Strike two you're out

This is Malt. She arrived at Kijabe hospital at 11 pm last night, after a seven-hour ambulance ride from Isiolo, a rather remote Kenyan town far to our northeast. In those seven hours, as her post-c-section mom held on for life, they called EIGHT hospitals and were refused admission until they finally made it all the way to Kijabe.

Why? Because yesterday the public sector nurses, clinical officers, mortuary attendants, lab and pharmacy personnel, all went on strike, for a "hardship allowance" to be added to their salaries. The entire government health system was paralyzed, leaving only private and Christian hospitals like Kijabe to suddenly fill in the gap. This was much worse than the previous doctor strike. Proving we can limp along without doctors, but we can't manage without nurses!! There are many issues of injustice tied up in who controls health funds, and how they are distributed. However I suspect that Malt's parents live on less than the INCREMENT the Kenyan nurses are demanding in their monthly salary. And there are the people who suffer and die when the strikes begin.

Malt's mom had two children, then lost two who inexplicably died just before delivery. Finally someone in her remote village sent her for antenatal care on her 5th pregnancy. She was found to have the blood type A NEG. Malt is O positive like her dad. So her mom's body began sending antibodies to destroy Malt's "foreign" blood. Sensing impending disaster Malt's mom asked for a C-section. And sure enough, by 24 hours of life Malt was turning yellow from severe jaundice and dangerously anemic.

And so we began the delicate process of putting a line in through her umbilicus and gently removing her blood and replacing it with compatible blood. Two teaspoons at a time. Over and over until we had exchanged her entire blood volume twice over. I finished at 3:30 a.m..

Malt still has a long way to go. She may live, or she may succumb. She was a bit premature, and her jaundice was severe enough to cause brain damage. The delay in her care certainly makes her survival less certain. Malt's story of a seven-hour ambulance ride to reach the 9th hospital for help is only topped by Lucy. I have to tell you that in this picture Lucy looks peaceful. She had just died. Lucy''s mom only lived about 15 minutes from Kijabe. But she labored all day at a small cottage hospital in the small town she's from. When she broke her water and started pushing and was going nowhere for some HOURS (maybe five . . . ) she was put in a taxi with some sort of nurse and they drove FOUR HOURS (12:3o to 4:30 am) to THREE HOSPITALS trying to get a C-section. At 4:30 they finally came back near home to Kijabe, where the mom proceeded to deliver a dead baby.

Well, mostly dead. There was a slight slow heart rate, with nothing else. No breathing, no crying, no moving, no eye opening, no nothing. I was called and even though I intubated the baby right away, gave resuscitation drugs and CPR and revived a heart rate for a while, Lucy's brain was gone. She didn't more a millimeter, ever. Her pupils were fixed, her reflexes gone.

Because the whole hospital was getting inundated with transfers and desperate people (did I mention the 29 weeks pregnant seizing woman? Or the two kids with meningitis?) we had no ICU space to even consider pushing Lucy along in her brain-dead state, hoping for a miracle. So I had the agonizing responsibility of calling it quits. Pulling out the tube, which was filled with excrement from this baby's stressed pre-delivery deterioration, and waiting as the heart rate fell to zero. And then sitting with the mom to explain and console. Who said through her tears, "God is faithful."

Lucy's life was not important enough for several hospitals full of people to take note and take action. We must stand against injustice for nurses, but not at the cost of the lives of the innocent. I am profoundly weary this morning. Nothing is more wearing than acknowledging defeat and waiting for death. Particularly the death of a baby who, if managed properly a few hours earlier, would have been alive, well, normal.

Not much else to say other than pray for Kenya, for justice and mercy to flow down. Because they seem pretty dammed up right now. I am falling asleep typing (we happen to hit this strike in a bad stretch where we are each on call 5 of 9 days . . two weekends in a row and two non-matching days in between, so that means 6/9 nights with interrupted or very little sleep), so I leave the last picture one of my other anchors. A morning jog with my dog, clearing the weight of that night of terrible decisions and sorrowful outcomes.