Maji is the Swahili word for water and I have quickly learned in Berega water is a luxury. Oh sure, my house has water that comes from the ground that is very salty and not safe to drink and we have rain water that has been collected from the seasons that you cook with and put through a filter to drink and I have also bought bottled water, but to everyone else, water is a luxury. For some reason God chose to put this town/village in Africa in a place where water is not in abundance. You go down the mountain a few hours and there is water in bountiful supply. Right now it is the dry season. Water is rationed at the hospital housing to two days a week. The family members of patients who stay in these small rooms behind the hospital have to go many miles to find water to bring back to cook the meals for the patient. We, Liz and I, recycle water in ways that you don't realize. Today we did our laundry and the neighbor's house girl came to get our soapy water to wash their floors and to use to flush their toilets. We collect the piped water from the ground in a tub throughout the day and wash our dishes in it. When the dishes are washed we water the plant with it. You just don't turn the water on to water the grass or wash the patio. Every drop has to have a very calculated purpose. We do have a shower that is now a hot shower, thanks to Brad Logan, and last night I couldn't help but wonder if I should be turning the water off in order to conserve it. I have only taken a shower every other day here, so maybe my indulgence wasn't too bad. This is the first major hurdle that H4A has to combat. We need water here, desperately. I have been told that you can dig for the water and in fact I have seen shallow holes that have been dug in the dry river bed to get to water. Brad has said that he has access to a water drill somewhere, but it costs $75,000 to bring here and then we have to have someone who knows how to operate it. One of my many tasks when I get home it to find some Rotary Clubs to speak to and see if H4A can gain their sponsorship for the drill. Water and better education lead to healthier communities.
My dear friend Liz has taken up championing for the latter. She does a great job teaching preschool to 5 and 6 year olds. They know their shapes, colors, numbers to 150, letters and can make good complete sentences all in English!!! They are smart, very smart. She is also tutoring adults in English classes. I have sat in on a few of her classes and these adults know more then they think. At the end of class they ask me questions in English about me, my family and where I am from and we discuss things. During this class is when Liz and I first hear about the Hungry Time. The Hungry Time is a real thing, it happens between the dry season and the rainy season when the maize crop has gotten very low and there is no water to plant yet. The next planting takes place around February. The Hungry Time is Dec-Feb and many people, children included, will only eat once every 3 days. We have been told that nobody dies from hunger during this time period but everyone gets pretty skinny. Liz and I have been brainstorming ways that H4A can help with this. We will have to talk to the boss about it first. We want to make sure that the children, pregnant women, nursing mothers and the elderly eat. Basically the most vulnerable population. We have a long way to go to get approval and money to do it. Please pray that this all works out and we can do the best for the most. We want to have a free feeding program where the children bring their plates and we feed them ugali (which is a maize lump of starch) and maybe beans. There is also a stew/soup made from maize and beans with a broth. Of course during this time the price of corn and rice skyrocket because nobody has any money but the demand is high. So we ned money now to buy the ingredients now. But first thing is first, permission from H4A and from the village government.
Now to where there is to Doktari (yes that is Doctor is Swahili). I had an indepth tour the other day of the hospital. The lady I saw early in the week with the ascites and possible multiple tumors is still here and still has a swollen belly. She happened to be puking and all I could think is where is the Zofran!!! She looked miserable and still needed to be tapped. I saw a pediatric patient with a burned leg that had a cradle over it to keep the sheets from touching it and the flies off of it. Another pediatric patient was in with a probable intestinal obstruction. He had a NG tube down and it was draining by gravity into an emesis basin. He may get surgery, he may not. The hospital here has 3 trained clinical officers. They aren't quite doctors and they admit it. They are more like the equivalent to Physician Assistants. As one said, "we do it all". I said " a jack of all trades and a master of none"? He laughed and agreed. So as we continued on, I got my first real look at Ward 5 which is the Maternity ward. The L&D area is 3 rooms on beds as old as dinosaurs and about as comfortable as lying on the concrete itself. There was a girl, 16, in one who had been admitted at 5pm but was probably in labor since 10am. She was uncomfortable for sure and as I reviewed the chart I quickly saw two red flags that would make any nurse cringe. There was meconium in the fluid and the baby had irregular fetal heart rate. She should have been in surgery right then. Plus she was little and the baby was big. Needless to say, she was my first c-section I assisted on as well. Before I tell you about that, I went to the premature baby room. Now being a former NICU nurse, I braced myself for the worst, but it was actually good. There were four hospital sized beds, two on each wall. Two of the beds were occupied each by one mom and one teenie tiny baby. One baby was 8 days old and weighed 1.8kg (3.9 lbs) and one was 3 days old and weighed 1.5kg (3.5 lbs). One mom thought she was maybe 32 weeks at the time of delivery and I have to think that the other mom was too. Due to lack of prenatal care, these women have no idea. This is also an education thing. These babies were snuggling dressed in sweaters, hats and wrapped with a foil sheet and blankets, lying next to mom. Kangaroo care is what we called it. The chalk board in the room indicated that these babies are growing, so something is going well. They can be discharged when they are 2.5kg, which is a little over 5 pounds. The key will be to keep the healthy in their homes to survive to age one. I was deeply saddened and shocked at the same time. I had to pull it together to keep from crying.
Now, on to the c-section. I had been warned that things were not what I am used to, but I had come here to see everything and truly had no expectations. I was told where to change and since the scrub bottoms didn't fit my bottom, I found a scrub dress that fit. I put my socked feet in white rubber boots, found a cloth head covering and was handed a disposable mask. I made my way to the scrub sink which was two faucets with a piece of hose attached to the end to avoid splattering and the soap was a bunch of powder in a bowl. I scrubbed my hands and arms the way I had been taught and then used my elbow to turn off the water. I made my way back into the OR and was shown which towel to use to dry my hands. There was a fabric surgical gown that I put on and then donned two pairs of sterile gloves. The patient came in on a rubber gurney that is hard to describe, but there were two poles through the fabric that were used to place the patient on the operating table. Keep in mind that she is 16 and no one is saying anything to her. I couldn't say anything that she would understand. She was scared. There was a scrub nurse there who got the instruments ready. The CRNA place the patient's arms on "the cross" as we call it. Two boards, one for each arm, outstretched. They use ether here too by the way. Dr. Abdallah and the nurse draped her stomach after he had cleaned it with betadine. I am not sure what drugs she was given before the ether, but when he put in an oral airway, she promptly puked. The section took 40 minutes. yes that baby was sitting in pea soup and came out pale, very pale. He was handed by the ankles to the baby nurse and she did suction out his nose and mouth thoroughly. He took a long time to come around. NRP was not happening. Finally his high pitched cries came forth. Meanwhile there was no suctioning of the blood in the uterus or the pea soup. It just ran on the floor and down the back of the patient. The closing had commenced. When he was done, and he did a good job, that's when he did a fundal massage and the blood came out the vagina. Very interesting technique. Overall, I felt that the procedure was as sterile as could be expected out here in the "bush of Africa". Today (Sunday) I asked how everyone was doing and I was told ok. The mom was put on antibiotics and the baby would be too to prevent pneumonia. At least now I know what to do in my next c-section and I won't hesitate to get that baby crying either.
Many things have been running through my head and if I think too much about any one of them, I start realizing that maybe this problem is too extensive and nothing can ever be better. With that thought comes the feeling of suffocating. I slow down and realize that the present has been this way for centuries and it cannot change in 2 weeks, 2 months or 2 years. But things can be better. Slowly better.
First we need water and then we need supplies and then we need better education here, which isn't formal education, but health education for the mothers and for the children. The Brits are slowly pulling out and H4A can get down to the real work. Creating a healthier community one mother and one child at a time.
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