Hello Everyone!
Happy Thanksgiving! Things here are going well. Work is going well, home is going well, even play is going well! :-) I haven't been sick in two weeks... How much better could it get?!
I have bad days at the hospital. Circumstances beyond my control frequently frustrate me and lead me to ingesting copious amount of chocolate, and sometimes even to tears. The gap between what is and what I know can be is so great and just adds to my frustration. Those around me that I trust, especially Alisa, often hear these struggles as I share my frustrations with them.
It is easy to focus on the could haves, should haves, and bad outcomes that we (not the royal 'We' but the collective 'we' as a staff at the Pediatric ward) have. There are a lot of deaths that happen in spite of what we do to try to help the patients. However, I want to take this Thanksgiving holiday to tell you, and to remind myself, that occasionally we do get the chance to witness miracles. Life that happens in spite of the things that we do or don't do. I would like to share with you one such miracle from last week.
Her name is Made Ubertha (mahd-ay oo-bear-tah). She is a seven month old beautiful baby girl. She is the firstborn of a 16 year old mother that cares about her very much, which is unusual for this culture. She is not afraid of me as many of the babies are. When I walk into her sight she does not cry, she simply stares wide eyed at me. She allows me to pick her up and play with her, though she doesn't really smile or anything, she just stares. And when I have her she always keeps an eye on her mom for reassurance. She was admitted two weeks ago for bronchopneumonia and is then was being treated for tuberculosis (TB) and malnutrition, both of which put her at risk for getting any other disease that she is exposed to.
On Sunday (the 12th) the mother rushed to the nurse's desk carrying her, asking for us to come look at the baby. After getting the nurses to translate for me, they said 'The mother said she stopped breathing.' My heart sank and I didn't expect anything good to happen next. Ruth Kahutji (kah-who-chee), an enrolled nurse (equal to LPNs in the States) and I immediately ushered the mother and child into room 7, which is our critical care area and contains the oxygen cylinder and emergency cart. The child was indeed not breathing and was having convulsions. They don't use the word seizures here, they say convulsions or 'fitting'. I motioned to another nurse to come into the room so I could tell her to call the doctor to come immediately. 'Immediately' in this culture is often something akin to the speed of molasses, but I knew that something needed to be done urgently. Then the baby started vomiting and having very shallow breathing. We turned her on her side and I got the adult sized oxygen mask, which is all we have, to place on her. She kept having convulsions and apnea (periods of not breathing). For the periods of apnea I got the resuscitation (or ambu) bag and mask from the emergency cart. It was an adult sized mask that I couldn't of used on her even if I had tried because it was old and malformed, so I sent one of the nurses to the maternity ward to get an appropriate sized baby mask. During the periods of apnea I tried stimulating her to breath, but she was not responding. The convulsions continued at regular intervals along with the apnea as we waited for the doctor.
During this time the mother asked me to take the oxygen off. There is a misconception in the culture that the oxygen can kill you. It does makes sense because we put oxygen on very sick patients, many of whom die. If you see this repeatedly and aren't educated about what the oxygen is and/or does, then it is easy to understand where the misconception comes from. I refused to comply with her request, knowing that any breathing the baby was doing wasn't adequate enough to get enough oxygen to her body and that she needed all the support we could give her.
Throughout all of this activity the mother was crying and trying to get in to see what was going on. I didn't really stop her because I didn't think that the baby was going to make it and I wanted the mother to be close to the baby so that they would both be comforted. We were still waiting for the doctor to come, so we continued doing what we needed to do, which included the decision to take matters into our own hands. The other sister in charge went out and got the intravenous Valium, which is how we treat convulsions here. Though the doctor hadn't shown up yet she felt comfortable enough to dose the baby so I let her. She continued to have convulsions though the apnea seemed to have stopped. The doctor did finally show up after 20 minutes (a time which is actually impressive, we have waited hours before) and wrote some orders, but we had already done everything she wrote for. It was well after my time to be off, and it was at this point that I decided to leave the baby in the hands of my colleagues. Before I left though, I showed all of them how to use the ambu bag, giving them very specific instructions on how and when to use it. When I left I was very sad because even with all we did, I still didn't think that the baby was going to pull out of it. My days off that week were Monday and Tuesday, and though I wanted to know what happened, I couldn't bring myself to call in. I didn't want to actually hear the bad news, so I decided to leave it until Wednesday when I went back to work.
Wednesday morning arrived and I went to work still a little sad about the situation. You cannot imagine my shock and amazement when the mother walked out of the room in front of me carrying this beautiful little girl! The mother doesn't speak English so I couldn't ask her any questions, all I could do was stare in awe! Finally I went to Sister Musenge (moo-sang-eh) and asked her what happened. She told me that after I left the baby actually got worse and they had to call the doctor back. She had many more convulsions, one that lasted fifteen minutes(!) and many more periods of apnea. When the doctor came she transferred the baby to the Higher Care Ward, which is their version of intensive care here. Apparently she stayed there Sunday evening through Tuesday morning when the doctor sent her back to us. They never figured out what was wrong with her that was causing the convulsions, they just seemed to have stopped on their own. Everything from meningitis (there has been a string of meningitis cases lately) to malaria that they tested her for came back negative, so they really don't know what was wrong with her!
The most amazing part of it to me is that there doesn't seem to be any residual effects from the multiple episodes of convulsions and apnea. If anyone goes as long as she did without oxygen (especially as many times as she did) there tends to be some brain damage, but there seems to be absolutely nothing wrong with this little girl! Words really can't convey how amazed I am at this little girl's survival! On Saturday (the 18th) I had the joy and privilege of sending Made Ubertha home! Praise be to the God who saves!
I am going to try to post Made Ubertha's picture on the journal page (the second link in the list below). If it's not there tonight then check back in a few days and hopefully I will have gotten it on there! I hope that this finds you all doing well and enjoying the company of loved ones!
love and hugs,
kimmie
Praises:
- my stepmom's surgery went well and she was able to go home that evening to recover!
- Mary seems to be settling in very well, she has been making friends with her neighbors and it turns out one of them will be her colleague!
- the volunteer from the Philippines that was in the accident is recovering well. She has a long road to go though. She broke an arm, ribs, had a pelvic fracture and a few crushed vertebra... It is amazing that she survived and that she is doing so well!
- For the life of little Made Ubertha that was miraculously spared!
Prayer Needs:
- Please continue praying for Rob and I as we try to practice medicine in difficult situations with a lack of adequate resources
- Please continue to pray for Mick & Suzanne's work visa. Also, Suzanne will be going to the States to accompany their oldest, Hannah, to settle in at college. Please pray that these last few weeks as a family will be precious and full of good memories and abounding in love. It is going to be hard on everybody to see her go...
- For safety for all of you in the States that will be traveling for the Thanksgiving holiday!
Posted by thekimmieconnection
at 8:16 PM GMT
Updated: Tuesday, 28 November 2006 8:34 PM GMT
