Sunday, 15 September 2013

Low birth weight week

Low birth weight means that a baby weighs between 1.5 and 2.5 kilograms at birth (3.3-5.5 pounds).  Very low birth weight is 1-1.5 kg (2.2-3.3 pounds).  And extremely low birth weight babies are less than 500 grams (1.1 pounds).

In developed countries where there is a NICU with ventilators and surfactant, super-specialists, and all sorts of medical technology, a baby who is born at 24 weeks gestation or about 500 grams is considered viable.

Our nursery doesn't have much in the way of fancy equipment.  It is a small, toasty room with one working warmer, a few baby beds, an oxygen concentrator, some IV tubing, NG tubes, one nurse or CHW or student, and lots of mamas taking care of their little ones.  Our 1.5+ kg babies (about 32 weeks gestation) have a pretty good chance of making it.  Get below 1.2 kg and the chances decrease rather quickly.  My smallest that has survived was 1 kg.  Baby of Diana!

Because of all the high risk OB over the last few weeks, we have babies that fit into every one of those weight categories described above--low, very low, and even extremely low.

Baby of Agnes (on the left with mom) was one of twins.  Mom delivered at home, as many PNG mothers do.  The babies were brought to the hospital after a couple of days because they weren't feeding well.  Both were small (1.3 kg) and sick with infection, so they were admitted to the nursery for antibiotics.  The first twin died shortly after admission.  The second one recovered from sepsis and has done really well... growing like a weed!

Serah (on the right with her baby) was admitted to the hospital at 32-33 weeks with PPROM.  Basically, her water broke too early.  After a couple of days on antibiotics and steroids, Serah went into labor.  The baby was delivered by c-section for breech presentation.  He weighed a whoppin' 1.7 kg!!!

Baby of Elis is another one who was born at home.  She was about 1.3 kg when she was brought to the hospital.  She has had a bit of a tougher course, still requiring oxygen and NG feeds.

Margaret was about 6 months pregnant when she started bleeding.  She came into the labor ward and was admitted for observation.  Several days later, she began to bleed so heavily that she passed out in a pool of her own blood.  I diagnosed her with a placental abruption.  The placenta was prematurely separating from the wall of the uterus.  We gave Margaret IV fluids and a blood transfusion to stabilize her condition.  She went into labor and delivered a 600 gram baby.  I had absolutely no hope that this little one would live more than a few minutes.  I was surprised to find that she was still alive several hours later.  Baby of Margaret was moved into the nursery where we cared for her until she was transferred to heaven--four days later.  I count every one of those days as a miracle!

When low birth weight babies grow to about 2.4 kg, they are discharged from the hospital.  I generally have them follow up with me a time or two to make sure that they are gaining weight.  After that they they go to the Maternal Child Health clinic for routine checks and immunizations.  I don't usually see them again unless they are sick.  This past week I saw one of "my babies" in the outpatient department.  Baby of Julie was about 1.8 kg when she was born.  Now she is almost 3 years old!!!  Her name is Cinderella :).  What a sweet encouragement after a week of craziness.

"So neither the one who plants nor the one who waters is anything, but only God, who makes things grow."
~ 1 Corinthians 3:7

Friday, 6 September 2013

High-risk obstetrics

I can't even begin to tell you about OB craziness that we have had the past week.  Well, let me try to give you just a little idea:  abruption, severe pre-eclampsia, eclampsia, aspiration pneumonia, preterm labor, chorioamnionitis, obstructed labor, post-partum cardiomyopathy, ectopic pregnancy.  Oh, wait... I forgot a few:  placenta previa, breech, PPROM, shoulder dystocia, classical c-section, hand presentation, post-partum hemorrhage, vacuum delivery, malaria.  And at the end of the day on Friday, a molar pregnancy.

GEESH.  I think we covered pretty much every complication listed in Williams' Obstetrics--plus some.  I don't think malaria is even discussed in that particular book.  With a week like that, there must be a full moon out there somewhere.  I need a vacation!

I kept telling the nurses to stop having emergencies, but they didn't listen.  Finally I had to write an official doctor's order and post it at the nurses' station.  I was on call last night, and guess what?  Not one phone call from D-ward!!!  Now why didn't I think to write an order sooner.

"But he said to me, 'My grace is sufficient for you, for my power is made perfect in weakness.'  Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me...  For when I am weak, then I am strong."
~ 2 Corinthians 12:9-10

Tuesday, 3 September 2013

Serve in PNG with Work & Witness

Have you ever thought about taking a trip to the far end of the earth?  Well this could be your chance!!!  A W&W team from Oregon is seeking additional members.  Here are a few of the trip details...

Date:  from June 9, 2014
Route:  LAX to PNG, with 3 days in Sydney
Approximate cost:  $4100
For more information contact Jeff and Jeralie Fairbanks:

Please pray about this wonderful opportunity!

W&W team built this toilet block for Nazarene Bible College. 
Dorm for male hospital staff was started by a W&W team.