Monday, May 30, 2011

When a C-section is really needed...

May 10-

Saturday we went to the Tengeru Cultural Tourist Centre. It was an incredibly cool place. They showed us their Biogas production- using cow manure to create methane gas and fertilizer.

We then went on an 8k hike through the Mt. Meru forest. The exciting journey down to the waterfall was so much fun. It made me want to visit Algonquin more at home. It was challenging, but I kept up with the guide (thanks to my Vibrams!)

That night we returned to a surprise cake for Steph! It was her 21st birthday. We went out for dinner at an outdoor place where you could order from many resturants. Innocent and Emmanuel joined us.

Sunday was a Lala Day. I DID MY OWN LAUNDRY!! May I add, by hand. We made a delicious meal of homemade tomato sauce and apple-pineapple crumble with custard for dessert.

Monday was a quiet day at the hospital and home.

However, today made up for the quiet day. Anyone who knows me, knows my frustration with c-sections and the insanely high rate at which they are used in the Western world. Today, I got to see patients who truly needed "emergency" c-sections.

1. Eclampsia

The mama was an 18 year old patient brought in by wheelchair barely conscious. She had been complaining of headaches. Her feet were edematous. And then she began fitting (seizing).

The theatre was already VERY busy (at least 10 c-sections scheduled). This woman was in desperate need of one. She had to wait until it was free. She received 20 units of magnesium sulfate and a Ringer's Lactate drip. We took her BP once with an inaccurate cuff (145/110), and the monitoring was limited until she went to the OR.

At home, I probably would have stepped back. FROZEN. Here, it is almost like it isn't real, meaning I don't need to be scared. I jumped in to do her blood pressure, held her during a fit. It was just part of the day.

2. Obstructed Labour

I will cry later about this. It was deeply disturbing in so many ways. I will think about her tonight. I will focus my energy on her.

She was 14. Literally a child. She appeared to be the same as the other mamas. Full, round, bulging belly topped by breasts ready to nourish a child. And then you saw her face. Her shaved black hair topped a child's face. Her bravery was not thick enough to hide her need for her own Mama. Never should a child lay in a bed with a dead fetus wedged in their vagina.

You could see the thick tufts of hair belonging this girl's unborn child; resting within her painfully swollen labia. Her body appeared tragically inadequate when viewed from this angle, compared to her full breasts and belly. Her baby had died during the 36 hours of ineffective labour. Perhaps a blessing, but most likely a curse.

This poor little mama will probably never bear any more children after the current body is removed. Either infection or a urethral/recto-vaginal fistula will leave her as a useless piece of her community. I'm not actually able to allow myself to comprehend the pain and tradegy. All I know is that this poor, sweet girl is not coming to the end of her nightmare anytime soon.

3. Malposition

A labour not progressing due to the fetus in a transverse position.

4. 2 Previous C-sections

... many more were awaiting scheduled c-sections for that day.

I delivered a baby on my own today. I learned a very important lesson- be very careful with the cord! I broke one while trying to remove the placenta. Whoops.

Sister Shao- being every so kind and helpful, just dug up to find the remainder of the cord and instructed me to mix 40 units of oxytocin in 500ml of ringer's. I hung it and waited for my next step. The oxytocin induced strong contractions that helped the placenta come out easily. I was grateful she didn't become angry. I know I am more confident now because of it.

She calls me Emmi. I really like it- I don't find it weird. I can tell she's taken a liking to me. She will be a woman I will remember many years from now. Especially when I teach someone else. Her patience is inspiring.

I also met a friend of the girls'who was a combo of the entire Foster family. Mark, Jane, Mike, Sammy and Jay. No joke, one British girl named Kat was them all. It freaked me out.

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