Sunday, March 29, 2015

Sefula Part Two: Baby


This will definitely be one of the hardest blog posts I anticipate having to write. 

This week, Rebecca and I (Danielle) were placed at a small rural health clinic in a village called Sefula. Though excited, I was hesitant to be placed here. I had seen the lack of resources at the hospital in Mongu, and had seen instances in which the care patients received was limited. It's not that the nurses and doctors here are not smart, or that they don't try there best. They do their best with the resources they have. And sometimes their efforts are enough. And sometimes they aren't. Even in Canada, our best is sometimes not enough. But I couldn't imagine what health care would be like in an even smaller clinic with less resources. And as hard as I tried not to, everyday, I found myself thinking of home. Of how the care these patients were receiving would be different in Canada. And I know that type of thinking is counterproductive. But it's hard not to imagine if a patient's outcome could have been different if they were back home. Enter: this week.

My week started off good. My first day, I shadowed an extremely intelligent nurse as we conducted small pre-natal clinics for the pregnant women in the village. I was actually surprised at how thorough the nurse was - every woman received a full head to toe assessment, was tested for HIV and STIs, and was given deworming medication. I was already learning so much. This first day provided me hope for the rest of my experience here - if they could provide excellent nursing care in a low resourced, small community clinic, then maybe I could as well.

My second day was my ultimate high. Most of my friends and family know that before I left, I dreamed of being able to deliver a baby in Africa. I didn't just want this experience, I craved it. Not only would it put so much of my acquired nursing knowledge to the test - it would also allow me to be the first hands to welcome a baby in to the world. This is what drove my desire. And when I arrived that day and saw a labouring mom, I knew my day had come. There were no doctors in this clinic, no midwives. There was only myself, the nurse, and Rebecca responsible for this woman's wellbeing. And I felt up to the task.

The woman was a gravida 5 para 4 - this means that she had been pregnant 5 times (including this pregnancy) and had delivered 4 babies already. It made me feel better that the mom maybe knew what she was in store for with her labour, because I certainly did not.

Though this woman could not speak English, the nurse taught us some important key phrases to help with the delivery. And after a few minutes, we were yelling "Kasha Ahulu Mama!" with every contraction. Roughly, this translates to "Push hard, Mama!"

The woman had been labouring since midnight, and actively pushing for two hours when I started to get worried. Rebecca and I couldn't hear Baby's heart rate. The nurse listened, and said she could hear it, but it was irregular. We knew Baby needed to come out quickly. We knew the labour wasn't progressing fast enough. We knew we were in trouble.

Back home, this lady would have been rushed for a c-section. Especially since this was her fifth baby. By this point, her body should know what to do. The baby should have been delivered hours ago. But Baby wasn't. And there was no operating room. No doctors to preform a c-section. There was only us.

The labour continued. At one point, a piece of the placenta was pushed out. This is extremely bad - the placenta needs to stay entirely intact or a woman is at risk of post delivery bleeding so severe it can often lead to death. It can also be bad for the baby.

At this point, Rebecca and I still couldn't hear Baby's heart beat, but the nurse assured us it was there. I began to wonder if it really was, or if the nurse was just trying to keep the situation calm. And at that point, I realized it didn't matter. Heart beat or no heart beat, all we could do was deliver the baby. We had no interventions we could preform. We had to let nature take its course.

Finally, after hours of active pushing, the baby started to descend. I could feel swelling on its head, and the nurse explained to me that it was called Caput - and it happens when the labour is prolonged and the baby's head starts bleeding. Was anything going to go our way?

And then the moment finally came. At 1:04pm on March 25, 2015, I delivered a beautiful baby boy into this world. The feeling cannot be described, the beauty of the moment never replicated. I felt so blessed in that moment.

And I wish the story could have ended there.

Most babies don't come out immediately crying. But after dried off with a towel vigorously, having their mouth cleaned, and having the cord cut, babies are normally stimulated enough to start stirring. However, our baby did not. And I paused as I realized a small, blue baby laid in front of me, not breathing.

We cut the cord, and rushed Baby to our work station. The nurse remained calm as she tried to rub Baby more to stimulate him awake. But my heart felt like it was beating a thousand times a minute. I became frustrated - how was the nurse so calm? And as I lifted my stethoscope to Baby's skin, all I wanted was to hear his heart beat mimicking my own.

I listened to Baby's chest, found a heart beat, and sent up a thank-you prayer. Though slower than it was supposed to be, it was there. But I knew that unless I got Baby breathing, it wouldn't be there for long. I re-cleaned Baby's mouth with a cloth and asked for an infant resuscitation mask. I began giving Baby breaths. With each pump of the mask, I was desperately trying to force Baby's airways open.

Give two breaths, check for breathing. Give to breaths, check for breathing. I frantically followed this pattern for three rounds. Then, it happened. Baby began to breathe on his own. And I swear, that first breath he took was the most beautiful thing I had ever seen.

Baby then started to pink up and move. And I will never forget the moment, as I checked Baby's reflexes (to check for brain damage), that Baby's little hand wrapped around my finger. And that squeeze was the only thank-you I would ever need.

When it was time for us to leave, Baby still hadn't cried. But he was moving. He was breathing. The nurse told me that he was possibly just tired from the long labour. I asked if we could check to see if his blood sugar was low (somewhat common in big babies that are tired), but there was no blood glucose monitoring machine. And even though my worry for Baby's condition was not completely gone, the nurse told me that she thought baby would be just fine. And as I started down at that adorable little chubby face, I knew that in that moment, there was little else I could do here. Baby had made a miraculous recovery. And I had to believe that overnight, he would continue to do so.

That night, I went home on a high. Not only had I successfully delivered a baby, but I had successfully resuscitated one as well. As I am sure some of you saw from my Facebook post, I was happy. And every time I looked at that photo of me staring down at that cute little baby I felt warm inside. All the support I received was amazing. It was a great day.

Again, I wish the story could end there.

The next day, I returned to Sefula. Rebecca and I had brought a package for Mom containing baby clothes, socks, slippers, and receiving blankets to adorn our new babe. When we arrived, I couldn't find Baby, but I assumed he was being greeted by extended family somewhere else in the clinic. However, I found Mom happy as ever, and gave her our gift. She was so grateful. We were so happy she was doing well.

I then went to the OPD section of the clinic to get my fix of Emergency Medicine for the day.

About an hour in, Rebecca, who was working in Maternity, showed up in OPD and beckoned me to come see her. I knew by the look on her face that the news was not good.

Tragic words came out of her mouth: "Baby died this morning."

My heart stopped.

Shock and grief overwhelmed me. I don't even remember walking to the Maternity area, but when I arrived, the nurse brought me into a small room. She unwrapped the blankets, and there on the bed, Baby lay still. And I knew he was gone.

I tried hard not to cry. I tried to be strong. But as I stared at the small, lifeless babe, I broke. The hand that squeezed mine, the lungs that I inflated, at rest. Baby's sweet, little eyes, closed. It was true. Baby had passed.

As I walked out of the room, there was Mom. She had heard the news too. She was crying hard.

I asked the nurse to tell her in Lozi that I was sorry for her loss. And then I sat down with her, and we cried.

I later found out that through the night, Baby spiked a temperature of 40 degrees. Baby had gotten an infection.

I knew that Baby had been given antibiotics, that they had tried to treat him. But it was the things I didn't know that were eating me inside. Was Baby properly hydrated? Was he cooled? Did they attempt to resuscitate him? I don't know the answers to many of these questions. But I do know that the nurses at Sefula are amazing. And I like to think they gave Baby a good shot at life.

Looking back on this experience is hard. Even now, I wonder if this was something I could have prevented. If there was something more I could have done. If I should have stayed overnight with Baby and Mom to make sure they were ok. And everyone says not to blame yourself. But when your heart hurts, it's hard.

In Africa, one of the sad realities is that they lose so many babies, they wait to name them for a while to see if they survive. Baby never got a name.

It was this experience that made me fully grasp the phrase of "This is Africa."

The other girls that I am here with have been great. And I am doing good. They are making me laugh, smile, and letting me vent. I really don't know what I would do without them.

And every day, I come more to terms with what happened. And I am learning that some things are just meant to be. And I have to trust in that.

But still, every time I stare down at my phone and see the background of that little babe, and miss him with all my heart, it hits me again that I am in Africa. And there are highs, and there are lows. And though the lows are low, the highs are high. And in the end, I hope they will come to balance each other.

I know I will never forget Baby. His life was one of my life's best parts. Though his life was small, it was a big part of mine. And I felt honored that I got to spend it with him. And happy that he got to spend it in the loving arms of his mom. Really, I guess that's all he could have asked for.

- Danielle

4 comments:

  1. I wonder why haven't they refered them together to Mongu.. Too bad

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  2. Dear Danielle,

    I hope that writing out your story has helped you. My heart breaks with you that you had to witness this sorrowful event, one that with the right resources could well have ended so differently. Adding a bunch more words here to your experience seems superfluous to me - you have said it all, at least for now.

    I am glad that you are able to process your experience with your colleagues. Too often, we do not debrief when we need to as nurses, and that is where burnout can start to take root. We need to care for ourselves too when we are part of things that go wrong.

    Yes TIA, This is Africa - and we are not there as UBC Okanagan nurses to feel good about ourselves for going for a few weeks, or to feel bad about ourselves for not eing able to do more. We are there to contribute what we can, which matters; to learn what we can, which changes us forever; and to keep acting as better global citizens when we return to our safe homes and good lives in Canada. To not forget and to retain a commitment to this partnership, and to all the ways we can stay involved in making this a better world.

    Take care and thank you for sharing your words with us,

    Tricia Marck

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  3. Thanks for sharing Danielle! I'm so sorry for how tough that must have been for you, and for that Mama. :( Thinking of you guys as you travel the journey. Linda Drew

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