Babies and Birthdays

Thursday, August 2, 2012

After getting Internet finally, Clare and I walked to the market to pick up a few things.  On Saturday, the Bishop wants to take us to “sea sound” which is a beach area for a picnic.  We are going to celebrate Richard’s birthday, a boy in the parish, who is turning 18 on Monday.  Bishop Chris is like a dad to Richard because his own father does not keep contact with the family.  He has moved to Honiara and taken up a younger spouse.  Clare and I decided to get him a gift, so we looked through all the shops until we found a soccer ball and backpack.  I stuffed our groceries in the backpack and we headed back to Fanulama.  We spotted Agatha in the market so we grabbed the bus home.  When we got back, Richard was in the garden so we quickly ran into the house.  I went back outside, and was absolutely stunned by what I saw.  Laborio and Limo, the two architects and craftsmen basically replicated my sketch of the crutch I gave to Bishop Chris only this morning.  My jaw dropped and Bishop said that he warned me the men were amazing.  I couldn’t believe my eyes.  These crutches were handmade out of beautiful timber, and nicer looking than any pair I’d ever seen!  I asked him how long he had been working and he just said, “after lunch.”  Wow.  I couldn’t fathom that my drawing had come to life in a matter of hours and that two children are going to be freed from Kilu’ufi after waiting 6 weeks in bed.  I will bring them their crutches on Monday and cannot wait to tell them the good news.   

Friday, August 3, 2012

I’m starting to get acclimated to the hospital and as a result I’m becoming more cognizant of the patients’ conditions.  For some reason today was a particularly hard day to get through, in the sense that I kept imagining myself suffering in a concrete building without the necessities to treat my illness.

I was supposed to assist Dr. Jason with outpatient today, so I headed there first.  He was tied up in the male ward already because last night, a teenage boy went into septic shock due to a ruptured appendix.  Dr. Jason said his systolic went down to 30 and they worked him up with antibiotics to resuscitate him.  When I saw the boy helplessly lying there, it was my first humbling moment of the day.  No one could operate because he would need general anesthesia.  Dr. Jason was to accompany him by boat to Honiara in the afternoon.  So that was that.  One of the 2 doctors at Kilu’ufi was leaving when he shouldn’t have to, leaving everyone at his outpatient clinic waiting outside until the nurse could not see anyone else or do anything further.  Even if people came from the bush to Kilu’ufi, they would have to go home.  I ended up helping Jimmy, the nurse, as much as I could.  Jimmy ended up taking over the exam room to see patients and prescribe.  Anyone who needed the doctor would have to wait.  Dr. Jason will come back Monday, and so will the patients.  I did not hear one complaint the entire day. 

After doing as much as I could in the outpatient ward, I went to go find Dr. Solomon in the Labor Ward.  A curtain divided the one delivery room where 2 women were in labor.  It was so crowded in the small space and so disgustingly hot that I immediately felt sick.  Dr. Solomon was concentrated on one woman who seemed to be obstructed.  Keep in mind that people are free to come and go as they please as they go into the delivery room, but certainly not their husbands due to custom.  And privacy?  No such thing.  The woman had been fully dilated for 3 hours now, which is a dangerous amount of time in the active phase.  Dr. Solomon still needed to do her female ward rounds, so she said to wait and she would perform a “vacuum delivery.”

We headed to the female ward, where I became a bit hostile toward the situation inside.  I don’t know why my reaction today was anger instead of sympathy, but I couldn’t help it.  We rounded first on the surgical side, where I saw how the patient I assisted with appendectomy was doing.  She still had a catheter, drain, and IV in, which I think is a recipe for infection.  Either way she was improving, but very slowly.  We moved on to an old woman with a huge mass on her left collarbone.  I was trying to figure out what was different about her when I finally realized.  She had wrinkles!  You might think I sound crazy, but I have seen so few elderly people in the Solomon’s.  As you can probably infer, the healthcare isn’t top notch and the life expectancy is quite young.  This woman’s lungs were filled with fluid, she was experiencing night sweats, and had this tumor that grew in 3 months.  Dr. Solomon mentioned cancer, and I know that sweating is a symptom of non-Hodgkin’s lymphoma.   We seemed to agree, but forget about any test to let the poor woman know.  I couldn’t say anything due to discouragement and I am not even sure what her treatment she was prescribed.  We moved on to a great case:  a woman who got a poisonous snakebite in the bush.  She went to a clinic, where a nurse aide injected the wound with petrol, aka gasoline.  No, I am not kidding.  I nearly fell over while Dr. Solomon just continued checking the wound without any reaction even though it was her first time seeing the patient.  They just laughed and said that it wasn’t the nurse aide’s fault.  Excuse me?  They said that nurse aides aren’t trained enough to know better, and she was probably going by “traditional” medicine.  I told them that if anyone did that in the US, they would be locked up, despite their intention.  They didn’t understand why, because the aide was only trying to help.  Dr. Solomon said I should just get used to the system, that’s what everyone else does.  It is the only way you can cope with events like this.  I asked if there was going to be police involvement and they said there wouldn’t be.  I decided not to say anything else so we could move on quickly to get to the obstructed labor.  We moved on to an anemic pregnant woman in need of blood.  We finished with her quickly and noticed that they called in an older man for blood.  I asked if they were the same blood type (it was her father) but before they could answer he took money from the husband and mother and walked out.  I was completely puzzled.  Dr. Solomon said that the father is going out to search for 3 people to donate blood so she could deliver and each person gets $100.00.  The people have to come to see if they are a match.  I couldn’t think of a less convenient method to get blood, but here it is the only way.

We had a few more patients on the non-surgical side, so we walked over (no rush, no complaints).  What I saw immediately took my breath away, literally.  There was a young girl, maybe 13, who was laying in her bed with family strewn across the beds near her.  She was only wearing loose pants to cover her massively swollen legs.  I couldn’t take my eyes away from her legs, which her mother was stroking, because it looked like elephantiasis from pictures.  When I finally looked away, I saw something much worse.  Her massive legs were juxtaposed with her skeleton-like arms, and her heart literally beating out of her chest.  You could see it popping through her skin, and I felt like I couldn’t breathe myself.  I looked at her chart and saw CHF, congestive heart failure, and it all made sense.  The edema, the micro and atrial valve issues, and her swollen stomach.  This is a condition you read about, and to see someone so young actually living it made me sick.  Dr. Solomon started the next patient, but I needed to ask questions.  I began with, “Aren’t we going to do anything?” 

“No, Lydia has CHF, and there is nothing we can do.”

“Not even Honiara has the supplies to operate?”

“(laugh) No, she would need to fly to Australia which is too expensive, and the government would not pay knowing her prognosis is not good.  She is too weak for any operation.”

“Couldn’t she have underwent an operation in Australia when she was younger for a transplant/surgery?”

“Too expensive.”

“How long does she have?”

“Weeks, maybe.”

“So she just has to stay here and suffer?”

“Yes.”

I’m not trying to be morbid, just real.  And Dr. Solomon wasn’t being cynical; she was being honest.  She is a great woman and understands how to work under the limits of her country and government to the best of her ability.  The government is supposed to pay for special medical trips such as these if they are approved.  However, Dr. Solomon told me that the people in Parliament spend the money allotted for healthcare on themselves when they are sick, even if it’s just the flu.  Many Parliament members have gone to Australia for minor procedures.  Dr. Solomon said that if she were sick, they wouldn’t even send her.  It’s time I realize that the world isn’t always rainbows when people on mission trips come to “help.”  The circle of life is inevitable, and Lydia’s family knew that and held themselves together automatically to keep her company for her last breaths.  They certainly mourn for death, but they take life so much further than we do.  Instead of weeping or panicking, Solomon Islanders by nature just stay strong; it’s all they know.   

I really needed a miracle at this time, and I got just that.  After heading to the labor ward, it was time to help with the obstructed delivery.  I took a deep breath to clear my head and gloved and gowned up.  This time, I actually realized that the final product was a baby, so I braced myself.  The poor woman had now been pushing hard for 5 hours (not even crying!)  Dr. Solomon was deciding what to do, and each time she left the room, my heart started racing and I took my stance (hands out to catch anything/one).  The mother was in the room and kept asking if we were close and I just kept saying yes!  You could feel the head so I knew something was bound to happen soon.  I found out it was her first baby and when I got so excited for her she started laughing in the middle of pushing.  Woops.  At 2:45 Dr. Solomon decided we should use the vacuum (I’ll leave it to the imagination).  Well this baby was a lot bigger and slower than the first one I saw.  Finally the full delivery started and the woman stopped pushing, looked down, smiled, and kept going.  It was hysterical.  I was concentrated on  being careful so when we finally got it and placed it on the mother I was elated.  The new mom started crying and it was the cutest stereotypical birth scene I could ever imagine.  The baby boy was beautiful (and huge!) and after clearing his airways he began to cry as well.

Kilu’ufi Hospital staff and the 3 doctors try their best to work with their people under their government.  I realized today that part of a doctor’s work is moving on and making decisions, even if it means an unhappy ending.  I got the reality check I needed today.  If you have family, health, and love, you have everything.  

Sunday, August 5, 2012

There was no time to blog yesterday, so now I will recount the busy day.  First, Bishop took us to market at 7:30 so we could pick up bread and various fruit for the picnic for Richard’s birthday.  After getting the necessities, Clare and I wandered over to Angela, who runs the shell jewelry table.  Needless to say, I think we are done buying gifts for our family and friends!  Angela is a member of the parish and even made us special bracelets as a gift.  I was happy to give her some business!  We raced back to the Fanualama where I saw that Liborio had finished the crutches!  They looked absolutely beautiful and I didn’t think I would be able to wait until Monday to give them. 

Clare and I helped the sisters pack the picnic and also got Richard’s birthday presents together.  We decided to make him an American CD too!  When it was 10:30, Bishop and Father Moses drove everyone in 2 pickup trucks.  The ride was stunning and I got to know many of the girls from Allegegio School on the way.  Sister Loretta was once again cracking everyone up and I couldn’t wait to arrive at the beach.  When we arrived, Bishop and the sisters said that since we were partially the guests of honor, along with birthday boy Richard, we were allowed to go run around instead of cook.  Clare and I were happy to play soccer with the girls and enjoy the sun.  Finally, it was too hot so I had some of the girls guide me to the edge of the coral reef so I could go swimming.  Believe me, I wasn’t trying to go alone.  And I still tripped and slipped plenty of times while walking through the sharp coral because of low tide.  I was wearing flip-flops but some of the kids weren’t wearing any shoes!  When I got to the edge, I jumped in to join Clare who of course had been paddling around already.  Bishop Chris was also swimming.  I jumped in with Christina and Veronica, and one of the girls threw me a snorkel!  When I looked down, the sight was better than the Great Barrier Reef.  I saw huge mounds of coral, bright fish, and so many colors.  Everything was crystal clear, and I could actually see and breath at the same time.  After I occupied myself for 45 minutes, I swam back in and made it to lunch.  After our sandwiches and pineapple, Bishop Chris organized a boys vs. girls soccer game.  This was a little unfair, considering Richard’s brother Gabriel actually has been recruited to the national team in Fiji and New Zealand!  Running on the sand was so tiring, but the girls held their own.  After the game, some people went to swim again but I stuck around on the beach to spend some time with Sister Loretta and the girls.  We ran around for a bit and they decided to teach me some dancing.  They couldn’t keep a straight face when I showed them my moves, but I told them I was just warming up.  I sat with Richard and Patrick as they tried to find a special North Malaita cultural song for dance.  But, remember how I attract disaster?  Well, I saw a cute hermit crab on the ground and decided it would be hilarious to put it on Richard.  I walked back over to where they were playing the music and put it on his arm, all of a sudden I saw a flash of brown and, “BOOM!”  I seriously stopped breathing for a second and then screamed.  A massive coconut fell just inches from my head in between Richard and I.  Are you joking me?  I would have been a goner.  There are countless people in the Solomon Islands who get injured from these trees and their dangerous fruit.  It sounds silly but seriously, not funny.  Sister Loretta has realized my affinity to accidents so she decided to hang on to me the rest of the day.  Everyone was laughing as I walked everywhere with my hands over my head and invented ”The Coconut Dance.” 

Finally, they found the song and Christina, Agatha, and Joe taught me their moves.  I was really enjoying myself and getting a little too into it.  I finally got the moves down and then Clare came to join.   We danced the rest of the time and everyone incorporated the coconut move.  Father Moses drove us to the Fui River to wash off the trucks so of course there was more bridge jumping!  Back at Fanualama, we sang happy birthday to Richard while many people made speeches for him, including Clare and I.  He was excited over his new backpack and soccer ball, so I was happy.  After some exercise and evening prayer, Sister Loretta told us that she was on duty for the Allegegio school dance.  Did she say dance?  We waited for Patrick and Simon to come pick us up so we could watch the island dances from the students.  When we walked in their dining hall, I was a little intimidated by maybe 200 eyes on me.  Clare and I enjoyed a few numbers until Sister Loretta told us it was our turn.  Excuse me?  Joe came and escorted Clare and I to the door to walk in to the auditorium where we saw Christina and the rest of the dance crew.  They said we were going to perform the North Malaita dance we learned at the beach!  I was too excited to be embarrassed, but also determined not to mess up their dance because that would be obnoxious.  When we entered, about 200 laughs echoed throughout the room and I waved and smiled.  I don’t think they expected us to actually know the steps, because we’re white girls, but oh did we prove them wrong.  Clare and I performed our parts perfectly, even the spinning and bending down.  I decided to take my part a little further and gave it my own little shake.  I think that went over well!  We were congratulated by Christina, Sister, Agatha, and the deputy principal who actually said that I had talent!  (to Pamela, Court, Meg, Jen, Dani, Mandy- thank you for supporting my dancing before I got famous!)  After that, I headed home after a crazy Saturday night and slept wonderfully.

Rebecca

This morning when I awoke from my slumber, I was greeted by Sister Loretta, “Hello, dancing beauty!”  At mass, students were congratulating me on my dance.  Apparently my new name is dancing Cayla.  After mass, Clare and I sat with the beach crew and waited for Bishop Chris.  We were going to head to Kilu’ufi for pastoral care and I decided it would be a great time to deliver the crutches.  After a pit stop to pick them up, I could hardly wait.  I ran to the children’s ward and handed the beautiful creations to Alick and Rebecca.  They fit each of them perfectly and all the parish kids and the children in the ward were there to witness the moment.  Alick looked beyond thrilled and Rebecca shined her bright usual smile.  When Dr. Solomon comes tomorrow, she can sign the discharge papers.  We visited a few familiar patients and everyone got to meet baby Cayla. 

The rest of my Sunday was very relaxing; I even fell asleep for an hour.  I awoke just in time to do Insanity with Agatha and the sisters.  I definitely could have skipped today but I had to tough it out.  We enjoyed dinner with the Bishop and Father Moses for our Sunday tradition.  We were celebrating their feast day and also remembering a parish close by in Lilisiana, Richard and Philip’s (a singer for Auki parish) village.  They had recently sent a canoe out traveling to Gizo that never made arrived.  There was a priest and eight others on the canoe, and we think that they ran out of fuel or hit rough seas.  Half of the people jumped out of the canoe to swim and half stayed in the boat.  Some bodies are still missing but three have been found dead.  The people who stayed on the boat were found.  The tragedies that occur in this country are numerous.  Bishop Chris said his father just sent over 40 life preservers for parish boats.  Throughout dinner we laughed about the dancing escapade last night and exchanged various stories.  I don’t even want to imagine that I only have one more Sunday left in Auki.

 Monday, August 6, 2012

I started my day off at Kilu’ufi excited that Alick and Rebecca would hopefully be discharged!  I spent my morning playing with the two of them in the children’s ward while some of the workers put rubber on the bottom of their crutches to prevent slipping.  I was speaking to Rebecca’s grandfather who said that they live too far from the school, so Rebecca just works in the garden.  I felt so sorry for this tiny little girl and her high-pitched giggle.  Dr. Solomon had not yet arrived so I worked with Dr. Joe for a while in the male ward.  There was a patient who had just died from anemia and liver failure.  The entire family was in the male ward as the body was taken.  Many of the other patients crowded around the area.  Once again I realized that there is no such thing as privacy.

Alick

I headed to outpatient with Dr. Jason as he began his enormous line of patients to see.  Sister Loretta was supposed to stop by with Clare to get her toe checked, so I waited until they came around noon.  Dr. Jason saw Sister and booked her for the operating theater tomorrow.  I joked that we were going to amputate and I think Sister is a little scared.  Dr. Jason can take that surgery.

Clare and I were going to head to town for the afternoon, but when Dr. Solomon came in, she said that there was going to be an emergency C-section around 2 o’clock.  I could not miss this opportunity, so I asked Dr. Solomon if Clare could observe the surgery as well, to which she agreed.  Clare and I basically ran back to Fanualama and I threw her a pair of my scrubs.  We ate some crackers and started speed walking back to Kilu’ufi.  By this time it was almost 2 and I was so nervous we were going to miss the operation.  Luckily we hopped on a bus and ran to the operating theater.  While we were waiting, we saw Alick and Rebecca carry their bags out to leave!  After months, both children were ready to go home.  Speaking of waiting, I totally forgot about Solomon time.  No one was ready for the surgery, including the patient, by 2:30, then 3:00, and then 4:00.  At 4:30 PM I was ready to sleep, but luckily we started the surgery around 5:15.  Poor Dr. Jason had to leave outpatient once again, and all the doctors looked exhausted.  Dr. Jason administered the spinal.  Clare was so excited to observe the surgery and I was amazed at her enthusiasm!  The girl is seriously the biggest champion I have ever met.  Her first surgery was a bloody C-section and she watched every bit of it as enthralled as I was.   Dr. Solomon was heading the operation.  She sliced through layers of fat, muscle, and peritoneum, until the uterus was exposed.  Slowly but surely we were able to lift out the baby boy and it was a beautiful sight.  Clare was smiling brightly and the next step was the placenta delivery.  I’ll leave out the details on that one.  Finally, two and a half hours later, Dr. Solomon, Allison the nurse, and I had stitched back up each layer. I was becoming exhausted, and it was already dark.  The mother and baby were doing well at the end of the surgery, and I felt accomplished.  Once we cleaned up, Clare and I visited the baby in the neonatal room of the Labor Ward.  We both stared in awe at this peaceful baby with crickets chirping the background.  The mother and surgeons worked so hard to bring a life into the world, and it was refreshing to sit for a moment and breathe. 

After our moment, Clare and I realized it was 8:30 PM and we hadn’t spoken to Sister Loretta!  She was probably wondering where we were.  The doctors were going to drive us home in the medical truck, but they were caught up in outpatient and I knew better than to believe “soon” was only 1 hour waiting.  I dialed Sister from the office and she had Ben, the Bishop’s Catechism teacher, come pick us up with herself, Sr. Matilda, and Agatha.  Clare and I recounted our busy afternoon and chatted with Sister as we scarfed down some potato and pineapple.  I feel like I have truly experienced a physician’s schedule today, and I hope that I will be able to endure the physical challenge that comes before the priceless reward of saving lives.  It is now 10:00 PM, and Drs. Jason, Solomon, and Joe are still at Kilu’ufi hard at work.