1 step forward and 2 steps back

Disappointment and heartache permeated through our group today. We started the day with a sort of “victory,” as Dr. Peevy, Ms. Peevy, Britni, and I began to think that we were truly making a difference and changing the protocol of newborn resuscitation here at Kibogora Hospital. 

We started the day early, as one of the Neonatology nurses called Dr. Peevy, saying in her best English, “Neonatology Emergency.” After rushing down the hill to the hospital as the rest of the group went to the church service, we found a 20-hour old premature baby boy in respiratory failure. After a few minutes of bagging the baby, we decided that we must intubate, or else the child would surely die.

Let’s just say that neonatal intubation, here at Kibogora Hospital, is not the norm. Given that, it took nearly ten minutes to find the necessary equipment. After a few minutes, we had a pink baby boy with oxygen saturation between 60-70%. We looked at one another, realizing there was no ventilator capability, and Dr. Peevy posed the question, “What next?” The immediate response was that we should pray. I turned to the oxygen saturation monitor and watched in true wonder and awe as the monitor read “99%.” While some people in this world would attribute this to mere coincidence, I cannot help but know in my heart of hearts that God was intervening at that point. We then realized that, without a ventilator, someone must manually bag the endotracheal tube to continue ventilating the child. Britni and I looked at one another and immediately decided that we would take it upon ourselves to speak for the group of students and commit to taking shifts to manually ventilate the child in his time of need.

There was only one last hurdle: Did the mother even want this intervention to take place? We have come to realize that resuscitation at end of life is frowned upon here in Rwanda. But this was different… this was the beginning of life; a life that, in the United States, would surely survive. To our great surprise, she desired for this intervention to continue. Feeling renewed, Dr. Peevy gave the nurses detailed instructions how to ventilate the child, as this is a BRAND NEW concept to them. As we left the hospital after 2 hours of resuscitation, the baby boy was stable, breathing on his own, maintaining oxygen saturation of 99%, pink, and only requiring 10 manual breaths every 5 minutes or so. We felt as though this was our “golden opportunity” to show the staff of Kibogora that persistence in resuscitation efforts could truly pay off.

Feeling renewed, Britni and I devised a schedule for all members of our group to cover shifts from 5pm-8am to monitor the baby, as these are the hours when the hospital staff is primarily the skeleton crew. Everyone was hopeful and eager to participate, even if it meant walking in pairs in the dark down the hill to monitor this child for 3 hours in the middle of the night, only to wake up the next morning to return to their normal duties.

Dr. Peevy and a few others checked on the baby around 3pm and his course was steady. As 5pm came along, we realized that the person responsible for the first shift had not been informed of this. Bryan, Luke, and I decided to walk down and cover the shift. We were not prepared for what we were about to face. As we walked in, we immediately noticed that the nurse had her hand on the Ambu bag, but was not ventilating the baby. We realized that the baby was not breathing and took over to try to ventilate. The child’s skin was dusky grey and though the stethoscope available was not the best quality, we were fairly certain the heart was not beating. Bryan and Luke continued to bag as I ran up the hill to get Dr. Peevy. When he returned with me, we came to the conclusion after 10 minutes that the baby had no signs of life and removed all tubes and lines.

It was quite the somber walk back up the hill to our house. Thankfully, Dr. Peevy had already informed the group by phone that the baby had passed, so we did not have to break the bad news. Thoughts of doubt, anger, sadness, uncertainty, and incompetence were like a whirlwind in my mind. And I know the same is true for the others. How could this happen? God has a plan for everyone, but this child had a fighting chance, in our opinion. A very good chance in the U.S.

Walking into this trip, I think that each of us had a realistic understanding that we were not going to “change the world” or even just change medicine in this culture. But, in small ways, we aim to make a lasting impression on the way certain medical situations are handled. However, we have run into some fairly strong opposition, as we have realized that things do not just change overnight or even in the 3 weeks we will be at this hospital. At the end of the day, though, we do not cause any change. We may work for it, but God is ultimately responsible for any change that can be accomplished. Who knows if they will set aside the impromptu Neonatal resuscitation kits we prepared after we leave? We can only trust in God that an impact has been made and that they have learned from our example through Him.

Distraught, I for some reason decided to check my email. God is truly great, as a perfectly appropriate answer was waiting for me. My mother had responded to an email, which I shared with the group. In short, she encouraged me to pray the Serenity Prayer.

“God, grant me the peace to accept the things I cannot change, the courage 

to change the things I can, and the wisdom to know the difference.”

Also in her email, she reminded me that in one short week, Easter will bring the celebration of the Resurrection.

“Keep your head up though. Easter is near and so are miracles and new life.”

Despite the happenings of today, we remain in good spirits. Yes, we feel somewhat defeated, as we felt as though our efforts would be fruitful and this child would pull through. Bent, but not broken, we feel inspired to remain enthusiastic about any future opportunity to foster change here at Kibogora.

-William