There are many things in life that cannot be conveyed in words, but I will do my best. Saturday, I was hoping to give Dr. Mark Karnes a “day off.” I could be first call and see the patients and he could get a call on updates, but since I still do not have license I cannot do surgery without him or care of patients outside of his supervision. We were in the process of inducing a patient that is a friend and physician at the hospital here, so he wanted to participate in that part of the day. The patient was quite complicated. She had severe preeclampsia and we were using a medication that is not available in Ethiopia to prevent seizures. The medication can be dangerous and the nurses are unfamiliar with it, so I spent most of my day sitting by her bed counting the two IV drips she had going. We don’t have any IV pumps, so you have to count how many drips go in in a minute to know how much medicine the patient is getting.
As soon as I finished seeing the patients in the ward, I was called concerning a patient that had been referred from the government hospital, a woman with twins…the first one breech. When I got her chart there was a note in it from the government hospital saying that there anesthesia equipment was broken (they only have one machine and have been using it the last 19 years). She is HIV positive and her body is wasting away. She has only been on HIV treatment for about 2 months. She needed a c-section so the ringing of Dr. Mark’s phone began. Dr. Mark and one of the general surgery residents did her surgery and two beautiful boys were born. She has two kids at home and these babies will be number 3 and 4. I am not sure if her emaciated body with many sores will be able to provide the milk these babies need or how much longer she will survive.
Then, I got our second referral from the government hospital. A laboring mother with fevers. I placed her on IV antibiotics and watched to see if she would make cervical changes. She had been in “labor” for about 12 hours with no cervical change, but wasn’t contracting very often and the baby looked good. As I was planning her care, Mark informed me we had a woman with a ruptured uterus had just been admitted to the ICU. I will let Mark tell the story, as I wasn’t there.
This was her fifth pregnancy. She had one 7 year old girl and the rest had died. She was acutely ill having travelled over 150 kilometers to get to Soddo. Her dead baby was coming “face first,” and she could not deliver it. Her abdomen was rock hard, filled with blood and her breathing was shallow and rapid. She asked me, “Can you save my life?” I told her there is only one Savior, Jesus Christ. After praying for her we got her ready to go to the OR. As she lay on the operating table, I held her hand and our eyes locked upon each other. As the nurse anesthetist was putting her to sleep, she started vomiting and I could see bile in the endotracheal tube. I yelled, “Suction her!” The anesthetist could not ventilate her lungs and she died right before our eyes. Just a few short minutes before we had been looking at each other. Now she was gone. She had told me earlier, “I came here for you to save me.
The patient with the high fever had initially made progress and then stalled and the baby was no longer tolerating labor, so we decided to do a vaginal bypass. Mark and the resident delivered a live, big baby girl. While they were still in the operating room Mark received news that another mother had arrived with a ruptured uterus. She had been to three hospitals before arriving here, but they all referred her on because they were unable to do surgeries. This was her fourth pregnancy and she was pregnant with twins. She had delivered one baby the day before (it was afternoon now). She could not deliver the second twin and in the process had ruptured her uterus. Her bare feet were caked in mud, amniotic fluid and blood from squatting on her dirt floor trying to deliver her babies at home. Her blood count was extremely low (the next morning after 3 units of blood her hemoglobin was 5.9) and she was working on dying. She desperately needed blood and surgery to survive. Mark brought her to the OR and I peeked in to see if they needed any assistance. A stillborn boy was sitting in the trash can by the operating table. They said all was under control, so I returned to our friend. A few minutes later the electricity went out and it was dark, so all I could think was I hope the bleeding is still under control. In the hospital we have a generator that kicks on after 90 seconds, but in surgery, in the dark, 90 seconds feels like a lifetime in a critical situation.
The highlight of the day was the delivery of our friend’s tiny baby boy, Ephraim. I was so impressed with her. I have never seen a laboring mom do so well. If the contraction was strong, when it was over she would say, “Oh, this is good. He is coming.” If it was short or not strong she was disappointed because it probably didn’t do much.
Shortly after her delivery we had a women come in who didn’t know how far along she was but was having heavy vaginal bleeding. We did an ultrasound and the baby wass only 32 weeks, but she had to be delivered. Since Mark and I are not only the obstetrician/gynecologists, but also the pediatricians Mark did the surgery and I took care of a little baby boy that was just under 4 pounds. Initially, he did well, but was having a hard time keeping oxygenated if he wasn’t warm. We have one incubator that does not work and heaters like you would use in your house to keep the baby warm. I sat in the ICU and held the baby on my chest with a heater at my side. As long as he was warm he kept up his oxygenation. A sister of the patient volunteered to stay on the couch by the heater with the baby. I went home and read to see what I needed to do to help this baby. When I got back to the ICU the one nurse that was in charge of the ten to fourteen ICU patients was sleeping on the one empty bed. I gave my orders, made my displeasure with his sleeping known and hesitantly returned home.
I slept for about fours hours. Another day had started. I went to the ICU first to see our patients. I found the little baby next to the mom and blue. I immediately grabbed him and put him on my chest and went to the heater. It was no longer working. The only oxygen in the ICU was being used by other patients. I then ran with him to OB because I knew we had another heater there. I ripped of my shirt and held him against my skin while the nurses went to find the heater and oxygen. He was slowly improving, but then stopped breathing. I did mouth to mouth on him until we had a bag and oxygen, but by that time he didn’t need it.
We then began to set up our own little neonatal ICU. I had a non-functioning incubator, a heater and an oxygen tank that only worked sometimes. I had to write out a prescription for the family to get and IV, IV
fluids antibiotics and medicine to help the baby to remember to breath. As the family was getting those things he started seizing. They returned from the pharmacy empty handed because they couldn’t afford the $4.50. I went to the pharmacy and told them to start a tab for me. I was not going to let $4.50 be the deciding factor for this baby. I now needed seizure meds, but the only seizure medications here are pills.
The baby doesn’t suck well, so I also had to get a tube to put down his nose into his stomach to deliver the crushed pills (1/8 of a pill) dissolved in water. Sophie, an expatriate nurse that works in a nearby village, was spending the day with me in the hospital. We spent the next 25 hours by this babies bedside caring for him. Neither of us felt comfortable leaving the baby with the nurses because he had stopped breathing about 5 times and we have no alarms to notify you. You just have to watch. Every time I have gone to the ward at night the nurses are sleeping on the couch or beds. Sophie stayed up all night and worked with one of the nurses to teach her everything on the baby and I slept off and on, but was available for emergencies. We also had another delivery last night.
This morning I had a fabulous nurse, so I felt I could leave her with baby to go to surgery. Mark and I removed a volleyball sized ovary from a woman that was filled with hair and teeth (dermoid), then we did a hysterectomy on a woman with a molar pregnancy and then the plastic surgeon and I removed a squamous cell carcinoma from a woman’s vulva (we removed the outside of the vagina near the urethra to the anus and the lower 1/3 of the vagina) and then took skin from her leg and swung it around to cover the hole.
I just got home and my mind won’t stop, so I am writing. I realized that I offered to donate blood to one of the patients and haven’t had a chance to (she got blood I just haven’t replaced it), I have a lecture to put together for Thursday, I haven’t paid the pharmacy bill… the list goes on. They are also appealing my medical license today. This may determine if I get to stay in Ethiopia. Thank you all for your prayers and support!