Tuesday, November 22, 2011

#79 Loaves and Fishes

Okay, so this is not exactly about feeding the 5000, but it is about miracles.

I can’t tell you how many dead babies I deliver. But it’s at least 1 a week. When you don’t deliver that many normal ones, that gets to be depressing. Normal babies usually deliver at home however. Okay, okay, stop thinking nice clean delivery in your bathroom with running water. Think, small dark hut with dirt floor. Painful. Hemorrhage. Dirty. To name a few words.

So when I can help prevent a few baby deaths, I praise God and it feels good.

When I first came here almost a year ago, there was a left over bottle of misoprostol in the office. I don’t know how many pills were in there exactly, but it wasn’t a full bottle. No big deal. I made a mental note to get some more on annual leave.

But I didn’t. You can’t exactly just go buy pills in the states at your local pharmacy without a prescription. And I don’t even have a prescription pad. Though I do have a license in Indiana of all random states. Ask me about that in a different conversation.

Anyways. Back to misoprostol. It’s actually very cheap in the states. But you can’t buy it here in Tchad that I can find. We use in in OB land for postpartum bleeding (8 or 10 pills) or for inducing labor. To induce women we usually use 1/4 of a pill every 4 or so hours. Inductions can take days and we continue it depending on how the cervix reacts (usually for 1 night). Once the cervix softens and or opens, we start oxytocin (the IV stuff that gives contractions).

Oxytocin drips here are dangerous because we don’t have an IV pump to monitor the amount of medicine going in. It’s a matter of counting drops, and that gets dicey. I NEVER give it at night. It’s not safe to give when your only nurse for maternity and surgery is covering 30 + patients.

For the last several weeks I’ve only had a couple of pills left of misoprostol. I keep saying, “It will be really sad when I run out of misoprostol.”

Two weeks ago I induced someone for postdates. She was 42 weeks. That in itself is a miracle to actually KNOW her dates. Now that I’ve been here for some time, I’m reaping the benefits of knowing how far along a pregnant patient actually is from my earlier ultrasounds. Usually people come in at 8 or 9 months and have no idea when their last period was. So I’m getting pretty good at dating ultrasounds.

Two weeks ago I said, “This will be my last induction with misoprostol.” I use foley bulb catheters too, but sometimes miso is better. I cut the last 2 remaining pills into 1/4 pieces. I gave the first 1/4 pill and explained to the nurse who was covering that night how to give it vaginally again.

God is really making our misoprostol work! She actually DELIVERED after 2 doses. It was her first baby, and she went from a closed cervix to delivering in only 2 doses. The end result was a healthy baby girl.

I put my precious stash of misoprostol away for the next usage. 1 1/2 pills left.

Abre is one of our OR nurses. His wife has been pregnant with her first baby. Six weeks ago she broke her water. If she would have delivered then, the baby would have never lived here. I gave her antibiotics and sat on her. I even let her go home later since she lives so close to the hospital and could come for ultrasounds easily.

Long story short is that today I decided to induce her. She was 1 cm dilated and not in labor.

We gave misoprostol. First dose, nothing.

Second dose. Drum roll....Within the hour she went from 1cm dilated to delivering. Seriously, God has made that stuff turn potent!

A beautiful healthy 2.6 kg baby girl. A baby girl who probably should have died, but is now healthy.

And I still have 1 pill left to use for the next patient.

Or two or three.



Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80

Olen et Danae Netteburg
Hopital Adventiste de Bere
52 Boite Postale
Kelo, Tchad

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