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Wednesday, May 25, 2011

A day's work

Walking into Kijabe Hospital, the Special Care Nursery (aka NICU, aka SBCU for special care baby unit) lies behind the windows you see to the right. Patients congregate in this grassy area to rest, get some sunshine, or pray. This door is the barrier between cold, high-elevation-escarpment Kijabe, and the tropical rainforest of the Nursery. I'm not sure I'd make it here without spending many hours of my day in the incubator temperatures! The current team, Ann the intern, Bob the clinical officer who knows more than the rest of us combined, and Limo the family medicine resident. They are writing notes on their babies and preparing to round with me. Overview of the nursery, from a back corner. Note the charge nurse Seraphine in dark blud in the middle, whose angelic name is appropriate, she's one of those people who knows how to get things done. Nurse Miriam holding Mary-baby-of-Jane. Mary was one of our tiniest preemies a couple months ago, and her survival looked uncertain. He mom suffered from post-partum depression, and one day just disappeared. It seems she was already grieving the death she thought was inevitable, and worried that her husband would resent the rising hospital bill. So she wrote a letter that basically said "I hereby give my baby to Kijabe Hospital." The nursing staff has fully cared for Mary and done a fantastic job. She's now 2.3 kg and ready to go home, only we aren't sure where "home" is. Our social worker and Kenya's Child Protection Officer found out the mom WANTS Mary, but is ashamed because she told everyone in the village that the baby died, and rather than face a change of story, she ran away. So they are evaluating a paternal uncle who wants to keep the baby. We're hoping that she can be reunited with her mother eventually, that the ties of love will be enough to redeem the poor decisions that Jane made in her grief and panic. This is Bedan, who was born with a large balloon of brain tissue and fluid protruding from the middle of his face, after he survived the removal of his encephalocele and a very serious against-all-odds-to-clear meningitis (acinetobacter for your medical types, 3 weeks of meropenem). He was still left with a gaping hole in his face, which we slowly reduced with scotch tape. Highly technical. This is the day he had plastic surgery to pull his face together. He'll need more, but this procedure allowed him to actually start to breast feed! And this is Bedan today (sorry I don't know how to rotate pictures, so just cock your head or lift your computer) on DAY 50 of life, about to leave Kijabe hospital for the first time. Yes, he was discharged. I will miss him and his sweet mom. Ruth, our current tiniest, at 940 grams. I love that warning behind her, as if she could suddenly jump out of her box. Shantal, whom I find beautiful, a bit more alert after several days of fever, convulsions, and lethargy, due to overwhelming infection. Almost healed. Luke, whose mom finds it very amusing that I have a Luke too, only mine is 18 years old and 6 foot 2 and coming in four days! But I digress, this Luke has an abnormal connection of his ureters to his bladder, which led to a serious blockage in his plumbing so to speak, damaging his kidneys before he was even born. For a few days it was touch and go with potentially lethal levels of potassium . . but now he's much improved. Still searching for the exact surgical solution. Mark very happy to be Kangaroo-Cared with his mom. Another content Mark (in addition to two Marks and a Luke, we have a John, and a doctor named Matthew, so the full Gospel is represented). These moms hand-express breast milk and tube feed their babies EVERY TWO HOURS around the clock. They are saints. Main entrance as I'm leaving this afternoon. Turn 90 degrees right and look down the road, our house is the faint yellow one in the trees ahead. Home at last.


Heidi said...

so, love the scotch tape closure and the succession of Bedan's photos! and what did I notice first in the photo of the docs at the counter? all of the cords hanging in the background! wow, you really are in the African medicine "promise land"! Such hope in that room!

Amy said...

oh my gosh the tape worked so well! So exciting!!!! I am so thrilled he went home and looks so great!!!!!!!!!!!!!!!!!!!!!!!!!!