there is no blood

it is july 6th, and i was joined by a young(-ish) boy on our walk to work today. he chatted with me pretty much the entire way while thu and amy followed behind listening. his english was decent but I spoke simply to limit the miscommunications (I feel my english may suffer during my travels). this is not a rare occurrence, making friends with strangers here is a daily happening. in fact, when thu and I went for a run today I definitely ended up racing a local... you heard me right :) he ran past us originally then walked ahead, so I ran up past him and as I went by he broke into a sprint. obviously an invitation to race - we sprinted down the road side by side, I was laughing, he kicked my butt. he slowed up ahead and I ran up next to him and told him “you’re fast”. we sprinted on and off a little after that, then I’d circle back to find thu. games with locals. what we’re really wanting to do is challenge the kids here to a pickup futbol match on the field we run by each day. wait for it, it’ll happen.

the hospital wasn’t nearly as fun as meeting locals. but it was shocking as ever… I got to be in the operating theater today. another experience worth writing about, but difficult to witness. I wheeled the woman, in need of a c-section, to the operating theater, literally on the opposite side of the hospital (convenient, right?). she was blowing air between her lips, making that motor boat noise continuously as we went. I was a little confused about whether or not they’d given her meds yet, I thought no, but her behavior was strange. anyway, we arrive and time passes and she sits quietly, waiting, her IV drip is causing her arm to swell because it is not properly in a vessel and her foley catheter bag is sitting on the floor between her feet. not sure what the cue to begin was, but they eventually asked her to walk into the theater and climb herself onto the table. this among the contractions she’d been suffering though as she was waiting. oh, and yes, they take all of her clothes from her first so she is literally naked on this bare table in a big room with a handful of people bustling around her.

she sits there shivering in the cold room, goosebumps cover her body. the nurse comes to sterilize her back, sort of. I cannot get past the inconsistencies and faults when it comes to sterile technique here. the anesthesiologist calls me over, wraps her hands around the lower back of the woman and says, iliac crest, as she emphasizes where her fingers sit. her thumbs come together at the spine, she digs one of her finger nails in, leaving a mark. quickly retrieving a long needle and syringe, she turns and stabs it deep into the woman’s back over the mark she has made. after pulling it out, readjusting the angle and reinserting it deep between the vertebral spines, cerebral spinal fluid begins to drip from the end. next she injects whatever outdated drug they’re using for the epidural. at least this woman gets an epidural. when thu watched the procedure they had trouble accessing the CSF space and gave up – voila! cesarean section without meds. any takers?

the doc comes in, wearing ohsu scrubs no less, and the mask he had requested from me earlier, inside out (? I know). the staff here want everything you have. they will ask for your masks, your gloves, and above all, your pens. as I’ve mentioned before we carry a handful of pens on us each day and without fail they are gone by the time we leave. he waits hardly a moment after the epidural has been given. two drapes and the patient is ready to go, wide awake and still shivering in the cold room. he slices from a.s.i.s. to a.s.i.s. (anterior superior iliac spine aka her hip bones) and her skin spits revealing a thin layer of yellow fat and then fascia. he cuts though that as well, tears through it more so, cuts the muscle and at this point a few of the woman are standing next to me observing and they keep repeating “there is no blood”. that’s debatable, I mean, there was some blood, but apparently not what they were expecting. the anesthesiologist brings out the blood pressure cuff and an ancient looking sphygmomanometer, er, the part with the pressure on it, not sure what it’s called alone, but it is wheeled out and attached to the cuff and it looks like a huge thermometer with some liquid that rises inside as she pumps up the cuff. our mama to be is hypotensive. they increase the rate with which they are giving fluids and begin to bag her. for a moment I’m worried this is going to get very bad very fast, but the surgeon is cutting deeper and now her shiny uterus is distracting me. he cuts through the superficial layer and then blunt dissects through the rest. once they’re in, he grabs one side of the hole he’s made, the nurse grabs the other, and they literally throw their body weight apart, yanking violently on all her tissue layers, attempting to widen the gap enough for a baby to fit through. the hole is not big but he gets his hand inside and somehow retrieves the baby’s head, which barely squeezes through. it is reminiscent of an SVD. the body is next. the baby’s cord is swiftly clamped and cut before she’s whisked away to be weighed and given an APGAR score. I glance back and the woman’s uterus is sitting atop her stomach, pulled out of the incision for the repair. it is large and thick with muscle after 9 months carrying a fetus. wild. the surgeon makes quick work of repairing the damage he inflicted, and then stuffs the huge, circular organ back inside the abdomen, like santa stuffing presents into his red velvet bag. yes, that is what it reminded me of. he finished closing. the whole thing was impressively efficient and I stayed to watch the next.

aside from a few of the more blaring instances of disregard for patient comfort, this was probably one of the most humane and potentially sterile-ish procedures I’ve seen here. the patient was not in excruciating pain, (though for the second woman I think her meds might have been wearing off by the end because she began to clench my hand tightly with the more aggressive maneuvers of the surgeon), and there was no yelling or slapping of the mothers (as I’ve heard will happen with the woman are “uncooperative”), and a sterile field was somewhat maintained considering the resources they’re working with.

I know so many of my stories have seemed jaw-dropping unbelievable, and we’ve been struggling to deal with the way things work around here, but it is not a bad place. they work with what they have, which is not a lot, and they do the best they can considering the differences in education and the expectations/standards of society as a whole. they simply do not have the means to wait by each woman’s bed holding her hand until she is finally ready to deliver. they must cater to the other mothers and wait until that crowning head appears before they turn their attention to that particular woman. we will help where we can, distribute what supplies we have brought with us, and educate when possible about some of the more evident places where they could easily improve (sterile technique in general, vaginal exams, proper suctioning of the babies’ mouths after delivery, etc). that said, many of this issues are here in the first place due to a lack of financial stability and government support. this is a government run hospital after all and it has nothing. we’re constantly running out of sterile supplies and if I told you how we sterilize the supplies here you wouldn’t believe me. I watched a nurse today perform an episiotomy on a patient using rusted and dull scissors that could hardly cut through the baby’s cord once he was born.but what do you do? where do you begin? the supplies we are donating will only go so far. our suggestions and teachings might only reach one or two nurses, and maybe only for that day. and then, surprise surprise, we’re back to feeling powerless. however, despite feeling helpless amidst all of these adversities, we can, at the very least, be helpful. and so we deliver babies and admit mothers and support patients, or we do the less glamorous tasks (not that I’d call delivering babies glamorous, but definitely gratifying), like fetching clean sheets or wrapping supplies to be autoclaved. we are here to help where we can and that is what we’ve been doing, or at least trying to do.