Daily accomplishments

We went to one of the villages to get heights/weights and screen for malnutrition or other reasons children should see a doctor. We did see some severely malnourished children. One child that is 1 1/2 years old cannot hold her head up or sit on her own yet. We referred these children. I enjoy going out into the villages to assess the children, so I'm glad we got to go. Here at the hospital, I in-serviced on feeding babies, and on the emergency carts we put together and the documentation form we are rolling out. We also made a bulletin board. We just cross out fingers that any of this will have an impact. It's scary to get sick here! Then, we took a ride in the ambulance. That's when we got the low down on the baby. We spent about an hour with them. We didn't get any calls. So, they just took us to several food stands, and didn't seem to understand, "no thank you". So, we tried something they called mango ice cream, but was not ice cream at all. It did have ice in it though. We had some mango juice, and bananas and tried a guava and some other fruit.

Regular Day

We did a few other things between all that! We went to Jeetu's farm and picked mangoes yesterday. Then, in the afternoon, we went to Baroda shopping. We got medical supplies, and also went to the mall for some India attire. We wanted to go to a grocery store to buy some supplies, such as water, stuff for breakfast, toilet paper and chocolate. But, we couldn't figure out how to describe grocery store to our driver. He took us to a fruit stand, then a little shack that sold this and that.  A bakery. We couldn't figure out how to communicate what kind of store we were looking for. So, we just had to get a few random supplies where we could. So much for the chocolate and toilet paper!

Tragedy

There was a birth 2 nights ago. It did not go well. The nurses deliver the babies. The mother was pushing for a long time. After 15 minutes, it is the protocol to call the OB. It probably took him 15 minutes to get there. The nurse said she wasn't properly dilated. I think the babies head was facing the wrong way, and the cervix was probably mis-shaped. The did an episiotomy (they always do). They cut it bigger, but no progress. Dr Mikwana came, the mother was tiring but kept pushing. The baby was finally born after probably 50 minutes of pushing. There was a lot of blood and the baby aspirated and didn't start breathing. They have been taught neonatal resuscitation, so I was auditing to see how they did. The problem was, the equipment wasn't checked ahead of time. I had made sure there was a bag and mask there. But, the oxygen tank didn't work. So, we did what we could. The doctor asked me to prepare a room in the ICU. I ran there, but the oxygen did not work there either. We had to get oxygen from the ED. This all took 1/2 hour. So, 1/2 with suboptimal oxygenation to the brain. And, once the baby got oxygen, we still was really struggling to breath! I was so worried. I stayed with the patient until 1am. And, the nurse in ICU was brand new. Not ideal. I knew the baby had suffered from anoxia, but I was hoping it would be minimal.

 

That doesn't seem to be the case. Yesterday, he started having seizures. Today, I was in the room working on the emergency cart we are putting together. The alarm went off. The baby wasn't breathing. I stimulated the baby, but the baby would not start breathing. I called to the other nurse and asked her to get the bag and mask ready. I called to someone else and asked them to call the doctor. The baby did not breath for 1 full minute. He was very grey. He was breathing when the doctor came, but then stopped again. The doctor had to resuscitate. We ended up sending the baby to Baroda. This is beyond what we can take care of here. It's very sad! :(

 

We heard later that night that the patient passed away at 11pm. It's a tragedy! The hardest part is, knowing this patient would probably have had a better outcome if we had equipment that worked!

Marriage

India is running into a huge problem. Male children are preferred. Because of this, since ultrasound was introduced, abortion of female children is common. Also, families are more likely to seek medical care for a male child than a female. With these two factors, Males outnumber females with a 100 to 70 ratio. The Patel community is struggling with this, because there are not enough women within their community for the men to marry. The leaders had a meeting and made some decisions. They are willing to pay other high caste communities to marry their sons. They are absolutely not willing to allow their sons to marry from a lower caste. And, if their daughters want to marry someone from a lower caste, "honor killings" within families are common. The Patel community held a matchmaking meeting this last week to help with this problem. 400 eligible Patel men were invited. 100 Patel women were invited. The men introduced themselves and told of their qualifications. The women were able to select someone that they would want to marry. Every women was able to find a match. Now, the parents have to get together to discuss this match. There will be another such matchmaking meeting on October 12th. I've been invited to participate. It's no problem that I'm a foreigner! :) Can't wait!

Hindu Culture

Culture. I love it! It is one of my favorite things about traveling! We are coming upon a brick wall in India, because of the Hindu culture. They believe in Gods. Many of them. And fate. Everything is supposed to happen the way it happens. You don't question that. You just accept it. That makes health care a challenge. If you are sick, you are supposed to be sick. If you get better, the Gods wanted you to get better. If you die, that is the way it is supposed to be. You should not try to change these things and mess with fate. So, providing medicine, are medical care or even coming to the hospital, sometimes can mess with fate. You are playing God. That is why they don't feel it necessary to assess and intervene if something is wrong. They have ordered 17cc's per feeding for our Low Birth weight baby. That is less than what is recommended. The baby got 10 cc's today for 3 feedings in a row. I asked the nurse why. She said the baby was asleep. I tried to feed the baby, and she took 22. This nurse did not seem fazed at all when I told her the baby must have more! I'll check back, but am not hopeful. And, they wonder why the baby is not gaining weight! :(

Nurse Education

My purpose here is to Educate the nurses on taking care of Pediatric Patients. But, I have learned my job is much bigger than that. These nurses have gone to nursing school, but the practice here is much different. They have been giving meds and delivering babies. I can't deliver a baby, but I do a whole lot more than give meds to my cute pediatric patients. So, I am teaching vital signs and assessment. Seems so elementary for a nurse, but that is what they need. And, of course, hand hygiene! I have been given a list of educational needs by the Pediatrician. My goal is to get through all of them. That includes: Hand Hygiene, Newborn care, IV, Feeds and temperature. I am adding vital signs to that. I have introduced vital signs in October, taught them in Jan, but found that they weren't being done when I arrived this time. I audited the first week, educated again yesterday, and showed up before doctor rounds this morning to walk around and do vital signs with them. I will continue doing this week. And, have asked the medical students to audit after I leave, to see if they are still being done. I have a nurse coming in July, so I will have her re-evaluate and re-educate. That's the name of the game around here. Re-education about vital signs! The UofU asked me to stay for a year, to tackle some of these problems. I said I would like to, but I also enjoy a stable job at home. And a clean bathroom is a plus! (As a side-note: I asked a sweeper to clean my bathroom. They cleaned my entire room, threw away the trash, and didn't touch the bathroom! I really think bathrooms are considered filthy here, so they are not cleaned. I have never had a clean bathroom here. Makes going into one less desirable. That, and the fact that there is no AC in there.)

Mount Abu

We took the weekend off to go to a cooler climate. We went to Mount Abu. The temperature was still 100 degrees, but it was not as humid. So, it was nice! We took a trek into the mountains, and so where the nomads live. Every day, the Nomads hike their goods out to market. They balance them on their heads. Then, every night, they hike back to their homes in the mountains. The hike was pretty strenuous! They are nomads, because during Monsoon, they have to move to higher ground. We also saw the caves they live in during monsoon season. These people mainly raise grain and milk cows. They also pick berries and fruit. There are many edible berries and fruit in the mountains. We had blueberries, mango's and limes that grow wild. It was a fascinating journey