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...