Generally speaking, we all start our days the same. We all wake up and hopefully get out of bed. And every night ends the same. We lay in bed and hopefully fall asleep. It is what is in the interim that makes life interesting. I never know what my day will hold. Today was an easy day. I went and saw the seven patients on the ward and then only had 5 patients in clinic. Not every day is like today.
Three weeks ago Mark was in Addis Ababa picking up a physician friend from Michigan who would be working with us for a short time. The day before Mark’s departure we had a woman come in who was in labor with her second child. When I examined her, I could feel two very small feet. An ultrasound showed the baby was no longer living. Her previous labor had lasted 5 days and left her with a stillborn baby. A section of her urethra was missing from the damage of the birth, causing her urine to leak freely down her legs. The tissue in her vagina was also scarred, and was now causing this baby to be stuck. Mark and I had to do what is called a “destructive delivery”. Before I came here, I hoped and prayed that I would never have to do this procedure. I hope I never have to again. The best part of this woman’s story is that she had never heard of the Hamlin Fistula Hospital, and we were able to direct her to them for a hopeful cure.
The next day I saw a mother of ten who appeared to be 40 weeks pregnant. She had a mass in her abdomen. I opened her in hopes that her tumor would be operable, but it wasn’t. Every organ in the abdomen was involved, so I stretched her skin back over the mass and sewed her up. Then I had to tell her husband and her daughter that our fears were confirmed. She had cancer and there was nothing that we could do. She stayed in the hospital for two days, where we shared with her the love of Christ. On the second day after surgery, we sent her home to be with her earthly family.
The next patient who came in was a pregnant mother of three. She came in because of extensive swelling. Anything below her belly button that you pressed left a finger print. After doing an exam and some labs, I had a diagnosis of renal failure, but didn’t know the cause. For those of you that know anything about the kidneys, her creatinine was 9.3 and her potassium was 7.1. For those who don’t know, this is BADNESS! Normally, she would be immediately put on dialysis, but we don’t have that. I tried lasix (to help her pee off the fluid) and steroids, but they didn’t help. In 36 hours she peed 3.5 ounces. I had been told that there was no dialysis in the country and the closest place was Nairobi, Kenya. Someone else said that a nephrologist had just started at the government hospital in Addis. So I got online and tried to find out. There is no such thing as a phone book in Ethiopia. You get numbers only by asking people for numbers. There was no available number for the hospital or for the nephrologist, but I did read about the dialysis machine they had. So the next morning, we packed her up and sent her on the road to Tikur Ambasa Hospital. I got a phone call a few days later from one of the residents there. He said they didn’t have a dialysis machine but she had begun to urinate. A few days later, he again contacted me to let me know she and her unborn baby were stable and would be going home. I don’t know if she was really stable or if there was nothing else that could be done for her.
Tamrat also came in while Mark was gone. His dad called telling me that at one point in the day, they thought that he was dead. After that, he continued to turn blue and have seizures off and on. I told them to come in. So they jumped on a motorcycle and came in through the rain. He was in poor shape when I saw him, and I thought we might lose him. God wasn’t ready to call him home yet. He was in the hospital for about 3-4 days and did well on a higher dose of seizure medications.
Earlier in the week, I had seen a woman who looked like she had a football between her legs because her female organs had fallen out after birthing her five children. I planned to take out her uterus and suspend the remaining female parts in her pelvis. When I met her, I was just stunned by her beauty. She was tall and slender. She stood with her shoulders back. Her skin was a rich chocolate. Her large eyes were captivating. Since I had been on call for 5 days straight, I decided to take the next day off and have Mark do her surgery. Her surgery went fine. Because of bleeding, they had to open her abdomen. This sometimes happens with surgeries, and it is the safest and best thing to do. Mark called in a visiting vascular surgeon to assist on the case. They didn’t find any bleeding, so they finished the case. That evening, we were sitting outside enjoying dinner when her vital signs started to change. Not one person decided to call Mark or me to let us know that she was in trouble. Then two hours later, she died. Still no one called. It wasn’t until the next morning during rounds that Mark was informed of the patient’s passing. By then, her family had been sent home with her body. We had no chance to speak with the family or give our condolences. Mark had practiced for 25 years in the US and never lost a patient. This loss was especially hard on him. It was a reminder to both of us that there is so little we can successfully do as physicians without good supporting staff.
The next week a five year old orphan was admitted for malnutrition. Her mother had died, and the family just stopped feeding her. She literally starved to death. So I spent the next two days reading about how to take care of malnourished children, and writing a policy for the hospital.
Almost everyday I work with couples that come to me with infertility problems. When I suggest adoption, they laugh. This option is NOT in any way considered. I do not understand it. Please pray about how we can approach the church leaders and educate the people of Ethiopia on adopting their own children, not outcasting the single mother, the sanctity of life… My heart is breaking for the almost 6 million orphans in this country.
This last week was a filled with premature babies, which means I get to play neonatologist. I was so glad to have the help of Sophie and two of her visiting friends, Jenn and Elen. We delivered five premies. Our three smallest babies weighed in at 2.4, 2.8 and 3.7 pounds at birth. None of them could suck, and none of them have names. I turned one of the labor rooms into a neonatal ICU because we only had 2 functioning heaters in the hospital. Two little ones were almost always in the nonfunctioning incubator to help keep them warm. The third was a little girl. When she was born the little boy was in the incubator and grandma was holding the other little girl. I had some fun with the grandma and nurses, pretending to be the babies. Here is the shortened version, but in English instead of broken Amharic…
Baby Boy- Hello! How are you? (Typical Ethiopian Greeting)
Little Baby Girl- Praise God I am good. And you? (typical response)
We were all roaring. Not sure if they were laughing at me or with me, but I realized how wonderful it felt to laugh.
The little boy was the one that scared me the most. He was delivered at about 28 weeks, which is the earliest babies can make it here. He amazed me because he never needed oxygen. When he was a day old he started having seizures, but medications helped control them. He was having a hard time keeping up his temperature, which can be a sign of infection, so antibiotics were started. His mother had been distant, only coming in the room a few times and only staying for a few minutes. I separated the babies because the others were getting too hot and he was too cold. I had mom move into his room, and asked her to hold him next to her skin. As long as he was held like a kangaroo, he stayed warm. The next morning when I came in, the mom had gotten hot so she turned off the heater, set the baby in the bed, and opened the doors to cool the room. The baby became hypothermic (thirty three degrees celsius). I was so mad. I told her that the baby could die if we didn’t keep him warm, and asked her to go to another room if she was too hot. Later that afternoon he had a big “event”. I am not sure if he seized or just stopped breathing, but I knew that if he recovered, he would never be normal. I have never wanted to take back something I said to a patient so badly in my life. About four hours later he was in the warmth of Jesus’ arms.
The two big premies have gone home and the other two littles are still in the hospital, but seem to be doing well. The little ones are 4 and 6 days old, so maybe they will get names soon.
Tonight, I get in bed and hope to sleep like I do most nights. It is the interim I must daily give to Him Who does not have one.