Last few days in Bahir

Tuesday we were monitoring laboring patients in the maternity ward when the midwives motioned for me to come examine a new arrival. Clearly, an umbilical cord was hanging out. Retained placenta? That was just the beginning. Her referral form stated, “blah blah health center referred to Any Hospital for retained twin.” She had delivered her first twin on Sunday, and now it was Tuesday! On exam, her amniotic sac was intact. I held my breath, and listened for a heartbeat. It was there- on day three after his brother or sister entered the world!! I wondered why she had waited so long to come to the hospital. “How far away does she live?” A midwife grabbed the chart, then said, “800 km.” A lightbulb came on. That’s why her referral form said, “To Any Hospital” and why she had taken so long to come.
Meanwhile, the laboring woman in the other room had prolonged 2nd stage (medicalese for: the part where the mom pushes the baby out). There were decelerations of the fetal heart rate (which can indicate fetal distress, head compression, or an umbilical cord wrapped around its neck, etc). Surely these patients warranted a phone call to the doctor! No, I was informed that they doctor would come around sometime after lunch, which was more than 3 hours away. Feeling helpless (we couldn’t give medications to speed up delivery without his signature), I watched over them carefully and then took my lunch.

When the doctor finally came, the first patient was given pitocin for augmentation of the delivery while we took the latter to c-section. This took an act of congress. (Actually, with the political process going the way it is, it was slightly less of a hassle.) We had to wait until the general surgeons were done with their current operations, wait for nurses to be available to get a stretcher, wait while the patient got onto the stretcher and was wheeled outside and through the other wards and into the OR. A live baby was born, although the baby was obviously distressed and took longer to breathe. Upon return to the ward, I checked on the woman with the retained twin. She had delivered! I peeled back the blanket to take a peek at the baby. I was startled to see the baby grunting, gasping for breath. I hurried to find the midwife. “What are we doing for that baby, the premature retained twin?” He looked at me, “Why? What’s wrong?” I answered, frustrated, “Did you examine him? He’s grunting, struggling to breathe!” He walked over and after looking at the baby, he stated, “We need to transfer him to the pediatric ward.” A little perturbed, I probed further, “Why wasn’t this done before?” He stopped in the hallway, but I motioned for him to continue, adding, “This is urgent! The baby cannot breathe!” He quickened his pace and explained, “There is no one in charge of the baby once it is delivered.” I was not satisfied. “But why was this not done immediately after delivery? Why did I find it just because I was curious to see her baby?” He repeated, “No one is assigned to the babies unless something is noticed at delivery. We are in charge of the mothers, and as you can see,” he motioned with his hand, “we have a lot of patients.”

In the end, no transfer was made because the mother had no one to support it financially and follow-up would have been necessary but impossible for this rural-dwelling woman who had travelled so far. I considered paying the $20 for the hospital stay of the baby, but I decided not to because after seeing the “Neonatal ICU” area which only had the capacity to put babies (unattended for the most part) wrapped and under light bulbs for heat with one oxygen tube and one NG tube (for feeding) and antibiotics. Even if they could have saved the little guy’s life, he would have been at risk of being in such a remote area as a premature infant. No, as hard as it is to stomach the statement, it was probably best to simply allow him to die peacefully next to his mother. And that’s what happened.

Comic relief

I had a few t-shirts which I rotated wearing with scrubs to go to work. As I was waiting for deliveries one day, the midwives were trying to remember my name. They said, “Is your name Dr. Sue-ez?” They got the S part correct, but I couldn’t understand how the rest of my name had been so mixed up. “You know, like the back of your shirt says,” one of them explained. Suddenly, I realized their confusion. My shirt had a quote on the back with the author’s name written underneath.
“A person is a person, no matter how small.” Signed, as you may have guessed it, Dr. Seuss.

I laughed so hard my sides hurt. “You think my name is Dr. Seuss? Haven’t you heard of the author who writes children’s books like ‘Green Eggs and Ham,’ ‘The Cat in the Hat,’ ‘Oh, the Places You’ll Go,’ and makes up silly drawings of animals/people?” Of course they hadn’t. But it made for a great laugh for me. I also thought to myself, What kind of person would wear a shirt with their own quote on it?

Lots of Tea!

It is a cultural formality to invite others to drink tea with you, so on my last day at the hospital and in Bahir Dar, we all drank many cups of tea and coffee. We had some in the morning with staff from the hospital, some at the Fistula Hospital, and in the afternoon I invited all of the students I had interacted with to come to a special tea to say goodbye to them. I was able to buy all 25 of them coffee, tea, or soda for about $7. Beautiful. We had a great time of reminiscing, they gave me a speech, and I was able to thank them for being my friends for the past 6 weeks, wishing them well in the rest of their careers. We took pictures and in general, it was a great way to wrap up my time in the hospital.

The leaders of the church invited Ryan and me to dinner with them. They presented us (especially Ryan) a certificate of thanks for his work in teaching at the Compassion program, coaching soccer, and donating soccer balls, clothing, and pens for their church. They also presented us with gifts of traditional clothing. They requested our input into how we experienced their church and what they might do better. They were grateful for our time there and wanted to let us know that they would love to collaborate with our churches back in the US much like the Australian church had done when they adopted the church as their Compassion church.

We capped off our last day by having dinner one last time with Charlie and Dee, once again with such wonderful food and conversation. Memar is thinking (at 9 years old) that she might want to be a doctor. She even came one day to the hospital to see what I did. She commented, “It was really dirty!” Dee assured Memar that all hospitals were not like that and that maybe Memar could come shadow me in the hospital in the US. Dee told me of a conversation she had had with Memar one night as she was putting her to bed.
Memar: “Could I be a cook?” Dee: “Sure!”
Memar: “Could I be a teacher?” Dee: “Of course!”
Memar: “Could I be a doctor?” Dee: “Yes, Memar, you can be whatever you want to be!”
Memar: “YES!” giving a fist pump. “Ok, goodnight Dee!”
It is inspiring to hear how their adoption of her is making her world so much bigger!

As they walked us back to the main road where we met our landlord for our ride to the airport, Dee whispered in my ear that they had just received the final confirmation that Memar was theirs! They had not told Memar yet, but the adoption was final! It was such an exciting moment, and we hope that when they come back to the US, we will be able to connect with them once again.