week thirty one-base group

being a part of the ‘base group’ this week is very different now that we’ve moved and are also in lecture phase. we now get to spend tuesday and wednesday in the ICU ward at the hospital. after monday lectures thats exactly what happened. tuesday was my first full day in ICU. it went really well. as a student we have to do four different case studies, all to do with the four main problems in pregnancy (eclampsia, obstructed labour, puerperal sepsis and PPH (postpartum hemorrhage)) and being in the ICU is the perfect place to be able to learn more and get information for a case study. when we first got there we spent some time cleaning down bed frames and window ledges etc... and then took vitals on the women. the one side is all pre eclampsia/eclampsia and the other is post cesarian. i worked in the eclampsia side, one of the side effects of eclampsia is extremely high blood pressure. and i soon learnt how high it can go. some of these women were 180/120 and with the normal range being 110/60 - 140/90 this is extremely high and dangerous. i also got to interview one women for a case study gathering basic information about her and her pregnancy and labour experience. it was such a sad story.

she had woken up in the hospital the day before (monday) and had to ask ‘where am i and when did i get here?’ she was told she’d been here since last friday and that she had delivered her baby friday but it was born dead..... can you even imagine? first off i didn’t know that one can deliver being unconscious, second, to wake up and find out you’ve been in the hospital for four days and you’ve lost your baby..... she didn’t seem too upset but sometimes the mom’s don’t show too much emotion. we prayed for her and she was discharged that day. she is fortunate that her family brought her to the hospital when she did because she was still alive, but i can’t imagine how she must be feeling after such a traumatic labour experience.

there was another women brought in while we were there who was having difficulty breathing. it was painful to watch her take huge gasps of air. she was only seven months pregnant the but the hospital staff were administer drugs to her to help mature the baby’s lungs and then induce labour in hopes of saving both mom and baby. the next day when we got there she was still there, she had delivered a tiny little girl who seemed to be doing well. the mom however was still not doing any better with her gasping for air. since the baby was so little we wrapped it onto her chest (kangaroo care) to help ensure the baby’s temperature stayed stable. well she ended up falling asleep (mom) and after some time one of the girls on my team tried to wake her and she would not wake up. even the hospital staff had a difficult time waking her up. she did finally wake but was so distraught and confused saying the baby on her was not hers. we tried to re-account the details of whats been happening to her but she continued to deny the child being hers. we eventually had to remove the baby from her in hopes that later she would ‘come to’ more. it was agreed that she needed a higher level of care than the hospital could give her and she would be transferred later that day.

that same day there was a women with an extremely high pulse and bp. she was in labour and we had been monitoring her and it was time for her to deliver. i was preparing to do the delivery and was with her for quite some time when it was realized that she would not be able to deliver. the head was not advancing no matter how hard she was pushing, and also by now the baby’s heart rate had dropped to 100 (110-160 normal) after calling the doctor it was decided a vacuum extraction would be done. it was a bit of a challenging situation, the doctor decided to fix her IV line as there were clots in it and that took some time, including him banging the end of the line against her bed frame spraying blood all over the wall and floor where her water and food were being stored. i was quite upset, blood is not something you want going ‘everywhere’. he began the vacuum and it took four tries for the cup to stay suctioned to the baby’s head. he was finally pulled out and only needed rubbing on his back and baby began crying! beautiful little boy. the mom however now had a pulse of 180, nearly double what it normally should be. and she had severe tears that were causing her to continue to bleed. another frustrating thing then happened, this women is laying on the table, exposed and bleeding, needing immediate care and the doctor decides to answer his phone! there are some things culturally that have now become acceptable but this is not one of them. most all staff carry their phones on them and will answer them no matter what it is that they are doing in that moment. we’ve even seen them do it during a cesarian, yes an operation, they simply have another staff member hold the phone to their ear while they continue to cut open a women's belly. ridiculous eh? anyways, in the end she was sutured and bleeding did stop. it was the end of our work day and we had to leave but i talked to one of the doctors about her pulse and they said they would go and make sure she was taken care of. so i can only pray she received the care she needed. and i do believe she did, most of the doctors in ICU are really amazing. it was a good experience apart from the vacuum moment but i learnt a lot and the staff their are really good and knowledgable. and besides the one answering his cell, he did a very good job at suturing her up.

thursday my group traveled back to the base clinic that we would work at before the move. i spent the entire morning doing antenatal care. take bp, check fundal height(measure belly), feel for position of baby, check hear rate and all done. the staff would take my results and go from there. i probably got to check almost twenty women! it was a fun morning, its nice that we’re all more confident in our skills and so are the staff at the clinic. they nearly let me do everything on my own. and when they didn’t quite believe me they’d re-check, but they always got the same as what i had! one staff even told me ‘hongera’ which means ‘congratulations’ haha! it was a good day apart from one of the bus rides we took where i’m pretty sure the driver didn’t know he was driving a bus and mistaken it for a race car. at one point he slammed on the breaks and because i was sitting in the middle seat in the very back i had nothing but isle to stop me and i flew forward two rows. if it weren’t for Celia grabbing my arm i would have kept going.... a little scary but i was fine!

friday i got the opportunity to go to labour ward because one of the girls wasn’t going. it was a really good day, started off a little rough with a breech baby born with a low apgar who still was not entirely stable when we left. but the rest of the day was great. i was asked to monitor one women who was just brought in from ANC and was told she was 7cm and this was her third child.... i thought okay, sure i’ll check her vitals and such. i went to check her bp but she was having a contraction so i thought i’d wait, then i noticed she was pushing and i thought, 7cm? not a good time to push she’ll tear or wear herself out. so i tried telling her to breath and not push but she was in no way acknowledging my existence. so i thought, i should check her then and pulled away the khonga she was wearing and there was the bulging membranes with the head directly behind out to its nose already! (i should know not to trust the 7cm we’re told by now but i did not this time!) i fumbled with gloves and someone broke the membranes and i got my hands ready just in time to deliver the body and slip the cord around him. a beautiful baby boy, let out a strong cry right away! i let him lay on his mama’s tummy for a while until she made it clear she wasn’t a fan of this anymore! haha! and clamped and cut the cord and handed him off to Naomi to weigh and do a vital check. after that everything continued to happen very quick and third stage was done before i knew it. she was cleaned and sitting on a postnatal bed with baby beside her only half an hour after she originally came into the labour ward! the quickest and cleanest delivery i think i’ve ever done! it was good because it was early on in the morning so i was able to monitor both of them and help out Naomi when she did a delivery later on that morning. it was a great way to end the week!

the weekend also went well, sleeping in and going to Shoppers Plaza to develop some pics, buy a few snacks for the week and hang out at the bookstore, kinda makes you feel like your at home! sunday four of us tried out a new church. it was really good! they meet at the cinema’s and it was english speaking. pastored by an American who has lived here for the past ten years. we met his family and a few others and everyone seemed really kind. our entire team is going next week! hopefully they’ll have enough seats! the rest of the day i worked on homework and studied for the monday test. and just relaxed. oh also got a bit of a haircut. one of my staff can cut hair so it was nice to be able to get a trim. but yes i suppose thats about it.... i’m in labour ward next week, only five more hospital weeks left and six in Tanzania.... pretty crazy to think i’m halfway (or just over) outreach.....

till next time....