Saturday, July 28, 2012

How do you know when to give up and when to keep trying?

In the US medical system, there are all sorts of rules and testing to tell you this patient will live or this patient will die.  If patient X has this, give this medication.  If patient Y has that, give another medication or do this other test.  Here....the same rules don’t apply.  We are limited.  But God is not limited.  He is the same God here as He is in the US.  Even against all odds, He can still work miracles.  

This past month I had four premature babies, who were on the brink of life and death, die.  I knew it was probably hopeless, but I still tried.  The “shades of grey” baby lived for 5 days and then died.  All that his mom said was “Grande merci” after all of that.  (Thank you very much).  

I had another baby that was born at 1.4 kg also...and died after 2 days.  The mom had delivered on her way to the hospital.  The baby survived the night without a warm incubator.  He screamed.  He had vigor.  We bundled him up and put him in our “box incubator” with warm water bottles.  I thought he might make it.  He lacked a sucking reflex so we put in a feeding tube and started a line for antibiotics.  He died later that day.  

Then I had a mom come in presenting with labor and a non-cephalic presentation.  She said she was “9 months.”  We brought her to the preop area to prepare her for a surgery.  While I was waiting I did an ultrasound just to be sure it was a term baby because with the vaginal exam you could just feel small parts moving.  The ultrasound showed that she was only 7 months and had twins.  I explained that we weren’t going to do the c-section because these babies could deliver vaginally and probably wouldn’t live very long.  

She delivered soon after and both of her babies were 1.4 kg.  And both boys.  They were small.  They screamed.  They looked perfect.  Both of them!  But the last 2 babies that I tried to save didn’t make it.  Was it even worth trying?  

Of course it’s worth it.  We still try.  Even when it looks hopeless, we still try.  It was cold.  It was pouring rain.  I ran to get the box incubator and some new, dry blankets from home.  I’ve been using zane’s old cloth diapers to keep the box babies dry and warm.  I boiled some water and filled the plastic water bottles.  

The two baby boys were already starting to get tired.  Each breath was harder and harder to breath.  They were just too small.  There was a village midwife who has been observing in maternity this month.  One baby died.  I encouraged the mom to hold the baby who was still living to show her love for him while he died.  The village midwife laughed.  “Let him die, don’t prolong the mother’s suffering to watch him.”  I knew I was probably going against culture, but the mother seemed grateful to hold her baby boy.  She had just delivered.  She was tired.  But she showed her love to her dying baby boy.  She just held him close to her.  Skin against skin to keep him warm.  She was grateful and tears ran down her cheeks.  

I imprinted both of the babies’ feet with ink on a small piece of paper to go along with some grieving kits that a friend is providing.  

It is all very sad and I wonder if I’m trying too hard to save the little ones.  In a place where it’s even hard to save the term babies, am I trying to hard to save the little ones?  I have two term babies on maternity right now that are probably going to die in the next couple of days.  

Then I had a couple of follow ups.  

This baby's name is "Doctor".  He was born at 1.4 kg and is now 6 months old. 
Two days ago I had a woman come to my house because her baby was sick.  He’s 3 months old with a fever and no other symptoms.  Almost always malaria this time of year.  He was born at 1.5 kg.  I had told her that I would pay for this little one if he ever got sick.  I was trying to encourage her come to the hospital and not just to stay home until it’s too late.  Now I’m just in awe that the little guy is still living at 3 months....and looking chunky big (the mom’s not giving water to her baby).  He survived at such a small birth weight!  I wrote for an IV quinine drip for 3 days and felt encouraged that little ones sometimes live too.  They all don’t die.  

Today I have another follow up.  I have a mom here who has breastfed exclusively for 6 months.  Six months ago she had a baby boy.  Her first baby.  Her baby boy weighed 1.4 kg!  We gave him iv antibiotics and eventually discharged her.  

Now she is back with a 7 kg healthy baby boy!  It brings happy tears to my eyes.  I took a picture of her and told her to come back next week to get the picture.  I explained to her that she could start giving her baby bouille (liquid rice hot cereal) and to enrich it with fresh peanut butter (we would never get away with that in the US at this young age).  And that now she was allowed to give her baby a little water, but only if it was boiled.  I wish I could tell her to give him fresh fruits and vegetables little by little, but the reality is that people just don’t have the money to buy that stuff.  They are lucky to buy rice.  

Somehow this little guy has conquered the first challenge here in Chad.  Birth and the first 6 months of life.  

Summer fun

Where's my brother going?
Watch me, Zane
Wait for me.

Wonderful water fun
Our own water park!  

Wednesday, July 25, 2012


So my friend Bekah sent me a box of cute little baby hats and socks.  I’ve started to give them away.  Last weekend we had 8 or 9 deliveries and somehow the women actually stayed hospitalized.  Usually maternity is treated like a drive-through, pop a baby out and go on.  However last weekend there were a lot of primiparas (1st deliveries), so somehow I convinced them to stay a little longer.  

Staying longer encourages them to breastfeed and not give their babies water.  It helps me to talk to the mother in laws to at least have them hear one time that giving water to babies is bad.  Just because the mother in law did it and her mother in law and her mother in law.....does not make it okay!  Why are so many 2 month old babies malnourished?!  It’s because of WATER giving!  The poison of babies here!  

So anyways...I sort of like my new moms to not give water.  Today I had a 2 month old baby come in who looks like death.  She’s 3 kilos and her arms are like toothpicks.  I’m sure no one ever told the mom to not give water....she wasn’t trying to be a bad mom.  She delivered at home....probably with her mother in law!  

Okay...not all mother in laws are bad.  Mine is actually quite good!  (she posts these blogs so she can change this to say whatever she wants!)  But here in Tchad, the mother-in-law controls you.  I’m slowly learning that.  So I have to get on their side to change things little by little.

I loooooved giving out the cute little hats and socks.  I took a picture of 6 of the women after rounds last week.  I showed the picture to Simeon and he told me that word will get out.  It will encourage people to deliver at the hospital.  Husbands don’t give their wives money here.  Women don’t have any money to buy clothes for their babies here.  But they are women!  They think clothes are cute just as much as those of us that have money do.  So if they hear that they can get a cute hat and some socks...they will come!  

I was very encouraged by this and think that our new bribe is a great plan to try to save some lives of moms and babies.  

It’s time I dive into the culture and start bribing too.  Everybody does it.  Literally.  But we won’t get into that now.  

Tuesday, July 24, 2012

Special Contest

Answer the following question:

Which is grosser? 

1.   A million flying termites attacking the lights on the post surgical wards and maternity.  Seriously, millions of them.  

 2.  Olen’s underarm abscess.  

Take a look at the photos.  You be the judge.  I know the truth.  

They are both pretty gross.  

Olen’s sulking because I’m exposing his problem in hopes of grossing everyone out.  Abscesses thrive in Chad for some reason.  I’ve seen them here on pretty much EVERY place possible on the human body.  The cure for an abscess is to drain it.  Yuck.  I usually say that every day here for some reason or another.  There are a lot of abscesses here.

As for the termites...Everyone is thrilled.  There will be good eating for a few days.  Termites are rich in protein and oil.  Yuck.  As the termites swarmed in tonight, people were running to get their basins and buckets to collect them.  You can’t deny free food here.  

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

Volunteers Welcome!!!

Monday, July 23, 2012

A Second Chance

It was my first time to the place since it had started up. 
Just being there caused a small lump to grow in my throat.  I didn’t actually break into tears, but if I would have let myself, I could have.  

I KNOW personally how much a place like this is needed.  

Even though I don’t round on pediatrics every day like Olen does, I see the need.  I round from time to time on peds, and I live here.  It’s easy to see that there is a need.  


It is everywhere.  

What obesity is to the US children, malnutrition is to Chadian children.  It’s just more acutely lethal.  

It starts at birth.  I’m sure you’ve read before on our blogs that it’s the norm for families to give their new baby boy or girl water instead of breast milk or formula.  Even if the mom doesn’t want to, she is a nobody.  If the mother in law says to give it, it’s done.  Sealed.  The kid doesn’t have a chance to get away from malnutrition from day one.  

It struggles.  It grows.  Somehow.  

There are so many barriers to healthy living here.  

Then there are amebas and parasites of all kinds here.  The vicious cycle grows.  Worms that crawl up into your feet and penetrate throughout your body.  Malaria.  Blood flukes.

There are social injustices here.  A little boy’s mother got into a fight with the new wife.  The husband is showing favoritism to his second wife.  Mom gets mad and refuses to feed the kid.  Nobody feeds him anything nutritious...for 12 years.  He’s doesn’t grow.  He’s never walked. 

There IS NO FAMINE HERE.  But still, we have malnutrition.  

Wendy saw the need.  Gary and Wendy have opened a place for mothers and children to go.  

A second chance.  

If these children were to continue on the same path, they would die....eventually.  Not an easy quick death.  A slow, painful death.  Drug out over many months and years.  Until eventually they would get malaria or diarrhea and not have the force to fight off the infection.  They would come to the hospital.  But it would be too difficult in this life.  The medicines only go so far when you don’t have a reservoir.  

Wendy and Gary have been in Chad for 4 years.  Before that was Cameroon and Guyana.  Wendy and Gary are some of our closest friends here and live 2 km’s away.  Wendy and I actually graduated from the same high school academy in the same class!  Go Ozark!  Um, we won’t mention the year.  
Gary and Wendy are both registered nurses.  And even though they both could fly a plane, Gary is the one with the license.  He’s also the one I would trust to take apart and put back together any plane around.   

Bronwyn, Carlie, and Athens are 3 volunteers who are helping run the place.  Bronwyn has been here a year and decided to stay longterm.  She’s the one with the cool British accent who had to get shaving her head off of her bucket list.  Carlie and Athens have been here 2 months and are registered nurses, taking a year out to come bask in the sun....hardly.  When they are not working at Wendy’s new place, they are volunteering for shifts in the hospital.  The entire team is working very hard to have a good start.

So in our little corner of Tchad, we’re looking forward to decreasing the staggering statistic that 40% of the children of Tchad are suffering from chronic malnutrition.  Not acute malnutrition.  Not a missed meal.  Chronic malnutrition.  Kids that haven’t seen a bit of protein or vitamin B in months.  Literally.  The cheapest and easiest thing to prepare for these kids is bouille or boule, so it is the staple of every Tchadian child’s diet.  It is a mix of water drawn from a contaminated well and unenriched flour (typically rice flour).  This is the most common.  And no flour in Tchad, regardless of its source, is enriched.  White rice or white flour of any kind. Completely nutritionless.  If they are lucky, there might be a little lime juice or maybe even a little peanut sauce.  

Without protein, without calories, without vitamins, they come to us with Kwashiorkor or Marasmus malnutrition.  We even frequently see Beri-beri and many of the other diseases common to malnutrition.  They come in puffed up like the Michelin man, but with toothpick thin arms and legs.  Or they come in with all their ribs showing and their abdomen sunken it.  Some babies come in dehydrated, with their fontanelles sunken in a couple centimeters and their lips dry and peeling.  Some come in with sores at the corner of their mouths.  Some come in with wounds around their anuses.  Some just have all their skin peeling off.  None of them are able to walk.  Many of them can’t even hold up their own heads.  

And typically, that’s not the reason they come to the hospital.  They usually come in for malaria.  They got an illness on top of their malnutrition.  Then they have nothing built up in reserve to fight off the infection.  They succumb to the disease far too easily.  Those that survive are lucky they got malaria.  Otherwise, their parents never would have brought them into the hospital.  

It’s the parents’ fault... to an extent.  To an extent, they just don’t know.  When I tell a mother that they should give their baby fruits and vegetables, they act surprised.  And they say they don’t have the money.  When I tell them that water has no nutrition, they act surprised.  But then parents do dumb things too.  They keep having babies that they can’t afford to take care of.  They have lots of babies, because they know some of them will die.  Their sign of wealth and success is lots of babies, not the resources to actually take care of their babies.  

So in a country where 21% of children never reach the age of five, somebody’s doing something about it.  They’re not just handing out medications.  They’re teaching. They’re teaching mothers and fathers about clean water, about proper nutrition, about gardening healthy foods, about how to take care of the children they have already.  

We are very excited to have a place to send children who need a second chance.  

But they don’t have a name for this place yet.  Wendy would like some help.  Any ideas?  In French?

Friday, July 20, 2012

One (by Lyol Netteburg)

“Happy Birthday to You, Happy Birthday to You, Happy Biiiiiiiiirthday dear ZANE.  Happy Birthday to you!”

So Zane had his birthday on the 25th of June.  All of the important people were here.  Like Cherise.  Um, there was Cherise... Cherise.

Oh and her parents.  And Bronwyn, Athens, and Carlie.  And Mommy and Daddy.  And Marci, Allah, Julie, Mahamat, Allah’s parents, Isabel... Janna couldn’t come ‘cause she was taking care of sick kids in the hospital.

Everyone paid so much attention to my LITTLE brother.  Don’t they see who is the BIG brother?  

Zane’s cake was pretty cool.  I like balls and so does Zane.  Mommy and Bronwyn put yummy frosting to decorate baseballs, a basketball, and even a soccer ball.  

I guess I like my brother.  He’s the only one I got.  He’s getting more fun to play with now that he can walk a little.  I can still do so many things he can’t though.  Like jump, run, talk in sentences and wipe my own bottom (sometimes I even use toilet paper!!!).  Those are all pretty important things.  
I like to try to convince Zane to do things I know I would never get away with.  He usually gets away with everything because he’s a baby.  They even still call him “Baby Zane”.

But I guess now he’s big because he turned one.


Fifteen months ago, we had little Zeke as a temporary, but important, part of our household for a quick couple weeks. During that time, we entertained the idea of adoption and treated him like he would be adopted into our family. We’ve flirted with the idea of adoption many times since then, but never really came anywhere close, despite all the peri-partum mortalities we see and all the babies we send home, knowing full-well that they’re not likely to survive the harsh realities of poor, rural Tchad. We’ve always felt that it would be insurmountable political challenges and would too drastically change the dynamic of our presence in Tchad.

Well, a man came to the door with yet another bundle cradling yet another orphan the other day... And we are taking the plunge. We haven’t done any official adoption paperwork, but we believe strongly that he will always be a part of our family and that nobody will hinder it.

Zane is now walking and babbling and we thought we were out of the newborn phase. But here we are back at square one with baby milk formula and getting pooped and peed on by something that’s constantly requiring being fed and held. Thank goodness that my mother-in-law is willing to help out despite having two other ankle-biters to chase around.

The dogs are more curious than they were with Zeke. Particularly Sheba. Curious and seemingly a bit afraid, despite their considerable size advantage.

Surprisingly, this one is even smaller than Zeke, but comes with a considerable amount of hair and very cute whiskers.

And this one was not orphaned in the typical fashion. No, his mother was eaten. Oh, the humanity.

I introduce you to Thumper, or ‘Fumper’, as Lyol would have it.
At any given moment, you’ll be likely to find Thumper in my scrub top chest pocket, nibbling contentedly on a scrap of lettuce. This is his Zen. Or you might find him on the floor hopping away from Sheba, Midnight, Lyol and Zane as if his life depended on it.

It just might.

Lyol may love him to death with his constant 1) Take ‘Fumper’ out of his basket, 2) Squeeze ‘Fumper’ hard so he knows just how much he’s loved, 3) Put ‘Fumper’ on the ground in front of Sheba and see ‘Fumper’ hop away, 4) Chase ‘Fumper’ and pick him up, 5) Repeat from step #2 ad nauseam.

Zane has a different tactic. It’s much more clean and simple. 1) Toddle up to Thumper, 2) Squeal with delight, 3) Smack him hard because he simply doesn’t know how else to express his love and excitement.

So far Sheba and Midnight have both picked up Thumper by the nape and started to carry him around. I’d like to think it’s mothering instinct, but I suspect it’s just the prelude to a mortal blow, in private.
Without further ado, here he is in all his glory, Thumper.

Sunday, July 15, 2012


Imagine you are pregnant.  Now if you are a guy, that may be a little difficult.  

Imagine you have waited 9 long months to deliver.  Most people stay at home to deliver, but not you.  No.  You go to the hospital.  

You get there and you are 4cm dilated.  You progress to 6cm.  

That’s all the history that was written in the carnet (medical booklet).  

I can imagine what happened next, but I don’t really know.  I KNOW that she had a c-section.  I KNOW something went wrong.  I’m not sure why.  

I KNOW when the family brought her to us she was a week out of her c-section and her abdomen was completely in the fascia (the stuff that holds the intestines inside) was wide open.  She was infected and there was a layer of granulation tissue covering everything, so we cleaned her out and packed the incision every day to try to stop the infection.  

Later we brought her back to the operating room and probed around some more.  We found that the uterus had also been either left open or not been closed properly.  Her lower uterine segment and rest of the uterus was wide open.  It was hard to tell what was what with all of the infection and inflammation.  After closing the uterus, which is actually hard to do late in the game, more cleaning, irrigation, and separating out the fascia, we closed the fascia with a couple of big drains in place.  

She is still recovering several weeks out with dressing changes of her incision, but the impact of her unimaginable c-section will forever be with her.  Her baby died before coming to us.  She almost died.  

We have received 3 unimaginable cases over the past several months that were from this other hospital not too far from us.  There is a “surgeon” there, but he or she can’t be a real surgeon.  If he or she were in a first world country, they would be put in prison.  

The first case was a necrotic colon that was opened and closed, not referred, and forced to stay at the hospital 3 days after the surgery.  Thankfully the family refused and finally brought him to us.  My dad removed part of his colon, put a colostomy (a poop bag) in, then later Dr. Greg and Dad reattached the colon to his rectum.  He’s now functioning normally again.  

The second case was a lady who had a c-section for “fetal distress.”  She was referred to us AFTER they had cut into her and figured out they did not have any sutures to close her.  She arrived with intestines swooping out of her abdomen.  At least that was the same day as her surgery.  

If you knew the roads here, you would understand that THIS IS DANGEROUS.  This would be dangerous anywhere in the world, but

The third case was this current c-section lady.  I don’t know why she had a c-section because this SO CALLED SURGEON does not have enough guts to write us a note to tell us what happened.  Why would they write anything, then someone could pin it on them I guess.  For now, they stay hidden behind the operating room doors????  I asked the family if they knew who operated and they said they didn’t because he or she hadn’t done rounds on them.  

Imagine.  Performing an awful case like that and then not having the guts to see your patient and follow up how they were doing.  For ONE WEEK!!!!!  He or she left her to die.

Imagine going to have a baby.  Being responsible and ACTUALLY going to the “hospital” if that’s what you want to call it, and then leaving almost dead and with a dead baby.  

This is especially frustrating when we have trained surgeons coming to volunteer here.  Trained professionals.  People who know what they are doing.  And because of our MCD, we have to have all of the right paperwork to be just so.  And.....this “surgeon” CONTINUES to practice without any intervention.  

At the last regional health meeting that Olen went to the “statistics” were displayed.  A lot of the math did not add up.  Still you could see that Bere does a lot more c-sections than other places.  So....the ‘smart’ leaders were ragging on our c-section rates.  However, it’s not that difficult to see that we are a referral hospital.  Uncomplicated deliveries deliver at home.  Any uncomplicated delivery can turn complicated quickly.  The complicated ones get referred to us....usually very late in the game.  I get so frustrated when big shots (who know little about OB anyway) sit behind their desks and look at numbers and try to harp on the good care that you know you are giving.  I would deliver at our hospital too if I had to chose between a surgeon leaving me wide open or closing me up.  You don’t have to be that good.  Just do the right thing. 

This is a corrupt place!  You could not even begin to imagine.  Please continue to pray for the healing of our patients.  Pray that this woman can imagine that there is a God who loves her even though she probably feels like dying.  

What happened to the other cases that DIDN’T get referred?  

I can imagine why patients come so late to the hospital.  They are scared.  And rightly so.  Before we came we were quoted that 3/10 patients would die intraoperatively during a c-section at other hospitals.  I can imagine why now.  

Sunday, July 1, 2012

Shades of Grey....

In actuality it was shades of bright red.  She was “6 months” pregnant and bleeding from her vagina.  This was her 7th pregnancy, but first time to the hospital for a delivery.   She had delivered all of her other pregnancies at home.  

I used to hate it in residency when someone would come in with “no prenatal care” with an urgent issue.  It just meant more work to figure out what was going on with mom and baby.  

Then I became one of those “no prenatal care” patients in New Jersey.  And thus Zane was brought into this world.  

Back to our bleeding pregnant woman.  She had no prenatal care.  Today she was working in the field and started bleeding briskly.  So she walked to the hospital, bleeding and all.  No one had been home except for her.  She didn’t wait for her mother.  She didn’t wait for her husband.  No one from home even knew she came.  (This in itself is a big no no here.  You should get the permission from your husband before coming to the hospital).  But she came anyways.  

The bleeding seemed to slow down some.  

I did an ultrasound.  Partial placenta previa.  The placenta was covering part of the opening of the cervix, blocking the baby.  I measured the baby and he measured 28 weeks.  This estimated him to be 1.28 Kg (less than 3 pounds).  I give her a shot of dexamethasone in case the baby might live (this is supposed to help develop the lungs).

There were several things to consider.  

Mother is bleeding.  To save her, I need to get the baby and placenta out quickly so that the bleeding stops.  

Baby is very tiny.  Will he live?  This would help determine my mode of delivery.

In the US the age of viability is 24 weeks.  Though this is a little grey area.  Babies that live at 24 weeks are miracles also, even with all of the fancy american help.  

This is NOT America.  We DO NOT have NICU or much means to help premature babies.  

I do a speculum exam.  She has several large clots that block our view of the cervix.  I very carefully move the clots, but still can’t see the cervix very well.  Is it possible to deliver this baby vaginally?   I do a digital exam (normally you don’t do with previa for fear of hemorrhage) and discover that she’s 4 cm dilated.  She continues to bleed a little.  

Okay...we need to do a c-section to stop the bleeding.  I walk her to the operating room and put her on a gurney.  

There’s another patient who’s already in the operating room, so she’ll have to wait.  

I consider my options again.  I dislike indecision.  Normally, you look at the facts and make an educated decision based on them.  Stick with it.  The facts aren’t going to change.  You can’t change the fact that this baby is so premature.    

I know this baby is not going to live.  He’s too small.  If he were in the states it would be an easy decision.  C-section right away.  Stop the mom’s bleeding and wisk the baby up to NICU.  But here, the smallest baby I’ve had live is 1500 grams.  Not 1200 grams.  He’s just too small.  

Why do I NOT want to do a c-section?  Because women don’t come to the hospital for labor.  The next labor would risk mom’s life if she stays too long at home when there is a problem.  So I avoid c-sections like the plague here.  From my history taking, 98% of women have lost babies here...term fetal deaths, neonates secondary to the delivery, or a child.  That’s not including all of the babies that are lost to miscarriages or preterm births.  That’s a reality.  People are “used” to it.  It doesn’t get easier, but it’s the harsh reality.  

I talk to her about possible vaginal extraction of the baby because he is too small to live.  She accepts.  She does not want a c-section.  How can she have a c-section when her mother or husband aren’t even here?  (In other hospitals people die during “uncomplicated” c-sections).  However, even a vaginal extraction is dangerous with the location of the placenta due to the risk of bleeding. 

I ask her if she wants more children in case a c-section is necessary due to bleeding.  It depends on God she says.  “Well, if He gave you the decision today, what would you say?,” I was trying to ask her if she wanted a tubal ligation.

She does want more children.  She has 5 girls and no boys.  She just wants a boy and then she will be done.  

Her bleeding mostly stops, but the risk of bleeding is too great, so we bring her into the operating room when it becomes available.

She gets spinal anesthesia.  I ask my dad for help.  I do another vaginal exam and find that she is 5cm dilated.  Maybe we should give her oxytoxin to progress her labor?  Also a big no no on a woman who is bleeding.  Or maybe we should just do a c-section to stop the bleeding faster.   

We decide on trying vaginally with possible destructive delivery.  But this would mean that the baby would not come out alive.  He wouldn’t live anyways.  This baby is too small.  I know he’s too small.  There is no question.  Right?  I’m not liking my indecisiveness.  I even say that out loud.  

We say a prayer and begin.  

I decide that feet first would be easier to deliver the baby, so we manipulate the baby around.  With a hand in the vagina, I find a small area that is not covered by placenta and break her water.  More blood comes out.  She’s still only 5 cm’s dilated.  I grab onto one of the baby’s legs and pull out a foot.  I look at how tiny it is.  If I just pull harder, the baby should come out, but his head would get stuck.  The baby pulls his leg back.  He’s fighting me. 

Grey areas are difficult.  At least this one is for me.  
Do I risk the mom’s life the next year to try to save a baby that is too small to live?  

It seems to me that Africa usually has less shades of grey and more black and white.  I’m not talking about skin color.  Though we do stick out like sore thumbs.  The death and suffering is very intense here.  Everyone knows it personally.  Because of all of the suffering, you either fully live...or you die.  Survival.  There doesn’t seem to be much in between here.  It’s more black and white.  

But this is not black and white.  

I grab the little foot again.  But I just can’t do it.   

So my dad and I do a c-section, deliver the tiny baby, and stop the bleeding placenta.  

He’s little.  Too little.  He actually weighs 1400 grams (about 3 pounds), a little more than I estimated. 

Is he too little?  

No, don’t get attached.  I did the c-section to stop her bleeding.  Really.  You can rationalize a lot of decisions in medicine.  It wasn’t to save the baby.  It wasn’t because I couldn’t do the destruction.    Really...I think.
 Lyol helped wrap him up snugly

He’s not going to make it.  

But is he?  

Maybe he’s one of God’s next miracles here?

Olen suctions him out, cleans him off and ties his cord.  He’s crying (the baby, not Olen).    

Janna is our pediatric queen, so we have her come over and put in a neonatal NG tube for feeding.  Seraphin even got an IV for iv antibiotics in his tiny little arm.  We arrange our special incubator, a cardboard box.  I brought the baby home to get some blankets and a little hat that my friend Bekah sent me.  I tucked some warm water bottles in Olen’s socks (not too dirty since we never use socks here) to keep this cutie patutie comfie and warm (it’s not hot season and does get “cold” during the night).  

We can give milk, give antibiotics, keep him warm and dry, and pray.  Please help us pray that this cute little miracle continues to live.  He is 3 days old today.  He has a special place in my heart already even though I know it’s taking a risk.  Mom’s milk has come in well now and the baby actually latched on her breast well this afternoon.