By Dr. James Appel - August 26, 2014

Today is a holiday in Liberia.  Not that anyone feels like celebrating much with the Ebola crisis projected to last 6-9 more months. As Mitchell from accounting tells me later when I ask how was his holiday:

“Boring.  We cannot do anyting.  Everyone afraid to go out.  Before we go see friends, ha’ some ice cream, but wid dis Ebola ting, we are afraid to go out.”

I admit, I overslept this morning.  I was exhausted.  Gillian has mostly finished rounds when I get up to the floor. I go see Mr. Carter, the husband of our administrator.  He has not improved.  When I look at the chart, he has only received one of the 6 bottles of IV fluids he should have received since admission yesterday.  And his quinine was only given twice instead of three times.  I call the nurse in and she quickly starts another IV and tries to make up for lost time.

The midwife comes up to talk to me about a patient who has been in active labor since yesterday.  The midwife on yesterday didn’t inform either Gillian or I that the patient wasn’t progressing even though I was in there for another delivery and remember seeing the patient already there.  She is now at only 5cm but has just broken her bag of water.  I tell the midwife we will see if this spontaneous rupture of membranes can get things going and tell her to inform me if there is no cervical change in the next couple hours.

Gillian has found a surfboard for me and we make lunch and get ready to go to the beach.  The sun is finally shining, but there is some wind.  We’ll see how the surf is.  Just then the midwife comes back.

“Da baby’s heartbeat is 168 per minute.”

“That’s ok, as long as it doesn’t go low.”

“She not progressing.  You need to come see her.”

“Ok.”  I follow the midwife up the two flights of stairs and then down the stairs from the wards into the labor and delivery suite next to the OR.

I check the woman and she is dilated at 7-8 cm.  The midwife is pointing to the partogramme and saying we need to intervene.  I really don’t want to do a c-section.

“How are her contractions?”

“Good, doc.”

I put my hand on the patient’s abdomen.  She is having regular contractions but not strong enough and they are short lived, lasting only 10-15 seconds.

“Let’s start her on Pit,” I say.  “Put 20 units of Oxytocin in 500ml of Ringers.”  The midwife sets up the drip and I start it slow and continue to monitor the woman’s contractions with my hand on her belly.  Within a few minutes the contractions are getting stronger and lasting longer, but still with good relaxation in between.  Within 15 minutes the woman exclaims, “I want to push!”

I check her and the infant’s head has come down and she is now completely dilated except for an anterior cervical lip that I reduce manually with the next contraction.  She starts pushing and in another 15 minutes has delivered a strong boy with a healthy cry screaming his lungs out.

I wash up and head home.  We get in the Gillian’s car with her “adopted” baby. He was premature and the mother initially abandoned him for several days.  Gillian cared for him and then the mother came back.  Gillian maintains contact with the mother and baby and takes him from time to time.  She’s had him since yesterday.  We drive down the main highway in Monrovia which parallels the beach.  We have been told there is surf at “A La Lagune” resort.  We follow the signs but find, not surprisingly, a lagoon with no way to the beach.  We ask for directions to the beach and follow a dirt road to a cement block making business right on the beach.  Trash is piled high and I have to pick my way through swamp and garbage to a rocky beach with a tiny stretch of sand.  Plastic waste is strewn everywhere and a young child is just finishing depositing a poop log worthy of a much bigger man.  The waves are crazy: a huge swell tossed and turned by a fierce wind has created a turbulent chop that is positively frightening.

We go back to the main road and drive south towards the airport.  Gillian says there’s supposed to be another good spot near a resort that begins with a “K”.  I see a sign that might be something so we turn down a paved road that ends on the beach near a nice hotel.  The sand is clean and the waves are still crazy even here.  But I’m desperate to surf.  I choose a place where it’s just choppy but the angle of the land makes the waves not come in too strong.  I paddle out.  It’s intimidating going up and down and sideways over these huge swells.  Finally, I’m out a long ways from shore.  I paddle over to where the waves are breaking.  A huge wave piles above me.  I turn and paddle and get caught by a huge surge.  I get to my feet but there is no wax on the board and my front foot slips off.  I get tumbled a bit and get back on just in time to catch the next wave.  They are all breaking and reforming three times so I catch the next two sections in and jump off right on the beach.  I’m done.