April 27, 2012    9:15pm

Last night about 1am the nurse called me and said the c-section is ready. I had no idea who it was, but it was no time for conversation with my limited French and my brain half asleep. I walked up to the hospital which is about 100 yards from my apartment in the gated compound. The big dipper was out and it reminded yet again of how big God is! I arrived on OB and the nurses pointed me to surgery. The operating room is found by weaving my way through dark dingy smelly hallway, often lined with people in stretchers. The patient was on the table, and the anesthetist told me she was OP (posterior or baby was "face up")...that was the history! I examined her and sure enough she was 9cm and OP and still quite high. This was her 8th child, but she only had 4 living children at home (an all too common tragic scenario in Niger). Her husband had consented to a tubal ligation, which is required for it to be done unless she has had 8 babies or 2 prior c-sections. The surgery went well, and she delivered a healthy baby boy!
During the surgery, the nurse came in the room and said in her limited English, that another patient was there who had a history of 2 prior stillbirths. I quickly made my way back to OB after the c-section and examined the patient. She was about 9cm and with my doppler I could hear a healthy fetal heart beat. The nurses only listen every 2 hours, and the midwives do all the vaginal births, but I hovered.....
I was nervous enough that when she was almost complete I asked her to push (via the nurse in French to the patient in Hausa). The patient refused. I listened again to the baby and the heart beat was closer to 100. I asked for a vacuum and the grabbed a used one off the counter. I didn't care at the time, this baby had to get delivered. The midwives and nurses were standing about 20 feet away and it was just me and this poor woman, on a dirty cracked mattress, naked and scared. Finally I convinced the nurses to help the patient push. I was praying constantly and my heart was racing. After about 5 contractions she delivered and the baby was limp. I quickly cut the cord and put the baby in the warmer behind me. I couldn't feel her heartbeat at the umbilical cord. The nurse started giving the baby oxygen while I held the mask with one hand and gave the baby chest compressions with the other hand with the baby's head against my rib cage. Oh how I missed the awesome baby nurses from Meridian Park! It seemed like eternity, but the baby started to come around and finally cried after about 10 minutes. When I brought her over to her mother, she gave me a big smile! The 2 grandmas were there and watching the whole time. They too gave a tooth-lacking grin at the sound of the baby's cry. One of them was so happy, she undid her skirt and showed me her basketball shorts underneath! I couldn't believe it! Then she started dancing and singing, so I joined her! From one emotion to the other extreme...that is life here in Galmi.

Her first live baby!

Rejoicing with Grandma!

We were in clinic a few hours later (it was a short night), and a woman came in with a low placenta, but no previa and no bleeding. She was about 34 weeks so we gave her precautions and instructions and told her to come back in a week. Her friend came back about 30 minutes later and said she was bleeding a lot. We raced out to the out patient bathrooms which are a row of tin, roofless, filthy pit toilets, to find her standing in a pool of blood. Thankfully our wonderful interpreter ran for a wheelchair and we got her to surgery quickly. One thing that is great here is the efficiency of getting a surgery going. The reason it is great is because there are no check lists, and the charting is limited (which isn't always in the patient's favor). The baby gave us a good cry at delivery during the c-section, but weighed only 3 1/2 pounds. After the c-section I went straight back to OB only to find what I had expected. The nurses idea of resuscitation is to put the baby still on the wet rag (not blanket) on the warmer, with the warmer OFF and a huge oxygen mask on that covers the whole face...and then they leave the baby ALONE and chit chat in their office around the corner. Most of you know I am fairly calm, but this TOTALLY PUSHES MY BUTTONS. There are so many unavoidable deaths. If they would only do basic resuscitation and stay with the baby the first hour, it would make such a difference. Thankfully, the baby was still alive, but limp. I tried to stress with the nurses what she needed, and I stayed with the baby the next hour to be sure she transitioned. The pediatrician (who leaves next week) came and saw her, and was able to place a small feeding tube into the stomach because she wouldn't nurse and was so small. I pray she makes it. In the states she would be totally fine.
Just before coming back here a woman came in with no fetal movement. She has had 8 children, but only 3 are still living. The ultrasound confirmed the baby had died. Her expression was flat and her eyes void of tears. The nurses are so used to this, they didn't even seem phased...

"Jesus wept, and in his weeping he joined himself forever to those who mourn. He stands now throughout all time, this Jesus weeping with his arms about the weeping ones:
'Blessed are those who mourn, for they shall be comforted.'
He stands with the mourners, for His name is God-with-us.
Jesus wept."
Ann B. Weems