The Road to Gimbie Letters

08/30/01

Dear Family and Friends,

I am not sure when this will get to you, but I will write it and try to get it off to you as soon as we have some kind of e-mail access. Those of you who have kept in touch with us will realize that our e-mail and phone lines are precarious.

Dr. Rose has been gone again for the past couple of weeks, and I am nearly convinced that is the reason why the e-mail has gone down. I guess it is good not to depend too much on technology out here. Thank goodness we can depend on the Lord.

We have had a medical student from Loma Linda University here for the past two weeks. He has not done any clinical rotations yet, so he came out here to get some experience and to help out. Both have happened. His first day here he arrived in the morning by bus and came to the clinic in the afternoon. He got to assist in a delivery of a newborn. This was very exciting and made him enthusiastic about his time here. After this we had a patient with cerebral malaria, again an exciting first. The nice thing was that in answer to our prayers and with a little help from quinine, he recovered.

Unfortunately, we had another pregnant mom come in and this next case was not pleasent. Her baby had died. We tried removing the baby with forceps, but the baby would not budge. We had to do a destructive craniotomy. This is when we cut up the child inside mom through the vagina and remove the baby. At least we got the baby out. This was a tough thing for our medical student to see, and that, combined with jet lag and not eating for ten hours, was a little rough on him. It all ended well, though, and mom is planning on having another child.

This was also a week of new things for me as well. While Dr. Rose is gone, usually Dr. Fetene does the c-sections. Dr. Fetene happened to be gone as well. In the meantime, Dr. Debebe, a surgeon from Addis, was filling in. Unfortunately, he got a phone call from his family in Addis stating that a relative had died. He had to leave in the next hour to make it to the bus. This left me all alone with no other doctors for the whole hospital, and no surgeon. I came home for 5 minutes and prayed. By the time I got back to the office, I found out that a relief physician had just arrived by bus to help while Dr. Fetene was gone. He had arrived on the bus that was to carry Dr. Debebe back to Addis. What a relief. I then discovered that he had just finished medical school and didn't know how to do surgery. I just prayed and kept working.

Of course, during the next couple of hours we had a patient arrive that needed a c-section. I told them to get ready. We have one really good OR tech that could help me, but we found out that he was out in town somewhere and we could not wait for him, so I went ahead with the surgery. Just as I cut through the skin, this tech walked in the door and we proceded with the surgery which, thank God, went well and mom and baby did fine and went home four days after surgery. The Lord has brought me to the brink several times this week as a faith builder, then blessed greatly.

There was one more incident that I wanted to mention in this letter. We had a mom who came in in labor and she had a baby in fetal distress. Dr. Ephrem, the temporary doctor, was filling in and he tried to deliver the baby, but it was stuck. He tried using the vacuum to get the baby out and it was stuck, so he called me to do the delivery. I came and he asked me to deliver the baby by forceps. I prayed and put on the forceps. As I pulled, the head finally began to move. I should tell you at this point that I have only used forceps before to deliver babies that have died, never a live baby. Well, baby finally came out and I could instantly see what the hangup was. Baby had a big head and it was facing up instead of facing down. I could also see that one of the blades of the forceps was across the eye of the baby. Before I worried about that, I had to get baby breathing. Baby had a tough delivery and had passed stool in the sac of fluid and had the stool all over its body. The baby was limp and not breathing for the first 30 seconds as we worked on the baby, then suddenly baby opened both eyes and let out a big lusty cry. What a relief, both for the cry and for opening both eyes. The forceps, other than leaving a little bruise, caused no problems to the eye and both mom and baby are in good shape. Again, the Lord comes through in a pinch and it really made me relieved.

Speaking of relief, after four days of no surgeon, I was beginning to wonder what would happen next. Sure enough, a patient came in Sunday morning with a stab wound to the side and about two feet of intestine coming through the wound. The intestine had been perforated in several places. Just was we were getting an IV started and I was wondering what would happen next -- would I have to do another surgery? -- I heard the surgeon's voice outside. He had just arrived! Talk about timing! God can sure time things closely but just in time.

We did have one other very sad case this week. Another obstetric case came in. She was seven months pregnant, had been bleeding very heavily from the vagina for two days. She came in in shock with a very low blood pressure. I discovered the baby was dead within a minute or two and confirmed it by ultrasound. The ultrasound showed that the woman had placenta abruptia. This is where the placenta prematurely separates from the uterus and bleeds briskly. Baby dies within minutes or less and mom can die from bleeding to death. I got the dead baby out in just a few minutes by stretching open the cervix. The placenta came quickly. We then noticed that she would not stop bleeding. This is a bad thing since she only had a hemoglobin of 3, about a fourth of the normal amount of blood. She didn't have much to lose. We were able to get two people to donate blood for her in the next few minutes, but still the blood would not stop flowing. She had gone into something called fulminant DIC. This is where the blood does not clot. We had blood all over the table and floor and none of it clotted. Even with the new blood transfused, the blood did not clot. Sadly, she bled to death right in front of our eyes. She had three other children at home. The husband was able to be with her for the last couple of minutes of life, but she was unconscious by then. I have only seen one other case like this, while in medical school doing a rotation at Bangkok Adventist Hospital. It keeps in mind the fact that this is a sad world and makes us long for a better one someday.

The good news is that the better world will come, but until then the little miracles we see daily continue to give us, and you as well, hope.

Take care until next time, whenever we can get the e-mail working.

Sincerely in Christ,

Nick, Phosfe, Christopher and Ian Walters