just unwind it

you’re not going to believe this one. I’m not sure why I’m the one who keeps ending up delivering the babies solo but we had another moment of chaotic panic this morning in the labor ward. we were helping out with admissions and had just finished with one of the mothers when dr. Ishmael said there was a woman about to deliver and that we should go help. we walked down one wing of the labor ward and didn’t notice anything too unusual, just a bunch of mothers moaning on and off with their contractions. amy turned to walk away, “no one’s delivering”, she said. I’m not so convinced, dr. Ishmael just told us a woman down here is about to deliver. I lingered back, searching the faces of the mothers. one mother in particular seemed to be pleading with me in silence and she grimaced with her contraction. she made desperate eye contact as she pulled her wrap away from her legs… sure enough the baby’s head was crowning. not again! are you serious?! my gloves were open and on the table before I even had time to call to dr. Ishmael. he walked casually over beside her as he instructed me to get my gloves on, fast! faster!.... shesh! I’m trying here! the first glove I put on broke.( I think the gloves we retrieved from ohsu’s extra supplies room are faulty and that’s why they’re there. even when you’re very careful they seem to break in the same place each time). I was frantically trying to double glove as dr. Ishmael was telling me to hurry and the woman was screaming “help me! please help me!”… talk about a little bit of pressure. literally pulled on my last glove as I was running up beside her. I placed my hands around the crowning, tiny head and told her to push. the baby’s head came the rest of the way out almost immediately. it was then that I realized the cord was wrapped around the neck. I could see it clearly, all slippery and white, wrapped twice just below the jaw. my stomach dropped. I looked up for guidance from dr. Ishmael. he wasn’t there. where had he gone?! are you kidding me?! like he has something better to do at this moment? I called to him, “dr Ishmael, the cord is wrapped twice around the baby’s neck!” I glanced over at thu and amy, they were both pretty much deer in the headlights staring at me. what are we doing here?! dr ishmael walked over just as I guided the body of the baby out. I’ve never wanted my hands to work more efficiently than as I was frantically trying to get the slimy cord unwrapped from the baby’s neck. “just unwind it” he said and I did and I lifted the baby onto the mother and rubbed her little back- start crying! please start crying! a small cry, and her color was good, dr. Ishmael looked pleased. I later told him that it was a bit stressful, that delivery, and he looked at me confused and said “how can it be stressful when it went so well?”… he has no idea. as I stood there clamping off the cord and tying it with a makeshift piece of thread, I looked down at the mother. she was beaming up at me, exhausted and shaking, repeating “thank you!” and praising me for what I had done. that’s what kills me about this place, if I hadn’t jumped in, if the baby had just been delivered, cord tight around her neck, what would have happened?

amy was a little overwhelmed by everything today. you want to talk overwhelmed? she has yet to be tossed into a deliver-this-baby-solo situation (though it definitely makes sense to me why a day in the hospital here takes a toll on her). among the many issues we’ve hardly got anything, supplies or educated supervisors, to work with. you should’ve seen the dull, aged scissors I had to use to cut the cord. we’ve been bringing in the donated supplies as we can but the need is so great, it feels as though we’re hardly making a difference. anyway, we stuck around for a while after that... I walked the mom over to another bed to have her second degree tear repaired. at this point amy was done. she told us she needed to leave and go wind down (we decided it was best to listen to her, don’t want breakdowns in the hospital). it is difficult to handle the chaos, disorganization, and lack of everything we seem to value in our medical system, here. I think today was pretty much the same as the last two days in the labor ward but something hit a chord with her more so than the other days. we took an early leave (how british medical student of us – no offense to anyone, but that’s just the way they do it) and went home to digest the morning’s events.

what’s funny about today is that we arrived at 8:30 in the morning to an almost deserted hospital. not a white coat in sight. we wandered from ward to ward, looking for someone, anyone to shadow or tell us how we can make ourselves helpful. we distributed more supplies. we’ve been bringing a little every day to areas of the hospital where we see the need. they are very appreciative of the donations. one of the funniest things is that we bring a pocket full of pens each day and lay them on tables and they consistently, without fail, disappear within minutes (dr. vick was right about them needing pens!). I never see who takes them but an unattended pen around here does not last long. by 9:30 we were pretty bored, so we decided to seek out George, the physical therapist here who we had met yesterday. turns our George is awesome. he took us along as he rounded on his patients. first to see many old and frail women he calles beebee. he’ll say “this beebee fell walking to the lou at night” or “this beebee fell herding her goats” and he’d show us the xray of the terribly broken bone, usually of the femur or a hip fracture, and we’d see the women laying here, the traction weight (a plastic bag with who knows what inside) maintaining the bone is the correct place for healing. the last patient we saw on this ward smiled and said hello to us as if she knew us. it wasn’t until he moved the blanket and revealed her dressing that I recognized the leg. this was the woman from yesterday, the woman with the terrible leg trauma. it broke my heart to know she was with it enough in the surgical room to remember us. no one should have to go though agony like that. now that we know where she’s staying we plan to visit again. just wish we could bring her some morphine.

next he took us to the pediatric ward. we rounded on young children with broken bones of all sorts, most from traffic accidents. this is the closest I’ve felt to unwell since being here and here’s why: the patient in the far corner of the room was a young boy, maybe 7 or 8. when George uncovered his leg the break was apparent only because his right food faced at a perfect 90 degree angle inward, his big toe pointing at his left ankle. that didn’t get me, what did was when George proceeded to straighten out the foot. the boy realized what was happening and started to plea with the doctor not to touch it, but George said for the outcome to be the best they needed the foot to be facing the correct way. ever so slowly he placed his hand on the little boy’s foot and began moving it into a forward facing position. the boy’s screams where blood curdling. with each degree his foot was twisted back to the correct position his screech would get a pitch higher until it was literally an ear splitting cry of agony. chills ran down my spine, I get that saying now, and I felt goosebumps spread over my body. I couldn’t take my eyes away. when George finished they placed a sandbag to hold the foot in place. the boy could tolerate it and so we left him. as we did George said “this is why in the US they think we are so barbaric here, but we do not have the way to put him to sleep and a few minutes of screaming is worth a better outcome”. I cannot argue. still, it is difficult to watch, as with so many things we’ve seen here.

to end on a funny note, i was saying phrases from our swahili book, just practicing funny things with dr. ishmael sitting there listening. i would say something and he wuold laugh because i would mess it up... i looked at thu and tried to say "i want to marry you" and he starts laughing harder than ever and says "you said, i want to kill you". apparently those two sentences are very similiar in this country... ironic? :)