Sometimes things happen because of what you do...sometimes in spite of

Several things have become obvious during my trip here...I have learned a ton since my time here as a medical student, Family Medicine is a perfect specialty as it allows me to care for a host of patients, and there is much I still don't know.

Here's a little example of this:

A few days ago I was attending a delivery.  Mom had been in labor a long while, but thanks to a few interventions she was able to avoid a C-section.  After an hour of pushing, the baby finally delivered.  Unfortunately, there was a large amount of meconium in the amnionotic fluid right behind the baby (in layman's terms - the baby had pooped a lot while mom was in labor; this is both a sign of a stressful labor for the baby and there is a risk of problems if it gets deep into the baby's lungs).  The baby wasn't breathing after delivery (not too abnormal - but something that needs to be rectified), but since there was meconium I knew I should intubate and suction the baby before encouraging her to breath on her own (which could lead her to aspirate the fluid deep into her lungs).  I relayed to the nurses, "I need the intubation and suction supplies."  The nurses search frantically.  A minute later the laryngyscope to intubate the baby is still unavailable.  "I can't let the baby not breath forever," I think.  Finally, they find a laryngyscope.  I make an attempt; the light doesn't work on it, making the equipment useless.  Since the baby must breath I go ahead and suction the back of throat and place the suction catheter down the nostril to see what I can get back.  Not the normal order of things, but at this point I'm having to improvise.  The baby starts breathing a little better.  Someone has finally fixed the laryngyscope.  Since I still hear fluid in the lungs I decide to try another intubation but at this time the baby is fighting me so I abort this attempt and suction more.  Thankfully the baby is starting to breath well.  When we discharge the baby a day later it shows no signs of aspiration.

Fast forward a couple of days, and this time I have a 29-week premature baby that is precipitoiusly delivering.  Mom's water had broke, but she hadn't sought care, so she had an infection her body has gone into labor.  "The head is here," shouts the nurse.  Looks like I'm not stopping this delivery.  I deliver the baby and place it on the bed.  She is nice and pink, but still not breathing.  I try to stimulate her.  She's still not breathing, and the heart rate is less than 40.  I drag my neonatal resuscitation algorithm from the recesses of my mind.  Next step is to provide ventilation with a bag mask.  I hope this works.  After a minute the baby starts crying an the heart rate is up.  I thank God, because I didn't feel as confident about the next steps, especially in Africa with limited equipment.

I share these experiences to give a picture of what life is like.  The past week I've been running the maternity department here, which is increased responsibility from what I am used to.  Thankfully, I've had good training that God has allowed me to use during this week.  Thankfully, He also hears my prayers and works even when I am at my limitations.  Thankfully, I can see all of your prayers at work too.  The time has been challenging, stretching, encouraging and I'm glad we could serve the missionaries and Togolese here.  We pray God would use these tangible demonstrations of love to give them a picture of Christ.  Keep praying for us!

"My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me...For when I am weak, then I am strong.

2 Cor 12.9-12

~ Stephen