Bere 2018 #5
It was Sabbath, the day I choose to go to church. At the hospital, it is a minimalist day. The doctors generally see the patients the nurses have questions about and other than that, the nurses do the rounds and change dressings. Dressing changes are at least half of what’s on the surgical ward. Some are infections after an operation, and some are accidents that are taking a while to heal. The dressings are usually done with a dilute bleach solution- which helps with the infection too. So I went in, to check on people before going to church. The surgical nurse had me see one old guy who couldn’t pee, even though he was here for a foot infection. He got a urine test and a catheter. Another lady was in labor, and was progressing well, so I didn’t need to be involved with her- the nurses deliver all the normal deliveries. After I finished with the ones they wanted me to see, I found Dr. Sarah and Gabriel and we headed off to a church about 30 min away. Dr. Sarah wanted some exercise so she rode a bike, and Gabriel and I rode motos. We wove though the village. Every 100ft or so there were a group of kids playing or working it the gardens by their houses. As we would pass they would sing out “Nassarra, Nassarra,….”(white person) smiling and waving. A few chanted, “Nassarra donne le cado” (white person give a gift). We wove through the village along the mud path with large potholes. We would go around the edge to stay out of the water when possible. A few times the puddle took up the whole road, to the trees on either side or someone’s field. Then we would have to go through the edge of the puddle (almost pond like). It’s the rainy season, so all the fields are green and beautiful. We pulled up into a small building with a tin roof. When I went inside I realized it was one of the “one day churches”. These are buildings that have been put up by donations, and are metal, so the termites cant eat them. I think the design and longevity of these buildings are amazing. The hospital is at least half made by them too. The Sabbath school was being given in French and translated into Nangere (the local language). Some were sticking to the lesson, but others had some questions that weren’t related. “If you become a Seventh Day Adventist- do you have to be re-baptized?” “Why is Sabbath on Saturday and not Sunday?” “Is Sabbath or Sunday the first day of the week?” (If you question these same things- ask me in an email, and I’d be happy to respond.) As we were finishing Sabbath school, a nurse called Dr. Sarah saying that a woman had arrived who she thought had and ectopic pregnancy. Her hemoglobin was 4.2 (normal is above 12). Dr. Sarah ordered some blood to start, and a pregnancy test. When asked what her vital signs were the response was her blood pressure is 12/7 (120/70). So at least I knew she didn’t have a low blood pressure at the moment. I hopped back on the moto and headed back to the hospital. I walked past the people around the wards that were sprawled out under the trees and on mats on the ground. The delivery room only had this patient in it. There are 6 beds with curtain partitions in between. This young woman had about 3 old women with her and a brother of the husband. Almost all the people here are thin, and usually when they’re lying on their backs there abdomen sinks in. Hers was distended up! I touched it and she winced in pain. I suspected she had a belly full of blood. The story I heard was that she had been up in the capital 3 weeks ago and saw a doctor for pain and they did something and said she had a pregnancy outside the uterus (ectopic pregnancy). They recommended surgery. She didn’t do it and a week ago came home to Bere. The last three days she’s had abdominal distention and increased pain. So they brought her in to be seen here. As I finished talking to her the first bag of blood arrived. They said other family members were on their way. I went to the ultrasound room and got the ultrasoud. I jelled up her belly and put the probe on. She had a lot of fluid in the belly- blood! The uterus appeared empty and above the uterus I could see something round with a baby inside it. There was no heartbeat, as expected. Likely a tubal pregnancy. This was her first baby! She needed a lot of blood and an operation to remove the ectopic pregnancy. I know that the anesthetist (trained on the job) prefers spinals, but this girl needed Ketamine, since she was already short on blood and giving a spinal in this situation can kill the patient with hypotension. Phillipe (anesthetist) arrived a short time after my call. The nurse brought the patient to the OR and we started preparing her. Getting an additional IV, putting in a urine catheter, getting the OR pack opened with gloves, scapel, and suture opened on the pack. Then when Samadi, my assistant arrived, we scrubbed an we started. I chose a low phanynsteal incision, and as soon as I got in the abdomen, dark blood came up like a fountain. We suctioned 4 liters of blood and more was on the table and floor around us. Eventually I could see to continue and I started to take off the fallopian tube that was a mess. The little 2month old fully formed baby popped out one side. Each time I see a small fetus; I am amazed at all the tiny features that can be seen. I completed moving the mess and started washing out the abdomen to try to remove as much blood as possible. Remaining blood can give the patient an ileus (the intestines don’t work well and are kind of paralyzed). I washed out with half liters of saline and used about 8 of them sequentially. Eventually it was mostly clear. I closed up the different layers and we were done.
I now remembered that the missionaries were getting together for a late lunch and I hoped they were still together. I headed over and we hung out for many hours. Hanging out with them affirmed to me that missionaries are very special people. They leave what is comfortable and known to go somewhere to do humanitarian work, be the love of Christ to others, accept hardship in many areas of life, put their family members at risk for diseases unknown to the western world, and so many more things. We had a nice evening together and great food too!