Sand, Urinary Stones and Babies

5-3-08

The wind whips up whirlwinds of sand that pelt your face and find you waking up in the morning covered in sand. Mmmm, gotta embrace the grit, mixed with sweat it makes for quite the natural skin exfoliate! That Friday morning found me in just that situation. It had been a windy night, the rooster crowed and I pulled my head from out of under the sheet shaking the sand from it and looked over to see Kevin still sound asleep under the eave of his hut. A few stars still twinkled in the sky, but in Africa as soon as 5:30 am hits, you have no choice but to awake with the goats and chickens or otherwise you take the risk of getting trampled. Sleeping outside on your grass mat has its positive and negative sides!

Kev and I joined Pierre, Brennon, and Washike for a beullile sharing session at breakfast. Kev's new favorite food is the beignets that Howaa makes every morning which we tear up in our beullile. She's determined to have him fattened up before he leaves!

I locked up my hut and lived my dream of walking down the sandy path to the hospital with Kev. It was the start of a beautiful day which was just about ready to get insane. You see we are once again without a doctor. The hospital administrator was gone, and the African surgeon who sometimes does surgeries here at the hospital (Dr. Ongram) was in Kelo. I had just finished doing all the dressing changes on patients, starting a urinary catheter on a lady with a vagina fistula who'd pulled her last one out during the night, and doing rounds with the head nurse Jacob, when the chaos began.

We called Samedi (the janitor turned surgeon) in for a hernia on an old Arab lady. He approached me on the floor and asked if I could assist. I told him I could, but the other nurse would be leaving at 1:00PM so I needed to be back on the floor before that. So in we went. Hans was circulating and giving IV meds, I did the spinal anesthesia, scrubbed and soon we had one patient done. With another lined up, a Dilation and Curettage (D & C), on a mother who had her baby 1 month ago and had been bleeding ever since. After doing the spinal on her, we found that her uterus was full of fluid. Samedi called an end to this D & C and said we'd have to wait for a Doctor. By this time sweat had soaked all of our scrubs. It was running from under our hats and down into our eyes and filling our mouths with its salty taste. We thought we were done, but that's when a nurse popped his head in the door and told us he thought there was a possible C-section sitting outside. A quick examination showed almost 48 hours of labor and presentation of the baby mouth first, yep she was headed into the OR. In between starting a catheter on her along with antibiotics a little boy arrived who a week ago had an operation performed on him to remove a urinary calculi (stone) and now he lay here on the stretcher pee squirting out of his incision right above his pelvis bone. I started a catheter on him. We were all out of pediatric urinary catheters so I had to use a 12fr on him. We then transferred him to a mat outside to wait until after the C-section for further evaluation.

We were running low on help, so Kev came in to take the baby. I did the 3rd spinal for the day (thanks to the teaching of Dr. Bond) and soon we had out the baby with the biggest head and lips I'd ever seen. After having his head compressed on the pelvic bone for such a long time his whole head had become edematous. I did a quick suction, Samedi cut the cord and I handed him to Kev. Shouting out instruction's for resuscitation. Kev was doing compressions with the help of Hans bagging and suctioning, but still no cry. I un-scrubbed and joined in the efforts. Soon he took a gasping breath and a faint heart rate could be heard. I began suctioning with the mouth suction piece removing a couple ml. of phlegm from his throat. After about 10 minutes we finally had a cry. I re-scrubbed and rejoined Samedi who had already sewed up the uterus. I finished by sewing up the skin and soon we had her transferred to the floor. Yes to the floor, it was 3:00 PM time for change of shift and the nurse who had been working with me had left early and left all the 1:00 PM meds un-done. Frustration central. I finally headed home with Kev at 4:00 PM and upon arrival at my courtyard collapsed on one of the mats. We lay there talking about Africa, its frustration's and its beauty and starring up at the vast clear blue sky above us.

That evening found us at the hospital house singing to bring in the Sabbath. We headed to bed at 9:00 PM laying our grass mats once again out on the sand. At 3:00 AM pounding awoke me on the locked tin door of our courtyard and to the question, "Is Liz here". It was the guard from the hospital. The nurse at the hospital wanted me to come, there was a four year old boy with urinary retention and he was at a lost of what to do. I donned by scrubs and walked down the dark path to the hospital. Half-way there I could here the scream's of the little boy. A urinary stone had made it's way all the way to the tip of his penis where it was stuck. I tired pushing it out with tweezers, and pushing it back in hoping to be able to relieve his urinary retention with a Pediatric Naso-gastric tube (the smallest size of urinary catheters left was 18fr). Nothing budged. I worked for about a half an hour with him and that's when a very large momma arrived in labor, making for two momma's in labor. I joined the night nurse in the delivery room just as baby #1 made its entrance into the world. He wasn't breathing so I began resuscitation as the other nurse changed gloves and delivered the next baby whose head was already cresting. Finally the baby I was working on let out a loud cry as baby #2 also let out a cry to let the world know she'd arrived. Two new lives squawked out their protest as we stood on the cement floor covered in fluid and blood. Now back to the little boy!

I was looking over books on anatomy in James office trying to see if the urethra narrows and if it was possible for the stone to come out, when a sleepy Kev arrived at the hospital. We agreed that if it had made it that far it had to be able to come out the rest of the way. After another ½ hour of screaming and kicking I sent the guard to get Samedi. Samedi arrived we immediately gave an IM dose of Ketamine and he began to work with the tweezers. Soon a little piece of the stone broke off allowing us to pull it out with a sigh of relief. I inserted the pediatric NG tube into his bladder and taped it to his leg since there's no balloon to blow up in the bladder.

Kev and I walked back to the hospital house it was an early 5:00 AM Sabbath morning. The sky was beginning to brighten as we fell asleep on cots at the hospital house.

Two days left of work here at Béré Adventist hospital, is it possible? Is it possible that next week I will be sitting down on a plane next to Kev, and then set foot on American soil, hug my parents, eat homemade tamales, sleep in a bed with lots of blankets, and to talk to my sister till late in the night. But as these next days go by I ask that you will remember the hospital in prayer. Satan has quite a battle-field set up here. Without a doctor and a hospital administrator he even takes more advantage of those who come here for help. Pray for wisdom; pray that we will remember to depend on Him, the great physician, and not ourselves.