Tuesday, December 27, 2011

#85 Witchcraft

There is witchcraft here, so I don’t want you to take this too lightly. But witchcraft wasn’t the case here. At least I don’t think.

Last Thursday night was a very busy one for me. I had been inducing a severely preeclamptic woman who was 37 weeks pregnant. The nurse who was covering maternity and surgery was less than ideal, so I stayed in the hospital to watch the oxytocin drip and make sure the BP was getting taken. I’ve been burned before by eclampsia here. I was in all evening, then went home at 11:30pm and came back in around 1am.

Her BP’s were getting too high, so I was considering throwing in the towel and doing a c-section when another patient came in around 2:30am. Her name is Isabelle and she was on her first pregnancy at 9 months. Her sister brought her in when she found her in labor at home. Apparently Isabelle had seized. BP written down by the nurse was 110/70. Sometimes women fake seizures here when they are tired, so I took note. Plus there is no pain killer here for labor, so they really suffer.

There was no fetal heart by the doppler and I could already see the head. Who knows how long she had been pushing. She could push a little, but didn’t have enough force. The sister kept holding the patient’s mouth shut and pushing on her chest to try and help. The patient’s lips were swollen.

Then she seized. It lasted about a minute.

Okay, that was a real seizure! BP 190/130. Great, no IV antihypertensives! (I have ordered some from Kenya by the way. They should be here by March).

There were a couple of used Kiwi vacuums in a drawer that had been washed. (I didn’t have any new ones). The forceps were all in the OR. One of the vacuums still had some suction left in it. I cut an episiotomy, put the vacuum on, and pulled out the baby. The student nurse had a stethoscope, and I had her listen to the baby to make sure it wasn’t alive. I rechecked, no heartbeat.

I sewed up the patient, cleaned her up, and several of us carried her into the maternity ward at 3 in the morning. There are 5 beds in the biggest room with many family members sleeping on the floor. A few little kids woke up to get out of our way, so lots of crying accompanied.

After we got her situated, I asked the husband how many times she had seized at home. Four was his response. Six was the response another family member at the exact same time. So in reality it was probably like 10 or 15 seizures at home.

I knew it was eclampsia (seizures that goes with high BP in pregnancy), but I have seen malaria with eclampsia too. So...I also started her on IV quinine.

There were seven or so family members by now in the room. I explained a little of what happened, then headed off to the OR to do my induction’s c-section. I finally headed home at 7 am just in time to breast feed Zane from his long night of sleep (He’s sleeping all night 7 pm to 6 am, Yay!)

After about an hour I headed back in to check on my 2 ladies with high BP. C-section lady was doing well.

Seizure lady. Well, she was unconscious. I walk into the room to find her seizing. No nurse present. They were all in their fancy schmancy nursing meeting. Seizing patient that I had spent half the night with was unaccompanied!!! So irritating.

I gave her some more diazepam. I had not given her magnesium because her lungs sounded wet. There’s no half way with magnesium (it’s 2 big injections in the butt here).

I went off to look for a nurse to get them to stay with her. The big group of family members started to get uneasy about her being in a coma. I explained the sickness and that we were also going to get a malaria test, but that she was on quinine just in case. All of this we were doing for free too.

They were upset that she wasn’t getting better. They said they wanted to take her to a witch doctor.

Normally I tell patients here that this is not a prison and that they can take people if they sign a release. But I absolutely refused for this poor girl. I told them if they asked again, that I would make them all leave. I told them only 2 family members. If they didn’t respect my rules, then I would not respect them and would not let them come in.

She had six or so seizures that first day. More Diazepam.

She remained in a coma. Her breathing sounded like the death rattle. I gave her IV lasix and some steroids. I gave her IV antibiotics. Her malaria test was positive. We paid for her IV quinine.

We prayed for her. I told the nurses to keep a close eye on her so the family didn’t steal her. Three days she stayed in a deep coma. Here in our hospital WITHOUT an intensive care unit. No oxygen. No x-ray. No electrolyte tests. No platelet exam. No liver function test. No creatinine.

She started arousing a little yesterday. Olen did rounds and texted me that she had started to wake up. It was the best Christmas present for me! She had been so close to death.

Today at rounds I found her sitting up. Praise God! I was so happy to see the whites of her eyes. Isabelle is still very tired. Please keep her in your prayers. And the family. And the people here in Tchad where witchcraft is so prevalent.

olen and danae



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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