Wednesday, February 26, 2014

Christmas reflections . . . in February

The following three vignettes were written throughout the recent holiday season. I share them now while taking a deep breath before the next plunge. My family and I are so grateful to be here in Africa. Thank you for your care, support and encouragement!

December Madness

December was a challenging month here at our Mission Hospital. While we were trying to get into the holiday spirit with Christmas trees (thank you prelit Home Depot tree that traveled well-second year in use and still going strong), twinkle lights, and a crèche made from a gourd, we encountered some difficulties up the hill. First and foremost, December is our July in Kenya. For all of you American docs out there, you know what this means: new interns. But this year we had some added stress: most of the doctors and nurses in Kenya went on strike. There were a few hospitals that remained open, and we were one of them. What this meant was that our patient volume and acuity sky rocketed. At one time on Maternity, we had over 130 patients registered. They came on foot. They came on piki-pikis. They came on matatus. And they just kept coming. There were women laboring in the halls, and often two or three women sharing a bed.  One morning I looked up and saw one of our nurse midwives, Evasha, standing in front of a woman he had just delivered. Another was about to deliver. He was covered in sweat, his hat and his mask were askew, more patients were coming in—they needed a place to deliver. All of the sudden, amidst the chaos, he stopped, threw back his head, and shouted: “His grace is sufficient! “

We stood in stunned silence, and then broke out cheering. Because--

--it was. Through all of the admissions, sick patients, normal and abnormal deliveries, emergency surgeries and late nights that turned into early mornings, His grace WAS sufficient—for us, and for these precious women whom we serve.

The Broken Ultrasound
In the thick of the strike, we lost all ultrasound capability. We are very dependent on our little ultrasound. We do not have continuous fetal monitoring, and we often do not have paper for the monitors that do work. Our one doppler was broken. Fetoscopes do work, but not to diagnose things like placenta previas or ectopic pregnancies. And yet His grace was sufficient in the midst of broken technology too. One of our visiting Obstetricians was on call the weekend the ultrasound went belly up. She had a patient who was bleeding, but the etiology was unclear. As she turned to look at the useless machine in the corner, a verse came to her: In all things, at all times, having everything that you need . . . (2 Corinthians 9:8).

In her own words: "It is a promise: I have everything I need tonight."

She got the ultrasound probe out and tried to turn on the machine—it flickered on, and she was able to see that the patient had a placenta previa. The machine then went off: AND IT NEVER FUNCTIONED AGAIN.

And the promise given to her covered us for the weeks we did not have ultrasound capability. Unbeknownst to us, an Obstetrician from America had felt that he should raise money for an ultrasound for Tenwek OB.  Now ultrasounds are extremely expensive, but when the call went out that our service was without an ultrasound, he was ready to purchase it, and with the help of folks from across the U.S. and here in Kenya, it is being brought out to us this month.

A Christmas Carol

Christmas caroling will never again be the same for me…

She was an HIV positive mom with a history of two previous cesarean scars who came in in labor. She went for cesarean in the morning, and the docs who performed the surgery reported that all had gone well.  My senior Medical Officer came to me after the patient went to recovery—he had been called because she was slightly hypotensive in the recovery room. Her urine output was still good, and she had responded to a fluid bolus. Her exam was initially normal, but she did not maintain her BP—and it dropped again despite fluid. We rushed her to theatre—and it took everyone, from anesthesia, to our nurses in recovery, to our staff in Maternity to get her to the table. She was becoming unstable rapidly. I opened her incision, expecting a huge gush of blood. Dry—no blood in the abdomen. What I did find was the BIGGEST HEMATOMA I HAVE EVER SEEN dissecting back into the retroperitoneum. The word from our lab came: NO blood. She was crashing. I asked my general surgical colleague to scrub in and we started to perform a hysterectomy. Still no blood. We thought she was going into something called DIC—where the patient is so overwhelmed by blood loss that their ability to clot is lost—and if not turned around rapidly, they bleed to death. At that moment, while we were working, we were praying, and sent the word out: we need A negative blood. My surgical colleague is A negative. He left the table and came back in with his own blood in a bag. Unit number one went in while he rescrubbed. Then something amazing happened: the word had gone throughout the missionary staff about our patient. Now it was evening, and the other missionaries were assembling for our annual caroling at the hospital. Before they caroled, all of our A negative folks donated blood. 30 minutes later, our patient had stabilized. As I took a deep breath, I looked up and saw a normal BP flashing on the anesthesia monitor. Freshly donated blood was being transfused.

 And just then, I heard them. Christmas carols were being sung throughout Maternity, by the very ones who had given their own blood so our patient could live.

Silent Night, Holy Night, All is calm, all is bright . . .

Strikes, broken equipment, a patient very near death. His grace was and still is sufficient. His strength is made perfect in our weakness. He provides what we need. A different kind of Christmas? Yes. But one I shall never forget.

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