Making any difference?

March 25, 2008

"I'm dreaming of a white Christmas...just like the ones I used to know..."

Strains of music come from the computer as Liz, Sonya, and I sit watching the classic movie that perhaps makes us feel a bit cooler. As we dream of cold snow while sweat drips down our faces, our rest period is suddenly shattered as one of the Tchadian nurse's face appears at our window. "There is a patient at the hospital that I need the doctor to see."

After already doing four surgeries this morning and doing consultations all afternoon with Dr. Bond, I don't really want to get up and go back to the hospital. "Go tell the doctor yourself. He's just next door."

My hope for peace, though, doesn't last as I hear Dr. Bond's voice booming a few minutes later, "Esther! Esther, come here! We have someone to go see at the hospital." Sighing, I get up, throw a scrub top back on, grab the keys, and head across the compound down the little path to the hospital with him.

As we walk in the consultation door, I immediately feel a little guilty for my unwillingness to come as we find a small Arabic girl lying flat on the exam bed. At closer inspection, she appears to be rigid as a board. Her legs are stretched out with her feet curled and pointed, almost like she's doing ballet. Her arms are both bent up close to her, and nearly impossible to extend. Her neck is stiff in one position and her jaw locked so that she can only talk by moving her lips.

Tetanus.

After telling David to start an IV on her, I follow Dr. Bond into James' office to look up in books what we can give for tetanus of what we have in our limited pharmacy. Amazingly we find some tetanus antitoxin kept cold in the small kerosene fridge that the lab uses. The problem is that it won't work for a couple days and we have to keep her alive until then. She has already spent two weeks at the hospital in Moundou before being referred here. If the tetanus paralyzes her respiratory muscles, we're going to have a hard time keeping her breathing and we will have to bag air into her constantly.

When Dr. Bond decides on her meds, two of them are very strong drugs that she needs very small dosages of, or they will kill her with too much. Instead of turning her over to the nurses who change with every shift, don't look at dosages carefully, and may give it wrong, Dr. Bond tells me to sleep at the American house and come over to the hospital every six hours to give those two medications.

That evening I set out the two syringes I would need with the dosages already in them and set my alarm for midnight. Stretching out, I try to relax and fall asleep in the heat...

10:30 PM, I've barely fallen asleep as suddenly I hear David in my confused slumber, calling me at the window next to my bed. "There is a woman who came having trouble giving birth."

"Dr. Bond isn't here, he's next door," I answer, knowing, though, that I will probably still have to get up and help.

Sure enough, a little bit later after hearing Dr. Bond go over to the hospital to check her out, I hear him come over to my side and call, "Esther, we need to do a c-section. I called Abel and Simeon to come help so come over when you hear the generator come on."

I get up and change back into scrubs and then try to keep myself awake as I wait for the loud rumble signaling we have power to do a surgery. A whole HOUR later, I finally hear it and grab my OR cap and face mask that we reuse and walk over, still a bit dazed. It is almost midnight, so I quickly give the tetanus girl her meds, one IV and one IM and then walk into the OR. Simeon is preparing the patient with Enoch, a nursing student. Dr. Bond is barking orders and grumbling about Simeon coming so late and Abel not even showing up. "Quick Esther, scrub in!" he commands me. Soon I'm helping him drape the patient with sterile cloths, Simeon is giving anesthesia, and Enoch is getting things ready to resuscitate the baby.

We pray and then Dr. Bond takes the scalpel from me and starts cutting the skin. As I start to hand him clamps, he barks, "No! First we get the baby out, then we worry about the bleeding." He continues cutting quickly through the fat, muscle, and fascia until we are into the abdominal cavity. Quickly I pull the bladder out of the way of his knife and he cuts rapidly through the thick uterus. The baby's head pops out and as he pulls it completely out and clamps the cord, I start suctioning the baby's mouth. Once the cord is cut, we hand the baby over to Enoch and Simeon, and pull the placenta out. As blood splashes everywhere, I understand now why Bond offered for me to wear the rubber boots.

It took under 2 minutes to get the baby out and now we spend half an hour sewing up the uterus, stopping the bleeding, putting a drain in, and finishing up. Now back to bed.

Crawling out of my bed at 6, I stumble back over to the hospital to give the drugs again to the tetanus girl who doesn't look any better yet. The books say that even at the best hospitals, half the cases of tetanus die. What chance do we have at this little bush hospital in Africa? While feeling discouraged, I stop by to see the new mother and baby we delivered. As the little baby's hand clamps over my finger, my frustration dissipates as I am reminded that we are making a difference here at this hospital. Just take it one patient at a time and leave the worries behind.