Poverty and Problems

Thursday
This morning I had out reach in Agdao. It is a neighborhood not far from the clinic and I have been there once before. Today we did not just do prenatals at the church but went out into the neighborhood for some home visits for some women who had already delivered. A woman from the church directed us down several alleyways to each little shack. The first 'house' we went to I found myself carefully walking up 5 steep stairs. I was praying they would not snap in half. At the top of the stairs I walked into what could be described as a tree house with out a tree. I was standing on a thin wooden floor, obviously at a slant. There was one hammock that I assume was for their 3 year old. We came to check on the one month old baby who was also in a hammock made of a baby blanket. We did our check before moving to the next home. To get to this home we walked down a few paved allies with gutters on each side filled with dirty water. When the ally ran out we found ourselves stepping carefully on small planks of wood over standing water. By small plants of wood I mean slivers of scrap wood. This house was closer to the ground but we still had to take a high step into the house. It was just a little bigger than the size of a car with one hammock hanging in the middle. One dresser, a tv, and small table lined the wall. Decor of Mother Mary were everywhere. I wondered if that was their entire home or if they had a neighboring shack with beds. I left wondering if that mother and her family laid on the floor to sleep each night. That is probably the case. The final house we went to is almost indescribable. We first crossed a large amount of standing water with bags of cement as stepping stones. We came to the house and all I saw was tin strung from one wall of a house to another. We were still outside. In one part of the wall I saw a bench, in another cove I saw a pile of mud filled with trash and wrappers and a stuffed animal. I just kept thinking to myself, this cannot be where they live. I was wrong! It was not were they lived. There was a small door that I hadn't seen and soon we all ducked inside. I literally had to bend over at 90 degrees to fit into this house. It was dark and moist just like a basement. One rug was on the floor where we were able to sit down. In a dark corner was a little hammock where I assumed probably two of the three children shared. The baby was laying on the floor, a blanket pinned around his bottom as a diaper. The ABCs were written on a piece of wood with chalk. I did not see a bathroom at any of these houses. I wondered if there was a community bathroom that the whole neighborhood used.

After seeing the homes these families live in, the reality of their poverty became real. I became a little irritated thinking of some of our supervisors who scold patients who do not get new born screening. I know how important newborn screening is but 550 pesos is a lot for these patients to pay. If they say they do not have the money, I believe them. I just wish their was a solution but we will just have to encourage them to save up their money for 9 months.

After outreach I ate some lunch and got ready for swing shift. About twenty minutes before shift started I was endorsed a labor who was ready to deliver. I was informed that she was non-compliant with the staff. She was not changing positions like they asked or breathing through contractions. I walked into the cubical to her laying in bed, eyes rolling back in her head. The midwife was telling her to breathe but she continued to grunt and push instead. BOW was visible and we did artificial rupture of bow. Then 2-3 cm of head was visible after AROM and I took over. Once head was out the woman got very tense. She straightened her legs and pushed her butt off the bed. The rest of the body was not able to come out because she was squeezing all her muscles down. We were attempting to pull the baby out but were unsuccessful until the mother calmed down and opened her legs. Baby was out at 1:49pm (another boy!) and I got all of the paper work, checks, and immunizations done and we were able to discharge at a little before 10pm. In between 2 and 10 I charted for two other births.

Catch #7 Jorian

The first birth I charted for was a little hectic because the patient was hemorrhaging. 1500cc was the final estimated blood loss. I was charting frantically as the midwives did everything they could for this patient. Giving oxytocin IM and starting an IV, giving methergine, external manual compression on the uterus, and finally sticking gauze packs internally. I was charting and handing everything the midwives needed to them while still keeping track of the time and shouting out when more meds could be given and when it was time for the next check. Some how I kept everything straight and got everything charted! The patient did great but if she would have been at home the staff said she probably wouldn't have made it.

The next birth I charted for was also interesting. She pushed for two hours total. When I arrived we had her laying the wrong way in the bed with her legs on the birthing stool. The husband was squatting behind her near her head doing nipple stimulation while our supervisor was seated between her legs doing head stimulation on the baby between contraction. When a contraction would start the patient would pull her legs up to her chest in a hyperflexed position with the help of midwife #2. Soon there were four midwives in the room and I was charting with each contraction. We did a position change that I had never seen before. It is called tug of war. So midwife #3 stood behind our supervisor who was seated between the patients legs. She leaned over her and reached for the patients arms. The patient took hold and would pull on the midwife as she pushed on the birthing stool with each contraction. It was quite the site if I say so myself. Once she delivered we had her lay the right way in the bed for the placenta to come out. Placenta was coming but had trailing membranes. Our supervisor attached a hemostat to the membranes but it took 15 plus minutes for the placenta to be completely out. Both mom and baby were healthy and it was time for shift change. What an exciting shift!