Ambulance

We've had our vehicle now just over a year and we continue to count this as a huge blessing in our work here.

I frequently think and remark how hard it was to not have easy transportation the first 8 months of being here and how absolutely wonderful it is now!

Just this week I transported two moms urgently to the hospital who needed to give birth imminently.  In the US I transported many moms via ambulance to our facility in San Antonio; however, I was never the ambulance driver and the nurse simultaneously.

I've learned you can actually drive quickly and carefully and reach back to palpate contractions in the backseat at the same time.  Also, a coat hanger makes a terrific IV fluid hook, and a shower curtain liner is invaluable to have in your car at all times to throw over the seat before a laboring mom gets in.

Recently we transported a mom late at night with myself, our client, the doctor, family members, and equipment squeezed in tightly.  We had to drive up a giant hill and my foot was completely flooring the gas and we were still creeping along b/c of the steep slope.  I just thought, "thank you God for this beast of a car and please help us get this mom where she needs to be quickly."

The other mom was having her 11th child.  Yes, you read that correctly.  That trip added new meaning to, "Time is of the essence".

My kids think it's funny what has transpired in our car while they are at school or sleeping when I tell them the next day :) 

 

Typical Tuesday

There are some days here when I think to myself, "That day was too awesome or unusual or intense to not write about."  Then life gets away from me and I don't take the time to sit down and do it.

Well today was just a normal Tuesday, but it's one of my favorite days during the week, so I figured I'd let you join me, if you'd like, on a typical Tuesday in Kigali, Rwanda. 

Tuesday is the day we have prenatal appointments in Nyabisindu, a nearby village.  For a long while, I wasn't doing prenatal examinations myself because I felt rather under trained and under qualified to dive into prenatal visits when my experience lies with labor and delivery.  I helped with histories, vital signs, and some of clinic flow.  All of this thorough prenatal work is usually done in doctor's offices in the US, so when they arrive to me in the hospital, that part is taken care of. 

Then one day a father-to-be called saying his wife was delivering on the side of the road and needed help.  That required that many of us leave our post at clinic and head towards the frantic couple.  We assembled a team of nurses and midwives and headed for the truck to go locate her.  After a quick headcount, I realized we had too many nurses going and decided I'd hang back at clinic to get things moving along while the others tend to the mom on the road.  I'm normally one of the first to jump in the truck, but on this day there were too many folks headed out.  

I went back into clinic and found several staff looking at me and telling me that I needed to start doing prenatal exams on clients since there were no midwives around.  It seems God needed me to step way out of my comfort zone to finally make the leap from histories and vitals to prenatal assessments. 

Come to find out I knew more than I realized in the prenatal realm, but still lacked a good bit too.  Since that time I've been really eager to fill in my knowledge gaps, practice skills that we don't utilize in the US (Leopolds, fetoscope use, etc.), and dive into seeing these mamas who desperately need quality prenatal care.

A huge learning curve is that I feel rather inhibited without fancy machines, with their bells and whistles, that I'm accustomed to in U.S. nursing.  I'm learning to work here with low tech, sometimes no tech, and it's an adjustment to say the least. 

So anyway, back to today:

Clinic starts with a bang in the morning and ends around 1:30-2pm.  I have to start with a big breakfast otherwise I'm useless after a point.

After taking the kids to school, our team meets up and travels by truck, land cruiser, foot, or motorcycle down into Nyabisindu.  I'm not brave enough to drive my car due to the poor roads, but my friends are brave, so I just tag along with them.

This photo totally doesn't do this near impossible turn into clinic justice.  We all cringe wondering if we will bottom out or get stuck each time. 

The women come early to get in line and they begin with a time of teaching, worship, and prayer.  This is about 1/2 the women here b/c I couldn't capture the whole room.

Here's my 'office'.  I know I'm not that old-nearing 40-but my knees and back sure do feel the impact of seeing clients for hours on the floor.  I'm used to it now though, but when I work in the US, a 12 hr shift doesn't feel so bad on my body after kneeling for most of the day in Rwanda.   

Today I could overhear my friend in the 'room' next to me assessing a client that I had seen last week.  You see, last week she was 42.3 weeks which would now make her 43.3 WEEKS!! (Impossible!)  Last week we completed testing on her baby and her ultrasound showed an aging placenta (surprise, surprise).  We sent her to the local hospital for an induction right away, but somehow she ended back up here still pregnant a week later!  Thankfully her baby was o.k. despite being massively overdue.  We referred her again for induction and will strongly advocate to get this baby out.  (We aren't able to deliver her at our clinic due to some risk factors; at this point our clinic is only performing deliveries on low risk moms.  The closest operating room that can perform emergent c-sections is a good 20 minute transfer and drive. My vehicle has doubled as an ambulance on more than one occasion.)

There are many moms that need ultrasound, lab work, fetal testing; however, they miss appointments or don't return calls because they can't afford the testing, despite the fact that the cost is very low.

I saw a mom today that I had asked to come for ultrasound more than once because we have a concern with her placenta.  I offered to pay for her ultrasound and she was thankful but proceeded to laugh hysterically.  I was rather confused and asked my translator what was so funny.  She said that the mom doesn't want me to give her cash for the ultrasound b/c she would use it on food for her kids instead.  I was struck by her honesty.  She wanted me to pay for the service at the clinic instead of handing over money (which I would have done anyway).

This is one of multiple conversations that leave me stunned and humbled each day at clinic.

Thanks to our donors that give us funds to keep on hand for situations like this and many others. 

My biggest learning curve has been determining with great accuracy fetal position by feeling mom's abdomen.  I've come a long way but still get them wrong here and there and it frustrates me to no end.

 

After several hours of seeing patients, I'm nearing my 'hangry' phase.  So I have a quick snack between seeing clients.  The mamas wait for hours to be seen, so I always feel a tad guilty about my snack.  They come hungry and thirsty and most are dehydrated.

 

After the last client is seen, I head back via motorcycle taxi.  First I have to find one.  

This is one of my favorite rides in Kigali. 

 I invested in a Harley Davidson helmet b/c well, I don't want lice from the helmet that the driver lets every other passenger wear.  And usually their helmets don't have cushion or even a clasp that works to keep the helmet from flying off my head.  Anyway..don't you love how the helmet is so tight and padded that it squishes my cheeks so much I can barely form a smile.

So the little log bridge in the distance is usually the route back, but it's impassible today, so I opt for plan B which is to go by foot.

Growing up my youth minister wrote a song about the length of my toes and how they could stretch across the vast ocean :)  That's what I thought about as I snapped this photo, and I hoped I wouldn't fall into the stream. 

After making it back to the birthing clinic, I pay for some clients ultrasounds and lab work before heading back home.

 2pm--Lunch alas (lentils, sweet potatoes, tomatoes, spinach).  Then write this blog post, pick up the kids after school, head to orthodontist, quick dinner, and music concert for elementary students tonight.

Thanks for joining me on my typical Tuesday!