Sunday, December 30, 2012

That is disgusting!

12/27 OK- medical friends. I need your advice again. I seem to have developed a nasty ingrown toenail infection even though I never wear shoes. But maybe that is the problem- 17 hours of standing in the dirty hospital with a laboring woman in a puddle of amniotic fluid, blood, urine and all the other nasty stuff that in hospitals I've worked in before we've quickly cleaned up but here they allow to accumulate... anyway. That is actually part of 12/28's post. This one is about this infection in my foot.
The night after getting back from the hospital
20 hours later...

I know that the correct thing would be to seek out a physician but lets be honest, that's not happening. I'm taking erythromycin because it seems to have good results with cellulitis and abcess here but I'm not sure it is working. Soaking often. Trying to be off it as much as possible. Any other suggestions? I'm thinking of switching to a cephalosporin if I can get my hands on a good one. 

12/28 I'm sure you all wanted an update! So maybe its turned a corner. Slightly less painful tonight and quite a bit less swelling. Still draining pus nearly continuously but less and doesn't smell as bad. But what to do with that granulation tissue? It is so sensitive and painful.
12/30 I may be the only one that finds these sequence pictures interesting but here it is tonight's anyway.

It doesn't look it but it is much better. Not draining pus.  Bleeds continually all day and still ultra sensitive  but swelling is way down. Was also weight bearing much more today which may explain the bleeding. Still unable to run (or walk without limping) but soon I hope!

Friday, December 28, 2012

Another delivery

Monday, Christmas eve, was a clinic day and I have to be honest, I had really thought it would be a quiet one. I had actually even asked myself if there would be any patients at all. If only. Early in the day two women came within 20 minutes of each other both in active labor. The first was dilated to possibly 6 and having contractions rather close together but was adamant that she did not want to go to the hospital. The only reason that she came is that she heard that I gave away baby sweaters. The second lady was a primip and not dilated very  far. But she told me she had been having hard pains since Sunday morning. We took tea together and she was indeed having long contractions about 3 minutes apart but seemed to be tolerating well. She wasn't sure she wanted to go to the hospital (very few village ladies do) and I didn't want to force her so when she suggested she go back home I didn't disagree but gave her husband my number.  Oh, meanwhile a lady came in covering her eyes saying she had been attacked by a spitting cobra and the snake had gotten some in her eye. The right eye was seriously swollen and tearing constantly. If I understood correctly it took them more than 30 minutes to walk from the garden to the clinic because she couldn't see anything. I gave pain meds and flushed the eye as well as I could with saline while the other nurse arranged transport. She told me that because the sight was already gone there was no reason to rush and they could take public transport.  No one complained and they quickly headed off on the back of a passing truck.
But back to my laboring patient. I just had a feeling about her. She seemed strong and I've found very few ladies that complain here about labor pains. And 24 hours already seemed long. But FHTs were good, BP was good, I had no reason to be concerned and chalked it up to first pregnancy worries. But it didn't surprise me at all when they called me at 10:00 pm asking if I could please come and help them. I arrived in the village and had a terrible time assessing her as it was really dark and my flashlight quit. They lit a candle for me but when I suggested we just go to the hospital everyone was quick to agree. They got all of their stuff together and we set off. We arrived just before 11 and discovered the ward was overflowing (20 beds full and people sleeping on the floor), there were 5 ladies pushing, three babies in the lone incubator and one stressed nurse (and a partridge in a pear tree) . It was obvious my patient didn't take precedence.  The nurse did a quick exam while I monitored her other patients (HA!) and declared her dilated to 3 and fine. She was to go walk around outside and she would be checked again in 4 hours. As there were no open beds anyway it didn't seem to matter that it was 11:30 at night.  I checked that Winny (the laboring mom) and Johnathan (the soon to be father) and Dina (their very young attendant who was 16 and brought along to fetch water, cook, and do the wash) didn't need anything. They discovered they didn't bring any mats to sit outside on and didn't have anything to eat. So I ran home and grabbed some things for them and brought it all back. At this point I decided there was little I could do for them so headed back home to bed. At 7 the next morning (Christmas) I stopped back in the hospital hopping for a baby. But no luck. Johnathan didn't have a phone so couldn't call me but they had never been checked again. They had been waiting outside all night. I got a bit assertive and asked the nurse to pay attention to my patient. She did an exam and told us she was to 4 cm. She also broke her water at that time which I thought was a terrible idea but did it before I knew what she was doing. I checked FHTs and they were still good but it was very obvious Winny was exhausted. Contractions were few and far between and externally felt much weaker than 24 hours before. We were sent back outside and I tried to get her to lay down and sleep for a bit.
Winny in a "labor room" at the hospital.
She said she felt too painful lying and wanted to sit. While talking, her husband mentioned that she had been feeling like this since Friday. Like what? Not laying because of contractions. Only sitting or walking. I asked Winny to clarify, knowing she told me Sunday. She said the contractions had gotten stronger Sunday but she had been  feeling them very regularly since Friday. I felt so out of my element. I knew something wasn’t right but clinically didn’t really have any indication except the long labor. Around mid-morning we decided to leave the hospital (as they were doing NOTHING for us anyway) and went to my house. I coaxed Winny into a hot shower (she had never had a shower before, let alone one with hot water) and then she laid down on my couch an seemed to doze off when her contraptions seemed to really pick up again. Several minutes long and quite painful. Everything seemed good, FHTs good, she lost a lot of amniotic fluid on my couch, had some juice, and labored for a few hours. It seemed time to head back to the hospital. They didn’t even notice she had been gone.  The nurse checked again and told her 4 cm. Seriously?! I asked for her to be examined by a doctor. She was crying during contractions and not moving at all between them. Once again they were very ineffective and slowing down. Finally, after asking for hours (literally, it was late afternoon by now) a doctor came. He started pitocin which she immediately lost control during contractions, thrashing, yelling then practically catatonic between. She was making me really worried. I didn’t have my stethoscope and the nurses were not checking FHTs but at least only an hour went by before the doctor came back. Actually he was checking on another patient but as Winny was in one of 5 labor beds all in the same room he had to pay attention to her too. He finally seemed to listen to me and examined her again and said maybe she had Cephalopelvic Disproportion as she was still not progressing at all. Her hips were wide and it didn't seem right but I was in no position to argue with him. I pointed out she had not progressed since arriving almost 24 hours before and had possibly been in labor for 5 days. He was doing a vacuum extraction on another laboring patient that was going very poorly so as the decision to head to surgery with that one was made he told me that if Winny was still unchanged he would take her to surgery next. Having no idea another solution I agreed (and immediately reached over and turned the pit off). I know this story is already too long but I have to put this in too. While one nurse and doctor were 20 minutes away (the surgical theater is nowhere near the delivery room) another patient began crowning with contractions  She was alone (most woman are- the staff hate it that I stay with the ones I come with!) and calling out in ateso. I stuck my head down the hall and told the other nurse she was crowning to which I got an eye roll and "I'm coming." I pulled gloves on from my pocket and tried to encourage the patient to pant. Yeah right. I yelled again for the nurse but within seconds the head came with an obvious nuchal cord so I slipped it off and the rest of the baby and placenta immediately followed. The mother had been laboring in nothing but a towel so I laid that on her chest with the baby. Still no nurse.  The patients have to bring their own ties and razor blade so they were right there. I tied the cord and cut- still no nurse.  I was looking around for something, anything to wrap the baby up with and put the placenta in.  Finally the nurse arrived and immediately started screaming at me. She was already mad that I was demanding so much attention for my patient and now more pissed about me messing with another one.  Whatever lady!
But back to Winny, She looked terrible. I went and got a gurney and loaded her up myself and headed over to surgery. It took him an hour and a half to finish the first patient (sections are NOT quick here!) and it was 10:00pm that he finally took her back.

30 minutes later we had a 5.8 pound baby. He was  clearly full term and healthy but tongue tied (ankyloglossia) and small! No indication of why the terribly prolonged labor. By 11:00 she was back on the ward and in bed. It was a really, really long day leaving me wishing for some midwifery training in the not so distant future.
Anyone want to weight in with things I could have done better, ways to help the patient, any ideas for next time? I'd love to learn from this...

Saturday, December 22, 2012

Christmas Carols

We sang some Christmas carols tonight at team worship and I love how these songs really hit me differently here. Partially because this is the first time this year I'm hearing them. I haven't heard them on the radio, in the mall, on TV or anywhere else. And also because life here is a bit more like Jesus would have experienced it. So, I've been hearing some of the words afresh. I want to challenge you too to hear them afresh too.
How about this one:

Truly He taught us to love one another,
His law is love and His gospel is peace.
Chains he shall break, for the slave is our brother.
And in his name all oppression shall cease.

Or this one.....

No more let sins and sorrows grow,
Nor thorns infest the ground;
He comes to make His blessings flow
Far as the curse is found,

He rules the world with truth and grace,
And makes the nations prove
The glories of His righteousness,
And wonders of His love!

May the awe of what our Savior has done be prominent in your mind this week!! 
Merry Christmas! 

*pictures from Nakayote in June, their "hungry" season..

Wednesday, December 19, 2012

A new branch of the culinary arts

I do a lot of driving back and forth from Karamoja right now and cooking is challenging to say the least up there. But I love cooking (and more than that, I love eating well) so I've embarked on a new branch of the culinary arts- manifold cooking. Anyone know any good recipes? I've successfully done chicken and rice and eggplant. But I'm open to other suggestions.

Tuesday, December 18, 2012

It's a girl!

So this is what I spent my birthday doing.... 
This is Ashley Jennifer. Born 12/18/2012 
My Team mate Tanya, labor coach and friend of the mother. 
Mother after a LONG labor but she did great!

Tuesday, December 11, 2012

Your mission, should you choose to accept it...

Ok family, I have a mission for you. I’m putting it here on my blog so that other people will maybe encourage you in it. Or even help you do it, that would be even better!  I’m willing to bet real money that you all have not taken any pictures since I was home last (12 months ago!) that I could put on my fridge. Pictures of Izaac or Ellie, with other family members in the background don’t count! So, with Christmas coming, I know you will be together. Please take some pictures! Then send them to me. Electronically is fine. I’ll figure out a way to print them. I know, it is a tough mission but I’m sure you are up for the challenge. This message will self-destruct in 5 seconds.
This is mostly unrelated to the post but a few days back I purchased  "Mission Improbable" 1 through 4. But Tom Cruise is in them and I only paid $0.50 for all 4 of them. Nice huh? 

Monday, December 10, 2012

Transformed lives lead to transformed communities

In my newsletter I mentioned the day that I headed out with the ladies from church in Karamoja to visit and help an elderly widow. (Mostly I have more pictures than could fit in the newsletter so I have to write some more about it.)  I should know by now that these ladies work hard! And that I was going to be tired and sore by the end of the day!! We arrived at the home of a blind widow (blind I suspect from incorrectly home brewed alcohol) who told us right off that she wanted to die. She asked for alcohol because she was hungry and didn't have any money. A few of the ladies I came with sat down and started talking to her and the rest started ripping down her fence. You need to know that I get about 2% of what is going on around me when out in the remote villages so I wasn't really sure what was up. But I could tell the fence was already falling down and it soon became clear we were gathering material  for a new one. Within two hours these 14 woman had build what I estimate to be 200 meters of new fence. 

Resting, admiring some of our fence, sitting together in the shade, praying over the home and sharing a meager lunch.
A few bowls of un-shelled sunflower seeds as all these women had for lunch and still they willingly shared.
And I don't want you to think this was easy work! It was hot, heavy, tough work to gather branches, dig a foot or so down into the hard ground then weave and tie this stuff together.  But I was there to provide comic relief. "Look at this foreigner! It looks like she has never build a fence before!" "But she is a woman isn't she?!"  "Yea, but her hands are so soft! And she has no idea how to weave!" "Strange! How has she survived this long in life?" "I know right?!" "Just watch her!" This is not a direct translation but you get the idea. :-) 

Nothing like a 60+ year old woman with a machete to remind you how tough these ladies are. 
As the sun was setting we wrapped up and began the trek home. 
The blind old widow and young grand daughter to care for her. 

Saturday, December 1, 2012

Back to Soroti

So we headed back to Soroti yesterday as we are still waiting on blood work for a definitive diagnosis  but are really thinking it is Glucose 6 Phosphate Dehydrogenase (G6PD) deficiency. There is still a chance it is an autoimmune issue but less likely. It is good know know what Abraham has but is discouraging as there is no cure. The only treatment is to avoid the causes that trigger a hemolytic episode and to transfuse if he does get into trouble. We will taper him off the steroids that he never should have been on in the first place, see if we can get him on some malaria prophylaxis and educate his parents on his triggers. This picture is Deborah and Emma, Abraham's parents and Abraham in orange. Also his baby brother. Missing from this family picture are his older brother and two sisters. 
Thanks everyone for your prayers!!