Sunday, November 23, 2008

sometimes you just have to laugh...

today my clinic day started with a local midwife bringing in five of her patients to be seen. we see this midwife, who leslie has fondly nicknamed petunia, monthly with whichever patients she has decided to bring in. and while she obviously has a desire to see her patients deliver healthy babies, i am reminded of the times and culture in which she learned midwifery skills as she always helps me out with each consulta. this morning she placed the second patient up on the exam table and helped her get prepared for her ultrasound as i turned it on and started the exam. at the end, i was able to tell the patient that everything looked find with her baby on ultrasound and that she was going to have a little boy. petunia looked at me with a knowing smile and said, "i knew it was a boy also." surprised, i asked her how she knew. in response, she knowingly nodded her head at the ultrasound and said, "i saw it on there." too surprised to hide my amazement, i "congratulated" her and got the next patient ready. as i performed the exam, i was unable to tell the sex of the baby, but happily told the patient that her baby looked okay. as we helped the lady up, i heard petunia say the word "baronsito" (little man) in a quiche explanation, and the patient quickly turned to me and asked if she was having a boy. i told her that the baby wasn't in a good position for seeing this area, and i was unable to know what sex it was. petunia looked at me again and said, "i know what it is." again surprised, i asked her how she knew what it was. she once more smiled knowlingly and nodded her head at the ultrasound. now i was also smiling as i asked her what part of the exam let her know what the sex was. she then informed me that she was able to tell by looking at the head. before i could question it, she proceeded to let me know that if it was a girl, we would have been able to see hair that came down below her ears during the head shots; therefore, since there was no hair that could be seen coming down below the ears, we could safely assume that this was a boy!

yesterday, i led a patient to sit down on the seat of a pregnant girl that had just walked out of the room. as she went to sit down, i noticed that there was two safety pins lying there, one that had unclasped and was sticking straight up. i quickly grabbed them up, but turned to leslie and told her that this patient had almost sat right on the tip of this safety pin that had somehow ended up on this chair. she asked if my last patient had been pregnant and when i answered yes, she told me that they must have fallen out of her clothes as it is common for many pregnant women to pin two safety pins to their slip to keep their baby from having a cleft palate. along these same lines, i have also seen them put some type of metal, usually a coin, over their belly button to also prevent birth defects. i suppose that when it comes to the health of your baby, something as simple as pinning two safety pins to your slip is not a big deal in comparison to the risk you face should this belief prove to be true...

last week, i had another young girl come into the san andres clinic and solemnly sit down in the chair in front of me. without breaking a smile, she informed flor (one of our spanish-quiche translators) that when she smiled her "pulmones" hurt. while still trying to take in the full reality of the complaint, i realized even further that when this girl used the word pulmones - which means lungs - she was actually refering to her shoulders. i couldn't help but think of what a doctor in the states would have done if a patient had walked into his/her office and told them that when she smiles her shoulders hurt. i gave her some tylenol for her shoulder pain and told her that this would help with her pain and i hope she would be able to smile easier this week :)

and there are few things that bring out more laughter and smiles than a birthday party! last wednesday, abi celebrated her third birthday. we were all very happy to see that she made it to her third birthday despite all of her accident-proneness and non-food items she likes to put in her mouth. we also enjoyed the birthday dance (which involves hopping around the room on one foot), eating the pancakes and cupcakes after she blew out her candles (using a little more spit than we would have liked to see), and exclaiming over each gift she received. true to her name, meaning father's delight, she truly does bring joy and laughter to the room and seeks to make sure that you too are laughing as she now asks leslie if "her mommy is happy" before she admits that she has done something she knows she wasn't supposed to :) here is a picture of one of her happiest situations... a table full of family and a huge stack of pancakes with birthday candles!

Monday, November 10, 2008

calfies and clinics

"for My power is made perfect in weakness..." sometimes we purposely put ourselves in situations where we are weak, knowing that this will force us to rely on our God. other times it seems like weakness is the only thing we have to cry out to our God from.

the house has somehow become full of babies... from little enrique to josey's "clan" of 11 puppies and the seven chickies pecking at the feed in the rabbit pen to the new calf born yesterday morning - as grace calls it, the "calf-y." it does seem that wherever you look, we are full :) benny - also called rotten ricky by some - is usually full of smiles and has shown himself to be a pretty low-maintenance baby, although always wanting to be in the midst of things and watch what's going on. the little calf has brought with it the promise of milk straight from the backyard (as soon as she is weaned from mom), and it has been fun to watch her and abi and grace as they are all smiles and laughter watching her learn to walk and nurse.

it has been babies and the promise of babies in clinics as well:
tuesday, we had a little boy come into chiminisijuan very dehydrated. he had been vomiting and with diarrhea for about three full days, and couldn't keep anything down, including the sips of oral rehydration solution that we were giving him. after unsuccessfully trying to place an IV in a few different locations, we told the mom that her child really needed to be in the hospital. after she explained to us that all the men in her family were working in the coast right now and there was no way that she could make a trip to the hospital, we told her that we could take her over there with the plane if she needed. she hesitated for a moment, asked for some more oral rehydration solution and then said she would go talk to her mother. she never came back.
although not a baby, we have been seeing an old man in chiminisjuan who first came to us completely swollen, with 4+ pitting edema up to his knees and ascites everywhere on an ultrasound of his stomach. after trying different treatments for about a month with him continuing to get worse, we finally decided to treat it as an end-of-life care type situation and gave him some ensure-types drinks and a bag of beans. two weeks later, he walked through the door with about 2+ pitting edema and about half the amount of ascites on ultrasound. another two weeks with ensure and beans and he came back with no signs of any fluid retention! we now can see that it was a form of severe malnutrition which is treated with high levels of protein.

and once again, this weekend consisted of clinics mostly filled with prenatal patients. the very first patient that walked in yesterday was a woman who was 17 weeks pregnant and bleeding. now i know that even in the states this is a situation where there are very very few answers, and so i - even more so - was left with no explanation or answers. as i looked this lady in the eyes, which were filled with questions and fears, i knew that the only answer i had to give her was to pray and wait.

and, while this again does not involve babies or clinics, it has been hard in some ways to be physically removed from our country during the elections... the emails and responses that i get down here are a wide range, from fear to tears of joy. i admit that i am not sure what to think, although i know that no matter what changes our country will go through, bad and good, we continue on seeking our God and praying for His will to be done and His grace to allow us to help carry it out.

and sometimes, like yesterday morning, it seems like all the situations over the week where you cannot answer questions and you are confronted with your own inadequacy seem to build up and create a type of exhaustion that seems to stem from the very real awareness of your own weakness. and i am learning that this is the time when God comes in - if you so allow - and reminds you that His strength truly is made perfect in your weakness... even when you are ready to cry in frustration over not being able to get an IV in on a baby that desperately needs it... or you are at the end of your ability to figure out what the little old man in front of you may need... or you have no answers to give the lady wondering whether her baby will be born a healthy little infant in six months or not make it to next week.... or you are unsure of what the future holds. thank God for His grace that reaches all of us and His power that thrives in the midst of our weakness.