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Sunday, February 04, 2018

Passivity and Push and Peter

Neither being passive or pushy carry positive connotations, yet both feel inevitable in a world warped by evil.  Once upon a time we learned that the two extremes of conflict are the most dangerous:  the obvious end of the spectrum is violence, but the mirror image is equally damaging, that of passive-aggressiveness.  Violence is the purview of the powerful, and passive-aggressive responses the fallback of the powerless.

Disclaimer: we're more likely to be accused of being pushy than passive.  As people whose solid education and  skin color communicates privilege, not to mention our roles in leadership and teaching, I am hesitant to complain about passive-aggressive behaviour realizing that it's roots run deep into colonialism and injustice.  However, as people who have put in 2 1/2 decades of struggle and love, there are days that the energy to push back against waves of passive indifference just drain us.  This is going to be a long post, for the few who wonder what work-days are really like.  Feel free to skip to the last few paragraphs.

Thursday was one of those days.  The push started Wednesday afternoon with a dangerous, brain-damaging level of bilirubin (jaundice) in a lab result in a baby brought in several days old.  The mom's O+ blood was reacting to the baby's B+.  I was pretty sure we needed to do an exchange transfusion, but there were two babies with the same name and some confusion about the lab samples and blood was not available and all the usual barriers.  In a hospital with no in-house call by anyone above the intern level, and with very sparse staffing, the administration had determined that we can do exchange transfusions (removing the baby's blood and replacing with donor blood) only in the daytime.  So we prepared Weds for the procedure on Thursday, and agreed we'd check one more level Thursday morning just to be sure.  We can generally only get labs five times a week--they are drawn Monday through Friday and batched throughout the day, with results released about 5-6 pm each weekday evening.  So it was a PUSH process to get the lab to agree to run an early (meaning 10 am) sample and release the results to allow us to proceed. 

Thursday I am the only consultant, our medical officer (resident-level doc) came in bravely trying to help but was clearly sick and I sent her home, so it was me and the interns, and then one of them said at 11:30 am he had to go home as well because he'd had a bad night of call.  THANKFULLY the jaundice had improved overnight and the level dropped significantly, so I was feeling like we might be OK, just me and one intern for our 40+ Newborn unit babies and our 20-30 on the paeds floor . .  .

Until we got to the LAST TWO BABIES out of all those that we rounded on.  Due to rampant infections my new colleague and I appealed that babies from other health centers who are referred to us be grouped in the third of our three Newborn Unit rooms, as a gesture of isolating new bugs.  In a busy and poorly staffed place (remember we are supposed to have over 200 nurses, the government has supplied about 80 and the hospital has hired another 50 from the small fees collected for beds and meals . . . and we only have just over half the doctors we are due, meaning about a quarter of what we need . . .) it's key to group patients by illness and by severity for attention and efficiency.  So my infection control attempt failed to carry the caveat of "and please tell me if the babies in isolation are amongst the sickest".  One of the two was 5 days old and slightly premature, jaundiced, vomiting, distended, had never passed stool, looked like a surgical emergency for bowel obstruction.  The other was also about 5 days old, jaundiced, gasping, with the cold hands and feet of shock.  Both had been admitted overnight by the exhausted intern who had left without telling us about them, and neither had any IV line, had received any medications, or had had any diagnostic tests.

I thought the shocky baby would die soonest, so focused on that one.  Two intra-osseous line attempts both failed because we don't have needles with stylets, so they plugged with bone.  Then it occurred to me that I might be able to still use the umbilicus, and with no instruments other than a handle-less blade I cut down and removed clot and jerry-rigged an ng-feeding tube as an emergency IV line, pushing fluids and antibiotics, while the nurse was setting up an oxygen system called CPAP.  Once that baby stabilized slightly I did a lumbar puncture thinking he may have meningitis, drew blood and moved on to the other.  Again had to put in an IV, do a lumbar puncture, etc all on a bench the moms use for seating because in the isolation room there was no other space, and all with moms helping me hold because the nurse and intern were swamped with other babies.  This one I thought needed to get to Kijabe or Kenyatta for surgery, but an x-ray is needed to make that request convincing.  The general MO of the x-ray department is to finish all the outpatients, then take the portable to the newborn unit last thing in the day.  By that time there may not be power, or it just gets pushed back until tomorrow.  So when I went personally to the department to try and get the tech to come mid-day, and he said "I'll be there in five minutes" I said "I'll just wait here and go with you" knowing he wouldn't.  He looked so flummoxed that I felt sorry for him.  So I speed-walked back to the Newborn unit (the furthest building from xray) and picked up the crib and carried the baby in the crib to x-ray myself.  Got a lot of stares, but it worked.

The day before Scott had to personally wheel patients to the operating theatre, do all the prep work, make phone calls to get the anesthesia in place, pushing hard to save a baby or a mom's life, only to later discover his team sitting in a lounge having tea.  Not that you shouldn't drink tea.  It is just the exhausting sense of inertia.  It's why six hours in this hospital wipes you out as much as 12 hours in another one.

There are times when we both feel the quandry of what is dangerous passivity (ignoring labs, delaying action, failing to show up, failing to call for help, pushing work off to someone else, missing days and more days of duty, staying silent in the face of rumors of harmful decisions or practices) versus what is a gentle and slow approach to cultural change.  There are other times when we feel the quandry of what is unpleasant pushiness (imposing our ideas, insisting on certain standards, doing work ourselves that our trainees should be doing, giving too many negative reactions) versus what is a needed stand for justice. And I know I don't get it right most of the time.  I end up tired and frustrated.  The baby in shock improved for 24 hours and then died.  The baby with the bowel obstruction thankfully went to Kijabe for expert surgical care. 

Which brings us to today's sermon from chapter 2 of 1 Peter.  Our preacher had a challenging passage about submission to the government and to authority in a week in which Kenyans saw their TV stations taken off the air and opposition leaders violently arrested.  The latter part of the chapter, he showed us, exactly parallels Isaiah 53.  Jesus is the one who pushed against the hypocrisy and injustice of the worldly leaders right through to death.  Yet one could also see the cross as passive, in that he did not bring change by force.  Jesus can meld the paradoxes of push and passivity into a non-violent protest that redeems by sacrifice. 

Would you pray for us to model that?  It sounds impossible. Would you pray for Kenyans to model that?  Because the spectrum of conflict actually comes around full circle.  The powerful (the government, the army, the wealthy) can push their way.  The average person passively shrugs, tries to stay out of the way, and hopes it will all blow over, unsure.  But then the poorest of the poor can be manipulated into the push of violence that serves the elite again:  they have little to lose, and a restless energy that can turn protests into riots.  Kenya has teetered on the brink of this all year.  What would redemption look like in the massive public health sector, and in this country?  How can average people and doctors like us live by Isaiah 53, by 1 Peter 2, by the cross, in a way that opens a path of life?  

1 comment:

Phyllis Masso said...

This situation is heartfelt and heart-wrenching because it isn't just a philosophical or theological discussion but a matter of life and death. May God grant you courage and strength and love to keep going, doing the right thing and being a good example.