Jessie

What a crazy busy week!

A team of ladies from Texas arrived Friday. Much of last week consisted of getting things ready for them. That, together with Jessie's antics, kept us pretty busy. We took Jessie down to the clinic last week to have an NG tube put in because she couldn't seem to keep any food down. She swallows a lot of air when she eats, and she is very difficult to burp. She was vomiting every time we fed her.  Her color was ashy, and she would only take a about 15ml at a time every couple hours or so (NOT enough!).



 I could fill a book with rantings about the inefficiency and inadequacy of the medical system here. The workers are doing the very best they can; they are overworked, and I'm sure they are tired. The midwife who inserted the NG tube was very hesitant. They don't even have NG tubes at the clinic (we took one with us), so he may have never done it before. Jessie's stomach is very active, and just the clenching of her stomach began to force the tube up as soon as he got it down. After much insisting and persuading, he consented to put a stitch through her nose to hold the tube in. He definitely hadn't done that before. They didn't have any suture kits at the clinic. He initially could only find an IV needle, which would have totally mangled her nose. Finally he came up with an internal suture kit, which had a larger needle than was necessary (but smaller than the IV needle). The thread with the kit was dissolvable, but it was the best we could do. He stuck her with some lidocaine, then tried to place the stitch.


It was brutal. I just remember desperately praying that the needle would come through. It finally did. He tied a loose square not around the tube.  Then we spoke with the HIV/AIDS Clinic workers who were there that day. One of the kids was supposed to have gone down for a checkup and to get medicine, but in the craziness of the week it was forgotten. Several long conversations later, they finally just gave us the medicine to take back to him.



Finally, we took Jessie home. She did great for the first NG feeding that Amy gave her. I fed her the next one, and she nearly scared me to death...


She kind of coughed, puked, and convulsed all at the same time. My first overly-panicky thought was that she had seized. My next overly-panicky thought was a bit more colorful as I realized that she had either jerked or vomited her tube halfway out. Her eyes widened into giant saucers, and she began to choke.  I pulled the tube the rest of the way out. The stitch placed by the midwife didn't hold-- the tube had slid right through it.

We left the stitch in hopes that the medical officer would be able to just retie it when he came to reinsert the tube, but two days later he still hadn't come. I ended up putting the tube down myself. We used the same stitch. She managed to cough it out a little a couple of times, but nothing too major. Then yesterday as I was changing her she got a hand on it and ripped it out, stitch and all. We tried giving her a bottle, but she's still not strong enough to suck down all 50ml, so down went the tube again.  We ended up having to duct tape the tube to her face to keep her from forcing it out again. Duct tape fixes everything! She looks a little ridiculous, but she's eating, and her skin has a nice pink undertone again. Today we switched her to Lactogen milk because instead of filling out she actually seems to be losing a little.  Hopefully her body will absorb it better. She's asleep on my chest right now. I love this little girl more than I thought was possible.

Today was very hectic, but things have settled down a bit now.  I think it just feels busy because there are so many people running around this place now.  The Texas group and I covered some nanny shifts, so we were pretty much with the kids all day.  As far as I've heard, everything went well. Sarah helped me with the Kinders, and we got a ton done. The kids know most of the NT books in order, all of the apostles, and about half of the Lord's prayer.  They also learned about the immune system today (which is super important knowledge to have in an HIV/AIDS inflicted area) and what colors mix to make other colors.  Sarah did some math with them as well. It was a really productive day-- I'm a pretty happy camper.


The kids are doing well overall.  Jack has a massive belly and jaundice. We're treating him for liver damage. Queenie has a mass of swollen lymph nodes just below her left ear. She's on amoxycillin, and it seems to be helping. There are a few runny noses, coughs, and rashes scattered around throughout the rest of them.  Besides being really clingy, Gladys is perfectly healthy. Jessie is still breathing, and for that I thank God several times a day.


7/7
I wonder if I will ever be able to hold a baby again without literally counting every breath and jumping at every yawn.

Jessie has had a rough couple of days. A couple of nights ago, she began draining blood-tinged foam from the mouth. It lasted for a couple of hours. Every little gasp was strangled by the fluids that her body just didn't seem to know what to do with. She could not maintain her body temperature. We had to put on gloves because of the blood, and it just felt so wrong to not be able to feel her skin against mine.  I truly and honestly believed with all of my heart that she was dying. I did not expect to find her still breathing in the morning.  No one outright said it, but we prayed for her as a group, and as the other volunteers said goodnight to her it felt like they were also saying goodbye.


But God must have been listening. I can't say that He brought her healing (yet)-- she is still a dangerously sick little girl-- but He did give us one more day with her, and then another. For that, I praise and thank Him.

 We switched her from formula to frequent administration of ORS per the recommendations of a doctor in Europe in order to give her stomach a rest and keep her hydrated. Penicillin can cause diarrhea, and dehydration could be deadly.  She's wrapped in several blankets and sleeping on my lap right now. The bulk of the blankets makes her look even smaller. Anything not wrapped in several layers is cold to the touch (which at this point is just her nose and lips). Her respirations are shallow, irregular, and slightly elevated.  She seems to be sleeping, but it's hard to tell because she can't shut her eyelids completely. She doesn't fight or cry at all. It's like she is just hibernating.  We're going to ween her back onto formula in about an hour.

Amy just got off the phone with a doctor in Lusaka who says we're doing the right things. That's encouraging. I hope it's enough. She also recommended changing her ARV (HIV/AIDS medication).  I hope and pray that we can find the medicine Jessie needs. There is so much red tape between sick people and medical care here.

Jessie is the third sick baby that I've dealt with since I got here. Each one has hit me a little differently. With Nicholas, I was mostly shocked.  His situation was particularly difficult because I still don't really know what was wrong with him. Gladys and Jessie are a little different. I love all of the children, but I love those two.  I don't know if it's just because I was here when they came or because I've spent sleepless nights with both of them. There was at least one time with both of them when I sincerely feared I was losing them, but so far they've both pulled through.  Whatever the reason, there's a special corner in my heart for those two little girls.  Still, Gladys and Jessie aren't really in the same category either.  I'm not exactly a fan of Malaria, but HIV/AIDS gained an enemy when it chose to pick on this little girl.  I've spent much of my free time in the past two days reading up on the infection process and mechanisms for treatment of HIV/AIDS. It is a brutal, relentless, crafty virus. I hate it. It can't have her. Not without a fight, anyway.