Friday, October 28, 2011


The Christians here say it is up to God whether someone lives or dies.
In fact, almost everyone here does. Why did the baby die in the middle
of the night. Inshalla. Its God's will. They will shake a mother and
say sternly, "stop crying. it is God's will."

Why did the Arab man die after the prostectomy? It was God's will.
Why did 4 children and 2 babies die in one night? It was God's will.

Why, why why? it was God's will.

Is it God's will that you don't give your medicines?
Is it God's will that you don't assess you patients?
Is it God's will that you feel like sleeping and not taking vital signs?
Is it God's will that you don't check on your patients?

I don't think it's Gods will.
I think you didn't do your job.

Stop crying. Your baby died because it was God's will.


Nothing is an emergency here. One thing I value about American medicine
is that everything is an emergency. Anything that is either affecting
or endangering someone's life is an emergency. Although many times
futile and expensive, we aid, abet, prolong, and fight for life.

Who can put a value on life? Is it better to live for 10 minutes than
to never live at all? Is it better to open your eyes and blink them and
look at the world and feel your mother's skin and experience the
sensation of air filling your lungs, to see the colors and the faces, or
to never have opened and blinked and looked and felt and experienced and
seen at all?

Is it easier for a mother to lose her baby after 5 minutes or after 14
hours? Is it easier to have had that time, or is it harder?

Its easy to judge here. Its easy to think no one cares. Its easy to
say the nurses don't care. Its easy to say the families don't care.
Its hard to be culturally competent when this culture seems so incompetent.

You have to get people to give blood here. Even if their relative,
husband, child is dying. They still have to be begged, cajoled,
threatened. Even then, sometimes they don't. Its easy to think they
don't care.

Mother's often don't hold their babies here. After birth, they often
hand it to the grandmother, then turn and face the wall. Its easy to
think they don't care.

Someone may be brought in hemorrhaging, or may have been in labor 20
hours. Then, right after they get here, their families may take them
away. They will die if they leave, and they leave anyway. Its easy to
say they don't care.

The nurses don't assess their patients here. There is little energy
spent on those who are dying. Its easy to say they don't care.

and i know that they must care. I know they must cry. I know they must
love their babies. I know they must love their families. I know they
must want the best for their patients.

I will be the first to day I absolutely don't understand this culture.
I am not being impartial. I am being judgmental. Do I have a right to be?


its not up to God and its not up to Allah.

Its up to me and its up to you.

its up to you to get oxygen in this hospital. Its up to you to get
better nurses. its up to me to be better. Its up to me to care even
when no one around me seems to. Its up to me to work harder. Its up to
you to work harder.

and maybe they would have died anyway. but why did they have to die
here, in t chad, with nobody to fight for them.

America, don't ever stop fighting for life.

.....(a few days ago, in the delivery room....waiting and breathing,
waiting and writing)

"This baby is dying right now. I've revived it 5 or 6 times. By
revival I mean CPR. Because I'm an expert in infant cpr.....It was born
4 1/2 hours ago. 2 months premature. 1.7 kg. She is so cute. Her
heart keeps stopping. I am doing CPR and someone is moving my operation
over, looking for a lost pen. A door slams, nurses walk in and out,
laughing, talking, watching. She came in 3 cm dilated already. By the
time the family bought the cefedipine (*** wrong spelling, desole, we
don't give Salbutamol here because the nurses can't be trusted to take
BP's), she was 4. She delivered 45 minutes later. She didn't make a
sound. No epidural. No nothing.

I should be breathing for it right now, but its against the skin and
they are laying down, the baby and the mother, facing each other, and I
think that's more important.

I don't want her to have 5 hours, i want her to have a lifetime. Its
not fair. Its not fair that this is her 4rth premature infant. Its not
fair that all the others died. Its not fair that she has never had a
baby except in utero. It is not fair there isn't a NICU team swarming
her right now. Its not fair that there isn't any oxygen. Its not fair
that if she was born almost anywhere other than here, she would have
made it.

There is a difference between seeing suffering and seeing preventable
suffering. Preventable suffering stabs a little more. Its the kind
that keeps you up at night and gets you up in the morning. The very
word preventable denotes personal involvement, responsibility. If
something is preventable, it can be prevented. If it can be prevented,
why isn't anyone preventing it? If no one is preventing it, why aren't you?

She is holding it skin to skin like I taught her. She loves it. I see
a tear on her cheek. I wonder how much babies know. I wonder how much
they see with their wise little eyes. I know its going to die, but I
keep hoping it will live. Maybe she just needs one more breath. What
if I stop before that one more? Maybe just one more round of CPR.
that's all. maybe. maybe. maybe. Live. LIve. LIve.

The infant mortality rate in Chad isn't just a number. It isn't just 1
in 8 births and 1 in 5 children. Its a real baby. with perfect blue
eyes that's try to cry. that's fighting for every single breath. its a
baby that would live anywhere else."

14 hours later, she died.

I wonder if the power to be incensed by injustice and suffering belongs
mostly to the young. To the ones who are freshly exposed to it. To
view horror for what it really is. Maybe we are the ones who should be
taken seriously after all. Age and sage and ad finem jade. That
doesn't change anything.

It is the tragedy of this life that vision is given to the young, but
power to the wise. Why can't the dreamers be 58 year old portly balding
hedge funders with more than enough money to buy the will of God.

Inshallah. I don't think so.

+++ Inshallah is my very poorly writ and most likely improperly spelled
version of the Arabic expression, If God wills it.

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