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Dedicated to Spreading the Gospel of Jesus Christ to the Miskito Indians of Nicaragua

Just Breathe!

It was Monday night, and Becky [Thompson]and I were sleeping when I was awakened by someone calling Becky’s name through the door. It was not the night watchman. When Armando is our watchman, he usually is the one who calls for whatever emergency the people bring.  I lay there trying to figure out who was calling, and trying to wake up Becky - she doesn’t wake easily! “Ya ba?” I questioned. (“Who’s there?”) It was Horacio, one of our friends from Francia. “What is going on?” I asked in Spanish. 

“Doctora! I need to talk to you a minute.” Becky was up by then, and we went outside.  He began to explain.  “My kid is very sick. It has come time for the kid to grow and it isn’t growing. Yes, very sick!” I was very confused. Huh?? People do not usually come to me at 2:00 in the morning to tell me that their child is not growing!  I figured I was not getting something. He turned to our watchman and explained it in Miskitu. I figured that he would then translate it to me since Horacio was having a hard time translating it to Spanish. When Horacio finished the explanation the watchman had a very serious expression on his face. “Ohhh,” he said with raised eyebrows. Then they all just stood there staring at me expecting me to do something, but no one translating what had been said.  “Well”, I asked feeling impatient, “What did he say?” Then it came out. His daughter was in labor and the baby wasn’t coming like it should and the MINSA nurse, Janet, was calling for our assistance. [MINSA is the national ministry of health agency.] Oh boy! Labor and delivery is not my specialty, but I was grateful that Janet was there. We got our stuff together and walked down to the clinic. We knew that we had no way to transport. If we couldn’t solve the problem with God’s help, the baby would die, and so could the mother. At 2:00 a.m. that does not make one feel any better about dealing with an emergency. 

At the clinic there were two village midwives standing around not doing a whole lot, the mother of the girl, the patient, and Janet, trying hard to encourage the girl to do her part.  The baby was in a good position, and crowned, but 16-year-old mom didn’t want to push! “Sip apia! Sip apia!” she kept saying. (I can’t! I can’t!) She had been in labor since the day before, but as is often the case, they had not sought help until way late in the game.  They had called for Janet at 1 a.m. Janet’s mom came, the respected midwife in the village. Janet was wringing her hands in frustration with the whole situation. Emilia, Janet’s mother took over, telling her that her baby was dying while she was delaying. We brought our Doppler, but I couldn’t find a heart beat. I wasn’t sure if it was because of my batteries, or because there was no heart beat. Finally, after much begging, entreating, and stern talks from Janet and Emilia, the mother began to push.

Two hours after we arrived, they got the head delivered, face down, dark purple and motionless. After the long labor, I was fearful of what that could mean. I grabbed the suction bulb and got practically under Emilia and the delivery table, to try to suction out the mouth and nose. Then the shoulders and body came out, and a wave of meconium-stained amniotic fluid and blood rushed down towards me. It was a hot, stuffy room filled with the smells of bodies, blood, and now this. I hadn’t eaten anything as it was the middle of night, and before I knew what was happening, I was heaving blindly. I had to run outside, still dry-heaving. I sat down on the bench outside and put my head between my knees.  As soon as I felt somewhat better, I hurried back in to pick up again.

  This baby was a high risk baby, to say the least. It had aspirated meconium, had not cried, and was not breathing.  They were suctioning out the mouth, spanking it, turning it upside-down and spanking its feet, all to no avail. Time was ticking and the baby was not getting precious oxygen. The midwives were blowing in his face, and trying some traditional things. I was getting impatient and more worried by the second. Janet took over again, and I suggested we do mouth to mouth resuscitation. “Da le!” she said urgently (“Do it!”). I had been looking at ways to provide a mask of sorts. I grabbed a piece of gauze and placed it over the face and Becky began rescue breathing, while I listened to lungs to see if the air was entering, rubbed the baby, and thumped its feet, trying to stimulate it to breathe.  He was born with APGAR score of 0.

After Becky had done it for a while, I took over with the rescue breathing. The baby was beginning to breathe some, but still not sufficiently on his own. “Oh God! Please let him live!” I pleaded silently, while concentrating on giving the baby air. Finally, 45 minutes after we began, the baby was breathing sufficiently on his own. We observed that he still was not crying, his respiration rate was 80, but he was pink, and moving some. At dawn Becky and I went up to the hill to eat a quick breakfast before returning to the MINSA clinic to help out some more.

When we returned, the baby’s mother was sleeping, his grandmother with the mother. The baby lay in a crib nearby.  I checked on him. His skin was cool, and respirations still 80-85, had not cried. We of course did not have an incubator, so I picked up the baby and gave him to the grandmother. “Take him,” I said in broken Miskitu. Then I went to talk with Janet about when we could radio Waspam for an Ambulance. We talked a minute about the need for him to get to Waspam soon. We both readily agreed he needed to go - the sooner the better. I went back to check on the baby.  The Grandmother had set him down again. She didn’t understand! I picked up the little bundle again and held him tight against my body, trying to warm him up. Patients began to arrive for consults. They all smiled and laughed at the “Miriki Daktar” holding the baby. They probably thought I was just carrying him around with me everywhere because I liked him. While I did like him, that was NOT the reason I was carrying him. I was playing incubator. I carried him around for an hour or more, counting his respiration rate every few minutes…80, 85, 90, 95. “Oh God!” I prayed again, “Please let this baby live! Don’t let him die.” I’ve seen enough babies die here. I wanted to see one live! 

We were surprised around 8 a.m. when Rusty and Abdiel returned from Port with the new Deuce (big military truck).  They had been up all night with vehicle problems and were just now getting in. Becky went up to see about the possibility of transport, as MINSA would not be able to get anything to us until at least 10 or 11.

While we were waiting on that, another messenger came to the clinic saying there was another woman in labor and not progressing. We went to check, and offered to transport since we were going anyway. We informed them that if they didn’t go then, they would not have opportunity if something went wrong. The patient and her husband and midwife were in agreement with going, but the mother of the patient decided against and so they decided not to go. This is one of the frustrations of our work here - waiting until something is past the crisis point to get help. We pleaded with her to go.  They could refuse help until emergency point, but what are we to do when they reach that crisis point because the refused the help we offered…Not help?? We got the other lady ready to go, and loaded up the Duce, and sent a final messenger to the other lady. Suddenly the husband appeared at the clinic on his bike, out of breath. “We’ll go!” he said. Praise God!

By the time we arrived in Waspam, the baby was crying heartily. So when the doctor saw him, she looked at me and said, “This baby is fine!” Janet and I explained again that it had aspirated meconium and you could feel his little lungs vibrate and rattle with junk as he breathed. The mother also seemed to have little interest in nursing. I felt like a fool for showing up with a baby that was crying loudly, but I would rather take the baby and them think me a fool when the baby appears fine, than not take the baby and be a fool when he dies. The other mother was admitted for observation. Later we heard via radio that the baby was convulsing and in critical condition. We had made the right decision. The baby is back home now, and doing better. What part do I have in his life?  Only God knows that, I am just called to be His hands, feet, and breath.  I pray someday this baby can feel the breath of the Holy Spirit giving him the only true life.