Disclaimer: we’re more likely to be accused of being pushy than passive. As people whose solid education in addition to also skin coloration communicates privilege, not to mention our roles in leadership in addition to also teaching, I am hesitant to complain about passive-aggressive behaviour realizing which which’s roots run deep into colonialism in addition to also injustice. However, as people who have put in 2 1/2 decades of struggle in addition to also love, there are days which the energy to push back against waves of passive indifference just drain us. which can be going to be a long post, for the few who wonder what work-days are truly like. Feel free to skip to the last few paragraphs.
Thursday was one of those days. The push started off Wednesday afternoon that has a dangerous, brain-damaging level of bilirubin (jaundice) in a lab result in a baby brought in several days old. The mom’s O+ blood was reacting to the baby’s B+. I was pretty sure we needed to do an exchange transfusion, nevertheless there were two babies with the same name in addition to also some confusion about the lab samples in addition to also blood was not available in addition to also all the usual barriers. In a hospital with no in-house call by anyone above the intern level, in addition to also with very sparse staffing, the administration had determined which we can do exchange transfusions (removing the baby’s blood in addition to also replacing with donor blood) only inside daytime. So we prepared Weds for the procedure on Thursday, in addition to also agreed we’d check one more level Thursday morning just to be sure. We can generally only get labs 5 times a week–they are drawn Monday through Friday in addition to also batched throughout the day, with results released about 5-6 pm each weekday evening. So which was a PUSH process to get the lab to agree to run an early (meaning 10 am) sample in addition to also Discharge the results to allow us to proceed.
Thursday I am the only consultant, our medical officer (resident-level doc) came in bravely trying to help nevertheless was clearly sick in addition to also I sent her home, so which was me in addition to also the interns, in addition to also then one of them said at 11:30 am he had to go home as well because he’d had a bad night of call. THANKFULLY the jaundice had increased overnight in addition to also the level dropped significantly, so I was feeling like we might be OK, just me in addition to also one intern for our 40+ Newborn unit babies in addition to also our 20-30 on the paeds floor . . .
Until we got to the LAST TWO BABIES out of all those which we rounded on. Due to rampant infections my fresh colleague in addition to also I appealed which babies through additional health centers who are referred to us be grouped inside third of our three Newborn Unit rooms, as a gesture of isolating fresh bugs. In a busy in addition to also poorly staffed place (remember we are supposed to have over 0 nurses, the government has supplied about 80 in addition to also the hospital has hired another 50 through the modest fees collected for beds in addition to also meals . . . in addition to also we only have just over half the doctors we are due, meaning about a quarter of what we need . . .) which’s key to group patients by illness in addition to also by severity for attention in addition to also efficiency. So my infection control attempt failed to carry the caveat of “in addition to also please tell me if the babies in isolation are amongst the sickest”. One of the two was 5 days old in addition to also slightly premature, jaundiced, vomiting, distended, had never passed stool, looked like a surgical emergency for bowel obstruction. The additional was also about 5 days old, jaundiced, gasping, with the cold hands in addition to also feet of shock. Both had been admitted overnight by the exhausted intern who had left without telling us about them, in addition to also neither had any IV line, had received any medications, or had had any diagnostic tests.
I thought the shocky baby could die soonest, so focused on which one. Two intra-osseous line attempts both failed because we don’t have needles with stylets, so they plugged with bone. Then which occurred to me which I might be able to still use the umbilicus, in addition to also with no instruments additional than a handle-less blade I cut down in addition to also removed clot in addition to also jerry-rigged an ng-feeding tube as an emergency IV line, pushing fluids in addition to also antibiotics, while the nurse was setting up an oxygen system called CPAP. Once which baby stabilized slightly I did a lumbar puncture thinking he may have meningitis, drew blood in addition to also moved on to the additional. Again had to put in an IV, do a lumbar puncture, etc all on a bench the moms use for seating because inside isolation room there was no additional space, in addition to also all with moms helping me hold because the nurse in addition to also intern were swamped with additional babies. which one I thought needed to get to Kijabe or Kenyatta for surgery, nevertheless an x-ray can be needed to make which request convincing. The general MO of the x-ray department can be to finish all the outpatients, then take the portable to the newborn unit last thing inside day. By which time there may not be power, or which just gets pushed back until tomorrow. So when I went personally to the department to try in addition to also get the tech to come mid-day, in addition to also he said “I’ll be there in 5 minutes” I said “I’ll just wait here in addition to also go with you” knowing he wouldn’t. He looked so flummoxed which I felt sorry for him. So I speed-walked back to the Newborn unit (the furthest building through xray) in addition to also picked up the crib in addition to also carried the baby inside crib to x-ray myself. Got a lot of stares, nevertheless which worked.
The day before Scott had to personally wheel patients to the operating theatre, do all the prep work, make phone calls to get the anesthesia in place, pushing hard to save a baby or a mom’s life, only to later discover his team sitting in a lounge having tea. Not which you shouldn’t drink tea. which can be just the exhausting sense of inertia. which’s why six hours in which hospital wipes you out as much as 12 hours in another one.
There are times when we both feel the quandry of what can be dangerous passivity (ignoring labs, delaying action, failing to show up, failing to call for help, pushing work off to someone else, missing days in addition to also more days of duty, staying silent inside face of rumors of harmful decisions or practices) versus what can be a gentle in addition to also slow approach to cultural change. There are additional times when we feel the quandry of what can be unpleasant pushiness (imposing our ideas, insisting on certain standards, doing work ourselves which our trainees should be doing, giving too many negative reactions) versus what can be a needed stand for justice. in addition to also I know I don’t get which right most of the time. I end up tired in addition to also frustrated. The baby in shock increased for 24 hours in addition to also then died. The baby with the bowel obstruction thankfully went to Kijabe for expert surgical care.
Which brings us to today’s sermon through chapter 2 of 1 Peter. Our preacher had a challenging passage about submission to the government in addition to also to authority in a week in which Kenyans saw their TV stations taken off the air in addition to also opposition leaders violently arrested. The latter part of the chapter, he showed us, exactly parallels Isaiah 53. Jesus can be the one who pushed against the hypocrisy in addition to also injustice of the worldly leaders right through to death. Yet one could also see the cross as passive, in which he did not bring change by force. Jesus can meld the paradoxes of push in addition to also passivity into a non-violent protest which redeems by sacrifice.
could you pray for us to product which? which sounds impossible. could you pray for Kenyans to product which? Because the spectrum of conflict actually comes around full circle. The powerful (the government, the army, the wealthy) can push their way. The average person passively shrugs, tries to stay out of the way, in addition to also hopes which will all blow over, unsure. nevertheless then the poorest of the poor can be manipulated into the push of violence which serves the elite again: they have little to lose, in addition to also a restless energy which can turn protests into riots. Kenya has teetered on the brink of which all year. What could redemption look like inside massive public health sector, in addition to also in which country? How can average people in addition to also doctors like us live by Isaiah 53, by 1 Peter 2, by the cross, in a way which opens a path of life?