Tuesday, May 6, 2008

hospital experience

Already I can feel myself getting desensitized and detached from the situation I wish to describe in this email.  It has been a hectic, stressful three days.  The goal of this letter is not for you to feel sorry for us here—God is always in control, every day and every hour—but for you to be so thankful for the American medical system that you enjoy and to better pray for our lives and work here.  We just started a chapter in our book with the sentence, “The medical team sprang into action.”  Not a scenario you’ll see often in this country.


This case started on Sunday afternoon while on visitation.  We saw a pregnant woman from our church who hadn’t been there that morning and wasn’t feeling so well.  When we visited she was lying on a bench, the four kids were unattended and there was no food or joy to be seen.  I went home and fixed some food for them and got my fetal scope to check on the baby –a 7 month pregnancy.  I heard nothing – no baby, no placental noise –quiet - so the next morning decided to take her for a sonogram.  Dan was just leaving for Abidjan, so Becky drove us to the hospital.  The sonogram confirmed that the baby was dead.


I can feel myself getting bogged down in the details ---you know I am a nurse and we are taught to document everything and the time it happened – smile.  I might just give a run down like that.  The hospital here is a compound with different buildings for everything –lab, maternity ward, pharmacy, operating room, waiting room, sonogram----each place is in a different building.  Remember that as I am running back and forth for this or that.  


We went from the sonogram to the doctor’s office –he ordered lab tests, an antibiotic, and medicine to soften the cervix.  Then we went to the lab for blood tests and waited there till 12:30 for the results.  She needed blood.  Next we went to that doctor who had to sign out the blood ---he was out to lunch, so we waited there till 3:30 PM.  He signed out the blood and I went to the lab to get it.  Meanwhile I went to the pharmacy for the tubing, needle, gloves, etc.  Every time there was anything to be done I had to go get the supplies from the pharmacy there on the compound and go get the medicine at a pharmacy out in town to put in the IV.  Are you getting the picture?  If at any point you don’t have money for the next step your treatment stops.  She finally was getting the blood around 5 PM (that I had picked up from the lab. in a plastic bag and sat there by her on the bed till they were ready to put it in.) and now they are not going to do anything more till the next day when they can again check the lab to make sure the platelets came up.  I got home at 5:30 PM.


Tuesday started with lab work ---go to the lab, don’t forget.  They don’t come to you and do anything.  Wait for the result –all is good.  Ready to start inducing labor – out to the pharmacies for supplies and medicine – and I mixed it ---water with methergin.  Back and waiting.  Doctors out to lunch ---so I left from 12:30 to 3 PM ---everything stops here, even the hospital, during the mid-day.  At 3 PM they put in a catheter and she started drinking one cup of the mixture per hour – given by me.   When the contractions started, the idea was for the catheter to come out and they’ll know she is about ready to deliver.   That is another thing ---all her medicines are there on the bed and we just administer them or the patient takes them, if they remember.  I stayed with her until all the medicine was in –1 liter of water – lasting till 6 PM.  I walked her around, didn’t seem like too much was happening. I talked to one of the other doctors and he said it took a long time.  The doctor we had seen acted like it was going to happen today.  So, I got her some food and left around 8:00.  Her husband was there for the night.


Now it’s Wednesday morning and we just checked on her – labor going super slowly.  Wed. afternoon the catheter was removed and I went back to be with her at 3 PM.  I need to describe these rooms –peeling paint, blood or whatever spattered on walls, plywood ceiling tiles hanging down, lights that don’t work; including in the bathroom, which is crawling with cockroaches; a non-functioning dirty toilet sitting there, the hole that used to be for a shower is used as the toilet and one uses a bucket of water to wash it down; vinyl mattresses – bring your own sheet and pillow, one outlet in the room – bring your own fan, screens dirty and torn.  Becky, my sister, bought an outlet strip – there were 3 ladies plus families in the room to use the one outlet which was only close enough to one bed.  I won’t provide details about the smells, though I was happy to see that in the delivery room they were using bleach in the water to clean with.  Dan was in Abidjan, so Becky was driving me back and forth – though I walked a few times.  The hospital is not far from our house ---maybe a mile.  It was great to have Becky there some of the time – cheerful and someone to talk with.  I could call her, “Bring more money.”


At 4 PM the midwife hung a pitocin drip ---remember, out to the pharmacies for the medicine and all the related supplies.  Meanwhile there was a girl, 17 year old there on the floor waiting for a C section.  She was eclamptic at 7 months and was in a coma though trashing around.  Her breathing was fine (this detail is important later on.)  With the drip going we were there for an hour when we moved to the delivery room – at which time (5PM) the breathing of the girl on the floor was sounding rattley.   In the delivery room I told the midwife that the girl’s breathing did not sound good.  While waiting for our friend to be ready to deliver, I watched the midwife and assistant do some bad deliveries (unnecessary episiotomy, no care of the women, just let a woman lie there and she “better not make any noise until the whole head is out,” then they go and push on the woman’s stomach while pulling on the baby’s head. They are routinely doing abdominal thrusts on the top of the fundus – the top of the uterus.  Talking about the placenta—they wrap the cord around their hemostats and pull it out.  I was cringing, and I had gloves on to help ---“just let me do one for you” – no way and they were getting a little upset—so was I.  They just wanted me to stay out of it.  In the interest of our friend I went back to our patient ---it is one big room, same peeling paint, but there was an air conditioner that periodically let out a lot of water into a drum where they kept their bedpans.  On the other side of the plywood partition we heard them slap the other woman at least 3-4 times.  What a mess.


Since it was Wednesday night, Becky left for church and I stayed and called to tell Ruth and Hannah to plan on going to church with the piano in a taxi by themselves.  They, along with Susanna and Lydia, have been great keeping up the house, helping the little ones with school and taking care of Esther while I was gone.


Our friend had the baby breech at 7:10 PM.  Here is where the story goes from bad to worse.  The midwife pulled hard on the baby, was reaching up inside and pulling even harder –plus getting mad at me when I was saying there was no need and no rush.  She finally pulled the baby out and ripped the cervix (that could have happened anyway, but I’m sure she didn’t help the matter.)  Then in the time I turned to take off my gloves she had pulled out the placenta.  Our friend started hemorrhaging big time and then going into shock.  The doctor was called.  The midwife had now started another IV line and was squeezing the IV bag for all she was worth to get fluid in.  The doctor came and checked around 8 PM went out –they were cleaning the operating room.  He said that with that much blood he feared a ruptured uterus and he would have to open up the abdomen to see and repair.  I am praying, “God, don’t let her die and please have it just be a cervix repair!”  At 8:30 p.m. they wheeled her away – I’m out getting more tubing and blood from the lab.  Then we waited and prayed and prayed some more.  Becky came back at 9 PM and we all prayed.  Our friend came out at 10 PM sleepy and only the cervix needing repair.  Praise the Lord for that.


Meanwhile I looked in on the other woman ---very congested and breathing badly.  Went back to the midwife ---“the woman is really not breathing well.”  No action.  Went back to the operating room to find the doctors.  Now all empty, except a guy cleaning the floor—all the doctors went to eat; they planned to do that C-section when they got back at 11:30 PM.   I went to call home (here they use cell phones like a phone booth) – to tell the kids, “don’t wait up for me.”  Our friend still needed more blood and the doctor said that if she started bleeding again they would have to open her up.


When I got back I found out the doctors had returned and had taken the woman to surgery – though she didn’t even make it to the door.  They said her throat was too swollen and that they couldn’t intubate her.  She died.  In the room there were some of her people.  One of the men said it was our fault, that we had taken her spot in line.  I said, “No, the doctors went to eat.”  I said I was sorry, so sorry.  Needless death – they had the money, were lined up.  I thought last night of our kids – we expect them to obey right away.  Saul – delayed obedience was disobedience.  The doctors – very good with their work, but not done in timely manner, and people die.  The girl might very well have been saved.  The people seemed to be Christians– from an Assembly of God church.  While we were out buying medicine and waiting, a girl we talked with trusted Christ!  That was neat.  She truly understood and prayed to get saved.  I’ll visit her again on visitation on Sunday.  She sells water outside the hospital gate.


Becky and I left at 2 AM – the blood was going and we figured our friend would be okay from there.  Praise the Lord that the bleeding had stopped.


Thursday our friend ate breakfast and was discharged at noon.  We took her home and got her situated.  Becky kept her kids until after dinner and then took them home.


Now it is again Sunday – she is doing better though still weak.  I went by yesterday to “complain” and to point out some of the unethical practices and I have an appointment for tomorrow ---or later if I can’t get there tomorrow.  Mondays are always hectic around here.  Anyway, it is not to just criticize – what good is that?  They are already understaffed.  I hope to arrange to teach a class to the midwives or something along that line.  Maybe I’ll be able to demonstrate how we do deliveries.  Today we witnessed to a big group ---there are always a lot of people in front of the hospital passing time.  Maybe God planned all this for another outreach opportunity ---though He surely knows we are short of time here.


Bye for now.  Praise the Lord for His grace that you were born where you are.


Love in Christ,