|Spotted off the track between home and hospital|
I was reminded by one of my friends not to forget to tell the beautiful stories, and I confess lots of my stories are indeed grim. I think that’s mostly because I am here to work at that very place where the stories would otherwise be much worse than grim - they would be your worst nightmares. It’s a grim place to be. Never-the-less there are some beautiful stories and this is one of them.
Shewanesh was pregnant for the first time and like just about everyone else who was going to have a baby in her village miles from Motta she didn’t visit the health centre or have any antenatal care she just waited for the day the baby would come. But one night she was quite sick and she vomited a couple of times so in the morning her family brought her to Motta hospital on a bus. I was leaving the hospital around as she arrived, and saw a crowd of midwifery students gathering round her as she lay there in her filthy ragged clothing and bare cracked feet, and I decided, on the basis of previous experience to investigate what was happening before going home. “She has vomiting” they said, but no-one was taking her blood pressure or her pulse or even listening for the babies heart beat. There’s one midwifery student who is absolutely the Best – like the Enrolled Nurse you come across in Australian Hospitals who is way better than most Registered Nurses – and I asked him to set up an IV line and get some blood off her, while another went to fetch the blood pressure equipment and something to listen to the baby with. I tried taking her Blood Pressure, expecting it to be low because of dehydration from vomiting but couldn’t hear anything - I listened higher – and higher - and finally got a Blood Pressure I couldn’t believe : 200/120. Just as Aweke got the drip in, Shewanesh suddenly arched her back and clenched her teeth and started convulsing – it was Eclampsia! I was so glad I was right there – we gave her the magnesium, almost immediately – a dose IV and another big dose into the muscle of each buttock - we put in a catheter, and then some IV medication for her Blood Pressure and she needed heaps of it and repeatedly. She remained unconscious after the fitting stopped as I did a quick scan with the donated Ultrasound Machine. It showed a live baby about 32 week size, 2 months premature and therefore not mature enough to survive delivery, but that was what was needed if Shewanesh was to survive. Nevertheless I decided to give her a steroid injection that might help the baby if it was actually an undernourished and tiny 34 weeker, a distinct possibility as pre-eclampsia and eclampsia babies are often much smaller than they would otherwise be.
I inserted the misoprostol, and six hours later broke her waters and started a drip to get the labour started. She was still unconscious and by then we had our blood tests back – it was terrible enough that she had eclampsia but she had a serious complication of eclampsia called HELLP syndrome, making it even more hazardous ( Platelets were 77, AST 280. ALT 240 for medicos!) The next day was Saturday so they were never checked again but in the meantime I was despairing – how could she survive this? Sometime after I was called back – I had asked them to call me when the baby was being born – a tiny boy, about 1.6 kilograms, still alive. “Wrap him up, keep him warm, look after him” I said, and went home.
In the morning Shewanesh was still unconscious, still requiring additional medication to keep her Blood Pressure down, but had stopped fitting. I couldn’t see the baby anywhere “Has he expired yet?” I asked, and they pointed to the bundle at the foot of the bed. I unwrapped it – and there he was, still alive, breathing and pink – which means his lungs were working well! “ Oh my God” I said “Hes still alive” And I decided we owed him a chance – all he needed was food.
We found a tube that I poked down into his stomach through his right nostril and we managed to squeeze a few mls of rich colostrum from his unconscious mother but it came back out his mouth – I pulled the tube out and saw it had a long row of holes along the last few centremeters so I cut the tube shorter so there was only one hole at the end, and poked the tube back down. This time the milk stayed down. We also got him a real woollen babies cap, knitted with wool I found in the Flat and gave to one of the cleaners after hearing she was a great knitter – that was after we had used a little cotton bag as a hat for the first prem we tried to feed.
From then on we fed this one every three hours even though the old lady looking after Shewanesh didn’t seem that interested, much like the family of that other baby I had tried to feed in this manner, a surviving twin that eventually the family let die. Meanwhile Shewanesh was slowly recovering and regaining conciousness, and her blood pressure was stabilising. After two days, I noticed the old lady was taking an interest in the baby so I decided to teach her exactly what to do, with a midwife interpreting for me. She collected the milk in a plastic cup that she had to wash clean first, then drew it up into a syringe and then filled a larger syringe barrel connected to the naso-Gastric tube, holding it just the right height so that gravity would let the milk flow in steadily but slowly.We discovered this old lady was Shewaneshs grandmother, but she was now a “Nun. She had borne three girls but always wished for a Boy! She quickly got the idea, and took on the feeding job, and seemed to be very pleased with herself. She was wonderful really. By now Shewanesh was sitting up with assistance and starting to eat and drink again, and then she also started taking an interest in the baby. I saw her smile one day and she had the most beautiful smile.
|Shewanesh, grandma and Baby :Note his NG tube and little red hat|
And finally they went home, at their request, still tube feeding him and waiting for him to be able to suck. I asked them to return for a check in five days, and when they did, yesterday, and someone announced Shewanesh was back we all rushed out to see them. Lots of beautiful smiles and hugs all round. Her blood pressure is nearly normal so we reduced her medication, and the boy is still going with his tube and an occasional suck. We’ll see them again in a week. And to think that at one point I thought they were both going to die! Yes, that was a beautiful story.