Baby Bulan and other little ones

Baby Bulan

They say things come in threes and that is true for us this week. We had three 1500 grams (a little over 3 pounds) babies admitted to the hospital this week. Baby Atna was born at a local government clinic and then transferred to us for higher level care. Baby Gabriel was born at our hospital and has a heart defect. Baby Bulan is one month old and was admitted with several malnutrition.

Baby Bulan (moon) was admitted earlier week. He and his twin were born in a village about a month ago and he weighed 2.3 kg at birth. Unfortunately, his parents seem to be lacking in knowledge or skill to care for their new children. Bulan's brother died last weekend and that caused their community to intervene and they brought Bulan and his mom to the hospital. Those first few days were touch and go as he battled infection in a very weakened state. But with IV fluids, antibiotics, and milk he has turned the corner. Those first few days he alternated between being lethargic and very fussy. Now he is sleeping a lot although if you waken him he will lie there contently. I imagine it is the first time in a long time he has had a full tummy. This morning his weight was up to 1650 grams. 

He still has a long way to go as currently all of his milk is given through a tube that goes through his nose and into his stomach. We will start with a dropper and work our way up to a spoon. He is now transitioning out of the ICU and hopefully soon out of the incubator. It will take awhile though before we feel comfortable sending him home and hopefully can also arrange good follow-up for him. 

Baby Gabriel (the baby with the heart defect) was transferred to our provincial capital city in hopes of getting at least an echocardiogram and seeing if his heart is something that could be fixed. Unfortunately, he passed away on the way there.

Last but not definitely not least is little Baby Atna. She is a tiny one and like most babies has lost weight after being born but so far there are no signs of infection or major problems with her heart or lungs, so we are hopeful that with good care she will soon start gaining weight.

Baby Atna - weighing 1.3 kg (just under 3 pounds) this morning. 

Back in the Trenches

Who would think checking cervical dilation would be exciting but after more than a year sitting on the bench, as I completed language study and waited for work permit, that simple skill felt good to be doing again. Funny, to think just 7 years ago I barely could find a cervix let alone tell you how far it was dilated. I had some awesome teachers and preceptors guide me to this point and hopefully now I can do the same for others. For several months now at the hospital, I have reviewed charts, shared advice as I was able, and talked through situations and problems with our medical and nursing staff. Occasionally, I would help out with a precipitous delivery or CPR in an emergency.

This week though I finally have my work visa and so can start working with and training our staff here. Today, it was a first-time mom with spontaneous rupture of membranes with no signs of labor and an OP baby. After checking her cervix and placing misoprostol, I spent time talking the staff through different positions the mom could be in that might help the baby turn. Typically laboring moms here spend most of their time on their back and occasionally on their side.

Then I went to see the mom who had an emergency c-section on because she came in seizing from eclampsia. She had a little 35 weeker who weighs just over 2 kg (4 1/2 pounds). He was busy being very upset at the lack of mommy time and breastmilk and since mom was now conscious I took him to the ICU for a visit where he promptly latched on and breastfed for close to 30 minutes. I wish I had been able to take a picture because he was so cute as he ate but my hands were busy holding him close and plus it felt like an invasion of their privacy.

There are two other little ones in the ICU and I don't know whether they will make it. One is a 32-weeker who weighs 1500 grams (just a little over 3 pounds) and the other is a 1-month old who only weighs 1600 grams (almost 3 1/2 pounds). He is obviously failing to thrive and his older twin has already died. Finally, there is also a toddler from an interior village with a very bad pneumonia who has been on the ventilator for almost 20 days now.

So just because I can finally get back in the trenches doesn't mean all the days are going to be happy ones. But I do have to admit I am glad to be getting my hands dirty again and soon the new school year will start and I will have a chance to shape some young minds and skills from the beginning.

Oh and by evening the laboring mom had delivered after a trip to the toilet (squatty potty) resulted in baby turning and a rapid delivery for a first time mom. :)

And so it begins...