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Monday, September 17, 2012

Strike 2, you're about to be out

Well, I felt about out today. This second major Kenyan doctor strike is hitting us hard, but one thing we are thankful for is that we're not totally abandoned.  Our Kenyan interns are in a difficult position, required to strike by their colleagues but also wanting to help us out because they're caring people.  So they worked out an arrangement to cover some extra night/weekend call hours.  Daytimes, however, it's me and the clinical officers, and today was a MONDAY in all caps.  

28 or 29 babies in the nursery when I left tonight, I kind of lost count, but am pretty sure they were all taken care of.  We had six admissions (which is a lot for a smallish intensive care unit) today.  Our competent clinical officer ended up going to the C-section delivery of the sickest one, and I did the intern-level work to admit the rest.  Well, 4 of the 5.  The 5th one I looked over and decided didn't need admission in the context of this crowding.  One good thing, I had to spit out some Swahili because everyone is too busy to help me.  Even the nurses were pushed to the limit.  I did three lumbar punctures and almost a fourth they brought me until I realized that baby was waiting for something else . . . It was just one of those Mondays where a lot of details had to be mopped up from a weekend where coverage is lighter.  Our OB service is one of the few left in the area providing safe C-sections, so the moms are pouring in.  We have several babies with serious infections from other hospitals, whom we are trying to keep isolated from our pristine majority.  Several with surgical problems who have come for our great surgeons but are too sick to be operated upon, so land in our pediatric care.  Two babies with cleft lips/palate who could not feed and became severely malnourished.  A delightful preemie who beat the odds of a 27-week delivery (he tested at 25 weeks) and now on hospital day 49 is cute as can be, but his mom is in tears about stress in her life and family and had to be begged not to abscond quite yet.  Many are improving, a few are struggling, and all require more thought and focus than I can give to so many sick ones.  We lost three kids on our services in the last few days.  Two died from severe congenital heart defects (again, transferred from other hospitals).  One was a normal 9-day-old whose frighteningly lethal bacterial infection just escalated in spite of antibiotics until his brain was full of pus.  THAT is hard, a preventable and treatable illness in many places, but too virulent for our resources.

Meanwhile in Kenya researchers have found a brand new species of mosquito that caries malaria parasites and bites earlier in the day, making it potentially a significant contributor to human illness.  Countries all around us are erupting in violence.  People we know are in risky places.  Kenya just recovered vests stuffed with explosives being prepared for suicide bombings in a neighborhood where our friends work.  The doctors and teachers are both on strike.  Elections set for next March are feared to be another stimulus for tribal violence.  I am a way-behind-in-planning mom who is still trying to book something for our mid-term weekend and something for a 3-day break between Christmas and airline tickets for Caleb . . . and so far striking out on all of that, which is frustrating.  

So in all of this, I have to rejoice that thanks to cell phones and internet I booked Luke and airline ticket to come home for Christmas (he usually does it himself but the best-price site only accepted credit cards and he only uses a debit card).  YEAHHH.  And I have to rejoice that my mom who is 76 and who loves to ride ATV's in West Virginia survived a potentially serious accident when she flipped backwards on a steep hill and came away with bruises and stitches but no broken bones or internal injuries, and her passenger was completely unharmed.  Miraculous.  And I have to rejoice in many other things I'm sure though most of them aren't coming to mind right this minute.

Because life is so often this way, a hard sprint of a day and then 11 pm catching up with the parts of our hearts that are scattered abroad.

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