I know it happens all the time and it isn't that big of a deal but it is still a let down when it happens. I had a primigravida mom laboring in the clinic today. She came in late last evening and the midwife was up off and on with her in the night. Around six am her labor stepped up, so by the time I arrived at eight the midwife was ready for a few hours off. I could understand why. The mom was laboring well but needed quite a bit of support. Which is actually a bit unusual for women here, as they tend to labor alone without much intervention. This mom was needier but I don't mind it as it is more of what I'm used to, so I willingly took over. However, there were also 20+ prenatal cases to see. (I totally lost count but finished off a new 500 tablet container of prenatal vitamins early in the morning and at 30 tabs per mother that is at least 17 women that I saw before 10am.) The mom was having strong contractions and not handling the pain well but was up moving around and dilated several cm between when I arrived and late morning so I thought we were doing well, except the head was poorly engaged. We tried lots of different tricks and everything else was fine so it just seemed like we were in for a long labor. Besides, it was taking me forever to get through all the other patients so I was going to be around the clinic for most of the day. I was checking FHTs often and initially I would have charted good variability (not that there is any charting here) however by one pm possibly they could have been called variable decelerations but really they were on the way to late decels. Without an actual tracing it was hard to call it but it didn't feel right. And the mother was weary and fully dilated and the head was still high. I was in the midst of discussion with the midwife when we had a snake bite patient come in that kept us all tied up for a while. Then when I slipped back into the labor room in the midst of a really strong contraction and put the doppler on it barely registered 90bpm, so our decision was made. The good news was in the process of getting her up (leaking amniotic fluid all over the place) and loading her in my truck (that is going to smell nice for a few days) the heart rate came back up. We made the 20 minute trip into town and I unloaded her directly into L&D. Technically we're supposed to register and crap first but there are a few perks to bringing in more than twenty patients per month. The staff really snapped to and patient was headed to surgery shortly thereafter.
Little side antidote, I usually use the clinic delivery stuff when doing it there but I also carry a delivery kit for home/side-of-the-road stuff. Today I cracked open my own kit because the clinic midwife was sleeping and I couldn't find some of the supplies that I wanted.
I tossed a disposable chux under the patient. (Every american nurse knows what I'm talking about but for you non hospital people it is this thing. We use them for any and every leaking fluid. As a matter of fact, even if you aren't leaking anything, but might be in the future, you get one tucked under you somewhere.) Well, the clinic staff went nuts. They think this is possibly the best medical innovation ever. Now, I've given them a doppler, an autoclave, a BVM, an obstetric calculator, and a variety of other things to make their lives easier. This one takes the cake for them though. They have requested a carton. I had to sadly explain that I only have three left and I am saving them for emergencies.
In other news on this lovely Monday, my dog has been missing for three days and is presumed dead. It seems that no amount of attempted bribery of the neighbor kids is going to bring him back this time. Also, one of the secondary school kids that I sponsor got really good marks this term and I had promised if he got Division 1, I would get him into a better school. He really impressed me with his hard work, so early this morning he was over to get the necessary requirements to transfer. Then he proceed to steal 300,000 shillings when he though I wasn't looking. This like three months wages for many people here. This is the third time he has been caught stealing from me. (How many times have I not caught him?!?) So we are done. Completely. What he stole was less than half what I would have paid in school fees for him next term so I can't figure out what he was thinking. More than anything else it makes me sad because he has such potential. But lets be honest, it also makes me pissed off. Oh, that seems like another thing missionaries shouldn't say.