.sond nasogastric

sond nasogastric  (in french).  or NGT.  or lifeline.

 I never thought I'd be putting in infant feeding tubes but I guess all those harsh nights in the IMCU payed off in some way. 

this baby is Bria Suzanne. 

2 weeks old.

 the first cleft palate I've ever seen that isn't in a textbook.  Medically speaking, she has a unilateral cleft lip cleft palate.

dehydrated, malnourished.

 the parents keep a blanket over her face most of the time.

 she isn't able to breastfeed, not that most mothers breastfeed anyway here.

it is common practice not to feed the baby 3 or 4 days after birth and then give it water.  water from village wells.  water they bathe with.  water that isn't boiled. 

there is a cultural misconception that the colostrum will harm the baby.  Also that babies need water. 

Danae (the OBGYN) will talk until she is blue in the face, "ONLY breast milk. no water."  D'accord.  D'accord.  they will nod and click and cluck.  minutes later, the grandmother is giving it water. 

and round and round we go. 

there are also a startlingly high amount of umbilical hernias here.  One of the volunteers here, Tammy Parker, has actually witnessed a ritual that they do to many of the newborn babies.  The midwife or other will hold their hands in the fire until it is as hot as they can stand it.  Then, they will push as hard as they can all around the umbilicus.  they repeat this until they get the chord off.  no literature that I have seen supports it, but we all surmise here that is the reason that roughly 2 out of 3 children in the village of Bere have umbillican hernias. 

anyway

so.  we get this baby.  and none of the six nurses standing around know how to put in an NGT.  well, if there is one thing I know like the back of my hand, its that.  Finally, something I have done before. 

nurse:  Lay the baby down. 

me:  NO! sit the baby up.  like this (comme ca)

nurse:  no, lay the baby down.

me:  No! comme ca.


so then we establish that laying down is not the optimal position.  fabulous.

her mouth is dry and cracked, so I had the mother expess some milk and gave it little bits with the siringe.   She was swallowing it well so I told the other nurse to do the same while I put the tube down. 

nurse:  What are you doing?  don't do that.

me: NO!! give it milk like this

nurse:  no, we are supposed to give it through the tube.

me: YES! but this will help get the tube down.


and round and round we go.

and the same argument about measurements of the tube.

so finally the tube is in.  after an arguement about how to cut the tape.  i probably should have just given in on that one. 

so then, I explain how we need to listen to it in the stomach. 

I show then how to check for placement with a small air bolus and how we should hear it gurgling.  and how we need 2 other nurses to confirm as well. 

so, instead of doing it like i said, he puts the stethoscope to the abdomen and says "I hear it."  without the air bolus.  those are some great ears. 

and round and round we go. 

and then i wrote out this long thing in french about checking placement before each feeding.

then Marci Anderson, MPH and also a lactation specialist, came in and calculated exactly how much we should feed her.  and i left instructions on that too. 

every 2 hours.  20 ml. 

I hope they feed her.

how sad is it when you work in a hospital where you HOPE  the nurses will wake up to feed a baby. 

but, I actually have great hope for this baby.  She got fed all day today.  She looks better.  Her skin looks better.  She has a strong cry.  We started her on antibiotics for her fever.  Her mother has great milk production.  I think she is going to make it. 

.......

I actually am enjoying Pediatrics.  It challenges me the most.  It is also the most interesting.  and the saddest. 

but.  

bright spot:  I GOT MY FIRST BABY IV TODAY!!!!!  5 months old!!!  the countdown is on.  I'm so excited. 

and really, when else do you get  to see 2 cases of  Burkitt's Lymphoma, 3 cases of measles, meningitis, cerebral malaria, chronic anemia, periorbital cellulitis, and every other presentation of malaria all in one day?? 

.thanksgiving

Thanksgiving was lovely. I loved it. We had such a beautiful,
perfectly wonderful, eat until you throw up American thanksgiving.

there was real, glorious, whipped mashed potatoes. Rolls made with
actual white floor. there was pumpkin pie, lemon pie, pecan pie, white
chocolate chip cookies.

there was ice cold limeade and mango salsa, fresh pineapple, chicken and
gluten and corn and cornbread.

yesterday, i got to hold a real cup of coffee in my hands, and then i
got to drink it. it was that slightly steaming almost burn your tongue
but not quite kind of coffee, with real sugar, real creme.

yesterday, i ate cinnamon pancakes with peanut butter, orange sauce,
guava sauce, chocolate sauce.

basically, yesterday was a culinary miracle.

so I am supremely grateful to all the amazing people that whipped up
chicken out of cucumber seeds, pecan pie out of thin air, and so
graciously donated all their carefully hoarded American treasures.

......

also, I know this blog has been slightly dark and depressing, so here
are some things I am grateful for -

the fact that, in a months time, I will be proud owner and rider of
a tchadian horse

the amazing family I live with

antibiotics

green peppers

Gutenberg, Graham Bell, the Wright brothers

rat poison

friends who are nurses

kimmy

abbie

angie

jessi

mellissa

kelly

clean water

the absence of celery

snail mail

Alaska

mosquito nets

guavas

drinkable water

care packages

dark chocolate

dreams

health

lemon zest

and

life
life
life
life
life

every single second

that i get to live this

life.

.harvesting rice

.free

.wwwwwwwwwwwwwwwwaaaaaaaaaaaaaa

so you've heard about the U-curve, the rut, the end of the honeymoon
when you can't look at your wife without screaming phase.

the phase everyone said happens to people that sail off to Chad.

well, that phase of course wasn't going to apply to me. just like the
airline regulations and pretty much anything in general doesn't apply to me.

so, even though this is going to put a smile on the face of all the
haters, i may just be there.

I'm exhausted. I feel like I have no time. I feel like the 10 months
stretching in front of me are an eternity. I feel discouraged.

and most of all....i feel like i'm not making a difference.

but, of course, you tell me, you ARE making a difference. you touch
lives every day. blah blah blah. just a smile can change the world.

and yes, i do espouse that theory. I do believe one person can change
the world. I do believe in the one idea. the one stranger. the one
helping hand.

i do believe in the tiny rock that starts a ripple effect. and yes, I
do believe that the world can be changed one person at a time, on tiny
act at a time. I believe that

changing a life changes the world. I believe that one good deed can
make a life worth living.

If i didn't believe that i wouldn't be here.

if I didn't believe that I wouldn't have given up everything to be here.

If I didn't believe that I wouldn't stay here.

But for me, for the people that really believe that, for the people that
wander the earth hoping to change something for the better in their
wake, for them, for us, when we feel like we aren't accomplishing the
one idea we staked our life on, then well, you have the rut.

today is 2 months.

I spend my days arguing in broken french. i spend my days being laughed
at.

news flash.

suggesting that you should actually document when you give a medicine
isn't a comical joke.
suggesting that medications should be carefully explained before the
patients leave isn't a cause for mirth.
suggesting that a medication that is stopped, one that is ongoing and
one that is started should not be jammed up together in one box and
documented with a single X is not a roll your eyes moment.

so, every morning, I ask for the papers (each patient has one paper) and
I say I want to "learn" (which, i do) and then I go patient to patient.
I look at the medicines in their box. I look at what was actually
prescribed. I look at what was actually given. 9 times out of 10, they
don't match up. too much of one medication, none of the other, did they
not buy it? look at the receipt, no, they bought it, well, did you take
it, oh we took it yesterday, no one wrote anything, no one documented
it. If i find one time dose medications just hanging out, i'll give
those. if i find 3 medicines all jammed up together, i'll make a new
paper.

i feel like a spend all day arguing about documentation. or not
argueing, per say, but insisting that things be wrote differently, or etc.

and i also feel like thats not my place really, not the best way to make
friends and get respected, not the best way to make my debut. But i am
just doing my best to try to document medications. novel concept.

but then, they all got their meds before I got here. somehow. they all
were treated and went home and may or may not have been okay. is being
so nit picky actually helping the patients? or is it making me feel like
I am helping them? I don't know.

and I've been really sick, well, aggressive flu-like symptoms minus the
fever kind of sick and had this really aweful incredably itchy started
from nothing dark purple bright red skin thing spreading all over my
legs and feet and ankles. i threw every parasite med in the book at it
and today is my second day of doxy and i think its getting better, but
its still frightening.

i had myself developing osteomylitis, cellulitis, being airlifted back
to America. of course, now i feel foolish because today i'm better.
its easy to be cavalier about life until its our own.

and i was so weak on sunday I tried to do my laundry and i was just
sitting there with the bar of soap in my hand and started crying because
i felt like i literally didn't have the stregth to wash my clothes,
which is my favorite thing.

and its all glorious until you have to sleep with rats. or, rather,
until you have to be awake with rats because they scratching and
scuttering prevents sleep.

it was just a rough week i think.

and i keep telling myself, the measure of a man is not what he
does/thinks/says in times of ease and sunshine, but in times of
adversity. but repeating that to myself made me even more depressed
because I wasn't handling it in such a brave and noble manner.

is it selfish to want to make a difference? I think it may be. which
may be the reason i'm in a rut because I don't feel like I am.

i came here so i could be a better person, so it looks like I better
stay a while longer.

cheers!!!

you know you're in.......

you know your in chad when.....
   
      you thank God for big mosquito bites because its probably not Anopheles

when.....

    your family conveniently forgets to tell you they built a new latrine behind a garden of corn because the old one was broken.  you use the old one and fall in.

when.....
   
    being able to kill cockroaches unafraid is on your bucket list

when....

    you find out several kilometers too late that your moto taxi driver just may be functionally intoxicated and you just hold on and hope for the best the remaining 20 km.

when....

     every other child that shakes your hand has ringworm

when....

    you feel that spending 30 cents was really too much money and try to argue it down to 20 cents

when....

    the thanksgiving turkey is going to be a goat

when.....

    the headlights on your motorcycle is actually your headlamp

when....

    it's illegal to ride 3 persons on a motorcycle, but ten people crouched on the roof of a careening vehicle is perfectly acceptable.

when....

    you get sent back home because you were riding your horse without a passport.

when....

    the second you start congratulating yourself on that fact that your new chambre doesn't have cockroaches, you realize a rat lives there.

when....
 
    you have to get poison for said rat on the sly because too many people were poisoning each other, making it now illegal.

when....

    you wish you had malaria because at least then you would know what was wrong with you.

when.....

    you show the bizarre skin infection that appeared on your ankles and quickly spread to the only non OB doctor and he laughs and says "you should probably get that looked at."

when....

    you actually see a case of measles

when....

    7 pm is really getting past your bedtime

when...

    the 12 year old picks up something you can't carry and puts it on her head

when....

    1 try out of 10, you can actually get into your email

when....

    a box containing anything packaged, processed, colored, or otherwise genetically modified sends you into hysterical shrieks of happiness

when....

    the nurses are reprimanded during worship for drinking wine concealed in juice boxes during their shift.

when....

    everyone around you is eating crickets (I ate one!!! took me 10 minutes and a wide range of sound effects and facial contortions)

when....
    
    washing clothes by hand is cathartic

when....

    your sitting in the dirt writing this. 





   

.go

to dream
to challenge
to go
to journey
to face fear and wrap it around as a cloak
to walk with it and push through the gravel to wonder
to a wrinkled face to a stranger whose every dream is crinkled like a fan outside the eyelids
 to capture the dusty coat
 the one eye,
 the barefoot,
 the dog lover,
 the misty-eyed angel
 warriors of the road -
 forever immortal, infamous, inglorious, the forgotten -
yet who lived among a spirit
 a feeling
to have shared and been a player in that wanderlust that will forever endure
 to have been a part of that song
 part of that twang 
 to have left your light tread on the uncharted waters -
the footprint before a frothing wave
 to know and feel solidarity with those other souls who threaded the miles alone
 part of an age
 of a generation
of a  tribe that spans centuries
 to look at that same gypsy moon
to know that others danced and etched their blood on the walls of that cave to the glow of the spectral embers
to sit where others sat
  so insignificant, so unobtrusive, like a dancing feather or pondering ant
 like a small quiet pebble or the splash of a fish
 here one moment....no one remembers your name....
 the road, did it matter?
 but it did. it does.
 in that moment.
  it did to dream,
to know that other dreamers have left home with stars in their eyes and hunger as their lantern
 to see a canyon or stand on a rock in the dashing sea
pilgrim voyager gypsy charleton gravestone bleached pile of glorious bones hippie bohemian evangelist artist savant entrepreneur rubber tramp leather tramp road warrior motorcycle king tourist anthropologist archeologist seeker seeker wanderer tumble weed
 to belong to the pioneer
 to tumble into the void -
 to see and touch and wrap your heart around all things human.
 human
 human
 when your down and tired and fading light and crumpled bills and linty coins and laundromat and old magazine and dirty newspapers cling to tattood brick
 to see a face a smile a person
 to hear their story
 to marvel at a laugh
 to share a look a meal
 a sardonic wink
 to find that pair of eyes and you know at once the things they have seen because you have seen the too
 strangers and you know you know they know
  why your backpack is your soul
 to leave love
 to leave comfort
 to walk into the arms of terror
to rise to meet suffering
 to open your eyes unblinking to ugliness
 to love beauty
 to crave it to starve for it
 to seek it
to welcome questions
the fog
the corner
forever cursed
forever blessed
always to wander
always to wonder
to go
go,
 why does that word
 2 letters
 1 syllable
how has it  mercilessly held such corrosive  and creative power,
 how has it shaped kingdoms and colonies and fiefdoms
 how has it created heroes and villains
 how it is fodder and fire for every ballad and every dirge
 how has it broken homes and liberated captives.
 the urge
the dream
 the itch
 the need
the fire
 to explore
 to seek
 what up Columbus
 Sacajawea you were one tough chick -
Japhy Ryder and Jesse James
Jane Eyre and Elizabeth Bennet
 Eminem and Joan Jett-
 to change to challenge
 to see
 the bering sea
the english moors
the african plains
 to the one who sailed to see if the earth was round
 who died in a bus
 or froze in the artic
 to all who lived an idea
who layed realism and cultural and societal trappings on the line
 to all those who dared
to all those who climbed
when they could not see the mountain
 to Daniel to David Korn
 to Doom who went to Hawaii
 to the flamboyant tourist
to the photographer 
to the captain
to the motorcycle
 to the covered wagon
to the prospector
to the cowboy
to the missionary
to the pirate
 to all those who decided to march frantic and insane
to jump off cliffs
to dive in murky waters
to trade the substantial for the hoped for
to trade the answers for questions
to trade the walls for sky
to trade the roof for stars
to trade the routine for the challenge
to trade the buried dream for the final journey
for all those who listened
who heard
who answered
who followed
the pied piper
of the word called go.
 . 

ideas?

either this baby was born this way....

or he had peanut oil poured all over him....

or he was born this way and then had peanut oil poured all over him....

.....

he does not have eye lashes or eyebrows....
his eyes do not fully shut or fully blink....

(Abbie, this looks like the rare disease you presented in class....what
was it called??

welcome to Chad.

welcome to chad.
the place the world forgot.
the place that no one knows about and no one comes.
the place that no one writes about and few can read.
the place you go because you care.
the place that teaches you not to care anymore.
the place that makes men.
and then breaks them.
welcome to chad.
the place the world forgot
the place where BBC fact profile statistics are living, breathing,
dying people.
welcome to the world.
the place we are immune to statistics.
the place where haunting memoirs and photos entertain but do not move
us.
welcome to the world.
where everyone scrambles for solace and soul.
where others problems cannot be our own or we will go insane.
the place where prozac is nessesary to truly watch the news
the place its easier to forget.
welcome to chad
the place the world forgot
. the place without anything anyone wants.
the place where people make a $1.00 a day
the place where 500 ml of IVF is $2.00.
the place where there is no oxygen
welcome to Chad
the place the world forgot.