The following is a fairly accurate translation of a conversation between a nurse and doctor in a small surgical hospital somewhere in West Africa.
“Docteur, what can we do for the little baby who is here?”
“What baby?” I asked the nurse.
“The little baby just outside your office who came in this afternoon. She has a very high fever, and is having convulsions. Her oxygen saturation was 36% (normal 95-100%) when she came in. Now that she is on oxygen it is 96%. I have given her quinine, ampicillin, ceftriaxone, and Tylenol, so her temperature has come down a bit, but she is still not breathing well and…well what can we do?”
(A word of explanation, in the evening and nights we have no lab, so no way of doing diagnostic tests, and even if we did our tests are so limited and of such poor quality that it doesn’t really matter the results, everyone gets treated the same. Quinine for malaria, ceftriaxone for typhoid, ampicillin if you are a kid, IV fluids and sugar. Most people get better)
“Did you check her hemoglobin?” (These kids are almost always anemic.)
“No, no one has the key for the laboratory, and the lab tech is gone for the day.”
“Well, it really doesn’t matter anyway, we can’t do anything about it, if the hemoglobin is low. We have no blood, because the refrigerator that holds our blood bank is not working, so all the blood is clotted in the bags. Also because we have no refrigerator we do not have ice to cool her with. How long has she been sick?”
“Two weeks. Oh yes, and her pulse rate is high, over 200. What can we do?” Josué repeated plaintively.
“You can give her 250 cc of lactated ringers. And we could give her 50% dextrose, since most of these kids are hypoglycemic, but oh yea, we don’t have any of that either.”
“But docteur, the family is out of money, they have no money to buy any more medications.”
“We could send her over to the Regional Hospital, treatment for emergency care is free there.”
“In her condition, she won’t survive the trip.”
“Josué, you are right, besides they won’t do anything more than we are doing, and likely they don’t have blood either as they often send babies and kids to us for transfusions. Give her whatever she needs and give me the bill, I will deal with it.”
Josué left my office to do what he could, I walked home. It’s been a while since we had a baby like this. But never again would be too soon. This perfect little girl, 8 months old, struggling to breathe, fighting for her life. She is going to lose, tonight or tomorrow. Even if we had all the right stuff, when they look like this, they all die.
Even still my thoughts are tortured. Should I call in Solange our lab tech? Maybe she could find someone with the same blood type and give the baby fresh blood. The problem is our other lab tech is on vacation this month, so Solange has to work every day. Do I call her in now and wear her out with a lot of work on a hopeless case, or save my call for a case where she can really make a difference. The chances of finding someone tonight, with the right type blood and no AIDS, hepatitis or syphilis, are pretty low.
We have been dealing with the refrigerator for a month now. Isaac gets it running and it breaks down again. He is going to look at it tomorrow, again. Problem is Isaac is an optimist, and he can fix just about anything. But I need it fixed to last, not work for 3 days and then break down again. I probably just need to buy a new one. But I feel like I have replaced just about everything here in the year I have been here. Oh, yea, it is not just a feeling, I have done that. Everything here breaks. Anything electrical from the US doesn’t stand a chance. If anyone tells you 50 hertz doesn’t matter, don’t believe them. 60 hertz electrical motors do not like 50 hertz power supplies. They will run, but not happily and not for long. But the stuff you buy here is mostly made in China, apparently in the factories with little quality control, so they don’t last too long either, and they are very expensive.
We are out of a number of commonly used medications. Why, you ask? Because, our supplier, the government pharmacy here, is out of them. Why are they out of these meds you ask? Because their supplier, the central pharmacy in the capital is out of the meds, or maybe they are in a warehouse somewhere and haven’t been unpacked yet, or maybe someone took them and sold them all, who knows? So why not just import meds from say, Kenya, you ask? Because that is against the law and is forbidden, because their meds are better quality, cheaper, and more available, hence competition. And why you ask is this important? Because we make a large part of our money on selling medications, and when I have to send people to outside pharmacies to buy medications it cuts into our income, which is barely adequate as it is. Also the outside pharmacies are way more expensive than we are.
Speaking of medications, today I reviewed the inventory of meds from our pharmacist. We prescribe a lot of Cipro, and I noticed we had 4000 tablets of Cipro in stock, set to expire the end of April, 2015. And in Africa using expired meds is a huge no no. They are very very sensitive to that, the general belief is that we dump our expired meds on them so they just get second rate stuff. I thought we had just bought a lot of Cipro. A trip to the pharmacy confirmed just that, we bought 5000 tablets the first of March. The Central pharmacy sold us 5000 tablets of Cipro set to expire in less than two months. Thanks a lot.
So I am trying to run a little hospital here, and make it self-supporting (that is the goal anyway, admirable, but ridiculous) with unreliable power, unreliable water, limited medication, limited lab support, limited radiology, limited staff, equipment that is constantly breaking down, patients with no money to pay for their supplies, doctors with limited training and experience (at least at first) in what they are expected to do…etc, etc, etc. And then I sit back and realize I have described life at every mission hospital I know of, Bere, Batouri, Koza, here.
Most of the time I can just ignore it, or bury the feelings it brings. Not tonight. As I looked Josué in the eyes and saw the pleading look, “docteur help us,” and I had to tell him over and over, there isn’t anything else I or you or anyone can do, all the anger, frustration and pain found its way to the surface, and I have to deal with it.
Tomorrow, I will be better. The little girl will probably be gone, out of sight, out of mind you know, and I will hide those negative feelings back down deep where they belong. I will face another day of unknown challenges, hoping that God will show me the right directions to go, the right decisions to make.
For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital as well as the videos she has made of Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.
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