Wednesday, May 19, 2010

I think it's Wednesday?!?!

Monday night Laurie, Cristy and I jumped right in and went to our first hospital shift. Logistically it has been hard to negotiate the scheduling. There are three unexpected women here and although there is a lot to do we have a limited number of translators etc.

At any rate we were feeling ready to jump in and so took the first shift. It is hard to remember exactly everything that has happened. My clock is a bit messed up from working all night last night as well. Monday, Wed, Friday the students are working and it is our job to help instruct them. They work alongside the graduated sage-femmes who work week long night shifts. Not so fun.

When we arrived the first night were three women in labor. A 27 year old woman having her first baby, a woman having her third and another primip laboring. The first mama had her baby within about two hours of us being there and just as she had started to push the ob came in and forced delivery with fundal pressure. I am not sure of his motivations or if that is a semi standard of practice. There seems to be an idea that some woman won't have the babies fast enough. Consequently the mama had a deep perineal tear. But the 6 lb. baby girl was healthy.

Our second mama was about 5 cm when we arrived around 7 pm. She was not having strong or consistent contractions and labor continued slowly throughout the night. Baby started off posterior and it was hard to get the mom to change to a position like hands and knees that could help her. We managed a few position changes but without much success. And as mama continued to labor the baby began to appear stressed, it's heart rate declining. Eventually, after doing some more aggressive techniques it was time to call the ob.

The ob works, from what I can gather, from 7 or 8 am until 7 pm. He is the only ob that we have encountered. A few months ago there was another ob on staff. Calling the ob in the middle of the night does not guarantee that he will show up. I imagine he has to draw the line somewhere or he will burn out. Not a job I could have, it would be too hard to say no. And even when he is called he doesn't always answer and when he does he has to call a driver who rounds up the doctor and his staff, driving them all to the hospital.

And Haitian time isn't fast paced as it is. So, when we finally called, after getting the baby out of it's posterior position but unable to correcting the swollen and de-dilating cervix, we really hoped he would show. It was about 2 am and we were out of resources and ideas and baby was really showing signs of distress. As the night progressed and mamas labor continued to slow we worried that we would probably lose the baby and possibly the weakening mother. It was and is still challenging to feel that helpless. All we could do was continue to support the mama and hope the ob would come to the hospital in time.

In the wee morning hours the babies heart rate bounced between 90s and 60s, well under the normal range and it really started to seem grim. We still weren't even sure the ob would come. In the end he did and prepped the mama for a c section. Laurie and I went into the OR with him and three other staff.

It was an ordeal finding clean scrub tops to wear into the OR--our shirts were far from sterile, but there isn't much here that is. We finally found paper hats to cover our hair and clean scrubtops and extra large pink crocs. I am certain we looked like clowns. The doctor was efficient. The OR was a small room that attached to what seemed like the supply closet. It was surprisingly well equipped with meds, instruments and machines, but seemed very primitive as though it belonged back in 1930.

A strange looking pumping machine, the cross like surgical bed and the piles of suture made it all the more surreal. But the cesarean was straight forward and within a few minutes, just before 6 am, I handed a 6.5 lbs baby boy who needed a lot of stimulation, but amazingly enough, no resuscitation. He was a little fighter and I hope he won't suffer any great damages from his prolonged distress.

Once the baby was stable we took him to the students for his exam and shots. And then we packed up and made the 30 min walk home in the already building heat. It was probably close to 7 am. The sun was blaring already. We walked by a church that is being constructed and where a group of men were having early morning choir practice. It was a touching way of ending the night.

Now to bed. Sorry that these aren't coming faster. There is a lot to do and it is hard to not just crash when I stop moving. I am doing well aside from a terrible heat rash! Tonight is only my second night sleeping. I sure that I will and hoping that I sleep through the barking dogs and confused roosters (they wake up at three am around here!). Tomorrow, if all goes as planned we will have a mobile clinic day!! Vitamins and supplies divided and ready to go! Good night.

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