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.

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.

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!

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!

Mud or Rainbows?

Lately I've found myself facing some unique challenges. I've found that when these challenges come (and we all know that they always will!) that although I can't always control circumstances, I can choose to control how I respond.

This was clearly illustrated to me in the last week as we had quite a bit of rain. I slipped in the mud one day on my way home from work. I nearly ate it but got my balance just in time. Nevertheless my shoe and foot were rather muddied. As soon as I got home I grabbed the camera to document the moment.

Not long before the mud incident I had found the need to grab the camera to capture some amazing rainbows. With the rainy season we sure get a lot of mud. It can be a pain trying to get from point A to point B. But we also get some amazing rainbows. And the flora becomes lush and green with flowers blooming everywhere.

So it's occurred to me that I have the choice to focus on the mud or to focus on the rainbows. The same applies to challenges when they come our way. Will we see mud? Or will we look up and see the rainbows?

Just Another Day

Well today was just another day in the clinic. Nothing particularly outstanding or special. But I don't often write about what a typical day looks like. In many ways our walk-in clinic probably has some similarities to clinics in the USA.

There are the patients who you know will not take your advice unless it is in alignment with what they already had in mind. There are the patients who started self-medicating before they came to you. Because antibiotics can be purchased over-the-counter here that one can be a bit scary at times. Bactrim is the drug of choice for patients to take one or two doses and then come in a few days later because the medicine didn't work.

Today I was the only nurse in the treatment department. I have to say that my preference is to work alongside another nurse because I strongly believe that two brains are better than one. Especially with some of the crazy things we see. But thankfully I didn't see anything too scary today.

My first patient of the day didn't really want to be at the clinic. She had malaria and clearly felt horrible. I think she just wanted someone to pick up the medications and bring them home to her. She was refusing a physical exam, refusing lab tests, pretty much refusing everything but medicine. Fun stuff!

I made a referral this morning for a two-year-old who is severely developmentally delayed. The mom brought her in because she has a respiratory infection. But she hasn't walked yet, is cross-eyed and doesn't interact with people much.

My typhoid patient of the day was diagnosed at another clinic. The mother of the 10-year-old girl brought her lab results and the medicine they gave her a week ago. She hadn't improved so they wanted another opinion. Well sure enough she had typhoid, unfortunately they were giving her antibiotics for a skin infection. So we started her on a new medicine and hopefully she will turn around quickly.

I had a 19-year-old girl who is finishing HS at a boarding school. She has a menstrual problem and is really embarrassed about her teachers and peers knowing about what she is being treated for.

My toughest case so far today was the three-year old with the third-degree burns on her hand. They aren't fresh burns but she has to come regularly for wound care. I had to pull of some of the dead skin before putting on a fresh dressing. The sweetie is a little trooper. Trembling all over and tears rolling down her face she holds up her hand to me to begin debrieding. I was wishing I had stickers to put over the bandage when I was done.

And the funniest case of the day was the old-man (that is a respectful term here) with the chronic ulcer on his ankle. So the ulcer wasn't the funny part. The funny part was that he told me "I'm here to get my dressing changed from my snake bite." I asked him when he had the snake bite and he told me "1950, and it's doing much better now than it was then!"

Just another day in the clinic. Thank you Lord for giving me this opportunity to reach into people's lives when they are at their most vulnerable. Please use me to make a difference in the lives of each patient I encounter this week....