From Pete: My First Delivery in Africa

Today's post is the first time that Pete, my husband, has ever written on the blog. His story is moving as he describes what he experienced while working in the Kenyan hospital today where we are currently living.

 I’ve been wondering for months, maybe even years, what my first delivery would be like when we arrived in Africa. A vaginal delivery? A cesarean section? Would there be instruments available? What about assistants? Would I even be in a hospital? You see, I’m used to the very best…

Most vaginal deliveries are attended by two or more physicians, an attending, a resident, and sometimes even another intern. By the time the patient is ready for a vaginal birth, she’s been monitored carefully for many hours, with baby’s every heartbeat recorded electronically (and on paper). We have a good idea of what to expect, and we also have everything we need in case something doesn’t happen the way it should. Sterile towels, gauze, masks and gloves, a vacuum device, even forceps for a difficult delivery, medications to stop bleeding and ease pain, sutures, scissors, scalpels…the list goes on. Most importantly, incredible OB nurses who are among the most calm and collected people in just about any hospital, certainly in Duluth.

For those vaginal deliveries that take an unexpected turn, we can change over for a cesarean section in about 10 minutes. By the time we arrive at the pristine operating room with the patient, awaiting us are perfect surgical tools sterilized and neatly wrapped, opened only by trained surgical technicians under sterile conditions who will later hand them to you when requested (most often even before, they know each surgery so well!). An anesthesia team is present to provide pain control with a spinal if there’s time, but they are ready with everything to intubate and breathe for a patient in case of a “crash section” (emergency surgery to save mom and/or baby). The Neonatal Intensive Care Unit (NICU) staff are already there with a resuscitation team and an incubator in addition to all the tubes, lines and cords needed for the worst of resuscitations. Oh…and those awesome OB nurses are there too.

I could go on, of course. But we’re not there. We’re in Africa. And it’s different here.

It didn’t start the way I expected, I guess. I was emergently paged to Casualty (the emergency department) to attend to an 18 year-old who was pregnant with her first child. She hadn’t reported any contractions, rupture of membranes, or vaginal bleeding. I didn’t have time to ask her if she felt her baby moving.

You see, there wasn’t any time for questions. When I arrived to the small room crowded with 7-8 beds and even more patients standing/sitting as they awaited care, the clinical officer (CO, similar to a Physician’s Assistant) helping the patient looked at me with panic. He pulled back a curtain to reveal a flurry of activity. The nurse was hurrying to start an IV while humming a hymn – I can’t remember which one right now. Another nurse had just arrived with an oxygen mask, freshly washed and ready for reuse. The CO rapidly explained that two girls had just dropped the patient off at the door and couldn’t be found.

I was at the foot of the bed while the CO spoke, partly listening, partly assessing. My hand felt her pedal pulse – weak and thready. I glanced up at her face just as the CO was finishing. She looked slightly ashen, and was gasping for air. Her uterus was at or below her belly button, meaning that the baby was either small or at about 20 weeks gestation or less. (A nurse confirmed she was 20 weeks pregnant shortly thereafter.)

Alright, Pete, don’t forget the ABCs. Airway, Breathing and Circulation. We have all sorts of these acronyms in medicine to help us remember a ridiculous amount of information (and recognize a whole lot more). There’s a pulse, she’s breathing (albeit with difficulty), but she’s losing her airway. As I moved to the head of the bed, a dark, liquid substance began spilling from the patient’s nose and mouth. We suctioned, intubated and started breathing for the her. Then we “dropped” (placed) a nasogastric tube and suctioned another 200 mL or so of the black substance from her stomach. We still don’t know what it was. By now the cardiac monitor was on and the patient’s heart rate was in the 130s (normal is 60-100 beats per minute). One of the nurses looked up a moment later and said the initial blood pressure was 70/50 (normal is 120/80 mmHg), but now she couldn’t get one. I felt the patient’s neck for a carotid pulse – there was none. “Start CPR,” I said.

I know all this sounds exciting, but really, teams of nurses and physicians all over the world do this often. It’s called a “code.” Someone’s heart or lungs stop and we basically have an algorithm (based on good science) that we follow to restart the patient’s heart or get them breathing again. It’s never fun, but it does become routine, at least when it’s performed by a well-trained team. This was a good team.

With the chest compressions came intermittent cracks (rib bones breaking from the pressure of compressions). At two minutes we checked for a pulse and gave epinephrine (adrenaline) to shunt blood back to the heart and encourage cardiac activity. There was not a rhythm that we could “shock her out of,” so we just kept doing CPR and using epinephrine every 3 minutes, checking for a pulse each time. After 40 minutes without a pulse, I called it. “Time of death: 10:24 am,” I said softly.

I helped the nurses clean up the patient, remove the lines, and apply fresh linens. Then I prepared for the hard part – talking with the family. They arrived later and I had a room prepared to tell them that the mother (and her baby) had died. They were inconsolable, of course. I spent a few moments there, but left them with the chaplain and returned to the emergency department where another patient needed care.

The mother was taken to the morgue in preparation for burial. Two days later, the family returned with one request: to have the opportunity to bury the mother and baby separately. I spoke with my supervising physicians who agreed this was reasonable.

I lead the family members, this time with the father of the baby, to the morgue and had them wait in the office. Then it was time for my first delivery in Africa, a postmortem cesarean section – another first. She laid there draped in a perfect, white sheet on a rusty, steel table. Even though the mother had died, I maintained very similar surgical technique as my attendings in Duluth had trained me to do. As I cut, the smell of formalin filled my nostrils. A moment later, I delivered a beautiful, tiny, lifeless, little girl. I carefully closed the mother’s tissues, even using a subcuticular stich to close the skin (a suture that is hidden from view). It wasn’t necessary, but it felt right.

I draped the mother again and then carefully attended to her little girl, only slightly larger than my hand. I washed her gently and placed her in a brand new swaddling blanket, her arms gently folded. One of the morgue attendants went for the father and the rest of the family. They arrived, not knowing what to expect, but when dad saw me holding his baby girl, he started tearing. I asked if she had a name. “Fancy…Fancy is her name,” he said, barely audible. “Well, Fancy is a beautiful little girl,” I said, handing the swaddled little girl to dad. “I’m sorry that her time with us was so short, but I believe that she is now with Jesus where there is no pain and no suffering…where we’ll all be together again.” I began to pray, my two fingers on the side of Fancy’s head as we invited God to be with us and bring His peace. Everyone, now with tears, gently filed out of the room. Dad stayed a moment, took one last look at Fancy, handed her to me, and said, “Asanti.” (Thank you.)

The refreshing African rain greeted us as we slowly walked back from the morgue to the hospital where we parted ways. It was early evening, and I was done for the day. I loosened my tie and draped my white coat over my arm to the let the rain wash me gently on the way home. I was greeted by a beautiful little girl who came dashing up to me yelling, “Daddy, Daddy, I have an umbrella for you.” I scooped Ella into my arms and kissed her. I walked toward apartment #7 and let my eyes meet Ang’s. She knew instantly. She just has a way of knowing that no one else could. I kissed and snuggled Sam for a moment before she quickly swept both children into their bedrooms for the night. I let the warm shower wash off the formalin, dressed and here I sit on our living room couch.

You might think now that I’m sad or depressed or maybe even upset about all of this, but I’m not. In fact, not at all. This young woman losing her life and her baby is tragic, yes. But in the end, I’ve never been able to stop someone from dying forever. Hester Lynch Piozzi, an 18 – century British author, once said, “A physician can sometimes parry the scythe of death, but has no power over the sand in the hourglass.” It’s true.

But I’ve also learned that one of the most compassionate acts we can do for one another is to relieve suffering and pain – to make room for healing. And tonight, when one dad looked back at another, there was a silent understanding that healing had begun, and then a quiet, “Asanti.”

Over the River

Sunday was another day that was spent together as a family. Pete was on call at the hospital all weekend, but he only had to actually go in Saturday and Sunday mornings to round on his patients. That took a few hours, but he was home by lunch. In the later afternoon, we took advantage of the perfect weather (wait, every day is perfect weather...75ish and cool in the shade) and went on a journey to the river. We hadn't yet been to the river, but we had seen it from the backyard of a friend's house. We filled our Nalgenes, grabbed our hats, and headed out to explore.

No matter where we are, Pete draws elementary/junior high boys. This group walked with us from our house to the road by the river before parting ways. Shortly after, a new group joined.

Honestly, I was a little annoyed at first. I had wanted to go on a walk with only my family. Just the four of us, wandering down to the river, hearing the rush of the water as it moved by the dam. I especially didn't want to share Pete with anyone. I feel like I share him all week with medicine and the people who need his knowledge and deeply caring spirit. I wanted it to be my turn. Yes, I get him when he comes home in the evening, but we don't usually have time to go anywhere since it gets dark by 7ish. And then I put my own feelings aside for just a second and realized these boys might not have anyone like my Pete. In the end, they did join us for our stroll. And I was glad they did.

Ella makes friends wherever we are. She has absolutely zero fear. I do keep a close eye on her here because of that, just as I do in the States.

These cuties took us to the river.

At last we made it to the river. It's not that it's a long walk. It isn't. We just took our sweet time, soaking the in the presence of our new friends.

We could hear the dam from a good distance away. The rushing water cascaded further down the riverbed, ending in a peaceful calm a few hundred yards away.

This is one of that banks of the river. Thick and green. 

Here is the other side. We met small groups of people coming across the bridge to go up the path. Probably heading home. I think the path leads up to a small village. I've seen the village from our friend's backyard. It sits between the river and a dirt road. Rumor has it (well, rumor to me, anyway. it's probably true) that there is a market there on Wednesdays. I'm hoping to make it there with another physician's wife to look at jewelry.

I was captured by the beauty of these soft, purple flowers over this metal roof.

Hello, cows standing behind Pete. Doesn't Pete look like he belongs in Africa with that hat? I think it's great. We each got a new hat before leaving Duluth. I'll eventually get photos of each of us in our hats. And you can see that we brought our big stroller. We haven't used it a ton, but it is nice to have on occasion. And it was great in the airports. I mostly carry Sam in our baby sling or Ergo carrier.

This group of girls followed us from the river to our house. They wanted me to take lots of pictures of them, trying to be super cool in every shot. Can't you tell?

Look at Sammy. They were all focused on getting their photo with him, but all he wanted was his giraffe. Girls swarm to him, begging to hold him and check out his toys. The thing here, though, is that they don't often ask to hold him. They will simply walk up to me and try to take him from my arms. I'm not a crazy mama bear, but I am pretty protective of my boy. I tend to only let those I already know hold him. Strapped in his stroller, he's fairly protected.

The walk concluded on our front porch with glasses of water all around. That always seems like a treat. Ice, too. Pete's friends, the group who came to play tag last Sunday and were back immediately after church this Sunday, ready for Pete to play again, often come by for ice. They love it. And I love sharing it. Ella does too. I let her hold the bowl of frozen cubes for the boys and she says, "There you go, friends! Have ice! It's cold." We're incredibly fortunate to have such great, new friends here. Two months isn't a long time, but I'm glad it's long enough to share life with some pretty amazing people, young and old.

Apartment #7

After attempting to post this tour of our cozy abode for days, I think it might finally work! Ella is playing outside with our neighbor and Sam is taking his afternoon nap. A perfect time to write.

Welcome to Apartment #7. You can find us on the ground level right in the middle of our building. We are surrounded by families from all over the world who are working here at Tenwek. Two of the families have small kids, and there are more kids in the houses just down the grassy hill. It's a perfect set up for Ella and for this mama. I can sit in the house or on the porch while Ella plays and Sam naps and still see Ella as she runs laps around our building with the kids. I also spend a lot of time sitting in the grass with a couple of the other parents in the morning. We talk about all kinds of things, including what it's like to live here for years and years while raising kids. Obviously, that's very helpful information for me. Someday I hope to do the same.

On to the tour. We start in our bedroom. Here you can see our double bed with a mosquito net. We tie it up first thing in the morning so the little bugs can't get inside, and then we pull it down over us as we crawl into bed. It gets pleasantly cool at night, so the heavier blanket is just right.

Ella and Sam share the other bedroom, which is actually working very well. Sam sleeps in his little tent that we've bought just after he was born. We wanted him to get used to sleeping in it before getting to Kenya. It's far, far easier to travel with than a Pack n Play. And we can completely close it to keep the bugs out.

Miss Ella wanted to show off her room. There are her "Acita" dresses that she loves to wear. 

 

We are fortunate and have a very nice size bathroom. The pitcher next to the sink is for brushing our teeth since we can't use the water in the faucet. It would likely make us sick.

I'm so happy to have a bathtub! Giving baths in it is a little funny, since the water comes out a little muddy. Dirt remains in the bottom of the tub when we drain the water. Ella goes in so dirty that even having dirty water is an improvement for her, so it's not a big deal. I'm thankful it gives us nice hot water!

 

And this is our great big kitchen. Isn't it lovely?! I was quite pleased when I saw it for the first time. 

 

This is another view of the kitchen.

 

And here is our living room. This is the only room I've decorated since we're here such a short time. I wanted to make this a comfortable room, though, since we do spend a decent amount of time in it. I'll describe my simple decorations in another post.

 

Here you can see our table. We've had some great meals there. The door on the left leads to the kitchen while the door on the right leads to a hallway where the bathroom and bedrooms are.

  

And that is that! I do have photos of the outside, but I'm just hoping these will post for now. We are very happy with our apartment. It's much larger and more comfortable than we had imagined. That may not be in the case as we travel in February, so we're greatly enjoying the space we have.

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Do you have questions about what it's like or what we're doing in Kenya? I would love to hear them! I can either include the answers in future posts or write a post just with answers to your questions. Any question is great. You can either post them in the comments section at the bottom of this post or post them to me on Facebook. We do have a Little Olsen page that is dedicated to this trip. I'll put a spot there for your questions.

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And now it's starting to rain, so I'm off to play a few inside games with Ella.

Kwaheri!

goodbye

yup, bug bites on my face. oh well!

Testing, Testing...Is This Thing On?

We've had a hard time getting things through on the internet the last few days, so this is a test from my iPhone. Everything is going very well here. Ella tells me often that she likes 'Acita' a lot. She really is having the time of her life running & playing with all the kids. Sam is doing well, too. We all are. I'm hoping we can get some photos through soon. I have a house tour all ready to share. But first, let's see if this one works.

A Day of Rest?

First, an update on the sleep situation around here. It was suggested by a seasoned missionary that we not allow Ella to nap for a few days. She has seven kids, I think, so I trusted her advice. Turns out, it worked! Ella has slept through the last three nights, but if you've spent time with little kids, you know what happens when they miss naps for several days, even when nighttime sleep is good. Today I only let her play outside for a short time in the afternoon due to her mood swings. Poor thing. Tomorrow we'll be back to naps. I'm glad this worked for night time sleep, though. It's something we'll surely keep in mind for future travel.

Pete had the entire day off today. We began the day with granola bars and milk from a box (how we drink it here) before a short walk to church. The service today was English-speaking with many hospital employees in attendance. It was a nice, full service. Next week we hope to attend a different local church with new friends. It will likely be in Swahili, which is fine with us. We're looking forward to the experience.

After lunch Pete and Ella headed outside to play. I took Sam out on a blanket in the grass so he could watch the kids. It didn't take long before numerous young girls were surrounding him. Such a little ladies' man already. Most of the girls are very good with babies since they probably help a lot with them at home. Sam loves the attention.

While Sam and I were sitting in the grass, a group of about 8 boys between ages 4 and 12, I'd say, ran up to Pete, asking to play. He had played with them a little the previous day and clearly, they loved it. I really enjoyed watching him interact with them. He makes sure everyone is getting a chance to participate and calls them "friend," which I know they like.

In the last two days, I've seen something beautiful return in my husband. When I first met him a little more than seven years ago, he was working quite a bit with the Sunday afternoon kids' group at our church in downtown Duluth. He would head out on the bus from the church to pick kids up on the Central Hillside, an area that houses a lot of at-risk kids of all ages. The bus would bring them back to the church where they would play, hear Bible stories, and be loved on. I only saw Pete with the kids a handful of times, but he was amazing with them. He exhibited a pure heart and great love when they interacted. Yesterday and today, I saw that part of him coming back. I had almost forgotten it existed. Medical school and residency have taken so much of his time and energy, making it easy to understand why he hasn't been able to spend time like that with kids in Duluth. Today he ran and played so hard that he fell asleep shortly after coming in the house, and he just might need some ibuprofen in the morning. 

When the boys approached Pete today, they were full of hope that he would want to spend time with them. I could read it in their eyes. As soon as he said yes, their bodies seemed to fill with energy and every one of them either tackled Pete or ran away to start a game of tag. Eventually, a few girls joined the game, too. The pack ran back and forth, up and down the grassy hill, laughing and calling out, "You're it!" in playful voices. At one point, many of them, including Pete, ended up in the tree house. As soon as they were back on the ground, they kept running. This went on for at least an hour, at which time someone realized how thirsty they were (probably Pete) and they all came running onto our porch.

By this time I was inside with Sam, so I mixed up a quick pitcher of Crystal Light and poured glasses as quickly as I could. I think we did about three pitchers before running out of clean water. We have a couple ways of getting clean drinking water here, but the fastest is to walk up to a big filter near the hospital and fill giant blue jugs. What better task for a big group of energetic boys? Off they went, with Pete as their guide, and all was quiet again on the porch.

The quiet vanished the moment they returned, of course. I saw Pete running down the path with a big blue jug in each hand and a boy on his shoulders. They were racing. And Ella wasn't far behind. She's certainly not one to miss out, even if the other kids are more than twice her age. Pete quickly ducked into our neighbor's apartment to borrow The Jesus Storybook Bible. Without a moment of hesitation, he drew the kids around him in the grass beneath a giant tree and began reading the story of Noah. They were transfixed on what he was saying. He did more than read. He explained things and painted pictures they could understand. I'm guessing that many of these kids go to church with their families, but it was like they had never heard the story before. As soon as the story was over, they jumped back into running and laughing and playing.

What I saw today gave me a glimpse into what God has in store for us. It's hard to remember the feelings of freedom and play during a packed, often frustratingly so, residency schedule at home. Sometimes it feels like that's all life is. But we know that God has called us to Africa and that He has brought us here right now to renew our hope in that whole big plan. It's not going to always be about medicine. Even though we haven't been here long, we're experiencing days that include medicine and many other things we love. We had a big family dinner together tonight that I cooked. We don't get to do that very often at home. It's so good for our hearts to feel what our future holds.

So even though it may not have been a day of physical rest, it was certainly a day of renewal. For that, I am incredibly thankful.

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Yesterday I got to do something I have been wanting to do for a long time. Ladies and gentlemen, I made my very own baby food. What made it so great, in my opinion, was that I was able to use the incredibly fresh fruit and veggies I bought at my own door. Food stands are very common here. On Friday, as I was walking back from an errand at the hospital, I met a young woman named Amy (about my age) who has a stand near the back gate of the hospital grounds. After talking, I told her I wouldn't be able to buy anything from her that day, but that she should come by so I could purchase something the next day. That's another common occurrence. Vendors come right to the door with bags of whatever they are selling on a particular day. (What would we have to do to get that going in Duluth?) I bought squash, bananas, and oranges and added those to my stash of apples, pears, and green beans. After bleaching everything (a requirement for nearly all produce), I cooked and pureed batches of squash, apples, bananas, and pears. I froze a good amount of the squash in an ice cube tray for easy storage. Later this week I'll make more. It's a bit time consuming, but it's really the only option here. And it's super inexpensive.

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Please pray for continued peace here in Kenya as the national elections approach on March 4. Last Thursday and Friday were the primary elections, and things went fairly well. We had originally been scheduled to be in Kenya until March 8, but now we'll be leaving before the elections. Possibly March 1. In 2007 the country erupted after the elections. We think it will be best to leave the country early in case anything does happen. We're praying for peace over the people here.

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Big day for Ella tomorrow...she's starting preschool! She doesn't know yet. I wanted her to be able to sleep tonight. Many of the local families have children around her age, so they have preschool three mornings a week. Ella is going to be thrilled. It will also give me some time to have chai with some of the women here I've really been wanting to meet.

Goodnight from Kenya!

Photo Friday: Day Four in the Sun

morning laundry

the amazing tree house in front of our apartment

the view of the hillside from the tree house

the doctor off to work

playing in the living room

my first cup of Kenyan coffee

Ella gave herself a pedicure

the walk to have lunch at the hospital

waiting for Daddy

at the hospital

orange Fanta & a Kenyan donut

traditional food at the hospital canteen

wee bananas

Ella with one of her new best friends

photos are smaller than usual due to the slower internet speed