When she arrived it was my turn to take care of her. Before she even came through the door, I knew we were going to be in for a long night. My co-worker insisted that she needed to have her kidney function assessed before she could get the CT scan. The contrast dye can injure a person's kidney's and if one has poor function to begin with (as is common in the case of long untreated blood pressure), the risk of further decline is significant. However, blood in a space that it doesn't belong shows up on the CT without any contrast dye. After I realized this I quickly tried to get the ball rolling in the direction of the scanner, but we had another problem. The power to the CT scanner ran on a separate generator from the rest of the hospital, and it had decided to stop working. We called a technician to come fix the generator, but he would not arrive for at least another hour.
In the meantime, since we were confident that this was indeed a brain hemorrhage, I sat down with my American guidelines for management and ordered the medications and studies to be done after admission. After neatly writing out all of the correct medications and dosages and nursing orders, I called my attending physician to discuss the plan. But I was in for a surprise. Most of the drugs I was intending to use were not available at Tenwek, but several related drugs were. So I rewrote the medication list and orders and waited for further instruction. Also, a US neurosurgeon was to join our team in 2 days and would be seeing the patient after he arrived.
The next two days was spent trying to manage symptoms and make sure things weren't getting worse. On her 3rd day at the hospital I went in to see how she was doing and she complained of terrible pain all night. I went over to the bed and gently felt the skin, muscles, and bony prominences in her neck to assess the origin of her pain. I then used my hands to calm the tissue I felt would best respond to manipulation and sure enough the tissue relaxed, but her pain did not improve. So I increased her pain medication and left to give some time for the manipulation and medicine to start working.
Several hours later I came back with Crystal to pray for the woman with her family all around. "She's feeling much better!" they exclaimed with joy when they saw me. I felt her neck again and sure enough much of the tension that was there before had resolved. I hadn't cured her, but at least she was more comfortable while she waited to be taken to surgery. She and her family were also greatly appreciative of our prayers and they were at peace with whatever the future held for her.
Medicine is different in Tenwek. We still ask questions, order tests, and prescribe medicine, but we are stretched to use the resources we have to help those we can. The population has many diverse illnesses not seen in the US, but others are well known. The pace of medicine is slower, not only because of the culture, but resources are also more limited. Every day is a new adventure. And every patient a beautiful image of God.