Another wedding...

   Last Sunday was Isaac and Heather's wedding. We went down on Saturday morning because we had a few things to do in Port. It seemed very strange that the machine was so empty. Trevor and Mirlene went down on the moto and Cam is still in Wisconsin. There were still seven of us but it felt like we were popcorn bouncing around in a popper because there was so much extra room. Saturday evening we went to see where Isaac and Heather are going to live then went to the family supper. They are living in town but where we ate was only a couple of blocks away and was like almost like a park. Big trees with benches set around. It was very pretty and only a little warm.
    The wedding was scheduled to start at 10:00. It started about 10:35. Some of the ushers didn't know for sure who all was family so led several of us "white" girls to the front bench. We sat there for a few minutes then opted to slip out the side door and go sit in the balcony. Not long after that Heather's brothers and sisters took those seats. There wasn't quite enough room for Isaac's little brother and two of Heather's nephews to sit there too so they gladly sat on the steps to the rost-room (?sp) facing the congregation. I thought it was pretty cute when partway through the service they noticed someone had a water jug and they took turns tipping it way up and drinking until it was fiinished. It was a warm day and the church was full. They didn't have quite enough chairs to seat everyone but I don't know how many people were actually present.  I was very thankful when the breeze came through the windows... Sometimes it brought wafts from the neighbors' houses where they were cooking lunch... And it seemed like breakfast had been a long time ago. The service lasted three hours then the family and close friends went to another place for the reception.  The family had had meals catered at the church for everyone else. The reception was held in an air conditioned building which felt wonderful! I guess we weren't getting out of there quite on time so all at once the air conditioner was turned off. Then a little later the music was turned wayyy up. We did catch the hint at that and got out. We were heading back to the place where we had spent night to change clothes before heading back up the mountain. We were almost there when we were informed that the road up ahead was closed due to a protest. That morning someone had been shot and the people were upset. We got to the house but knew we couldn't get through so I had a nice nap while we were waiting. About six o'clock Keith got the word that the road was open so we headed up. Got home a
little after nine then quickly made some cheese sandwiches for supper.
    The clinic has been busy lately. Fridays are usually short days but last Friday we went back to the clinic in the late afternoon  for a lady who was in labor with her first child. Probably an hour later we had another lady come in who was also in labor with her first child. So we had two ladies taking turns hollering. They were at about the same stage of labor so Keith called the other nurse who works there to come also. I was glad because they each had an IV go bad and each had some difficulties. The first one had her baby girl but then the placenta wouldn't come. We gave an injection but still no results. Meanwhile the other lady was getting really close. After 40 minutes we knew something had to be done so... The other nurse didn't want to be the one to do anything there so she went and delivered the other baby while I put to use the technique I had observed and almost fainted over.  I had to reach up in there and get the placenta out. It wasn't so bad and I was finished in a few minutes without even a thought of getting queasy, but then we had a bleeding problem. I ended up having to give her another injection for that and finally was able to stitch her up. Was I ever thankful that her baby had started breathing right away so we didn't have to worry about that. The other baby only took a few minutes to breath so wasn't a lot of stress there either.  Needless to say, supper was late that night and I was ready for a shower!
   The other day we had a little boy come in who had the worst case of malnutrition I have seen yet. And he lives only about thirty minutes from us. He had almost doubled his weight in one month, mostly fluid I'm sure. His hands were about an inch thick and his legs and feet were so swollen and cold the skin had burst open and he was just dripping fluid onto the floor. I didn't know if lasik would do any good but didn't think it could make him any worse so I gave him a shot and we gave them food and milk and told them to come back in two days. I didn't know if he would still be alive but he was and had lost two pounds of fluid. I couldn't see much of a difference but according to the scales he was two pounds lighter so I gave him another injection and told them to come back yesterday. They didn't show up yesterday or today so I don't know what the deal is.

 

The ax wound is healed...

   On Wednesday, which is the day our Haitian nurse has classes with the pregnant women, we had a mother come in to the clinic in labor. She was only six months along but the baby was coming. We suppose that for some reason the baby had died, maybe even the previous day. This mother has had three pregnancies without problems so we really don't know what happened. As far as we could tell the mother hadn't taken anything to abort the baby. Not long after she arrived her water broke and we could see the baby's hand but then she wasn't advancing with the labor. We tried giving her the medications we had on hand but it was soon obvious that she would need to go down the mountain to a hospital for a c-section. Meanwhile, the husband had went back home to see if he could borrow some money in case  they did need to go down. We got the ambulance and her ready and about that time he came back. He hadn't been able to get the amount of money we usually ask to take someone down ( which pays for gas) but had some so they loaded up and headed down to a hospital.
    Meanwhile, Todd's had some visitors here and the men and boys decided to go investigate the cave near here. Keith has talked to a member of the family that owns the land the cave is on and they were ok with us going there.  Someone, somewhere, heard there were white people in the cave and then the story gets rather fuzzy. Some say they are afraid if people go in the cave the devil will no longer come there. Supposedly there has been some devil worship there in the past. Seems like they would be glad if the devil stayed away. Others think there  are diamonds in the cave and that we were stealing them. Anyway, that whole deal has caused a huge schmozzle in the whole community. There has been talk of going to court ( although others say there was nothing done out of place) and having to pay a lot of money to the family who owns the ground. There is a magistrate involved and who knows who all else. All kinds of stories are going around about the white people tying up Haitian children and dragging them into the cave with them etc... We very well know that isn't true. The "chefs" ( similar to sheriffs) were waiting when they came up out of the cave and one of them fired a gun into the air, then they took some rocks that Chase had in his backpack and one of their ropes. That night yet the rocks ( pieces of stalactites) were taken somewhere to be checked to see if they had any diamonds in them. We are trying to lie low and see what will get worked out. Just an interesting tidbit that has caused a lot of talk.
   Last week I was able to tell the man who had had the ax wound on his foot that he doesn't need to come every other day any more, his foot is almost all healed up. There is nothing left to pack. It hasn't totally formed a scar yet but doesn't need a dressing anymore. He is happy.
   Another patient we had last week was a child who is one year old but only weighs about thirteen pounds. We have been giving his mom food for him for several weeks now and he never seems to consistently gain weight. He has been treated several times for ear infection too and last week both ears had another nasty infection. Plus he was very dehydrated and had diarrhea and vomiting. I tried several times to start an IV and finally got one in his head. It lasted the whole time we needed it that day. We gave him some fluid and antibiotics then let him rest a while and did it again so he had two doses of IV antibiotics before we took the IV out and let him go home. He had kept down all the pedialyte we had given him too so hopefully he is on the mend. He came back again on Friday for a check up and one ear was definitely better so... We gave more oral antibiotics to see if we can clear up the other ear and a second dose of de-wormer. If he still can't gain weight we will have to send him to a hospital to be checked for a bigger, underlying problem.
    Sallie left on Monday for Wisconsin. Cam went with her to visit for three weeks and work on the farm so it seems quiet around here....

After hours

   The past week we have seen numerous patients after hours. Saturday a baby was born. The mom was not cooperative and wouldn't lie on the bed so ended up having the baby on the floor. Then the baby was stuck with only his head out but we were handicapped because of the awkward position the mother was in. There were also some friends and family in the room so we didn't have enough space to work properly. They all were trying to help when the baby was stuck. That mom really got a spanking... They were slapping her on the legs and telling her to push etc... Eventually the baby was born and he didn't look too good! He didn't have a good color at all and his eyes were bulging. It only took him a few minutes to breathe though after we suctioned him so we were very happy about that but definitely exhausted from the whole ordeal. Then Sunday another baby was born. This was a young mom that was having her first baby. She also had lots of difficulty cooperating and did not want to push. I really think she was terrified about it all. She  refused to lie on the bed also. She said all mountain women sit on a rock to have their babies and wanted us to bring a rock into the clinic for her to sit on to give birth. Sorry... Not happening... This baby was smaller and did not want to breath. We had given the mom some oxytocin and it suppresses the babies' respiratory drive sometimes. I wish I knew which babies it would affect and I would be very hesitant to give the meds to their mothers but so far we haven't been able to identify any clues. Some cry right away and the next one doesn't want to breath for 15-20 minutes. This little girl seemed to be a fighter. Her heart rate and color were good but she wouldn't breath. We suctioned her and got out the oxygen and bagged her. We only have adult pulse ox probes so we can't check the babies oxygen levels, just have to go by color. First off, the stethoscope was broken so I couldn't find a heart rate and she definitely wasn't breathing... But her color wasn't bad. Got a new stethoscope and her heart rate was about 120. But she wouldn't breath!!! Her heart rate was strong so we didn't feel like we could quit giving her breaths and oxygen. We bagged that baby for almost an hour before she got to about four breaths a minute on her own. Not enough but better than nothing. The friends who had brought the mother were getting
impatient about wanting to go back home and we didn't know what else we could do for the baby so
about an hour and a half after the baby was born we sent them home. We told them if she was still alive the next day they needed to bring her back to the clinic for a check up.  The next day a neighbor brought the baby to the clinic. She was breathing normally at a normal rate now but definitely had a pneumonia. We tried to get her to eat and gave her some antibiotics. She didn't really swallow so I tried to get an IV in but wasn't able to. We put a tube in her nose to give her some pedialyte but she had a lot of secretions coming out of her nose after so not sure if her lungs were just that full of
secretions or what. We told the neighbor we couldn't do anything else but that they needed to take the baby to a hospital that night. I think she understood but don't think they took her. Several days later we hear the baby has died. An intensive care unit and ventilator probably could have saved her life but...
    Monday was a long day at clinic. One of my patients was a little girl, probably about 7 years old, who had had a piece of glass in her heel for 8 days. I cleaned it then got a hemastat to remove the glass. It took about four of us to hold her down and several times little pieces of the glass would break off. It was very stuck, but I didn't know it would be over an inch long!

The tip probably was in her bone and it broke off. If the piece of glass didn't have a sharp tip I don't see how it would have
went in that far. Then we soaked her foot and gave her antibiotics. She was supposed to return to clinic today and didn't so I don't know if we will see her again or not.
    Then last night I had been home about an hour when a moto was at the gate with a sick person. There is a mosquito born fever called chikungunya going around in Port and the Dominican. You can have very high fever, nausea, vomiting, and severe aches. This lady had just come back up from Port the day before from helping her sister who had this malady.
   At about nine in the evening one of the neighbors had a sick baby. The baby had a temperature of
103, had gotten an immunization earlier that day and also had problems with colic.
    I got in bed about 10:30 but wasn't asleep yet when there was a kamyon (farm truck) honking frantically at the gate. Actually I didn't know it was at our gate until later but was hoping that there wasn't another emergency. There was... A lady in labor. Keith went to look at the patient before he called me to be sure it was something that needed to be dealt with now, it was. The baby as crowning, but had been in that position for a while already and was getting no further. So we went back to the clinic. This patient had had one other baby that had died. She was just plain exhausted. We didn't put
in an IV right then because the baby was right there and we hoped we wouldn't need it. The mom had had nothing to eat or drink all day. With encouragement the baby was born about 25 minutes later. I was scared that the baby might not be alive anymore or would have problems because he had been in that position for so long but he cried almost immediately. Praise The Lord. But the mom had a little more difficulty. She bled a lot. We finally started an IV and gave her a liter of fluid because she was bleeding so much. Finally after a couple of shots the bleeding had slowed enough that we sent her home. Back into the kamyon she went, along with probably six others people plus the driver then several more people riding in the back.
   I forgot to tell you about a teenage boy who came to the clinic one day. He had had a tooth pulled earlier that morning and now his jaw was locked open! He couldn't even swallow his saliva. We are not sure if his jaw just got out of place or what but he definitely couldn't close his mouth and was scared. After some research Todd put his thumbs in this guys mouth and tried to get it back in place.
The first time it didn't work but the second time he tried it did. The boy was so relieved he started sobbing.
   All right, that will be all for tonight...