Trials & Tribulations

Monrovia Travel Blog

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Setting up for a dilation

What a week!  Its only by the grace of God that we all survived.  What could go wrong did go wrong.

Started the week by calling home on Sunday to talk to my folks.  My mom told me that my dog of almost 14 years, Nala, had died.  :(  What a way to start the week. 

Let me explain what kind of cases we did this week.  We have a surgeon from Spain, who has been here in Monrovia for a year doing pediatric surgery.  He specializes in anorectal malformation- where the child is born with the rectum in the wrong location.  These surgeries are done is 3 stages- sateg 1: a colostomy is done in order to prevent infection and allow the child to eat; stage 2: the malformation is corrected; stage 3: the colostomy is taken down (the intestines are reconnected).

Doing a dilation
  It can take up to 9 months to complete.  The other kind of surgery is esophageal dilations in children that had accidently swallowed caustic liquid causing severe burns in their esophagus and prevents them from eating or even drinking- we use different size dilators to expand the esophagus.  These children usually have a feeding tube- either an NG (a tube in their nose) or a peg (a tube in their stomach) and are in and out of the hospital for the next 10 years or so.  They often have surgery every week and because of that they often have no IV access (due to the need for frequent IVs).  This makes them a real challenge.

Monday: Between dealing with really sick babies with very poor oxygen saturation (the amount of oxygen in the blood), our ship decides to add its own problems to the mix.

Enjoying our well deserved night out
  At the beginning of our 2nd case, the power shuts off- no lights, no power, no nothing.  Normally the emergency generator kicks in and everything is ok, expect that the unfailable emergency generator fails (can anyone say Titanic?).  We have 2 different kinds of outlets in the hospital- white outlets (regular power) and red outlets (emergency power).  All of our equipment was plugged into the red outlets and it was at this point that we realized that our ventilator was not working!  We quickly switched over to the white plugs and it was business as usually.  One problem solved- no one was hurt or at risk.  At the end of that case, a loud high pitch alarm sounded from our vent, we paused and looked at eachother, saying "that sounds like the oxygen failure alarm!"  Sure enough, our piped oxygen into the OR had failed.
Believe it or not, this is Sarah's one and only drink!
  So as I'm running around calling for help and looking for an oxygen tank, I hear simultaneous alarms going off in the other other ORs.  Our entire piped oxygen supply was down!  Luckily, our case was done so we quickly took our baby to the recovery room (he was doing just fine), and all the ORs have large oxygen tanks in their rooms that they quickly changed over.  Another crisis adverted.

Tuesday:  We did our first round of dilations today.  They are interesting to watch and do, I wouldn't wish them on my worst enemy, but they are necessary for these children to live normal lives.  The average age of our patients this week was 2-4 years old.  They are very malnurished and are very tiny.  We will see them almost every week now until the end of the outreach.

I hold a tired baby
  One little boy had no veins left what so ever- I've seen better veins in a IV drug user.  Because we couldn't get an IV started in him, we had to cancel his case and the decision was made to put in a port-a-cath- a device placed under the skin that allows us to have easy access to deliver IV meds, at a later date.  We ended our day removing an infected kidney from a 2 year little boy.  This kidney was larger than he was (almost).  He was a sick little boy- hopefully he will be better now that its out.  But the case wasn't straight forward- there are rumors going around Liberia that Mercy Ships steals kidneys from their patients.  We've been working with the locals to dispell those rumors, we don't take kidneys.  Until Tuesday.
One of my roomies- Amy, a ward nurse, is a life saver!
  So we had to extra careful in explaining why we needed to take out this boy's kidney.  Oh the joys of working in Africa. 

Ended the day with an entire OR outing to one of the local resteraunts- Casablanca- a Morrocan style eatery.  It was a great way to unwind and decompress.  The food was ok, but it was more the fact that we were off ship that made it a nice night. 

Wednesday: More esophageal dilations.  Had to bring one of the kids back to OR because he had pulled out his IV and they were unable to restart it on the ward- poor kid, his veins were shot.  After that we brought back our other kiddo from yesterday and placed his port-a-cath, so hopefully next week we can go ahead with his dilation.

Thursday: I was sick.

Exploring the market
  I woke up at 6, just sick to my stomach.  We have what we call the Larry bug (named after a cute baby on the ward who has the nasty habit of making anyone who has come into contact with him sicker than a dog) going around the ship- the funny thing is that I haven't had contact with Larry for 2 weeks and all my roomies are ward nurses and they aren't sick.  I survived until about 1030, when I just couldn't take it anymore and asked my supervisor if I could go home early.  She agreed and I slept most of the day.  Woke up at 1530 due to the Thursday afternoon fire drill.  Had to 'abandon' ship and muster on the dock.  I swear they made it as long as possible just to torture me.  An hour later, we were able to reboard and I went straight to bed.
Reminding us that there is more in life than the OR
  Woke up again at 9, feeling a little better, went upstairs to let people know I'm still alive.  Went back to bed soon after that.

Friday: Felt better, but still had moments of wishing for death.  Another day of dilations and sick kids, but nothing as dramatic as earlier this week, thank God. 

Finally, the weekend.  Went to my orphanage again this morning.  A very hot day out, so after the lesson and craft, we played more quiet games, such as memory, Jenga, and painting fingernails.  It was nice playing with healthy, strong kids who are able to be kids.  Took an trip into town this afternoon to the craft market and then for ice cream.  A nice day.

Please pray for a safe and uneventful week next week.  We could use all the prayers we can get for our patients and our sanity. Thanks!

(PS: I went back and added pictures to a couple of old entries- 10/18 and 10/5 - check them out!)

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Setting up for a dilation
Setting up for a dilation
Doing a dilation
Doing a dilation
Enjoying our well deserved night o…
Enjoying our well deserved night …
Believe it or not, this is Sarahs…
Believe it or not, this is Sarah'…
I hold a tired baby
I hold a tired baby
One of my roomies- Amy, a ward nur…
One of my roomies- Amy, a ward nu…
Exploring the market
Exploring the market
Reminding us that there is more in…
Reminding us that there is more i…
photo by: ulis