Soddo Special Delivery    From Dr. Mark and Allison Karnes
alicek on March 14th, 2011

5/7/03

14/3/11

Here’s the latest news:

Well believe it or not there were no major catastrophes this week.  The maternity ward has been pretty slow and the surgical cases have all gone well.  We are praising God for this.  This has given us more time to do other things like meeting with the hospital administrator and nursing director to talk about how we can make improvements regarding patient care at the hospital.  We also have been working on various protocols for our patient care.

One problem here is the need to have ‘focused nursing care.’  That means one nurse is responsible for a particular number of patients.  This is a foreign concept.  Here, all of the patients on the wards are cared for by all of the nurses, i.e., one nurse may take vital signs while another nurse checks to see if the patient has taken their medications.  No nurse has his/her own patients.  Here, when we write orders for our patients to receive medications the patient’s family heads to the pharmacy to buy the medicine and brings it back to the room where it is kept by the bedside. This includes IV bags and tubing, injectables,etc. The family is responsible for giving the patient the drugs.  Crazy isn’t it?  So when an IV dose of medication is needed sometimes the nurses will ask the family if they have the meds and then she will administer it.

When I come into the ward and ask who is responsible for my patient I’m often met with a blank stare because all of the patients are generally taken care of by all the nurses.  This is how many times big things are missed like vital signs, meds, etc. because no one individual is responsible for a particular patient.  Patients have been admitted on the pediatric ward and the nurses did not even realize they were there.

Sadly this happened yesterday.  There are several orphanages here in Soddo and Stephanie Bowers manages one for babies and small children who are adoptable.  A ‘caretaker’ dropped off a severely malnourished little girl at her orphanage to be cared for.  This child had obviously been neglected and was near death suffering from kwashiorkor.  Her body was markedly swollen from the lack of protein and she was in kidney failure.  Her story goes something like this: her father had died and her mother had left her behind with friends and family to go looking for work in a town three hours away.  Those ‘caring’ for her essentially did nothing for her.  In the U.S. these people would have been arrested for child abuse and neglect.  They had dropped her off at the orphanage so that they would not be accused of murdering her when she died at their home.  After being dropped off Stephanie brought the girl to the hospital on Friday.  The outpatient Dr. wrote orders for her and she was admitted to the pediatric ward.  Her ‘caretaker’ came along with her to care for her but soon left the child alone.  None of the Drs. orders had been carried out by the nurses and the child expired Sunday morning.  She had not been fed, no IV’s had been started. No one bothered to notify Stephanie that the ‘caretaker’ had left so consequently Stephanie did not know to call another worker to come to the hospital.  This little 4 1/2 year old girl died alone not being fed or held.  No one was taking responsibility for her care.  This is a significant problem and makes one wonder if it is cultural. Did they think that the child was going to die so why bother?

Saying all of this, we do have caring nurses here who want to give good care.  It is just a matter of mentoring them and teaching them how to be more responsible and showing them how they can be more efficient in giving good care and taking ownership of  their patients.

Our responsibility here is more than just patient care.  We have to educate and love, educate and direct, educate and serve, and educate and mentor our physicians in training as well as our nurses.

Good News!!!  Today we have heard the first positive news about Stephanie’s license.  We have heard from the Ministry of Health that they will be granting her license next month!  This has given us tremendous joy. God DOES answer prayers.   Thank you so much for your continued prayers regarding this matter.  Stephanie is not celebrating until she gets the license in her hands but we  are thrilled.   Thanks also for your words of encouragement.  We look forward to your short notes of encouragement that help sustain us.

Allison’s blog follows.

Love, Mark

Webmaster on March 7th, 2011

28/6/03

This past week has been filled with joy and sadness. I would just like one week not to have a major catastrophe. With that opening statement, let me say that we had a marvelous time in Addis last weekend. We said good-bye to the Solfelts from Madison, Wisconsin. They came to Soddo to fill in for the Andersons who are on leave in the U.S. Dave had about seven orthopedic cases a day and Barb taught in Jackie Anderson’s school here on our compound.

It was great seeing our Ethiopian family again in Addis and getting caught up on the latest news from their family. We stayed in Asle and Kari Arseland’s apartment with Kari on the Norwegian compound. Asle, our anesthesiologist, is in Norway attending classes while Kari stayed behind. Our time was filled with grocery shopping, shopping for our home, going to a medical supply company, enjoying a few restaurants and picking up our guests, Alberta Brown and Dr. Will and Agnes DeBraber. Dr. DeBraber is an urologist, who upon arriving in Soddo got busy seeing urological patients as well as teaching and training our PAACS surgical residents in basic urological procedures and principles.

On Thursday night disaster struck. A 35 year old mother of five came to our hospital with third degree uterine prolapse on Wednesday in preparation for surgery on Thursday. Her internal female organs were literally hanging outside of her body, making it very uncomfortable for her to walk, sit, work and carry on her daily activities. This is a VERY common occurrence here. It occurs usually in women who have had many children and from hours of pushing and straining as well as having poor nutritional factors. The muscles and ligaments that hold everything in place get pulled and stretched and in many cases actually can disintegrate so that there are no supporting structures remaining and literally everything falls out. The surgical resident and I performed a vaginal hysterectomy on her as well as vaginal reconstructive surgery. Everything was going well but near the end of one aspect of the surgery we noticed increased vaginal bleeding. We had difficulty visualizing where the bleeding was coming from. I asked for assistance from Dr. John Foor, a visiting vascular surgeon from Indiana. The source could not be located so we decided to open her and we quickly located the source of bleeding. It was taken care of and while Dr. John closed her abdomen, Dr. Dejanae and I went below and completed her surgery. I suggested that she receive a unit of her husband’s blood. She went to the recovery room in good condition and everything seemed to be fine. We completed her case by the early afternoon and I went to the clinic to see more patients. The next morning as I was leaving the house I received a call from Dr. Paul Gray, the residency program director, who informed me that our patient had died the night before. I was totally devastated. No one bothered to call me. The resident had been called at 9 P.M. the night before and stated that her blood pressure had dropped and her heart rate had increased. He started an extra IV line, ordered blood and she expired. He did not call me. The nurses did not call me. No one called me to let me know that she was in trouble, even though we live less than two football fields from the hospital. I had no opportunity to evaluate her, to talk to her family and express my sympathy to them.

Both Paul and I talked to the resident and explained how important it is to notify the attending physician when things are happening to our patients. Also, the nursing care here at times can be so lackadaisical. Their ability to recognize when patients are getting into trouble goes unnoticed and their failure to act upon the critical situation means the difference between life and death. I have been so thankful for our OB, surgical, and recovery room nurses back at Mercy Hospital in Muskegon because they have been able to recognize these types of problems and take the proper steps. In my 25 years of OB/GYN surgical practice, I had never lost a patient. I owe a lot of credit to the nurses who were taking care of my patients. Nursing care is vital. The proper training of nurses is critical.

I discussed this case with Dr. John Foor afterwards and he reassured me that her pelvis was dry before her abdomen was closed. He felt that the most likely cause of her death was a pulmonary embolus (a blood clot went to her lungs). We will never know. An autopsy was not done. When I found out the news, her body and family were gone. The only thing that is known is that a young woman that was laughing and joking with us before her surgery will not be able to raise her five children. This is the reality that her children have to live with. This is the reality that I’m living with.

On a more positive note, this past week we received notification from Global Outreach of those who contributed to our work in February. We are overwhelmed with your generosity and praying how best to use the resources God is sending to our ministry. The needs are great. Thank you so much for your prayers, words of encouragement and partnering with us in this kingdom ministry.