Thursday, February 12, 2015

Where is the line between helping and enabling?

So there is this family that I write about a lot, Betty's family. Betty has 5 siblings by four different men. Her mother, Deborah, has a history of being highly neglectful but we are doing all we can to support the kids. A teammate pays their rent. I pay the school fees for 4 of the kids. We are all regularly giving food and clothes and charcoal and other daily needs. Then nine months ago Deborah got pregnant again. They came to me asking for more help. I gave prenatal vitamins and encouraged prenatal care. But here in Soroti there are plenty of free places to get prenatal screening so I declined doing it myself. Three months ago Betty told me her mother was pregnant with twins. I asked if they had gone for an ultrasound and Deborah said she hadn't. I strongly encouraged it again but refused to take them myself. Just before a trip to Karamoja last month Deborah was feeling like it was nearly time. She asked me for money to pay for transport to the hospital and airtime for their phone and a birth kit (items the hospital requires you bring like gloves, razor blade, etc...). I gave in on all these things even though I feel like this mother should be responsible for something herself.
Well, I got back from Karamoja after a exhausting trip and Betty called to tell me her mother was in labor and could I help? I explained I had helped already and they had everything they needed. Betty called back in an hour to tell me that her mother had gone to the hospital but had not brought her basin and things with her so could I help?  I explained again that I had already helped and if her mother knew she was going to the hospital why had she not brought her things with her?! 30 minutes later Betty is back on the phone with me but by now she has run out of airtime so she keeps flashing me and then hanging up to get me to call her. She tells me that something is wrong and I really need to come help. I explain one more time that they are in the hospital, doctors are there, I'm too tired and please stop calling me. (By now it is 8pm.) 45 minutes later she starts calling me again. And again. And again. Finally I call back. She says that actually they didn't go to the hospital. They just went to a little clinic near their house. It only has one nurse and she doesn't know what to do. Something is wrong. At this point I begin finding scrubs and putting my birth bag in my truck. But I'm angry. Not so much at Betty who is just a really scared kid who has no one else to call for help. But I'm angry at her mother. Why didn't she go to the hospital?  Why is her lack of planning my problem?! 
I arrive at the clinic and got "report" from the "nurse". (I'm not convinced that is what she was.) "She had been in labor since 4pm and nothing is happening. The baby is just too big." That was her report. I asked to see the prenatal notes and discover Deoborah has had NO prenatal care. I asked the nurse about FHTs. She didn't know. I asked about rupture of membranes. She wasn't sure. Are you kidding me?!  It was obvious contractions were strong and frequent and things actually looked pretty normal. Her bladder was full though so I thought maybe we could get her to pee and things would start progressing. I pulled a glove on and did a quick cervix check. She was fully effaced and dilated beyond 7cm but was still high (-1?). She had obviously ruptured already and there was thick green meconium.  Sh*t! This "nurse" was obviously not set up for any resuscitation and had already told Deborah that she needed to go to the main hospital so we packed her up and got her out to my truck.  Thankfully things happened pretty quick once we arrived. We managed to walk (carry) her into their "delivery" room. (Currently had THEE other women pushing and one having a repair all in the same room.) The doctor was actually around so she did her assessment while I put a foley in. The midwife got an IV started and the decision was quickly made to set up for c-section. While the doc went off to prep the OR, Betty and I had the responsibility of finding a gurney and getting her mother on it and over to the theater. (Different, unattached building with dark, uneven sidewalks). I wish I had pictures because there really is no way for you to picture this stuff.
As we navigated the dark walkways between buildings we were approached by the doctor. She told me that they didn't have a nurse who could do neonatal resuscitation so would I "scrub in" and join them in surgery. Gulp! Are you kidding me?! So as I said yes out loud in my head I was thinking when was the last time I reviewed that?!?
Thankfully he didn't need any resuscitation!! 
But things went well and he didn't need any help after suctioning the crap out of his nose and mouth and toweling off.  I can't tell you what his apgar scores were because I didn't take them but he was crying right away and had a great pulse. I'll be spending some time reviewing that in the near future. While I was calming down after seeing that my patient was fine, things were not going well with the mother. They couldn't seem to control her bleeding. She was hypoxic, hypotensive and hypothermic. The doctor looks over at me and tells me to give the baby to her sister and go run and get pitocin and three more bags of fluid. I guess OR didn't have either. As it was 11pm and there were only six of us in the whole of the operating ward  (the doctor, anesthesia, Deborah, Betty and another nurse who was holding pressure on the uterus) I was the only choice to run find supplies.
In the OR recovery room Betty was made responsible for a 5 minute old baby while I went back to the labor ward to find some pitocin and more IV fluids.
I think I woke all of these people sleeping on this sidewalk at least three times going back and forth, bringing the patient through and running for more supplies.
The women's post surgical ward. I wish you could tell in this picture than there are 16 people sleeping out on the veranda/ sidewalk. 
When I finally crashed in bed at 2am I remembered I said I wasn't going to bail this family out again. They they needed to start being responsible for themselves. If Deborah had gone for prenatal checks... if they had gone to the hospital instead of that little clinic.... if she hadn't gotten pregnant in the first place....
I couldn't help but lay there and ponder where is the line between helping and enabling? 

1 comment:

Jeff Chamberlain M.D. said...

I wonder if God asks the same question about us:)

I'm embarrassed to tell you about the delivery I just did. It is a walk in the park compared to what you go through.