The Good Things

I was on night shift a couple of weeks ago and I wrote most of this blog on one of them but never posted it because life was busy and then I got sick.

I have been on night shift this last week. My housemates have graciously given up their beds for me to sleep in at various times because the house is far cooler and quieter than my little dependance. Other than the usual trials of sleep and feeling generally gross (retrospectively I actually had malaria) my 12 hour nights have been filled with the usual work. I have been feeding my premie babies every 3 hours, putting up IV antibiotics, giving malaria medications and checking IV drop rates. The calmer hours of the night give extra time for letting mamas sleep and sitting in the ward feeding the babies.

The paeds ward I have worked in almost every shift since I have been here is one large room and is ever changing with the number of beds, cots and baby isolette cribs. My first night shift I had the whole 10 patients. By the time the lights were dimmed I barely had space to walk between the relatives sleeping on the floor. Interestingly my three patients who had beds (not cots or isolettes) all slept on the floor next to their mamas so all their actual beds were empty.

I end up spending quite a bit of time on the floor, reaching for patients between their bed and mama or other sibling or sitting on a stool while a mama gravity feeds her baby breastmilk through the nasogastric tube.

Some of these nights I had spare time and was able to let the mama go back to sleep and I would sit on the stool and continue feeding the baby, looking over the ward and admiring the beautiful, tiny baby in my hands. The premie babies are such sweet little things. We have worked so hard trying to fatten them up. Our work is paying off because 2 out of 3 of the original babies have reached 1.5kg and have now discharged! They will come back for appointments to check their weight gain.

Tonight for the first time since I arrived I have no paeds patients. Instead I have a collection of adults- snake bite, gastric cancer, fractured femur who is very confused, pulling at her dressings and not sleeping, peritonsilar abscess and abdo pain. I feel like I’m back at home in a medical ward! Thankfully this is because in the last day we have discharged many kids who are now healthy because they got treatment in time. You have no idea how relieved I feel about that. We still have several severe malaria admissions into REA each shift but most of them arrive before it’s too late. I often see them laying on their backs with their eyes open but a vacant stare or even asleep but their eyes aren’t closed. I think every time of the girl with malaria who I came across who had already stopped breathing, her eyes half open but no one was staring out of them. I don’t think that’s something I’ll ever forget.

This place has certainly changed me. I don’t think I can sum it up quite yet, if ever. It has been an eye opening time in many ways. I have the utmost respect for the missionaries who came out here and pioneered the way and continue to work so tirelessly at serving God through their various jobs (Christian radio station, village bible studies, nursing school, running the hospital and more). I always wondered if I had what it takes to live in Africa.

Tonight the termites are out flying around the lights and crawling on the floor. They are big winged, big bodied bugs that are continually being zapped on the bug zappers, sometimes for so long that you can smell them cooking. They aren’t the only bugs walking these hospital hallways. There are these other big beetles that also fly and crawl around. I usually give them a light kick to the side if they’re in my way. The flies are insistent too, relentlessly sitting on my patients, crawling over their faces, dressings or somehow getting into the baby isolettes. I think Australia’s insects prepared me well for being here.

 Fast forward through one week of sickness and first ever diagnosis of malaria:

I now only have 5 days left of my two month stay here. I have learnt so much and continue to be amazed and warmed at the family units I have seen caring for each other and community around them. I have seen severely malnourished kids get chubby cheeks and tiny premature babies get bigger. I have seen a miracle and heard of more. I have been so impressed by the skills and willingness of the Togolese nurses and nurse aids to help me again and again. (I’m looking forward to the day I can speak English to my patients!)

Life on my days off has been fun too. I love my little home and can always find something to do, cook, create or learn. I have grown to love the character of my home, the peeling paint and dark concrete floors. There are happy memories made here, from movie nights to housemate dinners to the constant electric shocks I get from my computer keyboard when it’s plugged into the Togolese power supply. 

Behind that wall is my house

My little dependance

My friends here have already asked if I’ll come back (or just stay). I have been wondering the same thing myself. At this stage, let’s just say God will have the final say.

Nothing Pretty

It is 0500, it’s still dark and I’ve given up trying to sleep. There is a lady who lives somewhere near us that has a mental illness who throws a large rock to the ground repeatedly every morning and sometimes in the afternoon. The force of her throw sends vibrations and a thud through the nearby houses. I can hear her powerful throw as she chases away whatever torments her.

I’ve been awake a lot overnight. I was getting a lot of headaches so finally decided to get checked for malaria, despite having a cold and feeling like I was probably overreacting. I tested positive for malaria, much to my surprise and relief that the headaches will be treated and disappear. After I got home from work I started the oral treatment which side-effects apparently give me insomnia. It was also a rough day yesterday and I’ve been reliving my day at work while trying to sleep.

I didn’t want to write every time I had a terrible work day and I haven't but it does help me to process and so here I am again, thinking of my day, tears spilling and blurring the screen in front of me. 

I was on nights last week but returned to day shift this week and started off the week looking after a baby boy who I had met on a previous admission. He was only a few weeks old with a very attentive mama and grandma who cared for him and his twin sister so well. He had gotten sick at home and his mama had brought him into the hospital where he’d gotten worse despite treatment. I assessed him throughout the day and didn’t like how he looked but he hung in there. I was worried though.

It’s so hard working in a country where you don’t speak the language and you don’t know the culture well enough to know what you’d even say to the parents of a child or baby who is very sick. In some African cultures you cannot tell them someone is dying because it removes all hope. Thankfully the expat doctors here speak French and working with the Togolese nurses and chaplains, we try the best we can.

I arrived at work in the morning to find out the baby boy didn’t survive the night. I felt so crushed for the mama. They had already left the hospital which I was selfishly glad of because I didn’t want to see that mama’s heartbroken face.

I was looking after the paediatric ICU again that day, along with the nursing students sharing the load and I was also orientating an expat paediatric nurse. Before we had time to do much the nurse aid called me to our 4 yo girl with severe malaria. She was seizing. And so began the day. We gave medication after medication, blood, antibiotics and airway support. We threw everything we possibly could at her and hoped it would be enough. There were wires and tubes everywhere but when I wasn’t next to her cot, there was a relative at her side. At one point I put in a foley catheter and was surprised when the ‘urine’ that came out was the same colour as the blood transfusion going in. We called the doctor over for the hundredth time that day. She said she’d only seen one other patient with urine that colour in all her years working there.

Conversations were had with the family as we waited to see how she would respond to treatment. I looked at her vitals and knew that it would take a miracle and prayed so but I also felt at a loss for words. Jesus. Jesus.

We made a plan before I went for lunch and I wasn’t sure she would still be alive when I returned, but she was. She kept going for hours. Her little chest heaving breaths through crackly lungs. We hadn’t been able to get a blood pressure reading on the monitor or oxygen saturations for hours and then I couldn’t palpate her peripheral pulses. I stayed by the bedside with the family as I watched her little body stop working. There was no hope in coding her and prolonging her death so we let her slip away but the thing is, it wasn’t pretty. Her mama was sobbing and I stopped being brave and just let the tears fall. We stood there while she breathed her last gasping breaths, the CPAP still blowing air down her throat. And then her heart slowed and stopped and what I knew was going to happen, happened. She was still and lifeless. I stood there wondering what she had been like. Had she been a bubbly, lively little girl?

I stood helplessly next to the family, so desperately sorry that we’d lost another child. Another beloved child. I felt so angry that kids and babies are dying of something that’s been eradicated in other countries but also an element of hopelessness. When will it ever end?

There’s nothing pretty about this. No nice way to tie this up. I know Jesus walks with them in sorrow and oh how deep that sorrow is. I asked God to give me a heart that breaks like His and I think this is what it looks like.