Taking Care of Newborns: From Kijabe Hospital, Kenya


        Pretty sure I have fleas.  Jim found these two little guys buried deep in my hair and wriggling up itches everywhere.  Now I learn that the previous neonatologist had also acquired some type of stow-away and so would not sit on the mom's beds or wear his white coat thru maternity.  But what am I to do?   The mom's wait longingly as I speak to the woman in front of them.  The want attention for their babies and for their concerns.  They delight when the blond mazungu doctor hugs them and stops to visit. Maybe if I were here long term it would be different, but for just six weeks, though its not very lady like - I guess I'll have fleas.

         Don't be mislead...I am not that cool about having fleas.  The first night we discovered them I must have combed 1 pound of Ultrathon repellent thru my hair.   I then got three "999" pages to maternity for worrisome deliveries.  Yup, there I was resuscitating babies with my deet drenched head.  I can't wait to hear what the Samali women have named me, something like "sour smelling doctor."

          Most of the on call pediatric emergencies are in the delivery room which has verified my decision to specialize in neonatology.  For the most part, a sick newborn in the delivery room does not stress me out in the same way that it bothers non-neonatal physicians.   I am working hard to teach the general interns here how to be calm and act even when the babies are tiny or need to be intubated.   My soap box has ben intubating babies who need to have meconium (first baby stool) removed from their tracheas prior to resuscitation.  The interns know tracheal suctioning needs to be done, but they are terrified.  So if a baby is floppy, not breathing, and covered in meconium the interns have been stat paging the pediatrician and then just waiting: intern shaking, child dying.  Now we review the steps at every delivery that I go to with them and we prepare.  If the child needs suctioning it is up to the intern to be the baby's doctor and I am there for support.   Jim says I am like a duck - above water smoothly floating along, underneath my webbed toes are spinning out prayer.

            During the night of three stat delivery pages, I had my first death in the delivery room.  The hospital is downhill from our apartment so I was pretty swift to respond to the call, but the baby was a still birth.  The intern briefly tried to resuscitate him, but then made the decision that the child was truly gone.  When I walked in there was a blue baby on the bed warmer with the end of scrub bottoms covering his face.  His mom was silent, stretched out toward him, blinking in disbelief. It was awful.  I went to consol her, but quickly realized this was not the time for a rich white woman whose fat, healthy baby sleeps at home to become involved.  I left quietly.

            I remember passing the guard on the walk home.  My mind was busy trying to figure out what I am doing here.  I am suppose to be a teacher.  I didn't teach anything.  Of course, that would have been inappropriate but why was I suppose to be there at all?  At home where my family slept, I wondered and waited for the next page.  I did finally realize, my intern had made the decision to let the baby "go" on his own - How advanced?  How intimidating?  So I called him and told him he did the right thing.  I told him that in my country we frequently get babies who didn't have a heart rate for 30 minutes but no physician was brave enough to stop.  I reminded him that saving the body once the person has gone is not triumphant.  Learning when to stop is not easy and is almost never clear, but is essential.  I told Jeremy I was proud of him and he was grateful (quiet and Kenyan, but grateful).