Thursday, January 15, 2009

Your wish is my command...

I hear your requests for updates. It's been a quiet few days with only three babies for me to report, all uncomplicated deliveries and swift, easy postpartum stays. I've also had a friend in town from Aus and I took a day off to go snorkeling and lie about in the sun. I'm contemplating doing that again tomor

We have had a rash of preterm labor mamas coming in at 30-33 weeks contracting, and with cervixes making ominous changes, in all cases malaria was the preceding event, all of the women were febrile, all the babies were tachy and I learned very fast how to start women on IV mag. sulphate, monitor for toxicity and have the calcium gluconate standing by. Have also administered malaria meds, beaucoup antibiotics and the occasional indomethacin suppository to try to arrest their labors as well as the standard steroid therapy to oomph up tiny fetal lungs (all things I will never do when I get home!!). All of the women have now been discharged and we all keep our fingers crossed that they come back in active labor at 37-42 weeks or thereabouts.

We've also had a rash of babies readmitted for feeding issues and weight loss accompanied in a few cases with some pretty spectacular neonatal jaundice as well. Have spent much time teaching teen moms (16, 17ish) to hand express, cup feed and then latch babies as they improve and are less lethargic. Can now officially say I've seen some babies with "oh my God" jaundice and some TTNB. Conspired with the neonatal nurse to "Rescue" a baby from the nursery and return him to his mama for some serious skin to skin and breastfeeding action. RR fell from 110 to 80 within 30 minutes. Felt good about that.

Hemorrhage mama will go home tomorrow after recovering well. At 23 (and the mother of 4 children) she is now in abrupt menopause and her Hemoglobin this morning was a measley 5.9 after 7 units of (still-warm med student) blood. Med Students incidentally, are feeling very noble. There's little doubt that their donations saved her life. No signs of Sheehan's Syndrome which was my next concern - her breasts are full of milk and her baby is growing apace.

The twins went home on Day 2 of life, nursing and growing like little weeds. Vertex twin #1 is on the right, his footling breech brother is on the left.
Tiny baby Henri also went home with his mama a couple of days ago having made it to 2.0kilo (4.4lbs) up from his 1.9kilo birthweight (below). We think he was about 33-35wks gestation, but dates are hard to firm up here, as prenatal care is so sparse, most women don't make it in to the antenatal clinic till well after baby starts moving, and rarely if ever keep track of their periods...

Started doing some clinic today also, which was a helluva change from the leisurely 45mins-hour long visits I'm used to at home. In 1 hour I saw 8 women, and in my broken bislama managed to counsel them a bit on the importance of their diet (trying desperately to get more protein into it), drinking lots of water, and actually triaged some minor pregnancy concerns ("legs blong me soa morning"= My legs cramp in the mornings - we chatted about increasing her intake of island cabbage which is an insanely nutritious wild green and bananas and milk - hoping for a bit more Cal/mag in her diet) and some more major ones: "Man is blong yu is im killim you?" = Does your husband/partner hit you? - sadly, three of my 8 morning clients replied that yes, they did. We then talked about how often... My mission now is to devise some strategies to be able to perhaps HELP them with this situation. Not so easy when you don't have much language, but at least now it's in their chart, so more folks can hopefully address this with them. Learning curve about vertical, but that's why I came here.

So it goes somewhere south of the equator...

2 comments:

~L~ said...

I admit to having some mad respect over here. That's....important work.

S said...

update! update! update!... :) :) :) (chanting from the stands...)