I have been struggling a little bit lately with how we are teaching our interns and how they are able to adapt that teaching when they go to some of the more rural hospitals in Kenya.
We teach them how to use a bag valve mask and then they go where none exists. . .
We teach them how to titrate fluids with care and precision (and pumps), and then they go to a place where IVs are difficult and unreliable. . .
We teach them how to advance feeds and supplement, and they go where there is no formula and their orphaned patients lack any way to have milk. . .
Last week, I got a call from one of our interns needing to transfer a baby. “I know they need CPAP, Dr. Arianna, but I don’t know how to make it.”
We came up with a temporary solution, but I laid in bed that night trying to figure out how to make it work more than once. (here is a blog david wrote for the hospital about what bubble CPAP is)
Then, a team came from Australia and my friend Leslie showed up with supplies from Children’s of Alabama, and we found ourselves sorting through boxes and bags trying to figure out what we could use. At first, I place a huge bag of extra blue tubing in a bag to throw out, thinking it wouldn’t adapt well to the vents and bubble CPAP containers we had, but the next day, I realized that if we detached the wires and readjusted the attachment device that we could probably make CPAP. I spent the next 2 hours taking out the wires and called my friend Mardi (also the medical director) who had mentioned a seminar at the CMDA conference on adapting adult nasal cannulas to CPAP.
She came to ICU between meetings and we laid our pieces in front of us – a soda bottle, blue tubing, a nasal cannula, and a random plastic piece that was in the box – add some tape and detached finger gloves – and less than an hour later we turned the oxygen from the wall to see if it would work.
The adult team was a little surprised when two pediatricians literally jumped up and down squealing and high fived in the middle of the ICU.
The modifications were bubbling, and we knew it would provide help to babies struggling to breathe. AND. . . we knew our interns could put it together almost anywhere they were given job assignments.
That night, I put together kits in precious ziplock bags – 10 of them for our graduated interns and gave them to Anne to give to her colleagues. We made 2 youtube videos (Here and here) on how to do it.
A small thing, but if each one saves a couple babies lives or gets them through transport to a NICU. . . it will be well worth the hours I spent watching MacGyver on TV, the precious minutes the team in Australia took to save the equipment, the work teams have done to figure out how to modify the nasal cannula, and the time Mardi and I spent one morning to make sure that our interns know we are still behind them, still praying for them, and grateful for the work they are doing in all corners of this beautiful country.