The number of patients coming to the clinic each day seems to be down slightly but today was a normal, busy Monday. I saw 30 patients and I'm sure each of the other nurses saw that many or more so my guess is that we saw a little over 100 patients today. My first patient was a little 3 year old boy who got burned on his face, neck, chest, and left arm on Friday a little over a week ago. His burns didn't look too bad initially so we gave some Ibuprofen and antibiotic ointment. Jay asked the family to bring him back on Monday. For some reason they didn't. They showed up Thursday afternoon after the clinic was closed for the day. The family had also put ashes on his burns so now he was covered in thick, black ashy stuff that was caked on and dried. They were not real cooperative, did not really want us to clean the burns but finally did agree to let us try to clean them after we gave some Ketamine for sedation. Jay got most of his face and neck cleaned to a certain extent but I didn't get very far with his arm. The ashy stuff was caked on quite thickly and wasn't really getting much softer even after I covered it with wet gauze for a few minutes. We were going to give a second dose of Ketamine but the dad didn't want us to. We had given the first dose IM and he didn't want us to give his child another shot because it would hurt, so we stopped cleaning. He was hurting too badly to continue. We put triple antibiotic ointment on his face and neck then bandaged his arm using silver cream. This was last Thursday. We told them to come back Friday morning so we could change the dressing on his arm but were very doubtful they would return. They did though. His face and neck looked okay and I was able to change the dressing on his arm without having to give him any sedation. We gave them several tubes of antibiotic ointment to use on Saturday and Sunday and told them to follow-up this morning for another dressing change to his arm. They came! I was so glad to see him back. His face looked good, the right side of his head, right ear etc... had quite a bit of dried drainage that I didn't try to remove. His arm looked very good though. Most of the burned skin had come off with the silver cream. I applied another layer of cream and a dressing and gave him some antibiotics for an ear infection and asked them to come back on Wednesday. Hopefully he will continue to do well.
I haven't seen as much malnutrition this time, until today. I saw three children who were malnourished and Chancela saw another one- the one she saw was only 3 months old, so technically too young to qualify for the nutrition program in Forèt. This program has pretty strict criteria but if the children qualify they are given peanut butter and monitored weekly. That program is our best resource for malnutrition in this area. Sometimes we will have some rice or "manna packs" to give out but we can't guarantee it because our supply also comes from donations.
Normally on Saturday I go to the market in Forèt des Pins. Sometimes Jay will go in the machine for supplies but normally we girls go on moto. With the shortage of gas in the country, the price to go on moto has more than doubled. The normal price is 100 goudes, currently the price is 250 goudes, one way. This past Saturday, we were planning to catch a ride with Jay as he needed to get some groceries. We were planning to leave about 9:30, until a lady showed up at the gate at about 9:00. She had come the night before, in labor with her 7th child. Everything seemed normal but she was only dilated to about 6 cm and her water hadn't broken so we sent her home, thinking the baby would be born probably sometime in the night. She came back Saturday morning, the baby still hadn't been born. Everything still seemed to be progressing well, just not as fast as we would expect for her 7th child. She was now fully dilated but her water still hadn't broken. I asked her if she had walked at all. No, she said she couldn't. (Just for interests sake, the evening before she had come on moto, this morning she had been carried to our house on her bed, from quite a ways away.) I had to be the mean nurse and tell her she had to walk for a while and I would check her again in an hour. With support from her family, she did walk for a while. Then she needed to use the bathroom so I told her she could use our outhouse. I was standing nearby and heard a splash, her water had broken there in the outhouse. When she got back in the gallery I checked her again. The baby's head was lower but she still wasn't ready to push so I asked her to walk some more. She did. I had just checked her again and it didn't seem like she was quite ready yet so I went in the house and was talking with Amberly when I heard some commotion in the gallery. She had gotten up to walk again but suddenly was ready to push. Of course they were right in front of the gallery door so they had to maneuver and I did too so I could get through the door to check her again. The baby's head was coming, right now. Chancela came to help and Jay came in a few minutes also. The baby was stuck for several minutes, with everyone hollering at the mom to "push"! I was afraid we would have some difficulty getting the baby to breathe after it was born because it was taking so long to deliver but I could feel that the cord was not around the baby's neck. That must have been our saving grace. I was able to get a finger in to help move the baby's shoulder just a bit. That little bit of repositioning allowed him to be born soon after. We only had had time to grab one towel so Chancela did the " move the family member away from the door manuever" so she could get another towel, the bulb syringe, and the cord clamp. The baby did well, breathing on his own and crying before we had even suctioned him very well. Jay took the baby inside to get him dried off and dressed and I stayed with the mom until she delivered the placenta. Soon after that they were ready to go home. We piled into the machin and headed to Forèt, and it was only 11:30!
No comments:
Post a Comment