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Thursday, October 06, 2016

And so it begins. . .

 . . this new chapter of life.

With awkwardness, hesitancy, humility, learning, mistakes, watching, plunging, trying, wondering.  Monday and Tuesday we rattled around nearly-empty wards, saw the few patients who had somehow been retained in spite of the 2+ week doctor strike, sat down with some key people (thankful for the peculiar pause which allowed this) to get their views and advice.  We had some haphazard tours, perking our ears and collecting facts and phone numbers as we went.  We heard multiple views on the strike's causes, the positions, the problems.  Though it was theoretically called off on Saturday, the first day with actual rounds, admissions, and operations was Wednesday, with today being busier.

On the huge positive side, Scott ended up doing a C-section today when no one else was available, and that's just one big hump that's good to be over.  Though he's done this over 500 times, it's a new place, new people, different sutures and instruments, and it's been a year since he was last operating.  Another huge blessing is that we truly appreciate the senior nursing staff.  There are a handful on each service who have weathered strikes and storms for decades, who are there because they are committed, who have the experience and clinical skills to make a difference.  And they have been welcoming, pulling us in for chai and working alongside us.  My sole paediatric colleague returned to work Wednesday too, and we had some good time to talk about the future.  There's an excellent University of Washington chief resident in Internal Medicine here for a year too.

However, it's still been an exhausting week (and it's not even over).  Being cross-cultural most of the time (except when we're alone in our little room) takes a toll.  We're hearing a decent percentage of the Swahili and stumbling along trying to talk.  The charting, the expectations, the rhythms, the attitude . . are all different.  Pray for us to be patient.  To go slowly.

Because sometimes it's hard.  Really hard.  I will be honest that there have been a few times this week when we've wondered what we got ourselves into.  In the moment I was trying to start Paeds rounds this morning, one intern told me there was a resuscitation in the NBU (Newborn unit = Nursery = lower level NICU) which needed help, and he'd stay and handle the dehydrated shocky new admission on the floor with the Medical Officer.  I went to the nursery and found no one resuscitating anyone, a dead baby covered with a blanket (2nd morning in a row to find that), and next to it a blue, tiny, gasping, not-yet-dead very small preemie.  As I got a bag and mask to get him breathing, his heart rate came up, . . .  then the power went out.  No electricity, no oxygen, no warmth.  I quickly assessed that he looked 26 or 27 weeks, and put him on the scale at 750 grams.   I looked over to the next bed and saw another baby marked by pallor and poor respirations that was about twice the size, but still tiny, 1.4 kg and 32 weeks . . . so with one hand I bagged the first dying baby and with the other called the intern to come bag the second one.  He couldn't help because he was in the middle of reviving the shocky dehydrated 1 year old.  So, two doctors for three emergencies . . .  I had to let the tiny preem go.  I made him as warm and comfortable as I could, and moved on to the baby I thought I could save.  By the time I got that one a bit stabilized (working around the power outage with an oxygen cylinder, working on the baby while on his mother's skin for warmth, setting up CPAP and getting meds into the IV), the tiny preem was dead.  He had been a twin, born out at a flower farm, brought in during the night.  At some point his twin had already died.  I don't think anyone expected him to live either.  I think moving on to the larger baby was the right choice given the realities of the limitations of that hour, but not the kind of choice I like to make.

The dead baby from the day before had been another premature baby, born under a bush by the roadside when his mother (who had no prenatal care) felt labor pains and started walking to town.  A good samaritan picked up the bloody woman whom she saw squatting in the bushes, and wrapped the cold wet baby in a cloth.  Good nurses warmed and revived him and we kept him alive 24 hours, but he had very immature lungs and couldn't last.  No surfactant here, no ventilators, no working incubators, no working monitors, etc. etc.  This hospital is the open door to the poorest of the poor, and they come bringing their floppy, cold, gasping, tiny babies delivered at home, or in cars, or literally in the bushes.  It's urban enough that there are hundreds and hundreds of pregnant women within walking distance, yet non-urban in the unreliable electricity, equipment, supplies, etc.

On the positive side, though, the intern did a great job with the 1 year old in shock, who improved as the day went on.  Then there was the kerosene ingestion (the brother left a can of it in the kitchen, the small child thought it was water) and the sickle cell patient with a hemoglobin of 2.3.  ICU-acuity in a very basic ward, but all getting reasonable care and improving.  And in spite of already 3 deaths in 2 days, as the morning went on I felt like there were opportunities to teach, to encourage, to perhaps save some lives in the short term, but to certainly impact lives of trainees for the very long term.

This morning I read this in a devotion about St. Francis and Clare, who lived in the 13th century and left lives of comfort and consumption to choose simplicity, devotion, and care for the poor:  "Francis and Clare showed us it is possible to change the system not by negative attacks (which tend to inflate the ego), but simply by quietly moving to the side and doing it better!"  Amen.  Pray that for us.  We want to quietly move to the side here, and serve in a way that motivates young doctors to work with integrity and skill.

Only four days down, and months and maybe years to go.  We're out of our element, and yet we know that this is exactly how all our missionaries feel.  We're supposed to be the leaders, and now we're leading by being right back in the thick of cross-cultural angst, trying to shed a small light, hoping to build some trust, working quietly by the sides of our Kenyan colleagues.  Keep praying for that.


Jan said...

Greetings, Scott and Jennifer, from Aweil, South Sudan! Thank you for the update. Am praying for you. Jan (with Cush4Christ)

Lissa said...

Heartbreaking post. I am praying for you. All I can do is imagine how many more babies would be lost without your skill and your loving touch.