Saturday, July 9, 2016

life update and why you should get your tetanus shot

So my plan has been to write a post once a month. I have failed again. Sorry. Since I last wrote I made a quick trip to Canada to attend a friend's wedding and see family. It was great to see everyone there again, if I missed connection with you I am sorry. I have joked that I am the missionary that never leaves as since arriving in Kenya in January I have made 2 trips back to Canada. The February trip, as you know was unexpected. This trip that I just took was planned already in January, and I am so thankful for that. I don't have any further trips planned so it will probably be a year before I am back in Canada. It was hard to be home without mom but also good to connect with my family. I have found since coming back I have progressed further out of the grief. The other day at work I was singing. I used to do that often but not in the last few months. It is good to feel more normal although I am sure there are times when it will seem to bog me down again. 

Work at the hospital continues and I would like to share a challenge that does not exist in Canada but is one of the hardest things about working here. Healthcare at Tenwek and many mission hospitals is often referred to as working in a resource limited setting. That limitation of resources vary vastly on the spectrum and Tenwek is a better equipped resource limited hospital. However we still have to be judicious concerning our use of this equipment. For me a weekly question is the use of our ventilators. We currently have 5 working ventilators (1 broke while away and I still can’t find a replacement part). When a patient is placed on a ventilator that means we can not use that machine for someone else so decisions need to be made about how appropriate this is. 

Let me share a story about this. A few weeks ago I got to work to discover a child with Tetanus had deteriorated over night and was placed on a ventilator. Tetanus is an ugly disease - so please get your vaccine. If it progresses to the point of needing a ventilator the chance of survival is poor, but there is still a chance and without the ventilator in this case the child would have died. So the decision was made and we continued to care for this child. Tetanus means the child may need a machine for 2-3 weeks. Therefore we are unable to use the machine to care for other patients with this machine (although I have 4 more) meaning other patients may die or may not. There are weeks when I only have 1-2 patients on a machine and some when all are in use. 
So here we were with this child on the machine. Praying, treating and hoping he will recover. 
However there is a second resource limitation here - the families resource. Staying in the ICU is an expensive treatment. About $100/day or more. That is cheap by western standards but if you only make 5$/day this is a lot. With all your funds going to pay the hospital bill still not being enough some families have to sell their land to pay the bill. Yes, Tenwek is a mission hospital and does provide care to all patients and we have a fund to help patients when needed but a large amount still falls onto the family and their community. So back to my patient after 2 weeks on the machine he died. Now not only is the family grieving a loss their savings have also been depleted. Limited resource is hard. 

Now a few weeks later I get a page, another child also with Tetanus, not doing well. Now what do we do. We have a ventilator available - do we use it? Is this a good choice? Again the family has no money? Transferring to another hospital is not an option as the government hospitals will also charge and require a large deposit up front. These decisions I hate. A colleague of mine once said “don’t make a decision based on what happened to your last patient” not sure if he was quoting someone else but we took this advice. We decided to put the child on the ventilator and 24 hours she is doing a little better and she came off the veniltator, not on purpose the tube fell out but momentarily stable. So we observe. She may need the ventilator again she may not. She may live or she may not. 

In closing - a public service announcement: this is the 3rd child with tetanus in a few weeks, 2 have died and the 3rd we still don't know. Please, wherever you live, ensure you have your tetanus shot. 

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