Through my eyes

I’m behind on my documentation for the past events. First of all, Sunday was very enjoyable and relaxing. We got to spend a good amount of time with the kidos over at the primary and secondary school, as well as return for devotional the the school on Sunday night. On Monday, I was back in the male ward, which I blogged about already. Oh and I also had kitchen duty on Monday. Tuesday brought about a chain of new events. The entire team packed into the bus and made the drive to Mbeya to view the Baylor Hospital. This specific hospital is part of BIPAI—Baylor International Pediatrics Aids Initiative. When we arrived we were introduced to a sweet lady named IJ who gave us a powerpoint presentation on AIDS. Lots of the information was very interesting and we were able to see the progression of many different medical conditions throughout the healing process via pictures on the presentation. The overall goal of BIPAI in Tanzania is to contribute reduction of HIV and AIDS related to morbidity and mortality among infants, children, and adolescents in Tanzania. They achieve this goal by a vision—to model pediatric clinical excellence empowering health professionals and communities to ensure sustainable, superior HIV care, treatment, enabling healthy and fulfilling lives for the children of Tanzania and their families. The objectives include

·      Support provision of family centered comprehensive pediatric HIV care and treatment

·      Enhance pediatric HIV case finding through a pediatric focused HIV counseling and testing model

·      Strengthen the local human resources and health systems capacity to provide comprehensive family centered HIV care and treatment services

·      Sensitize and mobilize people living with HIV (PLWHA) and the general community to support pediatric HIV prevention, care and treatment services

There is a lot of stigma here in regard to HIV which can cause further problems in the community. We were informed about a story of a young boy who had HIV and his family would not give him food or share clothes with him, and upon seeking medical attention he was beaten to death by people in the streets. This is a serious condition.

About 2.3 million children are currently living with HIV globally, representing 7.5% of the total number of people with HIV.

Mortality in untreated children is VERY HIGH. Left untreated, 50% infected children die before reaching age two. 200,000 deaths in children with HIV annually.

In Tanzania, 12% of pregnant women have HIV

160, 000 of children ages 0-14 have HIV, which accounts for 11.4% of all infections (UICEF 2009)

Those <15 years of age represent >30% of the population needing HIV care and treatment in Tanzania

Lack of knowledge regarding pediatric HIV in community and health care workers results in passive/late case findings and low pediatric enrollment in HIV care.

Sadly, here at the Chimala Missions Hospital, we do not have the reagent to do CD4+ testing. The resources are not available, so we no longer can give a test to determine if one has HIV or not.

We finished touring the hospital at Mbeya, which made me feel as if I were back in America. I’m not so sure how I feel about that, knowing that all of this money is put into one facility. I also question whether or not it is culturally appropriate, or if the people feel welcome here because it is so different than any other building in Tanzania.

After the tour, we went to eat lunch and then headed back to Chimala. It was Ashli’s birthday and we celebrated it after dinner back at the guest house. And around 9pm Ashli’s birthday wish came true. She wanted to deliver a baby on her birthday, and the phone rang with a message to go to OB. I joined Ashli down to the hospital and a cesarean section was about to be in progess. We scrubbed in and went into the OR. There were lots of complications during the procedure and the baby came out flaccid and not breathing. Ashli caught the baby and brought it over to the counter where we immediately started to perform CPR. She would count off, “1,2,3” and then I would pump. Apgar score for one minute was 4, and at five minutes was 7. The newborn’s heartrate had sped up and the oxygen, compressions, and pumping seemed to be helping so we continued working. We would get a grimace and a slight little cough every here and there but the minutes ticked onward. I kept saying, “Come on little boy, just tell me about it, tell me all about it.” Ashli kept stimulating the baby and checking the heart rate and observing for lung expansion. I had the pump in my hands. Although it seemed like an hour had passed, only about 10-15 minutes had actually gone by when the baby’s lungs started working without assistance. Momma was still open on the table and the doctors were working on her. We wrapped baby up and put him in the basinet to cart him down to the “uzazi” ward where momma and baby can be together. Ashli picked him up and put him on the scale to see how much he weighed, and as soon as he hit the cold scale we got the first big scream! He weighed 3.6 kg. We wrapped baby back up and then we all got close together and said a prayer for this new life.  Next we took him to “bibi” (grandmother), who was just gleaming with joy. She smiled so big, and she had one tooth in the front. I will never forget the moment we handed that child over and saw a happy happy happy grandmother. Then we cleaned up and headed back to see if we could help in the OR. Everything was under control, mama was doing well, and our job was finished.

On the walk back to our guest house Ashli and I were bouncing with happiness. It’s such a wonderful feeling after you experience a birth. The joy was screaming from our smiles. We stopped on the pathway home and turned off our lights to look at the beautiful sky. The sky was filled with twinkling stars. As we stared up at the sky we spun in circles and thanked God for such a beautiful creation. And then something made a screaming noise in the nearby distance and brought us back to earth. It must’ve been a baboon or something. We continued our walk back to the house and got ready for bed.

Today I woke up exhausted, yet excited to spend the day on OB. When I got down to the hospital there were two women in labor. I was on the ward alone, but Amy came and spent the morning with me, as the ladies slowly progressed. I found a chart for a young male burn patient in our ward and decided to return it back to male ward. I was further directed that he was in minor theatre, and when I got there, he was terrified and crying his little eyes out. He has second degree burns on about 40% of his body from falling into a fire. Now is the season where burns are very common because it gets cold at night. I got down on his level, held his hand and started rubbing his little head. There were only two other African nurses in the room who were about to start and IV so I decided to stay. I wanted to try and comfort this young lad because needle pokes are no  fun and due to his burns, he must be in an unbearable amount of pain. The nurses could not get an IV access point and stuck him three or four times. Everytime they would try a new site he would squeeze my hand really hard and cry out louder and louder. I kept saying dawa maumivu which means medicine and pain, hoping he would understand that this would ease his pain. Unfortunately no IV access site was attained, and eventually the doctor said no more sticks. This boy has very few places to get venous access due to his wounds and we do not want to damage them. The boy got an injection of ketamine via IM in order to go under short acting general anesthesia for debridement and dressing of his burns. Although IM takes longer to have the desired effect, within ten minutes his eyes were closed and we were ready to begin the procedure. Ashli, Anna and I scrubbed his burns with normal saline and pulled off all the skin that was peeling. Then we took betadine and covered all of his wound surfaces. Next we covered the burns with silver silvadene. We continued to put petroleum gauze over the burns and then dressed it with regular gauze and secured it with tape. We transferred young man back to the stretcher and brought him back to male ward. I can’t imagine the pain that he is experiencing. I feel for him, and want to help him, but there is nothing more I can do. He is in God’s hands. Please continue to keep this young boy in all of your prayers.

I decided that I needed to head back to OB because I had been gone for awhile, and the two laboring women were getting closer to delivery. The primigravida was at 9 centimeters and before I knew it she was pushing. The doctors had already gone for lunch but I had not left yet. Then Ashli popped her head in, and what a blessing she was. Amy and I were the only other two people there besides the two nurses. As the primigravida began pushing, and we were all working with her, the multigravida makes a yelp and the nurses nudge us over there. The head was coming and Ashli and I changed our gloves very quickly and delivered a baby unattended. The baby came out screaming and with an Apgar of 9 at one minute and 10 at five minutes. We clamped the cord, cut it, Ashli took the baby to the baby counter and I remained with mama to deliver the placenta. Mama and baby did wonderful and I am still in shock that we delivered a baby. I am so grateful for the education that I have received. All of my wonderful teachers have prepared us for moments like these. Baby number two was born with help from the African nurses while we were still caring for the other family. Thank goodness dear Ashli stopped by to check on me! I was so thankful for her help and we worked very well together as a team throughout the procedure. And just think, all of this happened before lunchtime.