit her she doubled over and began wailing. My eyes filled with tears as I wrapped my arms around her. Days like this are so hard. Yesterday we victoriously helped save a young life, today we lost one....

This is How We Do It

Every now and then I'm reminded of the vast differences of practicing medicine in the USA and in rural Africa. This morning I had another one of those little reminders.

Before moving here I had worked in an emergency room for a few years. Whenever we had a patient come in by ambulance we would get a phone call ahead of time. Before the patient arrived we would know the age, sex, chief complaint and some vital statistics on the patient. The patient usually had an IV in place by the time they arrived. Once the patient arrived a team would practically pounce on him/her drawing blood, giving medications, prepping for x-ray/CT scan etc.

This morning one of our nurses, Percival, came and got me from my office. "We have an emergency on the way. It's a child maybe about ten-years-old." I was surprised that she had this info in advance. So I asked her if someone had called to let us know that the child was coming. "Oh no, I just looked out the window and saw the mom carrying the child here." By the time we got to the front of the clinic the mother and child were almost here.

Sure enough it was an 11-year-old girl with severe malaria. Fever of 103.6, vomiting, weakness, headache, body aches etc. When I first moved here I probably would have motioned to send such a case to the hospital immediately. But with time I've learned that our clinic can manage a much higher acuity than I would have expected. Time and time again I've seen these cases turn around with just a few hours of treatment in our observation room.

Don't get me wrong, we do refer patients to the hospital, just not as quickly as my American mindset originally thought that we should. Yesterday we sent a 12-year-old girl to the hospital. After an hour of treatment it was clear that she was not improving and was possibly even getting worse. We all started working the phones looking for a vehicle to take her. It wound up being our ELI Kipkaren director, Peter who drove her to the hospital in a vehicle from the Training Center. As our staff carried the girl to the car and tried to make her comfortable the thought crossed my mind "This is how we do it." No fancy Western-ambulance transfers, no medical transport team, no frills, bells or whistles. But we always do the best we can with what we have to work with. And our awesome little team saves lives every week.

Peter later reported to me that the doctors who first saw her told him that there was nothing to do for her at the moment because our clinic had already done so much. The last update was that they would admit her for observation and do lab tests continuing the treatment we initiated in a few hours.

Our little girl today got some IV fluid, quinine, antibiotics and medications to stop the nausea and bring down her fever. After an hour her fever had broken and she was resting much easier. We will keep her for a few more hours to make sure she is really on the mend before letting her go home. She'll have to return for another injection tonight and again tomorrow morning.

Under an Acacia Tree

Health Classes being taught by clinic staff under an acacia tree

Just this month our clinic has launched Dental and Optometry Services. We are in the process of doing some community outreach for both of these departments. We are currently going on the road and visiting local primary and secondary schools. At each visit we let the children and teachers know about the services that are now available at the clinic. Then Jeremiah does a dental presentation and Kemboi gives a presentation on eyes and eye-care.

Kemboi using a model eye to teach about the lens.

Jeremiah demonstrates what can happen to your teeth if you don't take care of them!

At the end of the presentation Jeremiah questioned the children about main points from the talk. This young man answered enough questions correctly to earn a toothbrush and toothpaste!

Thankful

This weekend was a bit difficult for me. I lost uncle David on Friday and missed my little sister's baby shower on Saturday. I have to confess that Saturday afternoon was one of those times that I was really wishing I was in America and not in Kenya. Yet over Sunday and Monday my spirits were lifted as I took some time to count my blessings. Among those blessings are the people in our life who support William's and my work in Kenya.

This morning I'm taking a moment to be thankful for the amazing team that helps William and I to be here doing what we do in Kenya.

I'm so blessed with the support we regularly receive. I appreciate the little things like encouraging comments on this blog and uplifting e-mails. And let me tell you those care packages make my month when they come! The teams and interns that come and give of their time to volunteer in our village are such a blessing. I'm incredibly grateful for the partners who stand with us daily in prayer for our work here. And of course I am very thankful for the financial supporters who make it physically possible for us to be here. From the one-time donors to the monthly supporters, please know that you are making a difference in Africa through your giving. If you fall into any of the above categories please know that I thanked God for you this morning!

So as I move into the busy parts of my day let me begin with the thought that "This is the day that the Lord has made, I will rejoice and be glad in it!"

FYI from Haiti

I know that there are nurses who follow my blog. The following post is from a physician working in Haiti. They have an urgent need for qualified nurses to come and volunteer in their hospital. As I'm unable to go myself I thought I would pass the post along to those who may be willing and able.

ATTN:

We are in urgent need of nurses who are able to come down here and volunteer ASAP. We are specifically looking for people who are able to leave within the next 2 days, and stay for 2 weeks or longer.

Your role could include the following:

• Wound care (wound debridement, dressings, wound vac placement, etc)
• Med/surg inpatient care (with shifts being 12 hour days or nights, likely 5-6 shifts per week) with a probable patient load of 10-20 patients per nurse
• Acute care ER/OR nursing, assisting doctors in the care of injured and ill patients
• Managing the flow of patients, assisting doctors with completing medical records, gathering medications and supplies, providing discharge instructions, restocking supplies, managing the central administration desk, etc
  

MUST have the following qualifications:

• Be able to leave by Monday or Tuesday and stay for at least 1 week (prefer longer)
  
• RN certification
• At least 2 years clinical experience in an inpatient, ER, ICU, or OR setting. WOUND CARE nurses are especially needed, especially if you are also skilled in ER/inpatient care
• Previous travel to the developing (3rd) world
• Flexibility (you may be asked to do things that are not officially a part of your job description)
• Ability to work long hours and function in less than ideal conditions with less than adequate sleep
• Ability to submit to our medical chain of command that is already in place; we do not want people who are going to come down here and try to do their own thing (in other words...leave your egos at the door)
• Be able to fund your own travel to Florida, and possibly to Haiti (we are currently bringing in medical professionals free of charge on many flights from various locations in Florida, but this opportunity may not last)
  

We prefer the following qualifications:

• Previous medical experience in the developing world
• Ability to speak Haitian Creole
• Ability to stay 2 weeks or longer
  

While you are here, you will be staying in cramped quarters. You will likely eat snack foods most of the time and may not eat a hot meal for several days in a row. It is hot and dusty here. You will get dirty. You may not be able to shower every day. You will need to pack your bags with medical supplies from our needs list, and also bring in food for yourself (things like granola bars, fruit snacks, cereal, etc).

At the same time, you will have an very rewarding experience caring for some special and grateful patients. You will be helping save lives. And you will be working with some incredible people. This work is demanding, but very gratifying.

If you meet these qualifications and are interested, please contact Shelley Stammis ASAP at lexismom1972@yahoo.com and please cc me on the e-mail (halv0105@umn.edu). In your e-mail, please describe in detail how you meet the above qualifications. If you are interested but do not meet ALL of these qualifications, we are grateful for your interest, but please do not contact Shelley or me at this time, as we simply do not have the time to respond to every inquiry we get.

THANK YOU in advance for your interest and for caring about Haiti! We so appreciate your support and willingness to help.

Jen Halverson, M.D.

Heartline Clinic & Hospital

Photo of Robenson,
4 year old boy that came in very lethargic with a broken arm -
now doing really well.

Kids in Simone Pele, taken on one of the runs to pick-up patients.

In Loving Memory

Uncle David and Aunt Betty

After a long battle with ALS my Uncle David passed away at 7:30PM on January 21st. I can't write enough here to describe what a wonderful and amazing man he was. First and foremost he loved the Lord. He was a man who knew what he believed and lived his life by those principles. He loved my Aunt Betty and he loved his family. He was never afraid of hard work. He loved America and was proud to have served his country.

I remember as a little girl being amazed at his skillful style as he poured me a glass of milk. When I was fourteen and preparing to leave for my first mission trip he pulled me aside and said that he knew many people wouldn't understand what I was doing, but that he did and he was proud of me.

In recent years it has been hard to see my strong and vibrant uncle begin to lose coordination and mobility. I knew that his disease was progressing. But when I left the USA a year ago I imagined to myself that Uncle David would be there for my next visit. It's really hard to know that I'll never see that amazing smile and get one of those special hugs again. It's hard to know that I never got a chance to say goodbye. And yet at the same time I wouldn't want him to be here suffering. And I know that he is once again full and complete. I bet he is jumping around in heaven and doing a jig now that he is no longer constrained by ALS! His greatest desire was "That every one would come to Jesus for eternal salvation."

I would greatly appreciate your prayers for my family during this time of loss. Please pray especially for Aunt Betty as she has just lost her life partner. Thank you.