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#84 Shanksteps
Breathing hard I arrived to Maternity.  A woman lay on the delivery table with her eyes closed.  Blood was all over her wrap skirt and up her back.  Her abdomen looked pregnant beneath the flower print with blood all over it.  Her palms and feet were white for her black skin.  The maternity nurse was placing an IV.  He said her blood pressure was 60 and he couldn’t find a pulse but that her heart sounded fast.  Her family said she was 10 months pregnant.  I did an ultrasound and found the baby’s
head was down and that her placenta was blocking the exit. (placenta previa)
We told her husband we needed to do an emergent surgery and that she also needed blood right away.  The lab technician came and drew her blood and did the blood type.    The husband stood in the corner looking squeamish.    After much persuasion and harassment he finally had his blood checked.  Should I give blood or hope they find someone willing?  A neighbor gave blood and after getting the oxygen machine, giving her ketamine and placing a urine catheter, we started.
The tissues were pale.  The small vessels we cut oozed a liquid that appeared like blood and water mixed together.  I was careful to have as little blood loss as possible.  The little boy came out flaccid and blue.  His heart was going slowly and he did not breath.  I broke sterility (meaning I left the operation temporarily and help with resuscitation of the boy.  He started taking intermittent breaths.  One of the nurses continued bagging him as I reentered the surgery.  Mom did not loose too much
blood.
After finishing the surgery I again continued bagging the child.  The baby was still blue and now was not taking breaths like before.  We put the saturation machine on the baby now that mom was done and it was 5% (normal is >95%) With me bagging it climbed temporarily then plummeted.  We worked on him about 1.5 hours in all.  He died as we bagged.
The father and family live very far away and asked if they could bury the child behind the maternity ward since they could not make it home.  Out back he dug a hole and buried his son.
Many children are lost in childbirth.  And many complications occur from childbirth.  I saw another woman today who had been pregnant 7 times.  The first two each died at about one year of age from disease.  The third was delivered prematurely at 4 months gestation, the fourth is living, the 5th and 6th were twins and died 3 days after birth.  And the seventh died at 6 months of age from disease.  She now has been 5 years without another pregnancy and wondering what she can do.  She has obtained
a sexually transmitted disease, like from an unfaithful husband.  So I’m praying that after I treat her STD that she may get pregnant again.  I say we see about one or two a week that have infertility from infections.  With polygamy and promiscuity, even outside polygamous families, there are many with STD’s.
It was a long day.  Had 12 hours straight in the hospital today.  Am thankful to be home.  Just wish it could be with my family.  Please keep my mother-in-law in your prayers as she is facing end of life very soon.  Also for my wife who is taking care of her.  Thank you all for your love, prayers, and various forms of support.  In His Service, Greg

Shanksteps #83The baby was convulsing.  Her head was arched back towards her toes.  Toes were curled backwards.  The arms were beating a rhythm that could be confused with the drums outside.  Sweat beads formed on her tiny forehead.  And breaths came with long pauses.  Urine flowed all over her mother as she cradled her on her lap.  The nurse was trying to get an IV in the child’s flat rolling veins.  The child’s hair was very short and was straight with a reddish color (malnourished).  Finally the rhythmic beatingof the arms subsided.  As I tried to bend the neck forward it lifted the whole torso into the air.  A lumbar puncture to get spinal fluid was in order.  I prepped the back with betadine, dawned my sterile gloves and swatted at a fly landing in my sterile area.  It was persistent but so was I and finally he left me alone.  With Gods help I was able to get right in and withdrew a very cloudy spinal fluid. (Normally this fluid is clear like water)  I explained to the family the child’s need for IV antibioticsfor a few days then oral antibiotics for a couple weeks.  They were concerned about the price but knew that meningitis (infection around the brain) often kills children.  So we started treatment.A couple hours later I return to the ward and find the child laying flatter but with rhythmic beating of her hands.  I give an anticonvulsant and wait about 10 minutes.  Her brain is still irritated so it takes a second and third dosing.  It stops then returns in the morning before rounds.  After that the IV comes out and the nurses are unable to find another vein that is accessible and they give the medications intramuscular.Today she is starting to swallow milk dripped into her mouth.  And the day nurse was able to get an IV in so the medications are IV again.We are hoping that this year is not as bad for the population.  The first year we were here we vaccinated about 300 people.  The second year about 400.  There are 50 doses in each vial of vaccine.  So the people interested in being vaccinated get a list together, and when there are around 50 people a nurse goes out and vaccinates them.  They are charged 350 francs, about 75cents.  But even with that many don’t want to do it.  Others don’t do it because the local thinking is that meningitis is dueto something magic.  So what they really need to do is when they get meningitis is to get the witch doctor to do some sacrifices (chicken, sheep, goat or combination) and some other things to heal the person.  Also as we discussed before in emails, there is a “devils heaven” where people could go and sell the life of another to buy the life of their loved one with meningitis.  So between these ideas, cost of medications, and slowness of recovery (in general) it combines to make a difficult thingto convince parents to treat their children.  So many die at home without coming to the hospital or they go to a local dispensary that treats them poorly with an equally poor result.  We already have enough vaccine for 500 people this year, and hope that we will be able to use even more.In His Service, Greg