It is Christmas and every year we close our clinic for 3 weeks to allow our Kenyan staff to return to their families for the Christmas holiday.  It is the only time in the year the clinic is closed and it is a hard decision for us.  The last three years we have remained in Sudan over Christmas, operating the clinic on an emergency basis.  But that has proved quite challenging with minimal national staff and only our missionary doctor Tom and misisonary midwife Stephanie to attend to patients.  All our Kenyan staff return home today and therefore we ask for prayer for the clinic over the next three weeks.  In the last 24 hours we have been slammed with patients and 6 births in 20 hours.  Here’s how it looked, we only had one midwife as Stephanie had not yet returned from her R & R, she worked more than 24 hours without a break and with closing for Christmas we know the community will be affected:

6 mothers in labor between 10pm and 7pm. The first delivery was successful-a healthy child with good scores at 10pm. At 12 midnight a second mother came. She was an attempted home delivery, came with the baby between her thighs with the placenta still attached. Our midwife Margaret did a quick obstetric exam revealed that it was twins and preterm at around 7 months. The second twin was borne within 15 minutes. Both twins had very poor scores at birth with 2^nd twin barely having any respiratory effort.  Both of them needed oxygen with the same priority. But we have only one oxygen concentrator . So all the medical staff including our community health worker Gabriel, were working too fast as a team to resuscitate the two dying babies. We had 4 staff doing CPR, fixing lines, suction, setting up for oxygen praying during this crazy time, and improvising warm bags of water to boost the babies’  body temperatures (temperatures were <32 degrees Celsius for both kids) . We had to share the same source of oxygen for the 2 babies+ alternately giving both babies according to their response to resuscitation.  Their conditions were changing every other time with improvements not sustained enough to stop resuscitation. So we went on and on for 4 hours during which one baby, 1^st twin, died, and another mother in labour came. We put the surviving twin on oxygen (at 9am). This child seemed to have chances of survival but 1 hour later was resuscitated again.

The mother in labour who had just come had concerns also: she had been in labour for 2 days, was the first pregnancy and was so uncooperative. At around 10am she was fully dilated and was ready to push. All the patients including those who had come for review and admissions had not started being attended to yet. Our community health workers explained to them and made them calm and patient. Margaret was doing the delivery for this lady and 1 and half hours later she had not delivered. The fetus had developed distress already. Dennis was dealing with another new mother in labour who had just come and Tom was seeing a 2 years old child with very high fever and all other staff were busy giving health talks, taking care of the child on oxygen, giving scheduled drugs to admisions, registering and triaging patients. No one was free.  As Dennis examined the new mother in labour, Dr Tom jumped into the delivery room to help Margaret on the difficult delivery. One hour later, the contractions ceased and no progress had been made. So we spoke to the family on need for urgent referral. The lady was referred to Wau immediately.

The new lady in labour at was least 5 hours away from delivery and was advised to walk around.

We started attending to our regular patients at around 12 PM.

The new borne who was on oxygen later succumbed at 4pm, so both twins died. The lady who was taken to Wau was reported being prepared for surgery (C/S).

This evening 2 more mothers  came in labour. The lady who came in the morning is also close to delivery putting the number at 3 total mothers in labour.  Another 1 day old baby has been brought in with severe respiratory distress, dehydration, looking toxic. Is on Oxygen, antibiotics and rehydration.

We ask for your prayers for the family who lost the twins, for safe surgery for the lady referred, for safe deliveries of mothers in labor, and for staff to have rest thereafter especially Margaret.