Friday, August 14, 2009

Newborn Unit

As promised in my last post, I wanted to take some time to write about my experience in the Newborn Unit this week. I don't have any pictures to upload at the moment, so I apologize for that. Maybe I can add some next week once I take them.

The Newborn Unit at Moi Teaching and Referral Hospital is housed in a beautiful, brand new building called Riley Mother & Baby Hospital. For those of you who have ever heard me talking about IU's children's hospital back home, you may remember that it is called Riley Hospital for Children. The mother & baby hospital here in Eldoret was funded by groups from Riley in Indianapolis, so it was given the name Riley as well. However, it is called mother-baby for short. The hospital was just opened earlier this year and has helped improve perinatal and postnatal care for women and children all throughout Kenya.

Caring for neonates can be very intimidating, and in the United States, the NICU tends to be somewhat of a dreaded rotation. The babies are so tiny and extremely sensitive, meaning that you must be very careful when ordering things for them, even if it's something as small as IV fluids. Before starting my week's rotation through the newborn unit here in Eldoret, I was a little hesitant and didn't know what to think. However, I quickly learned something about neonatology that I wasn't expecting....I love it!! Treating the newborn babies is unlike any other type of medicine that I've experienced. Even treating infants and toddlers is very different, so I really like its unique nature. Caring for the neonates also involves a lot of calculations when figuring out how much to feed them. Anyone who knows me well knows how much I love math, so it should come as no surprise that I enjoy playing with numbers on the wards. Lastly, doing a physical exam or drawing blood on a baby just slightly bigger than my hand can be a little nerve-racking at first, but it actually is quite enjoyable now that I've gotten the hang of it. All of these factors added to my enjoyment in the Newborn Unit this week. I guess I'll just have to wait until I rotate through the NICU during residency to see if I like it as much back home! After all, there are a lot of differences between the units here in Kenya and those in the States (i.e. there are no ventilators here), so I may not end up liking it as much in the long run.

Naturally, during my week in the newborn unit, I fell in love with one of the babies there. Though there are so many kids here in Kenya that I would love to bring home with me, this one defintely takes the cake. He is so precious, and I wish that I could take him back to the United States with me and give him a good home.

This baby's story is definitely a sad one. He was brought to the hospital by the police, who found him on the side of the road outside an elementary school. He is a very healthy baby--just a little bit on the small side. The name on his chart reads "Abandoned baby Abraham". Though we care for abandoned babies quite routinely at our hospital, this child's story is unique. Since his admission, we have tracked down his mother, come to find out that she is in prison. In the United States, the correct way to handle this baby's situation would be to contact the mother and see if she wants to keep the baby. If she did, the baby would probably be put in foster care until mom was able to care for him. In Kenya, the situation is very different. If mom were contacted and states that she wants to keep the baby, Kenyan law states that the baby must be sent to prison to live with mom. If mom expresses no interest in keeping the baby, it is put up for adoption. From the experience of the physicians at MTRH, most of the children who are sent to prison to live with a parent end up coming back to the hospital sometime later with severe malnutrition. A majority of these kids end up dying.

This situation really got me thinking this week. The head physician in charge of the Newborn Unit right now--who, in my opinion, is very, very good--made the decision to put in the chart that the mom was contacted and stated that she didn't want the baby, though the mom was really not contacted. The physician was certain that this 3 pound baby would never survive in prision and thought his only chance at life would be adoption. What an ethical dilemma!! On the one hand, it seemed like the correct decision to keep the baby out of prison, where conditions would be grim at best. On the other hand, our physician's decision is one that will separate the child from his biological mother forever. Who is she to say that that is what's best for the child?? And on a different note, why does Kenyan law mandate that children in this situation be sent to prison in the first place?? All of these questions have been racing through my mind throughout this week, but I've finally come to the realization that it is a lose-lose situation. No matter what, Abandoned baby Abraham will suffer in some way, and some form of ethical conduct will be breached. In the meanwhile, he remains in our Newborn Unit, cute as can be, just waiting for someone to love him. As the plans currently stand, he will be put up for adoption once he gains a little bit more weight.

Well, that's all I've got for you from the Newborn Unit. Next week, I head back to my pediatric team on the wards. I'll miss being with the neonates, but I really enjoy the pediatric side of things at MTRH. This will be my last week here in Eldoret, after which we'll take off to do some traveling before heading back home. I can't believe I'm down to just one more week. I'll be sad to leave, but I'm definitely getting excited to get home and talk to all of you. The one thing lacking in Africa is my family and the saying goes, there's no place like home!

I miss and love you all. Take care and God bless.

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