Friday, May 20, 2011

Incompetent.

I met Ayen for the first time 4 weeks ago. She had a terrible history of untreated STDs and two second trimester stillbirths. Since she was already in her 5th month, she decided to see how I could help keep this baby healthy.

Suspecting several STDs, we threw everything in our pharmacy at her blindly.

Insisting that her husband get the same treatment, she brought him in the next day, but hadn’t explained to him why. Once he learned he had STDS, he refused treatment. 

Frustrating even my translator with his obstinate refusal, my translator explained: “He is stubborn. You know, those from the village, they don’t want to take medicine. They argue.”

Since he wouldn’t get treatment, I asked her not to have sex with him until after the baby was born. They both agreed and I sent her home.

She returned weekly for check-ups, and, yesterday, I was thrilled to learn her infections were gone. So, I was a little surprised when she returned tonight in pain.

Even though there was no bleeding, she explained that it felt like she was miscarrying. The pain was constant; it reminded her of the other births. Despite not having any contractions, she knew something was wrong.

Was she just afraid? Or was there something amiss?

Since her infections were treated, the only other thing I could think of was an incompetent cervix. Leaning towards her being more fearful than incompetent, I asked if I could do a vaginal exam. I was just trying to rule it out, so I could send her home re-assured.

She agreed saying, “Do what you need. That is why I have come.”

During the exam, it took me a minute to get my bearings. Soft and squishy, her cervix was hard to find at first, but when I did, I jumped.                -- What the heck was that?!  

Sudden movement startled me.     -- It couldn’t be... No. It’s not possible! 

Since she was already dilated, I tried to assess without moving things around. I didn’t want to make it worse. However, while checking for effacement, I got poked.
    --Her baby was playing with my finger!

Tiny digits rubbed against my index finger, flittering and jabbing me through the membranes. Momentarily speechless, I stood there, equally amazed and horrified.

She had an incompetent cervix.

Calling for Tom to consult, I gathered all the facts in my head in preparation.

    --- 70% efffaced. 2 cm dilated. Membranes intact. Tiny fetal parts palpable.

He came in a hurry, only to listen and shake his head in resignation. There was nothing we could do for them --not at 26 weeks. They needed to go to Wau.

Part of me was hoping he’d swoop in and stitch her up right then and there. I mean, isn’t that how it’s done on t.v.? The doctor does a quick assessment, takes out some nylon suture and saves the day.

But his downcast eyes made it clear. It was too late.      -- Sigh.

As he left, I called Ayen’s family in the room. Her husband --the same man who a few weeks ago argued he wouldn’t get treatment-- sat before me again, but this time he wasn’t arguing. He was scared.

Pulling no punches, I explained the whys and the hows. “Ayen’s cervix is starting to open. If it opens any more your baby will be born, and die. He is too small to breath on his own.”

An hour later we were still discussing the options and possible consequences. I was able to convince her husband to get treatment for his infections, but he did so grudgingly. The village in him resisted getting the penicillin shot (since it was an injection). The villagers fear needles.

I encouraged them to go to Wau, but was honest that the hospital there would not be able to do much for their child. They would unlikely be able to care for one so small, and doing cerclage is contra-indicated so late in pregnancy.

They opted to take her home on strict bed rest, instead. Explaining what that might look like, I tried to keep things simple, but it was hard. I kept saying, ‘if this happens, then do this. But if that happens, then do that’. By the end, Makom (her husband) looked dejected and sad.

Before they left, I prayed for them to see God moving in the miraculous. I prayed this child would stay inside and live. I prayed that Makom would see God’s goodness and be transformed. I prayed for the hope to remain in Ayen’s heart.

Will you join me?

I have no idea what God has in store. But their baby is alive and definitely kicking. Oh, Lord! Help this child live! Amen. Please pray for Ayen, Makom... and their little Poke! Thanks.