A crazy last hour or two of a busy day

Two babies: 1 born today 2 months premature and oxygen dependent. The other, 5 days old just out of the operating room following a formation of a colostomy and who suddenly stopped breathing. 

1 oxygen concentrator, 1 sats probe to measure their oxygen levels and an ambu bag. 

Queue what would have been a scene of comedy, if it hadn't of been so critical, of lining babies next to each other, equipment between them, giving each baby a turn and attention depending on which was the most serious at the time!

It was evident that we needed a way to give both babies oxygen. With a bit of creativity and a modified nasal cannula, I was able to construct something that worked well while the resuscitations continued.

Sometime later,  they were both looking pinker and stronger, and although the premature baby continues to need oxygen, they were both maintaining good oxygen levels.

Now to move them to a place where they can be cared for during the night.

Shifting patients around freed up a bed on the ward, a generator with fuel found, extension leads located and with precision planning of a military operation, one person grabbed the heavy oxygen concentrator, I and another nurse carried a baby each and then after a count of three, we were off. In record time, the babies were safe on a bed, receiving oxygen, having their oxygen levels checked.

By this time the day light was going, so we finished setting them up for the night wrapped up in hats, woolly jumpers, socks and blankets by torch light, both breathing well.

A Painful Beginning

I still have a very clear imagine in my mind of a picture I saw in a school text book years ago showing an old pencil drawing of somebody suffering a tetanic seizure. Their body contorted and the agony graphically etched on their face as every muscle in their body contracted horrified me. Having grown up with vaccinations being a routine part of life, I never expected to see anybody with Tetanus, naively imagining it was a disease resigned to school text books to scare children into getting their vaccinations.

With only a 58%[1] tetanus vaccination uptake, Chad is listed as one of the top 28 countries to contribute to the 110,000 deaths a year from neonatal tetanus[2].

Tetanus is an illness that results from spores entering the body through puncture wounds, or in the case of babies, commonly through cutting the umbilical cord with a dirty instrument. The resulting bacteria produce a neurotoxin which causes painful, and eventually life threatening, muscle spasms. Even with hospital care, the mortality rate of tetanus can be high as 60%.

Just over a month ago, a little baby girl, of 6 days old, was bought to the hospital experiencing full body spasms with even the slightest stimulation. It was incredibly distressing to see and her chance of survival looked slim. We treated her with a concoction of drugs, including incredibly high doses of muscle relaxants, minimal stimulation (no unnecessary touch and whispered ward rounds) and lots of prayer! A week on, though the spasms persisted, she began to turn a corner and we were able to place a feeding tube into her tummy so she could begin to receive her mother’s milk. A couple of weeks on from that, her spasms much reduced, she was feeding normally from her mother, tolerating being held and beginning to act more as a baby should. A further week on, discharging home was in sight.

Incredibly she went home last Wednesday. Praise God!

I was right to be horrified by the picture of a man in a tetanic seizure in my school book, but the reality is far worse. Tetanus is entirely preventable by a simple vaccination. My hope is that, one day, tetanus will also be something just confined to the school books of Chad.

Baby and Mum at the end of a painful beginning

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[1] WHO. 2008. Chad. Factsheet of Health Statistics.

[2] WHO. http://www.afro.who.int/en/clusters-a-programmes/mte/tetanus-elimination.html

Christmas Comes Early

Christmas has come early to the hospital this year.

A few weeks ago the hospital received two much anticipated and long awaited presents. But they were not made quietly in the dead of a frosty night by a man dressed in red, who arrived and left unnoticed. No, in contrast there was a great deal of curiosity at their arrivals and the accompanying entourage as they drew up to the gates of the hospital under the baking sun.

Two huge shipping containers, transported from America by ExxonMobil finally came to the end of their eventful and long journey. Having collated and packed the many generous donations, the containers sailed across the Atlantic to the shores of Cameroon, where they then embarked on a long journey by road to reach the borders of Chad many months later. Further long journeys by road were required to reach the capital city, on the outskirts of which is the hospital. Finally, we got the exciting news that, yes the containers were only 7km away!!!! Excitement and expectations rose, they were finally arriving. And then, no. The heavy rains that we saw over the months of July to August had left the roads impassable to such large vehicles and so further delays were necessary. So near yet so far! The anticipation was building.

A couple of weeks on, the rains had subsided and the roads had impressively quickly returned to sandy tracks and the arrival of the containers was once again expected any moment. It still however was a great surprise and joy to hear the roar of lorries and to look up and see an enormous crane type vehicle crossing the yard! This was then soon followed by the first container, having completed a 38 point turn in the road to get lined up for a run up to the hospital gate! With impressive speed given the size and weight of the vehicles and the comparative small space of the hospital, the first container was soon being lifted into the air and guided (extraordinarily, by hand of two guys pulling on a rope!) onto the its final resting place. 

One down, one to go. But it would seem the adventure and challenges were not quite over yet. The crane, in the bid to get out of the second lorry’s way, drove, and then promptly sank, into a patch of soft sand. While the unique ability of the vehicle to use its hydraulics to life itself out of the sand, thus allowing an ever increasing amount of wood, rubble and then whole branches of trees to be placed under the wheels, it only managed to dig itself deeper and deeper. An hour and half later, after much sweat, effort and frustration (on the men’s side, I provided water and took the photos!), it was eventually free. Twenty minutes later, the second container was in place and thirty minutes on, the lorries roared into the distance, crowds died out, the work of the hospital continued and our new containers were in place. They had finally, safely arrived!

After an Opening Ceremony, during which a governmental minister arrived to the resounding notes of the Alleluia chorus, speeches were made, a tour of the hospital given and then finished off with a mini feast of meat sandwiches and drinks (to the back drop of my drying underwear on the clothes line! Opps), the fun could start! Time to unwrap!!!

Stuffed full of generous and countless donations from people across America for the use of the hospital, from gauze compresses and drip stands,  to a new digital x ray machine, two generators, wheel chairs and theatre trolleys, unpacking them is proving to be a medical Christmas extravaganza!

The unwrapping begins