I feel like I got sucked into a vortex at the end of June and I just recently emerged. My closest ebola friend went home for a few weeks, leaving me to do the nursing schedule. Which I would normally enjoy because it's like a puzzle. My grandma had this puzzle that was all Dalmatians. The whole thing was just spots. This schedule was like a 1,000 piece puzzle of that. And pretend 30 pieces have been eaten by a goat. Several days after I inherited this task, I got called to a meeting. This is the gist: Ramadan starts in two days, during Ramadan Muslims don't eat or drink anything during daylight, and therefore anyone fasting cannot go into high risk. Two weeks later, we had staff cutbacks and said goodbye to half of our nurses.
Meanwhile, we were starting to work in several local clinics, training them to screen patients in a way that will alert them to any possible ebola cases, donning and doffing, making and using chlorine, etc. With all of this going on, I had nurses calling me at all hours of the day and night. One time a nurse called while I was sleeping (my shift starts at 8am, please don't expect me to be conscious at 5:30), and despite speaking to her, I had to go to work and say, "I know we talked this morning, but I have no idea what about."
But anyway, Ramadan eventually ended, our patient load decreased, and we got into a routine with the clinics. On my first day at my clinic, I was paired with one of our nurses from the ETC. He showed me around, introduced me to the staff, and then we went into the triage area to oversee the screening process. At first it's kind of like fishing. They ask the patients all the questions and you find a patient who meets case definition and it's like, "Yay, we found one!" But after a few days, you find yourself thinking, "Please don't have three symptoms, please don't meet case definition" on a fairly regular basis.
One day during our triage, we got a woman who was in labor. All deliveries have to be done in full ppe, just in case. We are in the clinics to oversee and guide the screening and infection prevention and control, so I asked the nurse if it would be okay if I just observed. I put on my partial ppe and stood in the postpartum room with the traditional birth attendants (TBAs). The delivery room is turned into the red zone when there is a laboring patient, so we just watched through the door. The TBAs were using all the face shields, so I had to use goggles instead. There is no anti-fog spray at the clinics. Within minutes, I was down to just a small circle on the top right corner of the goggles. Ten minutes after that, the baby was born.
He came out and didn't make any noise. And then I thought to myself, "Oh my word, I never really considered that this kid might not be alive." This country does, after all, have a terrible infant mortality rate. The nurse cut the cord and brought the baby out onto the "resuscitation table." She rubbed and rubbed the little guy and he still wasn't crying. Or breathing. So now I have actually seen someone pick a baby up by the ankles and hang it upside down. No effect. She then pulled the manual suction out of a bag in the corner (no bulb suction here). She and the TBAs fumbled around a bit trying to put it together. Finally the nurse said, "Please help us!"
After we suctioned the kid, he still didn't breathe. The nurse did more rubbing. Then she tilted his head back. I think I could teach CPR upside down and backwards, in my sleep, in two languages (not one they speak here of course), so I recognized this (albeit incorrect) maneuver. "Does he have a pulse?" I asked the nurse. "Do you feel the cord pulsing?" she asked me in response. Well, I'm not actually supposed to touch this kid, but here we go. No, I do not feel the cord pulsating. She wrapped her hands around him and started trying to do compressions. "You're going to have to push harder," I told her. She didn't. So I started doing compressions. Eventually, the baby moved a little. Then he opened his eyes. Finally, the cheese-covered little bugger started to cry. So whether we actually resuscitated him or we just agitated him enough that he decided to make a life-sustaining effort, I don't know. Either way, I was relieved.
"They will call the baby Sarah," the TBAs told me. "But it's a boy!" I said. "Yes, but he is your color," they laughed, referencing how pale he was from the lack of circulating blood.
These days at the ETC, we are quite slow. We actually had a 24-hour period where we had zero patients. It was strange. But that has left me some time to do a few things before I make my exit on Sunday. The other evening, a friend and I were able to visit two of the ebola cemeteries in our district. It's impossible to describe unless you've seen it. But it was nice to find our patients and remember them for a bit.
Last night, some of my coworkers had a dinner for me, which was really sweet and unexpected. We laughed a lot and ate really good food. As one of our doctors once told me (at the end of an argument), "We have been here a long time. We are more than colleagues, we are like brothers and sisters." (My response to that statement: "Yes, who FIGHT.") And no, I don't know what's next, so I'm sticking with the story that I'm joining a band of gypsies in Romania. You never know.
No comments:
Post a Comment