Friday, January 20, 2012

# 88 Struggle

I probably already have a blog named struggle since it’s such a fitting name here in Tchad.

But I tell you, the women really struggle here.

January is our busiest month, so the work at the hospital has been very busy. Tuesday we did something like 8 or so operations. Thankfully James came to take out a femoral rod, so I coaxed him into helping with several operations as Samedi (the usual assistant) was sick. We saw some really interesting stuff. Who am I kidding? It’s ALWAYS interesting here. We took out a tumor on the foot and groin that looked just like mud. Really, so weird. I’m sure it’s cancer, but we have no pathology. I talked to the family yesterday and they were just so greatful that we did something. They had been to several other hospitals already.

Last week I did 6 or 7 c-sections and 2 hysterectomies with c-sections. One of them was a ruptured uterus that was very difficult. The baby had died already. She was referred from a health center after they had tried a vacuum. I CANNOT believe we are allowing vacuums to be done at the health centers in this country. I will eventually change this! (probably not, but will put up a stink trying.) The other one was a woman who was “11 months” pregnant. She measured 7 1/2 months, but hadn’t felt the baby move for 2 months. So in reality the baby had been dead for quite some time. I tried for FIVE days to induce her, but just couldn’t get the cervix to dilate. Anna even found me a new stash of misoprostol. Some expired meds had been donated from Baystate and she found the stash while going through stuff in the OR! After miso, foley bulb, laminaria, foley bulb and oxytoxin to induce her, I reluctantly brought her to the OR to remove the dead baby by c-section. It ended in a hysterectomy because the uterus wouldn’t contract and the inside part of her uterus was dead. Her uterus was malformed too and her cervix could have never dilated. So she’ll never have kids. But she’s alive and doing well.

Yesterday I did 4 surgeries. I put on my big girl pants and did an inguinal hernia without Samedi. Abel and I made a good team.

The stories of the women who struggle go on and on. We don’t mean to be depressing in our blogs, but life is hard here! They were going over the statistics for last year and we had reported ZERO maternal mortalities in our hospital. Well, I KNOW that is not correct because I could name at least TEN women who died as a result of pregnancy that I know this past year (turns out there were at least 17). Someone said that they didn’t report it because the women hadn’t actually died during the process of childbirth. We’ll fix our reporting, but I don’t trust ANY statistics that are reported here in Tchad. The numbers are all off. The reporting is all off. And who knows about the neonatal mortality rate. All I know is it’s VERY high.

I was just called in at 3 am for a woman who came with “labor”. The nurses couldn’t find the heartbeat. She also had no prenatal care. I don’t judge people who didn’t have prenatal care. I know what it’s like for someone to label you with “no prenatal care.” (See Zane’s birth story.) Plus the prenatal care here is very minimal. I rarely see a blood pressure recorded if it’s done at the health centers.

I bring the ultrasound machine over to the delivery room and confirm that the baby was dead already.

Her history though is so typical. G4P3001. That’s our OB secret language. Translated it means that she’s had 3 other deliveries and only has ONE living child. Here, I take histories all the time and find that often only half of the children are living. A lot of times the babies die before or with labor.

She is fully dilated, breech, and the presenting part is the placenta. Great, that always means a lot of blood will be lost.

She had been in labor since yesterday and had pushed for who knows how long. I always take the history lightly because no one really knows what is true.

Joe, a student nurse, and I bring her to the OR. I give her fluids and call Simeon in to do a spinal for the hopeful vaginal extraction.

We’ve done this often. He knows the routine. He does the spinal, then I try my hardest to find a foot so I can get the baby out. If I fail, I have to do a c-section. I hate to fail. I especially hate to fail when the baby is dead. I hate to fail when having a c-section means a higher risk for delivery the next time. I hate to fail when so many c-section incisions get infected here.

We wait for some more IV fluid to go in so that her BP doesn’t drop with the spinal. That’s been happening a lot with c-sections lately and I’m having to worry whether my patient will die or not due to anesthesia. Seriously, it’s getting old. It seems to happen half of the time. We do not intubate here. We have no oxygen.

As I wait, our patient is sitting on the OR table. She is young. There is blood running down her leg, adding to the dried blood already there. Her feet are cracked and dusty. She lives a hard life.

I’m tired. I’m sitting on the floor waiting. I should go touch her hand and comfort her.

I force myself to get up to be by her side.

A liter of fluid goes in.

Simeon does the spinal. I put on gloves that are not long enough and start the process.

Even with the spinal I know it is not comfortable for me to manually turn and extract the baby. The patient is strong. She doesn’t say a word.

With time, the baby girl delivers.

Her uterus contracts nicely. Her bleeding stops. She is exhausted and falls asleep.

For the moment, her struggle is over.

Back at maternity I make sure the family knows to look and see if she starts bleeding again. I can’t trust my nurses to look. Well, there is 1 nurse for 30 patients...and there are 2 women in early labor that recently came in.

I head home after 4 in the morning.

I haven’t been sleeping well lately. After you’ve been here for a while sometimes you just start hearing knocks on your door. Usually that means it’s time for a break in sleep. Olen promises to take me to NDJ (the capital) Monday and Tuesday for my birthday, so it will be a much needed break.

olen and danae

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

Olen et Danae Netteburg
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52 Boite Postale
Kelo, Tchad

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1 comment:

  1. Hi Danae, I read about you and Olen in the LLU Scope and saw your blog. I just wanted to tell you that I am awed and humbled by what you are doing. Your family will be in our prayers. Hillary Starr