Wednesday, September 11, 2013

I Survived a Third World Hospital

It seems like there has been some confusion over what my situation over the last few days has been. Of course, this is understandable given that I haven't been in a position lately to do much good communicating. Let me just start at the beginning and tell the whole story.

During my entire pregnancy, I have been healthy and my baby has been healthy. I have been going to a doctor (ob/gyn) here in town for regular check-ups, and a couple of weeks ago she saw some signs that things may be starting to progress. It was her opinion that things would probably happen pretty rapidly--and, to her credit, that particular day it did seem like there was evidence of that. She wanted me to start coming in every day so that she could check the baby's heart rate and my blood pressure. I have been doing that, and things have continued to look good. However, things kind of slowed down after her initial assessment. The only real progress I saw after that was that I began to be dilated (so far 2 cm) and the baby was getting really low.  This was about a week ago, but nothing has changed since then except that the baby continues to get lower and lower. Other than general feelings of discomfort/stress and occasional soreness in my back, neck and shoulders, I have had no pain. Any contractions that I have are generally barely noticeable to me (well, only very recently have they started to be a little stronger, but they're still not painful). So, even though there have been some signs of things happening early, it is very likely that I won't actually go into active labor until my due date (this Thursday, Sept. 12) or later.

Something you should know about my doctor is that she is very cautious. If there is even the remote possibility of anything that could be a potential problem, she wants to make sure we check it out.  At one point she sent me to get an ultrasound (which they do at a lab here in town) because there was a slight possibility that the umbilical cord was in a bad position, but it turned out that everything was totally fine. Still, we had to be sure. On Saturday, she was of this same mindset when I went for my regular checkup and the baby's heart rate was a little low. Normally he has been at about 140 to 150, but that day it was more like 120 to 130. This was not necessarily a problem because the normal range for a baby is anywhere from 120 to 160, but it was a little odd for him. She sent me to eat some lunch and then checked me again--with the same result. So, just to be sure everything was okay, she sent me to the hospital here in town so that they could give me an I/V and then check the heart rate again. I was only supposed to be there a few hours, assuming that everything was fine. But, if there was a problem and they needed to do an emergency C-Section, I would be in the right place.

If this isn't already obvious, I just want to point out that Nicaragua is a third world country with socialized medicine. For many people here, it is great that they even have a hospital, regardless of the conditions. Our hospital happens to be way under-staffed with barely enough room for all of the people. Doctors don't have much time with individual patients, and it takes forever even to be seen by anybody. (There are some troubling physical conditions too, which I can describe in more detail personally if anyone asks.) We came to the emergency room Saturday afternoon ("we" being Tommy, my friend/translator Tania, and myself) with a long note from my doctor and the expectation that I would get checked out, get an I/V, get checked out again, and then probably get sent home. That seemed to be what was happening until they actually gave me the I/V and took me to a room with a bunch of beds where other pregnant women were laying around.

At this point, let me explain about the maternity ward situation at the hospital. There are two sections: one for the general populas with as many beds crammed into the rooms as possible, and another, nicer section with smaller, more private rooms (with maybe 3 or 4 beds per room instead of maybe 8 to 16) for those who pay insurance.  For ease of reference, we can call these two sections the "bad side" and the "good side." Since Tommy and I are not even residents here (yet), we don't have insurance for the hospital to be able to use the good side. One would think that we could just pay a certain amount, but apparently it doesn't work that way. The side I got sent to with my I/V bag was the bad side, which is run by a completely different staff than the good side. At the time, though, I didn't care because I was still under the impression that I would only be there for a few hours.

I want to reiterate here that I was only there to have my I/V and to make sure that the baby's heart rate went back up. But, once they checked me out, they figured out that I was already 2 cm dilated. I didn't have any reason to think that this was a problem because my doctor (who is very cautious) already knew about that and was already monitoring me every day. Meanwhile, it was taking forever for my body to take in all the liquid from the I/V bag (and we had to wait hours between times that anyone actually checked on me). Tommy ended up having to go and get me dinner. After eating, I was supposed to wait 30 minutes and then see how many times the baby moved in 10 minutes. (This instruction came from my doctor, who was communicating via the phone with Tania.) We were hoping for a least 3 movements, and I felt 4. I tried to pay attention in the next 10 minutes as well, and there were at least 5 movements, probably more. For my doctor, this was a good sign. Still, we didn't know about the heart rate. Nurses came to check stuff, but they hardly told us anything. Eventually it became clear that we would need to spend the night there. No one was actually communicating anything, so I guessed that it was just the hospital's policy that anyone still there after a certain time had to spend the night. I wasn't happy about this, but I figured they would let me go in the morning. Tania ended up staying with me during the night, sharing my tiny twin matress. However, neither of us slept well at all. It was physically uncomfortable, and I still didn't know what was going on with the baby's heart rate or if I would have to have a C-Section (though I figured probably not because if there had been an emergency they already would have done something). I maybe got 2 1/2 hours of sleep.

The next day (Sunday) the heart rate was back up to normal and I was just waiting for someone to tell me I could go home. Eventually I had another check-up "down there" and everything was fine there too (still 2 cm), but the lady said that they would need to keep me there to keep checking on me. At this point I began to realize that the hospital staff was thinking that I was supposed to be there until I delivered the baby, which might not be until Thursday or later. We had some people make some phone calls and eventually it came down to the decision of a particular doctor (on the bad side of the hospital). While we were waiting to hear something, I had an ultraound, and everything was great there too. Everyone who had checked me said that everything was fine with me and with the baby. But, when we heard the word from the doctor (who didn't even communicate with me directly but with other people in the phone chain), it came back that I would have to stay. No one came to talk to me about this or explain any reasons why. I was just stuck. (We would have just left, but then they would have refused to help us later when I needed to deliver the baby.) We were outraged, but it seemed that there was nothing we could do. Some of my friends came to visit me that night, one of whom is studying to be a nurse. She reviewed my file and was able to tell me that the reason I was being kept was because I was 2 cm dilated. No one seemed to care, though, that I had already been that way for days and was already under the care of another doctor. Tommy stayed there with me that night. I got a little more sleep than the night before, but still not enough.

I want to explain that the thing I was upset about was not even being at the hospital itself. It was already part of my plan to come to the hospital when I was actually in labor. (It was a long and frustrating process to figure out our plan, but, after weighing all of the options, the plan was to come to my doctor's office when labor started and just go to the hospital when it was time for delivery.) I wasn't even bothered so much about the idea of being on the bad side. I knew that the physical conditions are not as good there, but I was okay with the idea of being there 1 or 2 days after delivery if need be. The thing I was upset about was the fact that we had no control over the situation (and people weren't even explaining what was going on). Also, it wasn't even my due date yet, so I realized that I might have to be there for a week or more. Before coming to the hospital, I had been enjoying time at home with Tommy, our last moments together as a couple with no children. That time had been suddenly ripped away from me for no good reason. There were friends here who, after hearing about the 2 cm thing, were telling us that it was actually better for me to be at the hospital, but apparently people are taught different medical standards here than in the States. I can say that being there at the hospital was definitely worse because 1) I was barely sleeping and was very concerned that I would be exhausted by the time I had to give birth, 2) I had only very little opportunity to get up and walk around, which could have really drawn things out unnecessarily and made me all lethargic before delivery, and 3) the stress of the whole thing can't be good for the baby (or for me). On top of all of that, the physical conditions were bad, and the medical staff was downright mean. (I could say a lot about both of those things, but this post is already way too long.)

On Monday, I was somewhat resigned to the whole thing, feeling defeated. The situation got worse, though, when they kicked my translator out. She was able to make some phone calls to get something in the works where she would have a permission slip of sorts to be there. The process was taking a while, though. I had to deal with several situations where I didn't understand what people were saying. But, some of my friends started working on some other options. It became a possibility that I might get moved to the good side. This wouldn't get me home, but at least the physical conditons would be better and it would be a whole different set of doctors and nurses. I wasn't expecting that anything would happen soon, but at least I had the hope of some improvement. Once Tommy realized that I had to be there by myself, he decided to just be there at the hospital, even if he couldn't be in my room with me. Visiting hours are really funky (and they don't explain them up front, so they appear to be pretty random), but after a really boring morning and afternoon (during which the medical staff barely even checked me), Tania and Tommy (and other visiters) were allowed back in the room in the evening. We were waiting to hear from another doctor (who is known by one of my other friends) who has his own clinic but also works at the hospital. It was a possibility that, if he checked me out and everything looked good, I could be released to his care (I could go home and just go to him for daily check-ups) and come back to the hospital with him to deliver (just like the original plan with my doctor, but the hospital recognizes him as somebody). Finally, much later, the doctor came by for 2 seconds just to say that if everything looked good I could go home the next day. (We assumed that he meant that he would do the exam the next day, but he never really said that, though his whole demeanor was that of "Don't worry; I got you.") That was really good news, though I still had to wait for his actual assessment of the situation, and I would still have to stay there another night.

While we were just sitting there, kind of winding down for the evening, suddenly a nurse came in there to take me over to the other side. We were shocked, but we happily gathered up all my stuff. I was taken to a much smaller room with 4 beds instead of 9. The whole feel of the place was better (and the physical conditions were better). The patients were obviously richer "city" people instead of poor "country" people. Apparently one of my friends was able to make a phone call to the right person. Then, as we were sitting there, a doctor came in and asked why I had been admitted (in a tone that said "Why are you even here?"). Tania explained the situation to him and he seemed like he thought it was as stupid as we did. He examined me (he was an actual gynecologist; the staff on the other side were not as qualified) and said that everything looked fine with me and with the baby and that I should go home. We found out later that my doctor had talked to him about my situation, but no one could do anything while I was still on the bad side. I was told that I should just come back when labor actually starts, and when I come back I will be able to come directly to the good side without having to mess with the bad side. So, I got home last night around 10 PM, and once I got to bed I slept deeply for a very long time.

Obviously, we are so happy that I am home now. I went back to my original doctor today and the baby's heart rate is strong like it should be. The doctor said that she has a good relationship with the doctors on the good side at the hospital, so she should be able to help me more now once I have to go back there. As for me, I still feel fine, though the "activity" that I occassionaly feel going on is stronger than it was a few days ago, like something is gearing up but isn't quite ready yet. We are back to our original plan, so I'm just at home waiting. My feeling is, after all this nonsense, he will probably come on his due date (Thursday) just like he's supposed to. But, we'll just have to wait and see...

Before I close, I just want to mention that, while I was stuck in this ridiculous mess, I witnessed so much love from so many of my friends. There is no way I can possibly pay all of them back. I am so thankful for them, thankful for all of you reading this who have been praying for me, and thankful that God was with me even in the midst of all this.

Okay, now that I have told you the whole story, I'm going to go sleep in my bed. :)