After yesterday's intense babies, I was glad to have an excuse to not go to work today. ☺︎ It was the hospital nursing supervisors’ retreat. My coworkers and I headed to the rainforest to hike the suspension bridge and enjoy the beauty of Rwanda.
We have a bad respiratory virus going around the community, so are admitting a number of babies needing oxygen due to respiratory infections. We admitted a baby girl with the same respiratory virus, but something wasn't right. Her oxygen was really low even though she didn't showing many signs of respiratory distress. We worked on trying to get her oxygen to go up, but it wouldn't. Suddenly her heart rate jumped to 250 beats per minute! Yikes, that wasn't good. We checked, and the machine was reading right. The heartbeat was so fast I couldn't count it! I telephoned a friend, and we worked step by step through the different things it could be. We got a chest x-ray, then tried to get the baby to gasp, which for one particular problem could make the heart rate slow down. I tried pressing on her eyes—that took her heart rate down to 220, then right back up. The next treatment involved ice cubes...but our hospital doesn't have an ice making machine. I ran home and rummaged through my freezer. A bag of peas, perfect! Holding the cold bag to the face did the trick. The heart rate dropped 220, 180, 140, 120, 109... much to the amazement of my nurses who were watching the monitor. They marveled that the "Amashaza Treatment" (Pea Treatment) worked so well! We still have to get her oxygen levels back up to normal. And there’s a risk her heart rate will spike again. But my NICU nurses now know the "Amashaza Treatment,” so we can treat that. ☺︎
It was horribly hot in the NICU this afternoon. One of those days when my glasses almost steamed up when I walked into the room full of hot, humid air. Our littlest baby was wide awake, hot and fussy in her incubator. Her mama wasn’t around, so I got the delightful job of taking her out and holding her while she cooled off. One of my favorite jobs! ☺
In Kibogora’s NICU we’ve made amazing progress in taking care of babies. But today I walked away from the hospital, worn out, knowing that Africa had won. A little guy weighing 2.7 lbs. arrived at 12:30 p.m. and died four and a half hours later. His story begins at home in the hills high above Kibogora. The early morning light is just beginning to brighten the storm clouds covering the hills with rain. A woman delivers a premature baby at home in the dark, no electricity, rain leaking through the roof. The mama collects the things she needs and sets off with her newborn baby tied in a sling across her chest as she picks her way down paths and trails to the nearest health facility. It usually takes two hours, but with the rain and a new baby to carry, she has to go slowly. Three hours later she arrives at the health center. The nurses put the baby in kangaroo care, baby tied to the mother’s chest for warmth. This act keeps him alive for the next three hours while mother and baby wait for the ambulance which has to pick up another patient before coming for them. So, finally, six hours after this little one was born, he arrives at Kibogora, a place that can give him the medical care he needs. The problem is six hours is more than he can wait. For four and a half hours we try to save him, but in the end our care is too late. As I walk home, I'm frustrated—if the baby had gotten care sooner, he probably would have lived, frustrated that change is a slow process. Yet I also know that God knows what happened to this little guy and He loves the baby and mother. He is a God greater than Africa and has a plan. I don’t know that plan or understand it. But I pray for the mama as she collects her things and starts walking back up into the hills with empty arms, back to her life. I pray that she will feel God’s peace and love going with her.
OSCE testing—one of my least favorite days of the year, I have to admit! The nursing students at Kibogora Polytechnique learn nursing tasks and are signed off in skill labs before they can perform the tasks at the hospital. For this OSCE test, I was the instructor to sign them off on newborn resuscitation. I enjoy teaching, I enjoy helping the students learn...but when I have to watch 71 students perform the same skill all in the same day…well, it gets a little tiring! But since a good resuscitation makes such a huge difference in a baby’s life, it’s worth sitting for 461.5 minutes while 71 students pass by! The students had six minutes to perform their newborn resuscitation skill and then 30 seconds before moving on to the next station. Once they had performed five different skills, they were done for the day. If they got a 60% on each skill, they passed. If they got less than 60%, they have to practice some more and come back another day to retest the skill. I taught the students newborn resuscitation and they’ve been practicing ever since. So it’s satisfying to see how far some students have come since the first day.
This past week has been quite intense. Our Inzovu born around the New Year got sick and is the first baby ever to get platelets in our NICU! We learned we could do platelet transfusions just a few days before she needed one. Then a term baby was born who ended up being the sickest baby we’ve ever cared for to survive. He was also the first baby to get IV blood pressure medications in our NICU. Next, we got a baby with a strange skin rash that after consultation with a specialist in the USA via internet, we found out she has a rare disease. Another first! She too needed platelets. How odd that we had to give two transfusions in the same week! About this point I had had enough—enough really sick babies needing a lot of nursing care. Then we got a fourth—a tiny one weighing 2.2 lbs. God who is so good saw us through the week, and now all babies are on the mend and growing. I love seeing babies get better after I’ve had to tell the mother there’s very little hope. Four times God answered prayer! Here are pictures of three, but I don't have a good picture of the fourth.
As I’ve said before, I like thinking outside the box and being creative. But this project was literally “out of a box” and much more creative than even I could imagine! Elena came from Kigali and taught us how to make cardboard furniture for children with severe physical disabilities. We started with cardboard boxes, newspaper, paper bags, old nylons, flour, and water and turned all this into chairs! First, we made "boards" by flattening the boxes, laying them out, and gluing the pieces together with homemade flour and water glue. Once the boards dried, we cut out the pieces. We, of course, had to measure the children as these are custom made chairs for these special needs kids. We assembled the pieces with more flour and water glue plus ties made out of old nylons. (It’s amazing how strong nylons are!!) Next, we covered the furniture with two layers of newspaper and other paper scraps then called the kids back for a fitting to make sure the chairs were right. We made any needed changes then covered the chairs with brown paper. This is the step we’re on at the moment. Once the brown paper is on, we’ll decorate the chairs and give a coat or two of varnish. The idea is to recycle what resources are available in the community without investing money these families don’t have. I’m excited to see the finished project and how the kids do in their new chairs! Plus there are other things we can make such as toys for physical therapy exercises, frames to help kids learn to stand, and more.
A new Inzovu (Rwandan name for the tiniest baby in the NICU) was admitted last night, weighing in at 1.8 lbs. This weight can be a very dangerous one as these babies are usually 26-28 weeks gestation—very hard for us to save. But this little girl is actually 31-32 weeks gestation which is a much safer age; she’s just really small in size. And by her actions she has proved in multiple ways that she’s really older than she looks! She didn't need oxygen, just a little CPAP, and we were able to stop that quite quickly. She cries and is very active compared to a younger baby. And she didn't need nearly as much warmth from the incubator as her size would have made us think. Now to get her to grow!
When my parents were here, I started having a problem with ants in the kitchen. A couple of weeks ago I went to Kigali and when I came back, the ants had left! I was very happy about this, of course. But tonight, while enjoying my Christmas tree, I found they hadn't left…they'd just changed locations!