Mar 21, 2016

Unboxing the Philippine General Hospital Charity Ward, Part III: The Neonatal ICU

By Bobjgalindo via Wikipedia
[Image by Bobjgalindo via Wikipedia. This is not what the PGH NICU looks like.]
When I was at the OB admitting section and delivery room, one of the residents asked me, "Why did you choose [the Philippine General Hospital] to give birth in?"

I answered, "The hospital I came from did not have the necessary facilities for taking care of a preemie."

The resident smirked, "Neither do we."

It was a snide remark, but it was not all untrue. From what I've seen, the Philippine General Hospital (PGH) neonatal intensive care unit (NICU) is a poorly equipped place for caring for a preemie.

There were not enough incubators, not enough bassinets, not enough floor space, not enough medical staff, not enough milk supply, and not enough meds on hand to fully answer the needs of the patients.

But it is precisely these limitations that make the PGH NICU an amazing place. Because in this severely austere environment, the dedication and skill of the doctors, nurses, and nurse aides shine bright, like a beacon in a storm.

Entering the NICU

My husband brought me to the NICU to see our son the day after my C-section. 

Only parents are allowed at the NICU, and only one parent at a time, so my husband and my brother, who was visiting, waited outside. 

A doctor met me at the door and showed me where my baby was.

I was led towards an incubator. Most of the other babies were in bassinets, but preemies like my son needed more warmth, the doctor said.

I noticed that there was a heating pad inside the incubator. I realized that the incubator was not working, that's why the heating pad was needed. The "incubator" was really just a plastic box.

So what? For me, the main thing was that my baby was still alive. I was grateful for whatever help that plastic box provided.

Not much bigger than my hand
It was easier to look at the box than the baby. My son was so, so small. His entire torso could fit in my hand. 

He was fitted with a nasal cannula to help him breathe, an oro-gastric tube in his mouth for direct feeding, makeshift eye protectors for the anti-jaundice phototherapy, and an intravenous line in his foot for supplementary nutrition and meds.

My brother, who was also a doctor, had earlier advised me to talk to him and touch him. "Touch is a powerful stimulus," he said.

So I reached inside the box and gently stroked my baby's chest and arms, talked to him softly and tried not to cry.

Later outside, his doctor, a fellow in training, met me and my husband to discuss the condition of our child. 

She was kind but direct, giving no false reassurances. The baby still stopped breathing from time to time, she said. The enemies were apnea and infection. It was too early to tell what will happen.

But we could help improve his chances by doing kangaroo mother care (KMC) as soon as his breathing stabilizes.

Kangaroo Mother Care

KMC is when you put your shirtless baby directly onto your chest, under your shirt, and carry him skin-to-skin for at least three hours. 

Clinical trials have shown that KMC helps baby grow and develop faster both physically and mentally; relieves baby's pain from repeated blood collection; and may even help fight methicillin-oxacillin-resistant bacteria in baby's nostrils.

My baby's doctor also explained that KMC helps keep baby warm and preserves valuable calories; it exposes him to my natural bacteria, which helps to gently build up his immune system; and it limits his exposure to the multi-drug-resistant bacteria of the NICU environment.

PGH is a certified KMC institution. It strongly encourages all NICU parents, male or female, to do KMC.

Although the NICU has visiting hours, parents are allowed to do KMC 24/7. The NICU doctors, nurses, and nurse aides are very supportive. 

If you're craving to spend more time with your baby and the regular visiting hours are not enough, volunteer to do KMC. Then you can stay at the NICU every day and at all hours, and the medical staff will love you for it.

Daily Visits

I visited my baby every day after that. It was easy. The NICU was just two floors away from Ward 14B.

Then the day came that I was to be discharged from the OB ward.

I was not immediately allowed to go home. Because I was leaving my son in the NICU, I had to be interviewed by a hospital social worker first. They needed to know I could and would visit my child at least three times a week to ensure that his material needs (such as breastmilk) were supplied.

They required me to bring a barangay certification of residence so that if I did not return to the hospital, the police would know where to arrest me under charges of child abuse due to negligence.

For me, the idea of not seeing my baby for even a day was unthinkable. But that was me in my pampered middle-class condition.

For many people in the Philippines, a daily visit to the hospital is a very difficult and expensive thing to do. I have witnessed the sacrifices of these non-middle-class mothers for their babies, and I have nothing but admiration for them.

But that is another story.

When the interview with the social worker was done and the documentary requirements were completed, I could finally leave the OB ward.

It was a Tuesday evening when my husband brought me home to our other kids. The very next morning, we were back at PGH for the child we had left behind.

The NICU was at the fourth floor, so I decided to take the elevator. It would not do to be stair-climbing five days after my C-section, I said to myself.

There was a long queue. The single working elevator serviced seven floors.

After 10 minutes at the queue, I discovered that the elevator stayed about 45 seconds at each floor, so a round trip took around nine minutes.

When the door finally opened, only one-third of the queue could get in, so the rest of us had to wait again.

By simple calculation, a person at the end of the line would have to wait approximately 27 minutes before she could get an elevator ride.

The next day, six days after my C-section, and every day thereafter, I decided to take the stairs.

NICU Rules and Routine

Before entering the NICU, everyone has to wash their hands and put a hospital gown over their street clothes to prevent outside dirt from coming into direct contact with the NICU facilities.

My advice: as much as possible, always look for a freshly laundered gown, i.e., one that is still neatly folded.

Remember, NICU parents tend to cry. Heaven only knows what unsanitary body fluids are in those gowns that were simply hung up for reuse after the earlier visitors left.

---

Before you enter the NICU, make sure you have expressed breastmilk with you. The doctors and nurses will ask for it because it is the only thing they can feed to your baby. The Milk Code forbids hospitals from giving babies infant formula.

Without your precious milk donation, your baby will go hungry.

Although PGH tries to make sure the NICU babies always receive enough breastmilk through the milk bank, there are times when the milk bank supply runs dangerously low.

In the four weeks I was there, I witnessed two weeks in which milk was so scarce, babies who had no supply from their mothers and relied fully on the milk bank received only half of what they needed to thrive.

The babies were fed, yes, but they were obviously still hungry. They cried and cried and cried.

Imagine a room echoing with the wail of 16 hungry babies and you would have a good idea of what the NICU sounded like 30 minutes after feeding time.

The staff was visibly distressed. The nurses and midwives often muttered, if only they could produce milk themselves, they would. And you could see that they meant it.

To get more milk, they coerced, cajoled, and bullied every mother who came to the NICU to breastfeed one other baby in addition to their own.

Because I stayed at the NICU for 32 hours at a time, with only 16-hour breaks in between to get some sleep and take a bath at home, I was able to make sure my baby always had all the milk he needed. On good days, I'd have milk to share as well.

But how can anyone produce enough milk to feed 16 babies?

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PGH NICU's KMC chair (Image owned by St. Joseph Trading)
If you're doing KMC, it's a good idea to arrive before 12 p.m. This way, you will have at least three hours to do KMC with your baby before 3 p.m., when the nurses begin endorsing their wards to the nurses whose shifts are just beginning.

The nurses seem to prefer having no parents around during endorsement time, so I used the 3–4 p.m. endorsement period to take my snack and bathroom break.

The most comfortable way to do KMC is by wearing a tube blouse. This will ensure that your baby will stay securely in place even if you fall asleep.

PGH nurses usually wake mothers up when they doze off during KMC because the baby is in danger of falling. But if you're wearing a tube blouse, they will usually let you nap.

The next endorsement time is at 11 p.m. The nurses will ask you to take a break from KMC again because it's time for the nurse aides to bathe the babies and check their weight.

I used this time to have my dinner. My baby and I would resume KMC after midnight. I'd sleep in the plastic KMC chair inside the NICU. My baby and I would stay this way until morning.

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If you want to express milk on site, PGH NICU has a lactation station.

I hated using it.

Hear me out.

Before you express milk, you have to wash your hands. Of course.

You could use a sanitizer too, but any healthcare professional will tell you, nothing beats the cleanness of properly washed hands.

If your baby's most likely killer is infection, you will not rely on sanitizers. You will wash your hands.

But there is no sink at the lactation station. So before you go there, you need to wash your hands at the sink near the NICU entrance.

Then you have to walk all the way to the lactation station, about fifty meters away.

Then you knock and cross your fingers.

The lactation station's door is always locked. It cannot be opened without a key.

Only the nurses and nurse aides have access to the key. So you'd better hope that when you get there, there will be somebody to open the door for you.

Often, there is not. What I used to do was, after I washed my hands, I would try to find a nurse or nurse aide who would open the lactation station for me.

They would tell me to go ahead and they'd be right behind.

But with all the things that go on in the NICU, it often happens that they forget that somebody was waiting for them. And the door would stay locked.

How did the other mothers get in, you ask.

Most of the other mothers kept vigil at the bench right beside the lactation station's door. I never found out why they were not inside doing KMC.

When a mother's baby cries inside the NICU, a nurse would call the mother to go into the lactation room to feed her baby and then express milk for the milk bank as well. Perhaps the other mothers went in at the same time.

I noticed the mothers there usually did things en masse: have lunch, go to church, sleep, express milk.

I didn't join them for only one reason: I have always preferred to do things alone. That's all.

But I digress.

Should you succeed in entering the lactation station, you'll find hospital gowns on the chair. You're required to put one of these over your street clothes.

But you can't really express milk while wearing a hospital gown, can you? So nobody really wore those gowns.

To avoid being scolded by the nurse, we put the gowns across our laps.

Some rules just don't make a lot of sense.

Then there's the milk pump. The first time I used it, the collection bottles and breast flanges were newly washed.

But that was the last time I saw them clean. They were apparently passed from mother to mother without being washed in between.

Got milk?
I understand the limitations. There just weren't enough replacement breast shields/flanges and bottles to keep up with the parade of moms using the pump, I guess.

There was only one or two pairs of bottles that fit the pump. The expressed milk was stored in repurposed specimen bottles.

One cannot help but suspect that the hygiene standards of the lactation station somehow contributed to the rate of infection spread in the NICU.

Trying to avoid that risk, and also because I got so tired of knocking on a door that seldom opened, I learned to hand express my milk and did my milk letting directly beside my baby's bed in the NICU instead.

Continued in Part IV: Life at the NICU


The Nanay Notebook is written by Blessie Adlaon, a work-at-home and homeschooling mom of five. Check out our About page to know more about this blog's author and our policies on advertising, press releases, and reposting.

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