The View from the Hall

The view from the hospital hall, not always clear.  The prophet in me wants to shout for immediate justice even if it means turmoil; the pastoral side wants to see people grow in grace and love and knows that any calling down of fire and brimstone would singe my impure heart as well.

So we keep on keeping on, lending a push towards life where we can, speaking up when we can, recognizing the mercy that keeps us all alive.

 Like a baby born face first, which doesn't work very well, but by the time Scott got there and considered the C-section he was coming out mouth first.  Here he is two days later, looking like a prize fighter, but remarkably feeding well.  Life is rough, even for an infant, but mercy so often prevails.









Or this chest xray, which took so many days to get due to malfunction of the portable machine, the baby was actually better.  These are not great lungs.  These lungs should have had surfactant, an expensive medicine that helps premature babies.  Instead this baby limped along very sick on CPAP for a week and a half, and is now on just a whiff of oxygen.  I think he'll make it. Mercy.




Or this moment in the Newborn unit, teaching my clinical officer interns how to manage a baby just after delivery, watching them get the steps of resuscitation.  This one skill could make a significant impact on survival anywhere they go.  The night before, Scott had been called in for an emergency C-section after a trainee overdosed a mom who was being induced to deliver and went into a continuous tetanic contraction.  The baby wasn't really breathing much, but instead of giving breaths, the student was running around looking for D50 (high concentration sugar-water IV) to give in the rectum.  Hmmm.  Maybe time to review this skill.  Once Scott noticed what was happening he asked the anesthetist to intervene.  Apgars 4, 4, 10.  Knowing how to give some breaths makes a difference.

But there are many many other moments when the view from the hospital corridor has my ready to yell, or cry.

 This is about 30 pages of bills, totaling over 4 million shillings (over 40,000 dollars, or 40x the annual income of the average Kenyan).  Baby J is a 2 month old twin.  In late February, in the last strike, his mom landed at a local private hospital where she eventually got a C-section, but by that time he was in dire shape.  His brother was revived and fine, but he was limp and not crying.  He was sent to a private ICU in Nakuru where he was on life support for over a week and in the ICU for a month.  After a brief discharge home he was sent to another private hospital in Nairobi, again on a ventilator for a prolonged time, again in the ICU for weeks, with surgery to put in a feeding tube in his stomach.  This week his family's insurance and funding ran out, and they were sent in an ambulance to us. From the highest level of pediatric luxury and excellence, to a place with no monitor, an oxygen concentrator, some dedicated people but not much else.  I reviewed his records, and examined him, and had a frank talk with his dad.  Baby J will never be OK.  His brain was severely damaged around birth, his head has never grown, he can't swallow, can't cry, is severely malnourished.  It is wonderful to love such a baby; it may be criminal to extract a family's entire savings, and those of their relatives, before telling them the truth.  The dad thanked me for telling him.  The kind of person who could even dream of accessing this kind of care does not usually come to Naivasha, until they are completely bankrupt.

This baby's course makes me very sad, because I have to wonder if he represents the forces that keep the strike going.  Private hospitals, owned by politicians and senior doctors, making money off the people who have nowhere else to go?  I know that this does not represent the majority, but one has to wonder.  We are taught in public health that when something that hurts people (usually a disease) keeps spreading, look for the forces that favor continuation.  Could a profit motive be one of them?

I don't know, but it's been a long week.  An extremely premature baby (25/40 weeks) who lasted only a few hours after being rushed here from a peripheral facility.  A 2-week old who had lost 1/3 of his body weight because his mom had no milk.  Babies who can't breathe well, babies with severe levels of jaundice.

And towards the end of the week, the little girl who was supposed to go to the safe house, almost slipping through our fingers as her mom wanted to refuse, and she stopped talking again.  But a victory when the social worker and the police agreed to put her there yesterday.  Mercy again, mercy that feels like a small drop in the ocean of horrible things that have probably happened to her.

The view from the hall is so partial.  I can't see the long trajectories of peoples' stories before and after their moments of crisis. Working nearly alone, I get to put my arm around patients, feel the tears, and pray in a way that happens less when I'm part of an insulating gaggle of students and colleagues.  Trying to trust, the saved life of a mom with a ruptured ectopic pregnancy or another with a ruptured uterus because Scott takes them into the operating theatre, the the slow recovery of babies we care for day by day, are worth the hours and the sorrows.  Unable to see the years that precede and follow in each person's story, we have to trust that our moments of intersection work as points of mercy that change the world.