Thursday, February 9, 2012

Days are an amalgam of good, sad, curious and hard

She came with me behind the tent so she could be examined away from the eyes of her village. This would be her seventh child but it stopped moving several days ago. We were both squatted, my hands on her gravid belly, trying to encourage the fetus to move. The fetal head was under my fingers like a floating rock, the back and jutting angles of limbs also palpable. There was no movement. I was looking down at the grass between my feet watching an ant-size ebony black praying mantis hop from dry grass blade to a small brown vine. As I watched his antics, I wished for the reassurance of quickening, or the technology of a fetal doppler to listen for the rapid baby heartbeat I wanted to hear. Neither were to be found. After several minutes in the sun, I began to feel that empty feeling heat gives and slightly dizzy. Distant sounds of children and the march of camels behind me walking single file behind their lead camel,  his wooden bell quietly and rhythmically clacking.  There was still no baby movement and the little happy hopping mantis had long ago disappeared. 

The rest of the clinic day had been uneventful. There were several cases of measles in the community and a few children with complications- measles can predispose to opportunistic infections. These kids were miserable. Can you imagine suffering days of fever in 100 degree heat with no bed, no cool water, no shower, no bathroom? We gave vitamin A and antipyretics and instruction on hydration. There had been many deaths from measles in he community over the last several weeks. A vaccination campaign was reportedly sputtering along; however none of the children I saw that day reported vaccinations. We are working on coordinating a vaccine campaign.

The clinic in Hamey was almost over when I noticed a young mother holding a dirty blue cloth close to her. She was standing quietly near the door. A very still and very pale and very tiny foot was protruding from the dirty cloth she clutched to her breast. I beckoned her over and motioned for her to unwrap her little package. Inside was a dying 20 day old baby. All his bones were visible with skin stretched over his body. His little belly protruded.  He was breathing over 100 times per minute and using every muscle he had to do so. His lungs were coarse and his extremities were cool. We went quickly to work and were able to place venous access and begin fluids and antibiotics. As we were caring for him, the remainder of the team began grouping since we had to take the baby to where expanded care was available (the hospital in Dadaab). Several times the baby's breathing stopped and his heart rate dropped as well. I was uncertain he would survive the drive. Our Kenyan Police security said they would pray for the baby on the way back; I hoped they would be able to pray and watch for bandits at the same time. The baby did survive the two hours bouncing along a track through the desert with us. We turned him over to the staff at the hospital who were attentive and caring. Thinking of hospitals, please don't imagine any hospital you've been to in the developed world. While the staff is trained and effective, there is no monitoring, isolation, labs, sheets, or windows. Rooms are shared with a dozen patients. Tonight we stopped by the hospital and baby was still alive, but sadly not much improved. His mother had been feeding camel milk in addition to nursing because of trouble breast feeding. In the hospital, she was assisted in breast feeding and the camel milk was stopped. I'm hopeful for the baby but am uncertain about his chances.

Adults, however, are ok to drink camel milk and today we had another wonderful cup of camel milk chai after clinic in Kokar today. Sweet, salty, earthy, smokey, spicy and creamy. The community of Kokar gives our team amazing gratitude- both with food and kind words. The prior team finally had to ask them to stop cooking a goat every time they held clinic. I'm not sure I'm glad they did that, I'm starting to enjoy goat even though I eat it every day and would love to try a new recipe- roast goat Kokar style.

Days here are rich and I feel blessed to be of service.

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