It was a Sunday. We all had a rough morning on our respective units. Deaths, lack of supplies, understaffed, sick patients, and the usual list goes on. It was meant to be a short day, or even a day off, but we are nurses who love what we do, and so on our day off, we spent it nursing too.
After our hectic morning mentoring students on the wards, we took a short break, donned our nursing hats rather than mentor hats, and found the hidden gem of Busia County Referral Hospital. The NICU. The shelter among the Busia hospital storm.
In this quiet, warm room, hiding out within the chaos of the African hospital is a nurse walking barefoot, tending to the miracle babies of Busia. Every birth, every living child is a miracle, but surviving any birth complications in a hospital that lacks basic supplies and resources, is a true miracle. So we sat, on our break day, in this serene spot among a bustling, chaotic hospital, cuddling these miracles, and feeling their heartbeats against ours, as we awaited our laboring mothers to give birth. Coming from wards where we battle and surrender to death daily, it was refreshing to inhale the heartbeat and hopefulness of a fresh life... that was until we resuscitated an even newer life on the same table that these two premies lay, as they struggled to inhale their own miracle of life. But that comes later in this story.
We held human beings who fit into my palm. Their rapid heartbeat vibrated against my, now calm one. None of these humans had names yet. Many won’t have a name untill/unless, they earn an exit from this serene, yet enclosed room. Their battle for entry to survive this world was still being fought, and until then they were just a tiny bundle with a heartbeat. Sitting there cuddling the brand new bundles of life,but fighting to keep their life, brought on a feeling too surreal to put into words or images, because it had to be felt.
Our calmness was interrupted, a 28 weeker was eager to make an entrance into this world. We settled the babies, 3 babies per baby warmer. Fetus was 28 weeks, mom ran away from home, and had no prenatal care. There we were with white rubber boots and green plastic aprons ready for the 8cm dilated screaming 20 year old to deliver. We coached her breaths, we held her while she screamed in pain,we gave her no pain meds because there weren’t any to give, and it took 4 of us to hold her down and hold up her legs,as we guided her through each push.
Out came the baby, reddish, blue in color, but with a weak cry. Leah and I tended to mom and Ivy followed baby. Minutes later while Leah and I washed up mother, Ivy began resuscitating, baby, who turned bluer and dropped his heart rate shortly after delivery. We joined, Ivy; and it was only us, the 3 mezungus. We teamed up and resuscitated, all hands, all nurses, no docs, and no meds. Kenya has their own rules for resuscitation, we followed them, because we are in Kenya; 5 compressions and 5 breaths. We kept going at it, determined to bring this miniature human back to life. We stood there, each of us focused on our role, yet communicating as a team. Breaths, compressions and suction. We remained hopeful, and we continued our resuscitation efforts, all while twin premies shared the same baby warmer we were resuscitating on. We were sweating and having palpitations ourselves. After what seemed like ages, baby gave a weak cry, and so did we. Three muzungu nurses and a baby with a cry. It was an exhausting day off, working, and witnessing the miracle of life, but it felt so well worth it.
Our days on the ward are spent fighting for lives, and we often lose the battle, or can’t even fight. In this Kenya hospital, everyone is DNR, because even if we did resuscitate them, we lack the means to maintain a patient in that state of health once they are resuscitated. We have no ventilation equipment, no sedation meds, nor any resuscitation meds. When a patient dies we let them go. Each day that we are on the ward, teaching our students, we struggle to keep our patients from hitting that road block that leads them to that DNR state. We teach our students how to care for patients while they are alive, so that we can keep them alive. We can only save them while they live, but we cannot resuscitate, nor can we really teach them how to. Sometimes I feel like I watch these pulseless patients, and I want do CPR or give them a few breaths,whatever it takes to save a life, but my hands are tied. We had a few patients die because of glycemic issues, which we may have been caught if we had something as simple as a glucometer. But there is one for the whole hospital. So really we try to maintain lives, because even with the minimal supplies, we can still attempt at that.
So, there we were, finally with the means to save a life we went for it, long as it took, and we finally felt like a nurse, like a life saver.
We came home in a light mood,and we debriefed. It felt good to bring a life into the world, and then bring it back to life, only minutes after it entered the world.
That night we each prayed for that nameless baby boy. The next few hours would tell, or at least indicate whether he will win the victory over his nameless NICU sentence to a world with breaths, sunlight and growth; oh, and a name!
We came back to work still thinking about our baby, but got busy on our wards. That day, each of us, working on 3 separate wards, lost patients who had managed to crawl into our hearts. We knew we only had minimal means to try save them, and try we did, as we taught the students to do so as well. After one of the deaths that morning, the family member went to the nurse and with the most genuine, yet heartbreaking words, said “thank you for trying”. Sometimes, try is all we can do, especially in Busia, Kenya.
Needing some life and hope for the work we do, we went to check on our baby boy in the NICU. Our boy, had no name, no identification band that matched him to the mom who birthed him lay there, still with a beating heart, not great breathing,non impressive color, but alive; and so we went to have our lunch.
Hours later, we get the news. Our nameless baby boy, lost the battles to his nameless state in the NICU.
It was a rough day, with lots of deaths, including those who barely had a chance at life. I kept on thinking about our being there to deliver the child, and then being there to resuscitate him. The “butterfly effect” came to mind. We, the 3 muzungu nurses had to be there on our day off to deliver this baby and save him, even if it was just long enough for his mom to meet him and hold him. Long enough for our unnamed NICU baby to be held and cuddled by the human who birthed him. Our being there, allowed this mother to hold a living child, for the short time he was in the world to take his own shallow breath of life.
Working in a developing country, with 3rd world medical availabilities, we often feel short handed, and often hopeless when we can’t save when we know we can, and want to. Then, sometimes, we are someplace, at the right moment, to breath some air, compress a tiny heart, and allow a mother to meet her child while it still breaths.
We can’t always save a life. We can always try to in some way. However, sometimes, all we can give is moment in a life, a lesson for a lifetime, create a memory, for ourselves and for others, that may last a lifetime.
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