Thursday, April 7, 2011

I like geckos, just not in my kitchen sink

Yesterday (Wednesday) I finished call. It was a tiring week, with many difficult cases. After completing rounds monday, Joe (the director) complemented me on my work, especially since there were quite a few patients with strange diagnoses admitted while I was on call. It was nice to hear, and helped me to feel better, though I know I still have a lot to learn. After my last post, there were still more difficult cases who came in over the weekend, Monday, and Tuesday. There was an infant born Sunday with Meconium Aspiration Syndrome, which is where the infant has swallowed some of his poop before he is born, and then gets into his lungs, where it causes inflammation. Normally when a kid is born with known meconium in the fluid, we try to suction below the vocal cords to help prevent/reduce the risk of this problem. However, things are not set up for that here. Initially he did well after birth, for about an hour, and then he started having trouble breathing. By the time I got called and arrived, the infant was breathing agonally, about 10 times/minute (50 is normal for an infant). His oxygen concentration was around 27% (normal above 95%), and his heart rate was too slow, at about 90 (normally 120-160). As I and Karen, the med/peds resident, resuscitated the baby, I prayed “Oh Lord, please don’t let this infant die. I can’t take it right now. I can’t handle it if he dies. Please let him live, and be a witness for you.” It may have been a bit of a selfish prayer for my own feelings, but it was also for the infant, the mother, and the family. We resuscitated him for at least an hour as he gradually increased his oxygen concentration to about 50-60%. He was cold when we first started, so after getting the oxygen concentrator going, we had mom hold him skin to skin to warm him while Karen got the incubator ready. By the time we put him in there, he was breathing more regularly though his breaths were still a little shallow. As his temperature normalized he improved more, but still needed quite a bit of oxygen. We took turns during the night checking on him about every hour, because we knew there is not enough nursing staff to pay that much attention to the baby. The family was also involved, making sure that if he pulled the nasal cannula away from his nose, to put it back in right away. That was wonderful to see, because sometimes they distance themselves from an infant if they fear he/she might not live. During one of my checks, I let the papa hold the infant for a few minutes. What a beautiful sight! Taking him gently in his arms, looking the infant over, with such love and care! The next morning he was still alive, with an oxygen saturation as high as 82% at times. As of yesterday, he was continuing to improve, no longer needing the incubator, and breastfeeding well. He still needs a lot of oxygen, but it helped to switch to an adult size nasal cannula to give a little more positive airway pressure (it helps open the lungs a little more). We actually started to wean the oxygen a little because he was up to 92%! Praise the Lord! 
Thank you all for all your prayers and words of encouragement. They have been a blessing to me and truly helped!!! Though I am far away from you in distance, it made me feel close in spirit. 
I want to close this post with a few prayer requests. 
  1. Continued prayer for several very sick patients in the hospital, including the infant mentioned above. There is also a little girl who has had inflammation around the brain for what sounds like three weeks according to the family. She received one dose of antibiotics three weeks ago, then the family went to some traditional healers, and brought her here Tuesday. I’m not sure what her brain function will be if she does recover from the infection, so be praying for that as well. 
  2. Be praying for the tractor to get here from Brazzaville. There are several logistical challenges, including finances for getting the tractor here. It is needed to start one of the generators at the hospital, as all our electricity is either by generator or solar. The current tractor has to be chained to a large truck and drug around the hospital grounds until it starts, and then the generator can be started. 
  3. Praise God for bringing a physical therapist and Physical Medicine and Rehabilitation physician here at the same time! They are working well together to help some of our patients with limb amputations, hemiparesis from strokes, and one child with traumatic brain injury after a tree fell on his head. They may even be able to work with our workshop here to fashion a prosthesis for the boy who had his leg taken off below the knee due to a bad infection! I’m hoping we can learn how to do some of these things so we can continue to help others after they have left

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