Did I just turn into a labor and delivery nurse???

    I didn't realize that was my specialty... But the past several weeks it has been. This month so far there have been nine babies born at the clinic. And the month isn't quite over... The last baby to be born there couldn't quite wait until we got there. It was in the evening so Keith had driven us to the clinic. As we were driving in there was some frantic activity under and around a blanket by the clinic door. The baby had just been born so they carried mom, baby, and mattress in and put the whole kit and caboodle on the exam table. Thankfully this baby wanted to breathe so there were no problems there.
     But, the baby that was born before that... Is a different story. This mom came after hours also so I was the only one there (besidesApril) at first. I asked if this was her first child and she said " No, this was her fourth baby" and she was at nine months so I checked her. Instead of a head I felt a finger then a hand then an arm. Uh oh... But the baby didn't seem to be all the way against the mother's pelvis so I was hoping if I could get that hand and arm back in maybe the baby could still reposition.  So I decided to try that. It took several tries but finally I thought I was successful. Meanwhile Mirlene came and was trying to find the lady's file and was not having any luck. The lady said she had been to the clinic twice before. Come to find out after more questioning, this lady had never been to the clinic before and she already had five children. I'm not sure what the point of the previous lies was. I had also asked our Haitian nurse, Githane, to come as this was not a normal presentation. By the time she got there the baby was head down and in good position. I had checked the baby's heart rate also and it was good. But now the mom would not work with us! We gave medication and repositioned  and encouraged her to no avail. She did not want to push - so she didn't. Finally there is only so much you can do in a situation like that. We had her on the exam table then finally let her get on the floor because " she couldn't have a baby lying down." Finally, after several hours, she did have the baby. He did get stuck for a few minutes with only his head out but not for very long. Initially he had a heart rate but he refused to breathe. I suctioned some nasty stuff out of his nose and mouth but he still wouldn't breathe. We were giving him some oxygen too. The next time we checked his heart rate... It was no longer there. He also needed an intensive care unit. It was frustrating for me, we had been able to help reposition him so he could be born without too much difficulty and then ???
It seems like these ladies have a sixth sense about when there is something wrong with their unborn babies and they will come to the clinic but we still weren't able to save this one.
    There is a " frequent flyer" patient who has bad asthma that comes in frequently. She is non-compliant with her medication. I don't know how she takes them but they are always gone too soon. We asked her to bring someone with her to the clinic who could help her with her meds but she won't.
We have also asked her to bring any medication she has left with her when she comes to the clinic so we can see it but that doesn't happen very often. Finally, several of the meds we have been giving no longer seem to help her symptoms. It's like her body has become used to them but we really don't have a lot of options for asthma here. Today we heard she has died, not from her asthma though. She was apparently gathering sticks so she could cook when she fell over the edge of a ravine. She was found several days later so we don't know what really happened. I thought one of these days she wouldn't be able to breathe but...
     Yesterday April and I went to clinic to stitch someone's hand. Turns out these guys are drunk and keep telling us they love us and want to marry us etc... The one guy who was the worst off thought he needed to help us so when I get out the lidocaine to numb the guys hand he takes the other mans head and practically shoves it under his arm telling him " don't look, don't look!" Then I guess he thought it would help with the pain if he squeezed the guys wrist so he squeezes and squeezes. I don't think he ever even realized that my fingers were getting in on the squeeze half the time too. It made for an interesting time but we were glad when we could tell them we were finished, they could go.  I wonder if they will remember what day I asked them to follow up on.
    As soon as we finished stitching the hand it was time for church so we headed there. When we get there church had just started so we sat toward the back. A lady who is "tet fou" ( has mental issues) was there also. She had a lot of attention until she was "chased" out of the building. She ran and one of the brethren walked quite rapidly after her. She was making obscene gestures and talking and moving from one bench to another as often as she pleased.  During the morning service she marched in after church was started and sat on the front bench. Then she had to put her drink can ( evaporated milk) down on the floor. One of the little boys had great joy kicking that can all the way out of the back of the church when the children left for Sunday school. It puts a new twist on church at times...

More babies...

So far this month there have been five boys born at the clinic and two girls. On Sunday we were at the clinic waiting for a baby to be born when Keith called and said some twins that had just been born were on the way to the clinic also. So he and Candace came too, as we were thinking the baby would be born any minute. So... The lady in labor delivers a healthy nine pound girl and before we were finished with her the twins were there too. They each weighed a little over three pounds. They were both crying when they came in but it was obvious they had just been born also. They were about two months early. The mom didn't come, two uncles just brought the babies. They were partly dressed and wrapped in one blanket each but they were still too cold. The one didn't have good color at all but the other one was nice and pink. We washed them up a little then dressed them and wrapped them together in several blankets. When we were washing the one whose coloring wasn't good he had something strange all over him. We asked what it was and they said they had rubbed him with mayi moule ( grits) because he didn't want to breathe. They were identical boys, down to each of them having a small extra digit on each hand. We didn't do anything with the extra fingers now, we can later if they live. I don't think the one will make it but the other seemed strong so far.

We sent them back home with instructions to put them skin to skin on mom's chest, no clothes between and get them warmed up. Then try to get them to nurse later that evening. In United States those babies would have went straight to an intensive care unit... And we sent them back home... But there are no neonatal intensive care units near here.
    Last week on Wednesday we sent a patient down to Port. I rode with in the back of the ambulance with her because we wanted to keep her on IVF's. Two family members went with also. For those of you who don't know, the back of the ambulance does not provide a smooth ride at all! By the time we were 20 minutes down the road one of the ladies was sweating already and feeling quite car sick so I handed her a trash bag. I had warned them that they might get sick, and that I might too. I did okay, just every time after I spent a minute or two changing a bag of IVF's or checking her oxygen saturations I  would have to look out the front window and concentrate pretty hard on not being sick. The poor family member though, she threw up off and on all the way down the mountain. We were taking the lady down because she had had a baby at about eight o'clock that morning and had come to the clinic at 1215 because the placenta was never born. The baby had died. Well, by that time, everything was happening as it should and I just couldn't get my fingers in far enough to get a hold of the placenta. The more I tried it kept breaking into pieces so we took her down for a d & c.
   The little girl with the burned arm is finished with her dressing changes. I am very pleased with how well it healed.

   On Friday morning a lady came into the clinic with abdominal pain. She was seven months pregnant. This was her first pregnancy so she didn't know if she was in labor or not. I checked her and yes the baby was going to be born soon. I was unable to find a fetal heart rate though and the mom said the baby had stopped moving that morning. Shortly after she delivered a little girl, still born, no heart rate at all and bad coloring. I don't know what happened for sure but for one thing the mom had a bad infection.
   After hours that night another lady came in in labor. She had eight children already and really made quick work of the whole deal. I think we were at the clinic a total of one hour. April came with me to that delivery, she is turning into a nurse very nicely... And quickly.
   One other thing that happened last week,  a little boy had come in with some kind of an abdominal infection. We put him on antibiotics and it was looking much better, until that morning when the mom brought him in. I guess she wanted it to heal faster or something, anyway, she put some kind of leaves on it. Now it was infected worse than ever, and there were even a couple of openings in his skin. Zach was taking the ambulance down that day so we sent this boy and his mom down with him. The mom didn't have a cell phone. Several days later this boys dad came to the house very worried. He had been down to Port and couldn't find his wife and son. They weren't at the hospital where Zach  had dropped them off and the dad couldn't find them. It took several days to work that one out, but they were found at another hospital.
   That's all for tonight...

Don't you think the asparagus is ready?

 

This is one delivery I didn't stick around for...

One of the few suicide attempts I have seen here...

    A young boy, probably 14 years old, came in a couple of weeks ago with the complaint that he couldn't eat. He had sores around his mouth so I  told him I needed to look in his mouth. His tongue was covered with big sores which we found out were burns. He had tried to swallow some chemical used to spray in the gardens to kill himself. We don't think he swallowed much but he definitely got a lot in his mouth. The sores on his nose and around his mouth were from that too.

So we tried to find out what made him want to kill himself. His sister had brought him in and she said he tried to kill himself because he got spanked too often. Well, up here there isn't much we can do unless we actually see signs/symptoms of abuse and his symptoms were from the burns so... We couldn't really do anything except give him pain medicine and some protein drinks. He hasn't been back so only God knows what is happening there.
     Last week we had two children come to us with old burns. The first one was a three year old brought in by her grandma. She has burns all around her elbow and a few smaller  places on her torso. The grandma said she wasn't there when it happened but apparently the child fell onto a pot of food. When we asked how many days ago this had happened she didn't know for sure, probably eight or ten days ago. The burn was all dried out and had nothing on it and they had no pain medicine. I really can't imagine how painful that must have been. It was too dry for me to even attempt to clean the wound so I put some cream on it and a bandage and told her to come back. We never know if these people will come back for burn care or not because the first thing we do is put a dressing on it and they are taught to NEVER cover a burn. I'm not sure why they feel that way but I think they really have to have faith to come back for more dressing changes. This lady did bring the little girl back though and she has had 3 dressing changes so far. I am very happy with how it is healing.

 Today I had to laugh at the little girl though. While I was getting everything ready to do the dressing change I gave the little girl a sucker. Her grandma unwrapped it for her and handed it to her. She knew what was coming next and knew a sucker couldn't stop it so she threw it all the way across the room.
    The second child came with a burn to his hand, wrist, and arm. He is 11 years old. His burn was only five days old when they first came but they brought him because it was so painful he couldn't sleep at night. He has had one dressing change. This one looks like it will heal very nicely also. I'm just trusting they will keep coming back.
  Last Friday a young man came in and his complaint was that he couldn't hear. I looked in his ears and decided I would clean them with q-tips to start with. That didn't cut it. I had to wash them out and got amazing results from BOTH ears. I wouldn't have been able to hear either. It was just like as if he had had ear plugs in. Then I remember that these people have probably never even seen such a thing as a q-tip, let alone having money to buy them!
   Another man came in last week with a puncture wound to the back of his leg. It was very dirty. Then he says he can't tell us a lie so he will tell us what he did for it. First he had someone pour battery acid in it... I don't know why... Then he put sand in it! We got him some antibiotics and he is coming several times a week for dressing changes. Today I got more sand out of it when I cleaned it.
  Ok, that's all for now.

FYI - I am planning to stay here through December or January,  hopefully by then we will have found someone to take my place. I will gladly read emails if anyone cares to send them ;)
atoews5225@gmail.com

... A very infected arm... And another tooth abscess

 

This man came to the clinic with a very swollen, red, hot arm. Two of his brothers own a brothel in a local village. Apparently a girl that works there wasn't happy with this guy for who knows what reason, so she pokes his arm with a pin or needle that was obviously dirty. That had been 8 days ago. Around here a lot of people think if something causes you pain it helps to tie it up with a cloth or rag. It looked like his arm had been tied because it was so swollen then abruptly stopped but he denied having ever tied it. He had been poked around his elbow. Now it was swollen almost to his shoulder and all the way to his finger tips. We did get a lot of pus from his arm but it was still very swollen so we put a drain in his arm too then wrapped it up and put him on some strong antibiotics. We told him to return in a couple of days for us to change the dressing. He came back but for some reason got upset when Todd was re bandaging his arm and just got up and walked out without even letting Todd finish. We thought the swelling had gone down some and there was definitely drainage on the old bandage but I guess he thought the swelling was worse or something. So he leaves, with the drain still stitched in and his arm partially bandaged. He has never come back yet. We are afraid he could lose his arm but just today someone who was at the clinic who knows him said his arm is all better... So maybe he continued to take the antibiotics we had given. We don't know...
    Today an eight year old boy came in with an infected tooth. His mom said it had only been swollen for three days but it looked like it had been a lot longer than that. He couldn't even really close his mouth his cheek was so big. I was going to try and pull his tooth but Keith came and looked at it with me and we pressed on his jaw and got a lot of very foul smelling pus out. It seemed there were several teeth loose and infection several places so we didn't pull teeth, just put him on strong antibiotics and told him to return in a week. Hopefully by then the swelling and infection will have gone down enough that we can check his mouth out a little better. By the way... This was one case that Mirlene did not want to assist with. She felt too sorry for the little guy and left the room so I was glad Keith was there to help. She would have helped if no one else was there but since someone was, she got out of the room.
   More another day...

Is this just a freak coincidence?

     Last week on Thursday we had a young lady come into the clinic in labor. She came at 11:45 so we were expecting to have a late lunch. But her delivery was amazing! We got her up on the table and  checked her and it was time to push. We did start an IV for a few minutes but didn't need it for long because at 12:15 we left for lunch. The baby was born and taken care of and we had the mess all cleaned up already.  I did catch this baby, Githane didn't quite have her gloves all the way on! Everything went very smoothly and there was very little bleeding. We did have the mom lie down though while we ate just in case there were problems. We were going to check her after we ate then probably send her home. I got back before Githane  and they called me in there right away, the lady had stood up a few minutes before and was now losing a lot of blood. They had her on the table already so I checked her. There was definitely something going wrong. It was like her uterus was full of blood.  Finally I got most of it out then checked her again. Something didn't feel right. It didn't feel like more blood clots I was feeling, it felt like it was intestine! Then I could feel that my fingers had gone through a hole. Surely this lady didn't have a hole in her uterus too! She is only 19 years old but this is her third child. I started another IV and got some fluids running then called Todd to come and double check my diagnosis. Githane was back now too so she used the ultrasound machine to see if she could see a problem. She found a black hole right about the place where I thought there was a problem. So... I call Keith and tell him I have a patient that needs to go down to the hospital now for a surgery. That day it was Candace's birthday and we had a small party planned for that evening. He finally got one of the unit guys from Savann Mouton to agree to drive her down. One interesting thing we noticed about this baby, his ears were two tone. Both ears were dark until the earlobe then they changed to a lighter color. I have never seen that before. The patient got to the hospital okay but we haven't heard anything since. We are all very curious to know though, seems very strange that we would have a patient with this same problem so soon again. I guess the difference was that she had her baby at the clinic so we realized her problem several hours earlier than the lady the other week.
     Friday morning the whole family left for Port-au-Prince. We were supposed to pick April up at the airport that afternoon then we were planning to go to a beach resort for the night and part of the next day. On the way down we were stopped in the road because there was a vehicle coming from the other direction that was trying not to fall off the side of the mountain. It was a Land Rover or something like that so wasn't a small vehicle but the driver's side wheels were completely off the road. The driver was still in the vehicle but all the passengers had gotten out. If the driver would have gotten out he would have had to crawl out the passenger side. There was a kamyon there that they were trying to hook up some ropes to so they could pull it out. They got the ropes hooked up and started to pull... And one of the ropes broke and suddenly we could see the whole underside of the vehicle. The kamyon had stopped by then but the force of the one rope breaking was tipping the vehicle over. A bunch of guys who were standing there watching ran up and grabbed ahold and pulled the vehicle back right side up then they pulled again with all the guys there to help steady it. It worked this time so when they got back up on the road about twenty people were running to get in the land rover... So apparently it was a pretty full vehicle. Then we could continue on our way.
   When we were almost all the way down the mountain Keith got a phone call from April that there had been a flight cancelled so she wouldn't come in until the next day so we headed out for the beach several hours earlier than we expected. We went to a resort called Moulin Sur Mer. It was pretty
windy that evening so we didn't really swim in the ocean but swam in the pool. The next morning was beautiful so to the beach we went. After lunch we went to a museum on the resort then headed back to Port for Sallie's wedding the next day. We met April before supper then her and I spent night with the orphanage girls. It was an enjoyable evening with the girls. I grossed some of them out with a video of the cheek abscess we dealt with a little over a week ago. Right now the orphanage has twin
 boys that are one and a half months old then the little girl who is nine months old that we sent down from up here. The other orphanage workers are there on duty 24/7 so the girls had been keeping the babies at their house for night. That night they had the nine month old too because they were going to take all three babies with them to the wedding the next day. They don't have air conditioning down there and only sporadic electricity for their one fan. They run their fan at night so hopefully they can get some sleep in between the heat and taking care of three babies. Half way through the night the electricity went off but it does cool down a little at night. The babies were up at 6:00 so we got up too. Actually, April and I didn't get out of bed until 7:00 but the other girls each had a child to tend to.
The wedding was nice but long. It lasted about three hours and started about thirty minutes late because the bus bringing the choir had broken down. It was a very warm day and the babies got really hot. The amount of people that can sit on one church bench really increases over here. The ushers just keep bringing people in and we would all try to move a little closer so one more could sit but soon they would be there again with someone else. I helped with one song and the minute I got up someone came and took my place on the bench. I decided I didn't need to sit that bad so went to the back of the church and stood. Then I could at least feel a little breeze.  The reception was outside at a hotel by the ocean. It was breezy and beautiful.
    FYI- we just got a phone call saying that the man with the broken back died this afternoon. He is so much better off now.
    We came back up the mountain Sunday evening. We would have been back in good time but had some problems with the machine so we didn't even get started back up until after 7pm.
 Ok, that's all for now... Waiting to see what this week holds.