Miracles, Losses and Pulling Together
By Volunteer Nurse Chana Schaffer
Days at FAME are long. About a week and a half ago I had an especially long day. It started at 7:30AM and ended at 3AM. Our labor ward was full. We admitted a very sick mom and preterm baby who arrived after the mom delivered on her way to FAME. She tried to make it to the hospital for the delivery, but had to stop along the way to give birth.
The baby looked to be about 30 weeks gestation and was cold, blue and barely breathing when he arrived. We put him under the warmer immediately and helped him breathe with oxygen and a resuscitation mask. We put in a nasogastric tube and an IV to give him dextrose. He was struggling. We were able to warm him up to normal body temperature and keep his blood sugar up.
In the meantime we also admitted his mama. We discovered that she had severe pre-eclampsia, explaining her pre-term delivery. It took the teamwork of three nurses and one nurse practitioner to stabilize her. We treated her pre-eclampsia and controlled her blood pressure with a combination of intravenous and oral medications.
The other patients on our labor ward included a woman in active labor, a woman with postpartum sepsis and a blood clot in her leg, a woman with a suspected intra-abdominal pregnancy in severe abdominal pain, and another woman with postpartum sepsis who had a C-section at another hospital and had to have a lifesaving hysterectomy at FAME due to severe infection. A very heavy patient load indeed!
We were short-staffed on the night shift; Mama Mshana was by herself in the labor ward. The level of care that this group of women required was far too much for one nurse. Safi (our Ward Supervisor) came in to help, and so did I. We rose to the challenge and worked as a cohesive team.
At 11 PM we got an admission. Our on call doctor came into the ward with another preterm baby. The mother of the baby had delivered a month earlier at another hospital. The baby looked to be about 28 weeks gestation. They kept the baby in an incubator at the other hospital for a week, and then the incubator broke so they sent mom and baby home. For 3 weeks, the mother did her best to keep her baby alive, finally recognizing she could not do it alone.
This little baby boy was skin and bones. He was barely breathing and gray. We all thought that the chances for survival were low. We warmed him and supplied oxygen, and then we waited. To all of our surprise, he made it through the night! What a resilient little one. The next day we started intravenous dextrose to maintain his blood sugar and continued our supportive care. He was fighting to survive and we would give him every chance possible.
The first preterm baby boy mentioned was in severe respiratory distress throughout the night. Mama Mshana knew that he and his mother would need one nurse assigned to care for them both. She was already caring for the young woman in active labor, so she asked me to stay in their room to provide 1:1 care. I held the baby’s hand and stroked his head when he cried. It was painful on every level to watch him struggle so vigorously to breathe. I wished I could breathe for him to relieve his suffering. He passed away the following night. We supported him physically and with love until he took his last labored breath.
Another nurse, Julieth, had come to our aid at 11 30 PM and so did Kelley, our Women’s Health NP. Between the four of us we were able to provide safe and quality care to all of the patients on the labor ward. In addition to caring for our two preterm infants, we welcomed a healthy baby boy into the world when our laboring mama gave birth at 2 30 AM. This night was another amazing example of the teamwork that happens at FAME.
As exponential growth continues, more nurses are being hired to safely staff the two inpatient wards at FAME. Finding experienced nurses is no easy task. According to WHO statistics, Tanzania has 24 nurses/midwives for every 100,000 people. By comparison, the United States has 981 nurses/midwives for every 100,000 people.
The miracle of this very busy night is our 28-week baby who is defying all odds. He is gaining weight, eating expressed breast milk by mouth, crying loudly, and spending time out of the incubator on his mama’s chest for kangaroo care. He has astonished us all, and I feel blessed to be part of the team caring for him. We may not have all of the advanced technology available in the more developed world, but the nurses and doctors at FAME are moving small mountains in the care they are providing.