Asayech 5/3/11

I was walking down toward the hospital when I noticed some commotion near the OB room. As I drew closer I saw a bamboo and thatch stretcher lying outside. I walked into the delivery room as Solomon (one of our midwives) was turning on the vacuum machine. “I’m delivering a still born.  I know that you are not supposed to use vacuum for these cases, but the head is crowning and mom is exhausted”. The other nurses explained that the mom had been in labor for 3 days and had not felt the baby move in nearly a week. Finally today her family decided to bring her to us. It was clear that she was seriously ill and that the amniotic fluid was severely infected. There had not been a heartbeat on the nurse’s exam.  As Solomon finally got the head out I saw a perfectly formed little face and was so sad that the mother had to go through all of this; laboring for days to deliver a baby she knew was dead.

                Solomon delivered the baby and held it upside down to cut the cord. Suddenly, one of the eyelids twitched. Then the eye opened. “The baby’s not dead!” Kari cried. We rushed the baby to the table and began rubbing and suctioning her, but she still wasn’t breathing. The nurses grabbed the resuscitation mask and began to use the hand pump to help her breath. As we were checking her we noticed large purple and red marks on both side of her ribs. The skin around was stretched and buckled. The marks looked like scars, but from what? And the fact that there were scars meant that whatever it was happened some time ago. Clearly this little one had had a rough few months.

                After a few minutes the baby started breathing on her own, but it was very rapid. She and the mother were admitted to the hospital; the baby on oxygen and both on strong antibiotics. We left for the night not knowing if she would still be there in the morning.

                The next morning during rounds the baby was lying on the bed next to the mother. She was clearly hungry. We told mom to breast feed her more, but mom just looked away. We asked her what was wrong and she replied that she did not want to put the baby to her breast because she was afraid it would die. She kept staring at the baby’s scars. She didn’t want to get attached. We tried to explain to her that while there was a chance that the baby would die, if she didn’t feed her it would be a certainty. The mother wouldn’t listen. Fortunately, we had a secret weapon . . . grandma. The baby’s grandmother spent the next week by the bedside ensuring that the baby got what it needed. She would physically hold the baby to the mother to make sure she was feeding. After a few days the mother seemed to soften a little and started to feed the child without coercion. Then she began to hold the baby and play with her.

                After a week, both mom and baby were done with IV antibiotics and the baby was able to breathe without oxygen. We didn’t really know what would happen with the baby, but we had done all that we could and they were ready to get home. On the morning they were preparing to leave we asked what they were going to name the baby. The mother smiled and replied “Asayech”, which means “mirror image” because the mom though the baby looked just like her.

Welcome to Chiri 4/25/11

As you all probably know, I’m no longer in Matoso. Through a series of visa issues and other unforeseen circumstances, I was transferred to Lalmba’s other facility in Chiri, Ethiopia. This is a very different facility in that it has a 14 bed inpatient hospital in addition to the outpatient clinic and children’s home.  Chiri is at a very high elevation and a very different climate than Matoso, so we see very different illnesses. Life is always an adventure and always gives us opportunities to learn.  So, by way of introduction to Lalmba Chiri, here is a tour of the inpatient ward and the patients we are caring for there today.

                In the first bed is an 8 month old with tuberculosis. He has been coughing for 4 months and now has pneumonia on top of it. He also has a giant lymph node on his neck that may or may not be TB. Oh, and he has a vitamin D deficiency, too.  But, he is doing well on antibiotics and we have talked to the mom about making sure he gets enough sun exposure.  Unfortunately, Ethiopia has a shortage of Vit. D supplements so we can’t provide it to the family.

                The second bed is a four month old girl with pneumonia. She has scars all over her abdomen from visits to a traditional healer. The method of drawing out anything bad is to burn the skin over the affected area.  The burns are healing without any complication, but the cough continues. The good news is that she has been weaned off oxygen and is breathing fairly well on her own. We are just waiting for the fever to subside.

                The third bed is a one month old boy with apnea. When he came into the clinic he would stop breathing every 3 or 4 minutes. His heart rate would slow from 140 beats per minute to 40 beats per minute. Finally his brain stem would kick in and wake him up, but he was getting so tired. He’s been on IV medication for over a week and has not had an episode. Now we are weaning him off and seeing how he does. Hopefully he’ll go home soon.

                Bed four is a baby who is going home tomorrow. He was admitted with dehydration and pneumonia, but is now eating and drinking well and his lungs sound great. His parents, who can’t be more than 16, are getting prepared for the 6 hour walk home.

                Bed five is empty. There was a two year old girl with a lung infection. She had been improving and then took a turn for the worse. The referral hospital didn’t have the equipment to treat her and the family didn’t have any money to pay them anyway. We told the grandmother that we could try one other antibiotic and keep her on oxygen, but the grandmother declined. She wanted to take the child back home to see her mother before she died. We had to respect that decision. Unfortunately, they live a 2 hour walk from Chiri. Without oxygen the child likely died in her grandfather’s arms on the way.

                Bed six has a little boy who came in severely dehydrated. He got IV fluid and hasn’t vomited since. Right now, he’s screaming his lungs out and trying to pull out the IV. Around here, that’s a really good sign. He should be going home soon.

                The three beds in our isolation room are filled with adult TB patients. One is a man with very severe anemia. He has been on TB treatment for 2 months, but is still coughing up blood. Fortunately, his anemia has improved with Iron and he has not required a blood transfusion.  Another is a man who came in with pneumonia and then revealed that he had been coughing for a few months and had lost a lot of weight. So, we started him on TB treatment, too. The last is a woman who came in so weak that she could barely stand. She said that she had only been coughing for five day. We did a test anyway, and, sure enough, it was positive. So, she went to join the isolation club and started on antibiotics and IV fluids.

                The last patient is in our malnutrition room. His mom is one of the patients in the isolation room. She has been so ill that she has not been able to feed him well for almost a month. He is 5 months old and looks like a newborn. But, he is hungry, which is a good sign. His goal is 1 ½ cups of special formula a day; he is averaging 3 cups. We will treat him with the formula until he gains weight and mom is able to feed him at home.

                So, those are our patients. What I have learned during my time in Africa is that if you focus on the patients you can’t help, you will lose hope. The only thing you can do is focus on the victories and know that you did the best you could for the others.