Thursday, March 18, 2010

Let's just recount this day, shall we?

Wake up call at 6:30 am because the mother of one of our new malnourished boys was in labor and almost ready to push. I am lucky, since Dr. Michael is an OB doc and Sara is the queen of deliveries, they went down instead of me. That's nice, since mornings are one of the only times of quiet in the day. I go down at 8 for morning rounds. The baby is born a half hour later after only a few pushes.

Meanwhile, we see that one of our little girls, Shinaika, who has been in the hospital for two weeks already is starting to take a turn for the worst. She has major lower body and abdominal edema that is making it hard for her to breath. We were beginning to suspect the key issue was heart failure as it has been hard to distinguish a diagnosis without any tests. She hasn't slept well any night she's been here because of pain and difficulty breathing. But this morning she definitely had a gaunt look to her face that was making us all a little nervous.

Meanwhile, the family of the newly born baby wants to go home, meaning they are taking our boy, Djino, the malnourished boy (the actual patient) home too. He is five years old, weighs 24 pounds, and one of the most severely malnourished kids I've seen ever. He has an open pressure sore that covers his whole right buttock. He is suffering, can barely find enough strength to lift his body to a sitting position. You know a kid is suffering when they cry out to God when you change his bandages, ugg. He's only been here for two days and now that the new baby is born the family wants to go home. There is no doubt in my mind he will die at home, but this decision from the family is so difficult to swallow as it seems like Djino is of little priority now. Hard to take to say the least...

Next, on to the clinic where we get back-to-back babies who are having feeding issues. One, five days old, with a completely open cleft palate and lip. He can't suck in order to breastfeed so I try to pump mom's milk in order to spoon feed the baby, but after much conversation with the family, they "can't" stay in the hospital in order for us to follow the baby. So, away they go with a can of milk and a spoon for baby. Next we see a three month old girl with an obvious congenital disorder who is maybe 3 pounds if we are generous. It's almost shocking to see how thin her arms are. I think she is actually smaller than a peanut. She's not coordinated enough to breastfeed well, so mom's milk is gone. They however, agree to stay! So we will be able to give her milk and follow her weight.

Meanwhile, we hear our heart failure girl is not doing well. The family thinks she is going to die, so they want to take her home. Esther and I run over to the hospital to try and reason with the family that we are starting new meds to help her heart. Then the most brilliant thing came to mind. We run to go find, Dr. Lary, a retired doc from Seattle who has just arrived in Passe Catabois today as a part of a team working with Bruce! He has pediatric and cardiac experience (imagine the perfection of that coincidence). We finally track him down and he is so glad to come assess our girl. He walks into the room crammed with family and random on-lookers and it falls completely silent. This man works in silence for a full five minutes, listening, palpating, listening again...I mean...you could hear a pin drop. He finally steps aside and says: "She has mitral valve insufficiency. She's in heart failure. Let's put her on a big dose of lasix, some dig, and an ace-inhibitor. It will work for this, this, and this reason." That right there was our little ray of sunshine in this storm of a day. Who needs diagnostic tests when Dr. Lary is here? And so we did just that and now we continue to wait on our girl, the meds and the patience of the family.

Meanwhile, (back to our day) I learn that our other new malnourished girl has gone home, without any consulting with us. Apparently the grandma came and saw she was not better after two days with us and took her home. All you can do is sigh at this point and say, ok...and try not to take it as a slap in the face. I have to remember we are here for the people, not to force them to do anything. They can take or leave what we offer them I guess.

Meanwhile (yes again), back at the clinic, where another woman has been laboring since the morning, is having trouble with the delivery. Her abdomen was such a weird shape that Sara and Michael thought that it may be breech, or even twins. But all in all, after a little vacuum action and an explosion of pus, the baby was born ok. Now that's the way to end the day! OH did I mention our water has been turned off all day?

The work eased up around 4 and we were able to have small break. We were able to go the the bakery and drink something cold and sit for a few minutes. It was nice, until we heard the 10 day old baby we saw yesterday was back with diarrhea. yes.... it never fails, there's always something calling the moment you sit down!