Another night in the hospital last week has passed, and I again think about how weird and different practicing medicine is in Kenya, even in our great Kijabe Mission Hospital. The nigh of obstetric call started with handover. This is where the doctors who are leaving, but have covered the day, “hand over” the care of the patients in the hospital to the doctors covering the night. As I listened I felt my stomach drop a little as I realized the night would begin poorly. There was a young mother in the hospital whose baby had fetal hydrops which is a problem in which an en-utero infant for a multitude of reasons has swelling all over the body. These babies do not do well. She needed emergency delivery at 27 weeks of pregnancy, and we knew the baby would likely not be able to survive after delivery. Even more problematic was that she had a scar from a previous cesarean section which meant that we were going to do a preterm surgery. These usually go well, but they have their own increased risks. We took her back to the OR, and as I delivered the baby’s head through the uterine incision it looked so perfect, and I thought nervously that maybe we had the diagnosis wrong. But as the rest of the baby delivered the terrible swelling over the rest of the body was very obvious. He lived just 10 minutes before dying.
I came out of surgery to hear that a twin pregnancy that had arrived just a bit earlier had been evaluated and only one heart beat could be found. I placed the ultrasound on her abdomen and confirmed that one of the twins had passed. The mother cried as I told her, and her husband looked angry wondering what had changed in the last 10 days when her last appointment had shown two healthy babies. What could we say? She went quickly for an emergency surgery, and on delivery the first twin showed signs of having died several days prior. Its hard for a pregnant woman with twins to sort out the movements of her babies. She could not have known that all she was feeling were the movements of one of them.
Obstetrics can be a great joy when it goes well. But when it is bad, it is so sad. God help us all to show compassion!
From Peru to East Africa, Caires Find Ways to Serve the Underserved
Click the above link to read a generous article from our alma mater, Abilene Christian University. We are thankful for our education, and we are thankful for all the good work being done by graduates of a great institution. It was nice to have the article written about us, and what is even better is how I run into ACU graduates all over the world doing mission work. ACU is a school that is instilling its students with a sense of purpose. Go Wildcats!
I am back on the obstetrics service. Family doctors are good at floating in and out of different areas. Within the last year we have had family doctors working in pediatrics, internal medicine, obstetrics, the outpatient department and emergency room. For most of us it is a pleasure to move around the hospital. It keeps life interesting. The reason I am back on obstetrics is one of the volunteer obstetricians is leaving, and so the consultant staffing is a little bit low. So I am back to fill the needs of the hospital. We are starting this call right with a woman with severe pre-eclampsia, pulmonary embolism, and treatment with warfarin and one previous cesarean section scar needing an emergency surgery. She also has a large anterior uterine fibroid. Without explaining everything, let me say that is a tough case. Below is the team that will take care of it.
In Kijabe we have had people, especially from Abilene Christian University, come and visit us unexpectedly. They are either passing through, or they are involved in mission work in Africa, and they call to stop by. It is the greatest blessing for us to see them. We are always happy to be remembered! Again just this past weekend we were honored with a visit from friends we may not have seen for 20 years. We took them up Mt. Longonot which is a hot and dusty hike. We all came down ready to eat lunch, and then waited for 2 hours for our food to be served. So I think we may have lost old friends just as soon as we made them again after putting them through that sufferfest! 🙂 Everyone is welcome in Kijabe!
All my obstetric calls seem to take me on to places I do not want to go. My last call started with a older woman with severe high blood pressure at about 26 weeks pregnancy. These pressures were so high she was at risk of seizing, and her baby was not getting the blood flow through the placenta that it needed to live. So off to the operating room we went to deliver this too young baby. To complicate the matter there were big benign tumors all over her uterus. God is good and we were able to deliver her baby without too much difficulty. Unfortunately 2 days later her baby passed. 26 weeks is a threshold age for premature babies at our hospital where the chance of survival decreases. This same mother did end up seizing 2 days later from her pre-eclampsia, and is still in the ICU being treated for very high blood pressure. As this was going on we had a call that a patient was coming in with a molar pregnancy, which is a non-viable pregnancy that can transform to a cancer. She had been bleeding, although she was stable on arrival. Then another call came with a possible ectopic pregnancy arriving (an ectopic pregnancy is a non-viable pregnancy outside the uterus which can cause massive bleeding killing the mother). We started evaluating her, and a another call came in letting us know that a woman with a cancer of her hand (she was going for amputation of her entire arm the following day) who happened to be pregnant had unfortunately lost her baby. It is called an IUFD or intrauterine fetal demise. Did we need to induce now or wait until after surgery. We decided to wait and get the arm taken care of first. Another older woman rolled into the casualty (ER) with severe pelvic pain. We admitted her and it turned out that she had bilateral tubo-ovarian abcesses that were causing her to become septic. This are major infections of the female reproductive organs. Somewhere amidst all of this another woman arrived. She was 38 weeks pregnant, and she had a huge vulvar abcess due to an infected Bartholin’s gland. We admitted her to prepare her for surgery the following day. It was a busy night, and not all of it is exactly the bread and butter of family medicine. Oh yeah. I have just been switched off of medicine to do a month of full time obstetrics. The needs of the hospital must be met. 🙂 What have I got myself into?