Prayer Project: Scoliosis

Sarah came for her first prenatal a few months ago. She stood out from all the other ladies though because she brought her own chair.

Born with congenital malformations and scoliosis, making walking impossible, she stands at roughly 4 feet tall and gets around in a wheel chair.

Early on we discussed the need for an elective cesarean, and she completely understood. Her family had already started saving money for her to deliver in Wau.

I was glad for this insight, but even more so when I heard a surgeon was coming on staff. I discussed her case with Dr. Mike shortly after he arrived, and he reviewed her in person this week. He says she would be an excellent candidate for surgery here.

It's hard to tell with her shorter-than-usual abdomen, but I'd venture to say she's 7 months pregnant (or roughly 30 weeks gestation). I know that means her due date is two months out, but I feel the need to cover her in prayer now.

Will you join me?

Please pray for her to carry her baby to term, and deliver without any complications --whether that's here or in Wau. Also pray that she would not be fearful. Every time I see her she seems more withdrawn and afraid. Thanks. 

Feverish.

Ajer showed up at 3:30 pm saying she was having a bit of bleeding on and off and was worried. She insisted there were no contractions, but as I checked her I noticed several mild ones in short succession.

“But Ajer... that is a contraction right there,” I argued, “Isn’t that painful?”
“Yes, but I’ve been having those for a few days now...,” she explained.
“Oh...”

When I touched her belly to palpate position, I was surprised by how hot she felt --even for such a blistering summer day. It could be simple dehydration... or it could be something worse.

“Have you had any fevers recently?” I queried, trying to pinpoint her diagnosis.
“Yes. I had one last night, but it went away this morning.”

This felt like more than simple dehydration, so I got out my thermometer. She was burning up with a temperature of 38.0 C.

Her baby’s heart tones were also high (168, 172). Not good. Perhaps the fever was causing the contractions, but I doubted it was the other way around.

She was sick... but with what?

She tested negative for malaria and complained of no other symptoms except contractions.
    --Humm....

The vaginal exam showed she was dilating; but with such mild contractions, I didn’t expect her to deliver any time soon. (For any midwives out there: she was 2 cm, 80%, 0 station, IBOW.)

So I started her on prophylactic malaria medicines and antibiotics --just in case-- then hung some IV fluids. The minute I hydrated her though, her contractions picked up speed.... and strength.

I had barely finished giving her IV antibiotics when she started getting grunty. Her fever soared higher (38.8 C), and her baby’s heart tones raced even faster (176).
    -- What was going on?

She felt something come out from between her legs, and I looked down to see water.
    -- Humm.... strange that she’d have rupture at 2 cm. Very strange, but okay.

I started counting contractions and measuring their strength. They were strong now, lasting 45 seconds... and happening like clock-work every 2 minutes.
    -- Seriously.... something was up.

Then she started pushing.

“Ajer... please don’t push. You are only 2 cm dilated. It’s not time now.”
“But I’m not doing it on purpose,” she promised. “I just can’t help it.”
“Please don’t push...” I continued. “Don’t...”

Then I looked down.

Her bag of waters was bulging, and the baby’s head was right behind.

“It’s coming,” she half grunted, half pushed.
        --Yes. It most definitely was.

My helper moved lightening fast to prepare the room for the birth, and I slipped a pad under her butt. The next push he was born.

She went from 2 cm to baby out in 43 minutes with a fever of 38.8 C!

Unfortunately my story does not end there. Even before the placenta was born, she started dumping blood. And by the time I got it out (15 minutes postpartum), she had lost over 1500 cc. Fortunately, oxytocin helped stop the bleeding, and she slept through the night.

This morning everything looked normal and I was about to discharge her when she reminded me about the tear.
    -- The tear? Which tear...? She didn’t tear during the birth.

She went on to remind me of how she got a severe 4th degree vaginal tear after her last birth at home. She came to us initially for help, but we referred her to Wau for an operation. She went but never got it fixed; she didn’t have the money.

However a few months later she got pregnant again, and was told she could not get the surgery until after she delivered.

As she explained, I remembered running into her in town a few weeks back. Yes, of course I remembered her. We had discussed the option of her getting surgery with our surgeon instead.

Dr. Mike reviewed her and said she was a good candidate for surgery; he wants to schedule her back for the beginning of April.
         --What a blessing!

It’s strange that she neglected to say anything during prenatals, or even during the birth. But I’m glad she reminded me of it this morning!

Her previous tear helps explains the unusual fever and lightening fast birth though. It helps explains a lot.

Praise God she got to us in time for a safe birth and quick antibiotics for both her and her new son! Thank God that she can now get the surgery in town! Please pray for them to heal quickly, and for her to have a successful surgery. Thanks.

Surgeon in the House.

Dr. Mike is a general surgeon from Florida who has come to serve this community for the next 3 months. His happy manners and quick wit have already made him quite popular; and I’m confident his many skills will make him even more so in the coming months.

He will be working at the government hospital since we don’t have space in our clinic. Plus, the government hospital has a tiled room designed for just such surgeries.

The staff has been organizing the equipment and setting up the room for the last few days. Yesterday they did their first surgery --a hernia repair on a 7 year old boy. I’m told things went very well.

It sure is nice to have a surgeon in the house!

Butt Surgery.

This week, Dennis and Tom performed surgery on a 5 month baby by removing a very large growth on her buttock.

When they told me they’d be removing this growth, and they wanted my assistance, I thought it’d be a few centimeters in diameter at most, but I was wrong.     --Way wrong!

Yom, being just 5 months old, had a tennis ball sized growth on her left buttock that had been growing progressively since her birth.

Understandably worried, her family brought her in to see what could be done; Tom and Dennis decided to remove it surgically.

Even though, I wasn’t much use to them, I was glad to watch the surgery. After sedating the tot, they infiltrated the area with lidocaine, cut, and tied off any bleeders.

It took just over an hour, but eventually, they were able to remove most of the scar tissue and close her up.

I can’t help wondering how such a growth can happen in the first place?

Knowing she was handling her surgery well, we laughed calling it a ‘Butt-ectomy’, and joked about her being the ‘youngest person to get liposuction’.
    -- I know. Corny, right?

Anyway, there is no doubt in my mind, this growth would have haunted her for the rest of her life if not removed. In Sudan, any unusual growths are thought to be demons or curses. To have them brings harassment and ostracism, I’m glad that Tom and Dennis could help her in this way.

Please pray that Yom would heal quickly and that it would not re-grow. Thanks.

Mastectomy!

Yesterday I participated in my first mastectomy!

(For those who have been following this blog for some time, you will probably guess who got the procedure. Yep. Mary!)

I first met Mary a few months back when she came in for a prenatal check. (Read her story here.) She explained that her right breast got really big after one of her births, and she had not been able to breastfeed from it since. As she sat on my consultation table, it sat beside her. It was big. It was cantaloupe-sized big.

Fast forward a few months, during which time I spoke about her case with the doctors. Tom seemed optimistic that he and a surgeon friend might be able to do the procedure when he (the surgeon) comes in May. But when Tom saw her breast this week, he said it would be easier than he thought. Why not do it now?

I couldn’t see any reason to wait; sure there were possible complications (pregnancy, no operating room, minimal staff, etc.), but doing the procedure now would give her time to heal before the birth.

When I shared this news with her, hope danced in her eyes. Twelve years is a long time to live with a dangling appendage.

Asking her to come back on Friday afternoon, Tom and I looked into what it would take and discussed the details. Tom was confident it would be a simple procedure, but didn’t down play the risks either. Using local anesthetics, we’d cut; if any bleeders occurred, we’d just ligate them and move on.

Nervous and excited, she returned yesterday afternoon. The clinic was (blissfully) quiet as we prepped the room and explained the procedure in detail (once again). She said she understood and was happy to do it now, adding that it was extra bothersome in the heat and it’s hard to sleep. (I can only imagine!)

I won’t bore you with the details. Suffice it to say, it was all about meticulous cutting, ligating arteries, and suturing everything back up. The hour it took to cut it off was long and grueling, but the blood loss was minimal.

When I showed her the removed portion, weighing in at 2.3 kg (or 5lbs), she smiled gleefully. I must admit, I didn’t expect such joy. But then again, if a part of my body had haunted me for 12 long years, I think I’d be ecstatic to see it go, too!

Long story short, we stitched her up and watched her through the night. We plan on daily wound dressings over the next few weeks and I’ll be sure to update you on the progress. Please pray for a quick recovery and that no infection sets in.  Thanks.

The breast before surgery.

The tissue after it was removed, weighing 2.3 kg.