This will be a bit of a shorter post, mostly because it's 1am right now and I have to be up in a few hours. However, I still want to give you a few updates from the day, so I'll try to make it worth your while. This is Jason's last day here, and it ended up being a pretty good one with a decent number of interesting cases. We met up with Dr. Wegner to round today after morning report, which was pretty straightforward, and he mentioned right off the bat that there were two women in labor so if anyone wanted to catch a baby they should head over. Kara hasn't done OB yet, so she was more than excited and he took her over. We rounded on some patients and then stopped by to see how she was doing. She had arrived right after the first woman had delivered, and the second was at about 4cm dilated and getting close. Speaking no French or Lingala, and never having delivered a baby before, she was a bit nervous about it and asked if I would stay to help out a bit in case the nurses and midwives just left (which they seemed like they were about to do). I was talking with Dr. Harvey this evening about how in medicine we usually say, "See one. Do one. Teach one." However, in Africa it's "See one. Teach one." And that was pretty much my experience today we joked. I've seen a few deliveries, and helped out with them, but never really delivered a baby by myself. Thankfully this one was pretty straightforward, and the midwife/nurse was still in the room and gave Kara some tips (kind of, in Lingala and very unclear). So I just tried to give her some input along the way from things I had seen in the past and things I knew about OB to make it go more smoothly, things to watch out for with the baby, etc. She did a great job and it went really well. When I first walked in the room the 19 yr old mom was lying on the floor naked, and refusing to get in the bed. We were trying to get her up so we could check how dilated she was, but she wasn't quite having it. This was her 3rd baby as well, and I don't think she seemed to happy about it. We finally got her up in the bed and the midwife came over to check and we realized the baby was crowning. Oh, guess we should push. It's interesting here. They pretty much yell at the moms if they make too much noise or scream at all. The baby came out, cephalic presentation, nice and easy. I was kind of wondering if they planned to clamp and cut the cord, as they were taking their sweet time, so I finally pushed the supplies towards them and signaled for them to clamp it. Then Kara clamped both sides and cut. They placed the baby on the table and Kara started to get the placenta out. I went over to suction out the baby more and they brought the clothes over. Very oversized, extremely fluffy, suffocating looking, clothing. For how hot it is, we don't know how these babies aren't overheating (or maybe they are) with the number of layers they put on them. Kara and I cleaned and dressed the baby, and then carried her over to the mom (baby girl by the way). Mom pretty much shook her head and said no she didn't want to hold her. So Kara and I held her and pretty much were just like, okay then. The moms here don't get too attached to the babies because they aren't sure if they are going to live. They don't name for a bit either. But they also don't realize that skin-skin contact is good, or that you can breastfeed right away, etc. It's a real shock to me the human race has survived. Before modern medicine, the number of babies who died from lack of understanding of things must have been insane. With the number of complications we see in the states that we deal with in deliveries, I guess I'm not surprised so many babies die early on. Anyway, baby girl is doing well, just not being held by mother at all. At least Kara rocked her first delivery and we are telling her she should consider OB as a specialty now. And I guess I lived up in part to "See one. Teach one." (Though I'm really giving myself more credit with the "teach one" part.....really I just gently guided with some English words).
We saw some clinic patients afterwards with Wegner. Mostly patients who were there to follow up for some past procedures and such. One young lad who had an inguinal hernia who was recently treated for malaria, so we were waiting for him to be clear of that before the surgery. Another boy who had cut his biceps tendon with a machete, and initially the other hospital just sutured the arm closed but didn't repair the tendon (they tend to do that here....not much knowledge of laceration repair). So, Dr. Wegner had reopened him up and fixed it. He has decent use of his arm, though not full. We also saw a girl who drank lye and basically destroyed (pun intended) her esophagus. They placed a G-tube and unless someone can come and help create a new esophagus out of her transverse colon or her stomach, she'll have to keep the G-tube in longterm. We also saw our little girl who has TB and did an echo on her. She has some pockets of fluid, which we aren't entirely sure what's up. The X-ray tech just got back but they don't have the chemicals to develop the X-rays, so we are still blind. Our crazy lady from yesterday is still here and still crazy. I don't really know what they are doing with her. Her family members tied her to the bed and have to keep someone sitting on top of her to try to keep her calm. The poor patients in the beds adjacent to her must be annoyed because she just screams constantly. We also had a guy come in who was basically in a coma, who is an alcoholic and sounds like had been drinking a lot and then didn't drink some for a bit. Jason tried the arm drop test to see if he was faking it or really out. What you do is lift their arm over their face and drop it. If they are faking, they catch themselves and prevent their arm from hitting their face. If they are actually in a coma.....hit in the face. Well this guy wasn't faking it. We all laughed because we've only seen people fake it when you do that test.....so it was definitely entertaining (sorry patient).
We were seeing some more clinic patients when we had an emergency case come in. This guy was working for someone in their field, chopping down trees it sounded like. Anyway, he had a big tree branch fall on him, breaking his left radius and ulna, and cutting his face and leg open. I have some nice before and after photos I'll post later. He had some pretty deep lacerations on his face above his eye and on his chin (down to the bone, muscle exposed) as well as one above his right knee, down to the muscle with some damage to the tendon. I gathered supplies and started to work on his face and Jason joined up and started working on the dude's leg. Kara and Stephanie came in and asked us to teach them some of the other type of suturing, so Jason taught them the mattress suture and I showed Kara some inverted deep layer stitching and some tips with stitching up a face. Sephora was also there and I showed her some suturing tips I had learned from the plastic surgeon in the DR as well. Once we finally got him all stitched up (I probably spent too long trying to make the guys scars minimal) Dr. Wegner joined up and we casted the guys arm. Tomorrow the plan is to place rods in the radius and ulna, so that'll be a fun surgery. Looking forward to it.
Anyway, we got him all fixed up and he looks pretty good overall now (except for really fixing his arm yet....stay tuned!). We grabbed lunch about 3pm, which was CROCODILE again, sweeeeeeet. Then we headed back to check with Wegner before going to the CPR class. Remember the Resuscitation Committee meeting I mentioned? Today was the first BLS training course for the nursing staff here. Wegner gave an overview of why it's important and Stephanie and Sephora did a skit of good and bad technique. We then played "Stayin' Alive," 1977 version, for everyone, which they got a kick out of. Then we broke into groups to make sure they knew how to do the modified CPR. Jason and I taught a class with Sephora translating. Our group really got into it, it was pretty awesome to watch. The one guy was singing the song for everyone to keep the right speed. We also got a sweet pic afterwards, so check that out later.
After that I went to the Wegners house for more MANGO and some dinner ensued. Jason joined and we hung out with them for a bit. Then we hopped our bikes and rode to visit with the Harveys for Jason's last night. That was fun and good to spend more time with everyone tonight and get to know them more. We played some card games, worked out our final bills for staying here, and Dr. Harvey read us a cool story about a doctor and his patient (doc from the Mercy Ships whom he met). Jason is all packed up and ready to go, and hopefully things go smoothly tomorrow. We are meeting bright and early to open the container as a group that just arrived so they can unpack the supplies. That's it for now. I'm too tired to keep going, so I'm just gonna call it and I'll give you some more updates later. Thanks as always for reading.
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