Firstly, happy 23rd birthday to my friend Nicole!! Even though this will be very late when I post it, I just wanted to wish you a very public and possibly embarrassing birthday greeting! All the world must know that today we celebrate you!
Anyway, back to things in West Africa.
Tomorrow, our trio heads out for Tamale, our connecting stop! From there, Jean and Bob will move down to Kumasi, then Accra with Ishmael, and I will head over to Damongo with Pastor Abraham! I am excited to see him, and all the kids at Redemption Childrens’ Home, and to see my nurse friends at the Health Assistants Training School (HATS) in Damongo. J But I am also sad to be leaving Pastor Jonah and the community churches (especially the screening of the Bible movie in these places!!), the theater fellas, and all the other friends I’ve made in Saboba. So I tried to make our last day here count!
I spent the morning working in the lab with Isaiah, Tina, and Nelson in the lab, and let them all know I was leaving for Damongo and that I’d be back April 2 to see them all again. By then, I think Nelson will have left for Accra to finish his lab technician training! I will definitely miss big Uncle Nelson and his cool manner. Isaiah and I were doing sputum slides…
Which turned out to be integral information for me in the care of one critical patient in the male ward. He was under respiratory distress, and when I looked at his folder, I remembered his name from the lab form that I saw earlier that morning! Jean asked whether he had a sputum test done, and I was able to answer her yes, and then call up Isaiah to check the book. He confirmed that the sputum test results showed this poor guy had tuberculosis. We were immediately able to transfer him safely to a “quarantine” room and give him the necessary treatment. I felt excited about actually feeling useful around here!
In the childrens’ ward, our little Anufo-speaking toddler was doing much, much better! He was sitting up and not struggling to breathe anymore. His breathe was still slightly raspy, but overall, SO much improved. Thank you Tabitha for all your help, even when you haven’t arrived yet! Additionally, our enlarged spleen patient was doing better as well–although his abdomen was still distended, the family informed us that it was like that even before the snakebite incident that caused this whole thing. Jean believes it is a retroperitoneal bleed (not in the gut cavity), it is not harmful, and that it will be absorbed over time, reducing his belly. Thank the good Lord almighty. I keep having to remind myself that this little boy was supposed to die, and that God saved his life for His own glory. And we praise Him indeed for this miracle. ❤
Rounds finished and it was time for work in the operating room. I do believe Jean is feeling close to normal now, and almost recovered from the typhoid. Things have been looking more routine, and she has been more active, so I thank those of you who have been praying for her healing! It’s good to have her back! Today we did two surgeries!
The one I assisted in (I still get really giddy about this) was an umbilical hernia on a little 7-year old girl. It was getting large enough that it hung down and began to look like an “elephant trunk,” Jean said. The sac was about 4-5 sonometers long (I think sonometers are as long as centimeters… correct me if I’m wrong!). Is this not so fascinating to you? I find it very interesting! Jean knows her way around the body so well. It’s hard for me to pick out where everything is (although my anatomy class and lab at school definitely helped a lot), but Jean flies through everything and knows exactly where to go inside the incision.
The second surgery I requested to assist in (a TWIN c-section!!! And a tubal ligation), but was shot down. Understandable! I really don’t want to mess up a sensitive case anyway! As we were prepping the patient, Solo, Alex, and I guessed what the sexes of the babies would be. Solo guessed two girls, I guessed a boy and a girl, and Alex tried to cheat and make TWO guesses! A boy and a girl, or two boys. The little mischief maker! Well, it didn’t matter because Solo won! He says that now Alex and I owe him a cow. J Yeah… Don’t know what we’re going to do about that one!
Ah, one more thing–Solo was just hilarious in the operating room today. He chose the biggest trousers in the scrubs pile, tucked his shirt into it, and hiked them up to about his pectorals. I was laughing so hard at how dorky he looked, but he seemed to not even notice! When he saw me busting my guts, he looked at me and announced, “I can even UP it more! Like a fat American!” ooooh my gosh. LOVED that one! I even got pictures of him in this get-up so I can show you all later!
Anyway, the delivery was super quick for both babies, and both of them had 10/10 on the scale whose name I still can’t remember. I was SO happy to see such healthy little kids! As much as I love deliveries, I still get very anxious because there’s always a possibility it might not turn out well for the baby or the mama or both. Mama Stella carried those precious babies out of the operating room, one in each arm, and the tray of equipment balanced gracefully on her head. After that, even with the tubal ligation, the surgery was quick and clean. Easy peasy, lemon squeezy.
That last c-section ended our work day. The theater was cleaned up, Mama and babies were reunited in the lying-in ward, and all our scrubs were tossed in the laundry bin. Solo picked me home on his bike again, and on the way we passed by Buddy George, whom I finally saw in street clothes, and not a uniform! I got his contact so I could check in on the childrens’ ward while I’m gone, and I wished him goodbye for 10 days. So much will be going on at SMC without me, and I’m definitely going to miss it.
One more Solo gem that I forgot about! He’s just on a roll today! He was telling me that while I’m gone, he will be traveling for a funeral, and he has to bring “A peek! You know, the ahneemahl?” on a lorry. I had to ask him like 5 times to repeat himself before I realized he was saying ANIMAL, and it was actually a PIG! I laughed there on the street for all Saboba to hear. I’m so going to miss Solo so much when I’m away!
At the bungie, I ate a HOT DOG for dinner! I like hot dogs…definitely! Diana, my old roommate, can verify this fact. J Bob grilled some up, but it was my ingenious idea to take a piece of the soft long baguette-ish local tea bread, cut it in two, and use it as the bun. This resourceful creation brought me right back to my college days when Top Dog on Durant or Hearst was the midnight snack of champions. Even Usher knows this is true; he was spotted there last year, fo reals. Hot dogs. Mmm, mm, mm!
Around 7, the electricity shut off again… YEP. Thank you, Volta River Authority. Jean and I had yet to do our packing for our trips! The generator was a God-send for sure, and we turned it on in order that we could gather all our things into our packs. Jonah came over to the bungie, where he could sit in not-darkness, and we talked as usual. I told him that he always makes me think of Habakkuk 3:17-19, because he is a farmer, and because He is always grateful for what the Lord gives him, no matter what.
Though the olive crop fails and the fields produce no food, though there are no sheep in th epen and no cattle in the stalls, yet I will rejoice in the Lord, I will be joyful in God my savior. The Sovereign Lord is my strength, He makes my feet like the feet of a deer, He enables me to go on the heights.”
Living example, or what? Pastor Jonah just makes my day every time I see him. Unfortunately, I had to quit our chat in order to pack for Tamale, because the generator’s petrol was running down, and when I came back, Pastor Jonah was almost asleep on the couch–poor guy! He had been clearing the land on his farm from weeds in order to prepare for the planting season that will come soon, God willing! Pray for rains for Saboba!! I sent him off to his own bed at home with an Uwumbor ti ti me kitaa, which I am getting so much better at saying, even though it is a tongue twister!
Almost as soon as I was getting ready to snuggle into bed in preparation for the travel ahead around 11pm, Jean called me. “Ann, we have an obstructed labor case.” But this was no c-section–nothing I was used to! “The baby’s stuck in the vagina so we can’t section her, but we might do vacuum suction or a symphysiotomy.”
Quite unfortunately for me, I could imagine exactly what a symphysiotomy was, having learned my anatomy at college. I shuddered. This was not going to neat and pretty like the c-section we had earlier today. Jean and I barreled along the little dirt road to the hospital in the lorry, and practically burst our way into the delivery room. Remember, everything was pitch-black since the electricity had gone off. The only thing lighting the little room were our two headlamps and a weak little battery-run lantern. Mama was in a ton of pain, clearly, but was handling it so well. Africa Strong, people. I am constantly amazed by these patients.
**WARNING! If you don’t like icky medical stuff, don’t read these next few paragraphs!
Jean tried the vacuum suction the baby out a couple times, and I could see the head crowning!! It was so exciting and stressful simultaneously, but after a couple times, it wasn’t working anymore. It was time for the pubic symphysiotomy. Gory, people… gory and shudder-worthy. The cut went all the way down the bone and through the tough fibrous connective tissue in the middle of the pubic bone. There was only local anaesthetic for this, and for the episiotomies–I’m telling you, this 20 year old from Togo deserves a medal for bravery and strength.
Buddy George was recruited from the childrens’ ward to help basically pull the entire pubic bone apart at the symphysis. Stella and I grabbed one leg, he grabbed the other, and we pulled her apart with all our strength. Yeah, I told you this wasn’t going to be pretty… The space we opened up would allow the big baby to pass through the small pelvis, and if this would save the mama and/or the baby, we were definitely going to do it, blood sweat and tears. After I don’t know how many more minutes of us pulling and Jean vacuuming and cutting, and one incident where Ishmael popped his head in about a moto accident patient (to which we all silently screamed, “NOT NOWWW!!!” while Jean shooed him away)… the little girl came out.
There was a wave of brown muconium (baby fecal matter excreted because of the high stress of labor) and then she emerged, still and lifeless–Jean later said the baby passed away probably before this woman crossed the Oti into Ghana. I couldn’t look–I didn‘t even know it was a girl until sister Maggie told me later. At that moment, I couldn’t remember a time that I felt more ineffective, useless, dirty, exhausted, smelly, and distraught. Even so, I was in slight shock and couldn’t process everything or even utter a word. I was so glad Jean was there to be strong and show trust in God and gratitude for who He is despite everything. If not for her, I probably would be traumatized by this delivery.
**This is the end of the bloody medical stuff.
“God saved that woman’s life,” she praised Him. “It would have been nice if we could have saved the baby, but we’ve got an alive mother, so…” I listened to her and realized how blind I was to that because of every other anguish that I saw. I stood there, supporting the mama’s open leg with my arms while Jean sutured her perineum up. I looked at the mama and thought about all that she went through–since she went into labor this morning in Togo. She appeared surprisingly calm, not a tear shed, but even though I know women in Africa are so much stronger than what I’m used to, I still could see she was just trying with all her might to hold it together. She had just lost her baby after one dreadful delivery, and I can’t imagine a pain greater than that. All what I have expressed of my own thoughts is nothing compared to what she must feel, Africa Strong or not.
After the sutures were in, and our mama was cleaned up, Jean went to attend to the moto accident patient and I stayed with the mama, fanning her and holding her hand while Stella was mopping up the blood and muconium. I prayed over her and just gave her “therapeutic touches” as Ishmael would say. This poor girl was three years younger than me and had already been through so much. I hated to leave her in Saboba the next morning when we will travel to Tamale. I want to talk to her and see her recover day by day, but I can’t. I have to trust, and remember I can’t keep watch over everything. I have to give up control to God. Even so, she will assuredly be on my mind and in my prayers frequently when I am away.
It was past midnight. I had to tell her goodbye finally, and leave the hospital to go back home with Jean. Jean was coming back from the moto accident patient, and everything was fine and stable there, thank the Lord! Alex and Ishmael did a good job of suturing him up, and I saw them and the patient emerging from the theater together–the patient on two legs, only hobbling a bit from the dressings around his ankle! Amazing! Jean and I wished them a bleary-eyed thank you and goodnight, and headed home.
On the way, Jean told me that our mama had probably been given locally-made syntocin (synthetic oxytocin), which caused her uterus to contract before the cervix was dilated enough. The baby was thus pushed up against the closed cervix so hard that edema (liquid swelling) formed around it, causing it to become stuck there in the vagina. The baby’s life could have been saved in Togo, but Jean definitely thought they were messing around with local treatments instead.
Talk about adding frustration to an already sad case. Hearing about all these traditional medicine practices harming patients instead of helping them is just maddening sometimes. It happens, and it happens a lot. Even though I see many good public health outreaches occurring just in the short time that I have been here (Maternal and child health, AIDS, family planning, some hygiene), there still is so much work to do.
Well, it’s late and like usual, I’ve written too much. I will end like this on a note similar to how I feel…overwhelmed, tired, discouraged. Tomorrow we’ll head out to Tamale, and just like after the last still birth I saw in my first week at SMC, I’ll be gazing out at the yellow savannah flying past trying to sort all these things out in my brain.