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drokelley-blog · 6 years ago

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Okelleys in Tenwek 2019

Since returning from Africa, my wife Dana and I have found it difficult to respond when asked how our trip was. “Good” or “great” is the usual one-word response but many more adjectives come to mind, as it was a trip filled with a mixture of different encounters, experiences, and emotions. And somehow just one or two words do not suffice. It would definitely be accurate to say that it was eye-opening.

We came to this particular place because of the Many family. Most folks know of our long-term friendship with them, so I won’t elaborate here, but it was wonderful to visit them and experience what life is like for them at Tenwek. I believe they are where the Lord wants them to be, but like life anywhere, Tenwek has its share of happiness and hardships. We had learned what we could ahead of time about Kenya and Tenwek from materials provided by Samaritan’s Purse who took care of all the logistics of our trip, as well as from conversations with the Many’s and also from our daughter Claire, who had visited with them for several months in 2015. But nothing really could prepare us for a place that is so different from our everyday experience back home.

Our drive to Tenwek hospital took us 4-5-hours from the airport in Nairobi on a rough road that had become paved only 5 years prior. Tenwek is located in the rural highlands of southwestern Kenya which has no large or modern cities nearby, yet the population in the general area is quite large. In addition, patients are referred from long distances for treatment at Tenwek which is one of Africa’s largest mission hospitals. As you might expect in a developing country, the people there do not have most of the things we take for granted. Clean water, reliable electricity, passable roads, and adequate sanitation are still hard to come by there, and there would be no access to adequate healthcare without Tenwek Hospital. It is a 300-bed teaching facility with a long evangelical-centered mission to provide the best healthcare possible. 72 of those beds are designated to the maternity service, where I spent my time working as a member of the “OB service”.

Most women in this area give birth at home. There are smaller clinics in the area which provide very basic care but lack the ability to handle most emergencies. So, women who come to Tenwek either arrive from their village, or are referred by these smaller clinics with little or no prenatal care and are either high-risk or suffering some sort of complication related to pregnancy or childbirth. The maternity service delivers about 3-400 babies per month, and also receives a large number of patients who have delivered elsewhere and are experiencing complications. The single delivery room holds 3 delivery beds or “couches” and is used for deliveries, triage, and labor exams. There is a 5-bed “labor” ward for laboring patients, inductions (of which there were usually 4-5 daily), and any high-risk antepartum patients. Of course, this ward stays full and often spills over to the other rooms on the unit, which normally accommodate lower risk antepartum, postpartum and post-operative patients. Healthy newborns stay with their mothers. Mothers whose babies are in the neonatal intensive care unit (NICU) stay until their babies are discharged. The NICU has a capacity of about 45. So, the halls are normally crowded with patients, visitors, and staff, and it is not unusual to have 2 mothers assigned to the same bed or 2 babies assigned to the same isollete due to overflow. There is one O.R. in maternity for cesarean sections, or other minor procedures, but it is only available from 9 AM to 4 PM. Outside these hours an emergency cesarean section must be done in the main O.R. or “theatre”, which is in another building.

To say that the conditions in the hospital are different than what I normally have available at home would be an understatement for sure. That being said, Tenwek provides excellent care for maternity patients considering their limited resources. Nurses manage all labor patients and perform all uncomplicated vaginal deliveries. They have medications such as Pitocin and magnesium sulfate for inductions and treatment of preeclampsia but do not have infusion pumps. They also have available the usual medications to treat postpartum hemorrhage. There is no continuous fetal monitoring available including for patients on Pitocin or with other high-risk indications. There is no epidural service available. Intermittent fetal monitoring and a vaginal exam (VE) usually are performed by the nurses every 4-6 hours on all labor patients. Inductions are performed with misoprostol, Pitocin or Foley balloon. Patients are not screened for group B strep but antibiotics are available to treat infections and are given preoperatively. Patients with one previous cesarean are allowed to “TOLAC” (trial of labor after cesarean). Everything is in short supply, and items we normally consider disposable in the U.S. are “repurposed” until they are no longer usable, such as Bovie pens and laparoscopic trocars. O. R. packs included cotton drapes and towels, which are sterilized and reused.

2-3 nurses cover active labor patients and inductions in 12-hour shifts, and 2-3 to cover postpartum, gyn post-op, etc. There are another 2-3 in the nursery caring for the newborns who are sick or premature. As I mentioned, the nurses perform the labor checks, non-stress-tests (NST’s), and routine deliveries and call the intern or physician for complications. The only patients directly under the supervision of the OB team are antepartum admissions, post-surgical patients, and patients with complications. During my time there were 2 medical officers (completed one year of post-medical school training), and 1-2 Ob- gyn’s, depending on who is available on a given day. The Ob-gyn doctors are currently Americans including Dr. Cheryl Cowles and Dr. Angela Many, but there is a new Kenyan Ob/Gyn starting soon who had just completed residency training in Uganda. There were also 2 clinical interns and 3 medical interns. Clinical interns have similar training and background to physician assistants in the U.S., whereas medical interns have completed medical school and will be medical officers at the end of their internship. Night and weekend call are divided among the Ob gyn doctors, medical officers, and family practice residents; however, the Ob doctors are always on the hook if needed to help with complicated cases. The interns take call also, and work pretty much like interns in our training programs back home, which is to say “hard”. On the OB service during my visit there was also a 1st year family practice resident and a 2nd year surgery resident. The daily rounding list included post-op, antepartum, ICU, and any other patients with complications and usually had 40 or so names on it. There were usually 10 or more new admissions every day. Many patients presented with “LAPS” (lower abdominal pains) and were full-term or post-dates based upon their last menstrual period but had no prenatal care and no ultrasound to confirm their due-date. There is one portable ultrasound machine on the maternity ward used by OB physicians and medical officers for performing scans. Typically, these patients would receive an ultrasound, NST, and a VE and were either induced, kept in the hospital for observation, or discharged undelivered and given a follow up appointment in the clinic in 1 week with the prayer that they would keep that appointment or return in labor and deliver a healthy baby.

So, between daily rounds, clinic, scheduled surgeries (non-emergent surgeries are booked on Tuesdays and Thursdays in the main theatre), new admissions, and emergencies, the OB service kept very busy. In fact, the number of patients and seriously ill patients was more than I had ever encountered in one place. The diagnoses on our rounding list resembled the contents section of an obstetrical text book. Tenwek mothers are also chronically anemic and that is a bad thing in obstetrics, where the potential for rapid blood loss is high. We ordered more blood transfusions during my 2 weeks than I have in over 10 years and possibly my entire career. Family members were required to donate, and nursing students, medical staff and missionaries were also called upon often to give blood in order to address the critical need. OB patients occupied 3 out of the 6 ICU beds in the hospital the first week I was there. Unfortunately, 2 of the 3 did not survive their illnesses. We also had several babies born premature and several stillbirths and most of these outcomes could have been prevented if they had gotten to the hospital earlier in their illness. I often thought of how back in Knoxville I would transfer such seriously ill or preterm patients somewhere else for their care, but at Tenwek there is no such thing as “somewhere else”. I took call 4 nights in 2 weeks including an entire weekend. I lied awake at night waiting for the beeper to go off and it usually did. I was able to take call from “home” (our small apartment at the guesthouse which is a 5-minute walk away), but they were not particularly restful nights.

Tenwek is a teaching hospital. So, we would begin “teaching” rounds every morning between 7 and 8 am, just like back in medical school and residency. This took some getting used to since I had not done this in 30 years, but I did enjoy the interaction with clinicians in training. Of course, acting as first assistant and helping an intern learn to perform a cesarean section requires patience, but this is critically important at Tenwek as the goal is to train more Kenyan nationals to provide for the healthcare needs of their country. There were daily conferences such as grand rounds, and “M&M” (morbidity and mortality), just like in any traditional academic setting. But there is also a clear spiritual emphasis here that cannot be missed; one that is related to the spiritual well-being of the interns, residents and ultimately the patients. The motto at Tenwek is, “we treat, Jesus heals”. Prayers are said for the patients before rounds and before every surgery. These prayers became a great source of comfort and strength to me personally as we cared for many seriously ill patients. In addition, a morning team devotion preceded rounds each day, and there is a devotional meeting for the entire medical staff every Wednesday morning in the hospital auditorium. In the evenings there are small group meetings for Bible study and fellowship in the homes of the missionaries for medical staff, interns, and students.

As you might gather from my description, the daily conditions, work load, and severity of illnesses which I encountered during my time at Tenwek was almost overwhelming. And yet I was humbled and amazed by the ability of the medical staff and missionaries to carry on tirelessly with great compassion and concern for their patients. Before the trip, I read a book entitled “Miracle at Tenwek”, which describes how the mission of Tenwek began and has since remained focused on seeking God’s leadership in sharing the gospel through medical missions. I believe that the success of Tenwek is due to the fact that the focus is still the same today. “They still do it right”, was an assessment I heard from a returning missionary in describing Tenwek in it’s mission to train individuals to provide compassionate care for the physical as well as the spiritual need of their patients.

So, to find one word to describe our trip to Kenya is difficult. It was a trip filled with joy, kindness, and beauty as well as suffering, sorrow, and poverty. But if I had to choose one word, I would use the word that another visiting physician kept saying: “amazing”. It’s a good word to describe Africa, Kenya, the Kenyan people, and the missionaries who work at Tenwek. But it is also a great word to describe God, whose hand we saw in every aspect of our trip.

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travelingtheusa · 4 years ago

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TENNESSEE

2021 May 4 (Tue) – We went to Oak Ridge this morning. It was called the Secret City back in the 1940s. Oak Ridge was one of 3 cities where the atomic bombs were produced. Its population went from 1,000 to 50,000 people in 6 months. Unfortunately, the museum was closed. So was the Museum of the Appalachia and the Museum of Tennessee. We got to see a short film at the NPS office, which was a little booth located in the corner of the Children’s Museum.

We then drove to Knoxville. There wasn’t much to see but we drove around to look at the city. We drove into the Old City and past Market Square. The city had lots of old buildings mixed with new construction. We stopped at Corner 16 for lunch. It was an excellent choice. The food was outrageous. We bought some of the chili to bring home for dinner.

2021 May 3 (Mon) – We packed up and left Lebanon at 9:30 a.m. It was raining and rained for most of the drive. About three-quarters of the way to our destination, the skies opened up and it poured. The rain was so heavy we could barely see past the hood. There was a break in the rain just as we arrived at our new campground – the Windrock State Park Campground in Oliver Springs. It rained all night long, sometimes ferociously. There was lightning and thunder and, at times, hail.

The campground is very high class. We spotted at least 3 Prevost RVs. Those are very expensive rigs. This campground is up in the mountains and is nicely laid out, neat and clean with plenty of space between sites. There is extra space for ATVs. This seems to be a favorite spot for ATV riding. The campground is at the head of many trails leading off into the wilderness. We’ve been watching them come and go for the two days we’ve been here. Covered in mud and debris and smiling from ear to ear.

2021 May 2 (Sun) – We drove into Nashville today to go to the Johnny Cash Museum. His life story was quite interesting. His parents couldn’t agree on a name when he was born, so they named him J.R. Years later, when he tried to enlist in the Air Force, they insisted that he had to have a first name so he chose John. That morphed into Johnny as his musical career took off.

It cost us $20 to park for two hours. The parking lot appeared to be 3 in 1; three different machines for different areas of the same parking lot. It was strange. The town was bustling with people. It was so crowded that we had to step off the sidewalk to go around clusters of folks gathered outside restaurants and shops. No one was wearing masks outside, although you still have to wear a mask indoors. Looks like things are finally starting to loosen up. Infections around the country are dropping as people get the vaccine and venues are beginning to open again. It feels very hopeful.

We wanted to have lunch in Nashville but it was too crowded. We hopped in the truck and drove back to Lebanon. First stop was at the number one and number two restaurants, according to Trip Advisor. But, you guessed it. Too crowded with long wait times. We finally wound up at Cracker Barrel. The gal who checked us in said it was 20 to 30 minutes. We waited almost an hour. The food was good, as usual, but the long wait took the bloom off the rose.

After lunch, we stopped at WalMart to get some groceries. Then it was a stop at the liquor store to pick up some spirits. And finally, we stopped at a gas station to fuel up for tomorrow’s trip. We got back to the campground at around 3:45 p.m. It started raining later in the evening. Weather forecasters are saying it’s going to rain for next two days.

2021 May 1 (Sat) – We packed up and after a brief stop at the dump station to empty the tanks, we were on our way. It was 2-1/2 hours to Lebanon where we are staying in a KOA. This campground is very tight and also on uneven terrain, like our last campground. It is lucky we have a pull-through site. It would be very hard to maneuver between all the rigs and on a hillside.

Once we were set up, we took the laundry to the machines and did the wash.

2021 Apr 30 (Fri) – We drove to Lexington (still in Tennessee) for lunch at Dan’s Café. It was a small house converted to an eatery. It had a 50’s flair to it. The food was good.

After lunch, we drove to Parker’s Crossroads and toured the battlefield. The north and south clashed there and had an intense 5-hour battle where neither really won. The confederates were able to escape and cross the Tennessee River but not before causing havoc for many miles on their mission to disrupt Union rails and resources. The battlefield is spread out with walking tours and storyboards recounting the activities that went on at that point. The Visitor’s Center had a video that told the story of the battle. It was quite informative.

Next door to the visitor’s center was the Tennessee State Veteran’s Cemetery. We drove through the grounds. There were only about 50 graves. It is a new cemetery just established in 2018.

After getting some fuel, we stopped at a gas station shoppette to pick up milk. They had loads of beer and soda to go with lots of snacks, but no milk. The closest supermarket was 24 miles away. We drove over the bridge to the next gas station shoppette and were able to find milk there. Thank goodness!

We got news that the Washington, D.C. caravan we signed up for has been cancelled. The caravan was scheduled to take place the first week in July and the plan was to march in the National Parade on Independence Day. The parade, which is run by the National Park Service, has been cancelled. In addition, several other tourist places around Washington, D.C. will not be open. Also, the number of rigs signed up for the caravan fell to 11. That’s below the minimum threshold of 15 rigs for the caravan to go. We will still go to D.C. for the 2 weeks we planned to be there. So will our friends, Rick & Brenda from Florida. Our other friends, Hank & Brenda from Texas, cancelled out of the D.C. caravan but they will join us on the drive from D.C. to New York for our caravan around Upstate NY. I sent an email to the manager at Fort Belvoir to tell her we will still be coming for the 2 weeks we reserved.

2021 Apr 29 (Thu) – We pulled up stakes and left Memphis at 10 a.m. It rained during most of the drive. In addition, as accident occurred right in front of us. The traffic was at a stand still for an hour and a half. Two tractor trailers and two cars got into it. One of the cars had 3 kids in it. Luckily, no one was seriously hurt.

We finally arrived at the Natchez Trace RV Park at 1:30 p.m. It was a little tricky getting into our site around the trees. The slick mud didn’t help things a bit. The trailer wouldn’t level right either. It kept resetting itself and the RV was on a tilt.

2021 Apr 28 (Wed) – We dropped off Bonnie’s urine sample to the vet’s office this morning. The vet came out and told us there is no urine infection. She also refilled Bonnie’s liver medication for 3 months. I asked for 4 but they only had 3 boxes. Oh, well. You take what you can get.

After the vet, we drove to the Blue Plate Café where we met Steve & Diane for breakfast. Not only was the food good but the company was also enjoyable. We stayed for over an hour and a half.

Next stop was at Vitamin Shoppe where I got some vitamins. Paul is still not feeling well. He’s still suffering the effects of the vaccine.

2021 Apr 27 (Tue) – I took Paul to lunch (or did he take me?) at Las Tortugas Deli Mexicali. It was a different kind of set up. You ordered at the counter from a menu that was in Spanish with English in parentheses. We recognized very few of the dishes. We both wound up ordering sandwiches which were very good. We brought leftovers home.

I called the vet’s office where no one knew anything about what I was calling about. I left a message for Dr. Bates to call. I called again at 5:30 pm. The doctor got on the phone and said she left a message today. There was no message on my phone. She didn’t know anything about a urine sample so we agreed to bring another one in tomorrow. She said she would refill Bonnie’s liver medication. Five months’ worth will be waiting for us when we drop off the urine sample tomorrow.

Just as we were sitting down to dinner tonight, there came a knock on the door. It turned out to be Diane. She and husband, Steve, were on our Utah caravan. He served as the Weatherman. They will be staying here in the campground until Friday. We agreed to get together for breakfast tomorrow.

Paul is feeling cruddy tonight. He is feverish and achy. Guess the vaccine is doing its thing.

We got a call from a campground in Ticonderoga, NY today. The manager had looked over the list of RVs I sent her and decided they couldn’t accommodate the larger rigs. They cancelled our reservation. What a disaster!!! Less than 3 months to go and we lose a campground. We would be lucky to find another place that can fit 22 RVs at this late date during the height of the tourist season. I felt sick. Paul jumped on the Internet and did some research. I tried calling the campground we were going to stay at before the cancelled one to see if we could just extend our stay. No luck. They are booked solid for the week after us. Paul found a place 65 miles east in Peru, NY. I called and they were able to fit us in. I sent a list of campers and RV sizes. Hopefully, things will go OK. I also got a call from another campground on our caravan saying our deposit was due May 1st or our sites would open up. I quickly sent off a missive to SMART HQ to send out a check. That could have been a serious problem! Luckily, the fates were looking after us.

2021 Apr 26 (Mon) – We went out to lunch at a BBQ place. The food was good. Then we dropped off a urine sample at the veterinarian. Bonnie is acting like she has a urine infection again. *sigh* She just can’t seem to get past this thing. The vet she saw last time was not in, so a tech took the sample and said he would handle everything. Also pass on our request to refill Bonnie’s liver medication.

We then went to CVS where Paul got his second COVID shot. I picked up some Mother’s Day cards. As we were standing on line, Paul saw a young man wearing a motorcycle helmet put two car chargers in his pocket and walk out. He yelled at the guy but the clerk, who was ringing up a customer in front of us, just giggled about the incident. She just shrugged it off.

I called the vet’s office later to see what happened with the urine sample but nobody had anything to say about it. Guess I will talk to Dr. Bates tomorrow.

2021 Apr 25 (Sun) – It was cold this morning. The heat pump went off about 2:30 a.m. this morning. We keep that off because of the noise it makes. It turns out the furnace was not working. It looks like the techs did something that made the controls work improperly. We cannot get the furnace to turn on.

All Vanleigh personnel were gone early this morning so I posted our issue on Facebook. Sure enough, the tech folks were still monitoring the website and responded to my post. The tech said he would send us a new program for the Spyder Control Panel. Apparently, he knows exactly what they did. Aaaaarrrggghhh!!! We’ll have it sent to Travis & Sam where we will be in two weeks.

We packed up and left Hot Springs at 10 a.m. It was a long drive. We pulled into a parking lot at a mall around noon to make ourselves lunch. We arrived at Agricenter RV Park in Memphis around 2:30 p.m. The host couldn’t find our reservation and it turns out that I had made reservations for a different date. He was able to clear up the confusion and find us a spot.

After that lovely RV resort in Hot Springs, this feels like a slum. Lol. The RVs are very close to each other in rows with grass that needs cutting, no trees, and stone campsites. The road is asphalt that needs some repairs. Several of the campers are long term as we saw 40 lb. and 100 lb. propane tanks outside their RVs. The cost was higher than I expected but reflects a military discount. Guess we can expect charges to continue to increase with all the new RVers out there and no new campgrounds to accommodate them.

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ralphmorgan-blog1 · 8 years ago

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Stopping the opioid crisis in the womb

Knoxville, Tennessee (CNN)The sound of a heartbeat pulsates through the air, and a grainy image of a baby flashes on screen. Jessica Hill smiles from her chair in the ultrasound room.

Gathered around are her doctor, nurse and best friend.

They are all eager, anxious, excited -- and worried about the health of the baby. In that way, this ultrasound is like most.

But what's happening in this room is anything but routine: Jessica, 28, is hooked on opioids and detoxing during pregnancy. Dr. Craig Towers is the pioneering -- and controversial -- obstetrician shattering the common medical belief that this approach could lead to the death of the fetus.

Moments earlier, Jessica's baby underwent a stress test to see how she was progressing, a way to make sure the stress of detoxing is not harming the child. "She didn't like it at all," says Jessica, who is in her 35th week of pregnancy.

"It means that she's paying attention to what's going on," says Towers, who specializes in high-risk pregnancies at the University of Tennessee Medical Center.

Jessica admits to making many mistakes, but here, she is making what she says is the best choice of her life: getting clean for her baby. She also has an 8-year-old son who has been raised by her mom. She hopes detoxing will further heal their relationship.

A tattoo above her heart reads "From pain comes strength."

Tell us your story of how you or a loved one is working through an addiction to opioids or other painkilling drugs, from successes to struggles. Text/WhatsApp us at +1-347-322-0415

She wishes she could lean over her belly, put her lips by her daughter's head and whisper to her about life lessons. "I'm working on building our relationship and trying so hard. I mainly want her to know that I won't make those choices any more."

Jessica marvels at the screen. "Is that her little face?"

"Yeah, that's a cheek," Towers says.

"She's got chubby cheeks," Jessica replies.

When Jessica first came to Towers four months ago, she was taking a standard opioid-based maintenance medication, called Subutex, meant to keep her from getting her fix from the street. She had been told at a drug maintenance clinic that detoxing would kill her fetus.

When she went to a doctor who she hoped could deliver her child, Jessica was humiliated. She had informed the doctor she was taking Subutex to tamp down her urge for painkillers. The doctor, she says, told her they don't "take irresponsible patients."

"I was just so upset, because they just shunned us away," she says.

The maintenance clinic then referred her to the University of Tennessee Medical Center. Jessica first visited a doctor at the hospital's prenatal clinic in December and was introduced to Emily Katz, the substance abuse coordinator in Towers' office. Katz saw a young woman who needed help -- but, more important, wanted help.

"We snatched her up," she says. "There was just a spark in her. When I told Jessica, 'I think we can help you,' tears just streamed down her face."

It's now mid-March. Towers has weaned Jessica off the medication slowly, with Jessica making the hour-long trip from her home in Morristown to his office every two weeks, almost always accompanied by her best friend, Stephanie Moore. Today, Stephanie chimes in with cheerful jokes about the baby's stubbornness, similar to her mother's.

In between visits, Jessica texts and phones Katz, who was motivated to help others after her brother died of an overdose. The two have become so close over the months that both say they're like twins separated at birth. Jessica has nicknamed Katz "Nurse Barbie" for her attractiveness and her straight blonde hair.

On this day, Katz quietly observes during the ultrasound, making her show of support by just being there.

Jessica went completely off the opioids over the past week, a critical juncture during any detoxification. She suffered through diarrhea and other ailments. Only once did she give into her urge, taking one Subutex pill. "It sucks," she says.

In those down moments, Stephanie and Katz remind her why she's going through this: that the struggle is worth the pain.

But even with all that Jessica has endured, there's no guarantee her baby will be free of the violent tremors and excruciating pain that marks those born to addicted mothers. About one in five women who detox in Towers' program still sees her baby suffer withdrawal after birth, depending on how early in pregnancy the mothers were able to become drug-free and how their bodies metabolize the opioids still in their systems.

Towers assures Jessica that her baby will be safe if she continues to not use. With the due date a month away, he says he wants to begin seeing her twice a week to make sure she stays on track.

Her pregnancy was not planned, and Jessica worries that child services could take her daughter away because of her history of drug abuse.

"The only way they would take her from you is if you were using something off the street or if there's something in your drug screen that wasn't prescribed to you," Towers says. "That's why I just want to see you a lot, make sure you're doing OK, and if there's any issues, we prevent a relapse."

The next few weeks will prove critical. Jessica will lean on this supportive cast: the doctor, her best friend and "Nurse Barbie."

Towers knows all too well what's at stake. Three days earlier, an expectant woman who he hoped would enroll in his program was found dead of an overdose, the first such death this year in Knox County.

Concerns over relapse risk

Every 25 minutes in America, a baby is born in withdrawal from opioids. They shake violently, vomit constantly and scream incessantly. Upon arrival in this world, one of the first things the newborns are given is an opioid to lessen the intensity of their shakes.

Delivery rooms have become overwhelmed, especially along the Appalachia corridor stretching from Ohio and West Virginia into Kentucky and down to this northeast corner of Tennessee. The average hospital stay for a baby suffering withdrawal lasts about 17 days, costing more than $66,000 per child, according to the US Centers for Disease Control and Prevention.

Tennessee alone experienced a 15-fold increase in babies going through withdrawal from 2002 to 2012. And the numbers have continued to rise.

How to treat these babies has become a matter of urgency among doctors, clinicians, researchers and social workers. Are we failing these newborns? What are we not doing that we should? Can more be done on the front end to prevent the shaking and vomiting?

Almost everyone agrees that the nation must tackle this issue with a comprehensive approach. But the opinions on what to do vary. Long-standing guidance from the American College of Obstetricians and Gynecologists on detoxification during pregnancy has been this: "Withdrawal from opioid use during pregnancy is associated with poor neonatal outcomes, including early preterm births or fetal demise, and with higher relapse rates among women."

At a summit on prescription drug and heroin abuse in Atlanta in April, participants from across the country discussed the increasing number of babies going through withdrawal and how to best care for them and their mothers. Experts stressed the need for better treatment programs for pregnant women, especially in rural America.

Detoxification during pregnancy wasn't considered a viable policy approach at the conference. Some experts said it would be careless -- even reckless. Even if detoxing were medically safe, they said, the risk of relapse was too great, putting newborns in danger as soon as they went home.

"My biggest worry about detoxing in pregnancy are rates of relapse," says Dr. Stephen Patrick, assistant professor of pediatrics and health policy at Vanderbilt University and an attending neonatologist.

Recent studies have found that women who use opioids have a 40% to 70% rate of relapse, Patrick said. He said he admires Towers' work to try to improve outcomes, but there are too many "questions about detoxification and pregnancy."

"I would never say that detoxification may not be the right thing for an individual woman, in the right setting with the right supports," Patrick added. "It's just that overall, I find it worrisome because of relapse rates."

One couldn't help but wonder: Why would a doctor stake his career on something so risky?

'We can win'

Towers, 62, never expected to be a trailblazer in this field. He'd followed the protocol for nearly four decades: Never detox an expectant mother because of the possibility of "fetal demise," the clinical term for a stillbirth.

But about the time he arrived at the University of Tennessee Medical Center seven years ago, the opioid epidemic hit. Women kept asking why they couldn't detox during pregnancy.

He looked into the research, expecting to confirm everything he'd followed for years. "To my surprise," he says, "I found it came from two case reports."

Those two cases in the 1970s set the course for doctors to advise against detoxification. Towers dug further and found that five other, mostly overlooked studies involving about 300 women had been done over a 23-year period beginning in the 1990s. Each indicated that detoxification didn't pose a risk to the fetus.

He embarked on his own study and found detox to be safe. "Over the last six years, I've detoxed more than 500 women without a loss," he says. "There really is no data in the literature to support that detoxification will kill the baby. Like I said, it came from a propagation of two single case reports in the literature in the 1970s."

Detoxification, he admits, is not for every woman. His patients have horrific back stories that too often include rape, physical abuse and generational addiction. "Each case is complicated," he says. "We never coerce anybody or shame them into detox. The patient has to be interested in this. Otherwise, they're not going to succeed."

Like others, Towers worries about relapse. When he started his detoxification program, the rate of relapse among the participating mothers was more than 70%, compared with 40% and 60% for all people in addiction treatment nationwide.

Four years ago, he hired Katz so women could stay in constant contact with his office throughout their pregnancies and for eight weeks after they leave the hospital. He hopes to increase that supervision time to six months to a year. But already, he says, the rate of relapse since adding the behavioral health component has dropped to around 17%.

Not a single woman has fatally overdosed after going through his program. "Knock on wood," he says.

He gives speeches across the country to spread the news of his research, and he meets with insurance companies in hopes they will pay for it. To deny women who want to get clean the opportunity to do so is wrong, he says, especially as they enter the crucial role of becoming a mother.

"This is a treatable disorder, and we can win," he says. "Hopefully, one of these days, we'll change the protocol for the country. We just have to continue plugging away."

And shouldn't the medical community try to stop generational addiction in the womb, he wonders, rather than allowing the cycle to continue?

CNN asked to follow one of Towers' patients during the detoxification process. Jessica agreed to share her story, but only in the confines of his office. She didn't want to draw attention in her small town and wanted to protect her son from cameras.

"The main thing I want people to know is to take my testimony of where I was to where I am now," she says. "And maybe if it can help one person make a better decision, then it would be worth it."

She calls Towers' office a "godsend" for getting her on the road to sobriety, something she says she could never do on her own. When she first came to his office, she was taking 8 milligrams a day of Subutex. Some days, she took twice that amount.

She'd been told that her baby would die if she tried to detox, so she was following the maintenance therapy program prescribed to her by the previous clinic. She wept when Towers told her that if she stayed on that level of Subutex, her baby might suffer withdrawal in the weeks following birth.

"I told him I wanted to be off of it, but I just didn't know how to be off of it," she says. "That's what started the whole thing of him helping me."

Jessica works in an assisted-living community. She likes helping the elderly, speaking with them and hearing their life stories. She's pushed through days of feeling horrible and the terrible loneliness brought on by detoxification.

"It's always that wage of war in your mind -- that you feel so crappy. It's so hard to try and do the right thing," she says. "You have those thoughts of, 'why have I done this?' "

Her friend Stephanie has talked her off the ledge in moments of desperation. "When I want to make a stupid decision," Jessica says, "she yells at me."

"I have a really good support system, but I had to choose to walk away from all the negative people in my life."

Jessica has lost more than 10 friends to overdoses in recent years -- a stark reminder of the need to stay sober.

Two 'great childhoods' diverged

Jessica and Stephanie met at church 21 years ago. Jessica was 8; Stephanie was 9. Stephanie immediately stole Jessica's Bible, starting their relationship off with a tussle.

But soon, a friendship blossomed. They sang in a choir in their hometown of Morristown and took up leadership positions in church. Through youth group, they went on vacations to places like Destin, Florida, and Dollywood.

Stephanie, the petite one, often ended up underneath her sleeping friend in the backseat on road trips. "She was always like that," Stephanie says, holding up photographic proof.

Morristown is a picturesque American landscape in the northeastern corner of Tennessee, where the tops of mountains dance with the clouds and where US and Tennessee flags fly on telephone poles along Main Street.

Places like the Timeless Elegance Tea Room occupy space near the Jersey Girl Diner downtown. Steps away, the Village Gunsmith Gun Store anchors a corner. A sign posted along a country road advertises "Angus bull for sale."

It was an enjoyable youth. "We did everything together," Stephanie says.

Adds Jessica, "We really had great childhoods."

But their lives took disparate paths. When Jessica was 14, her father died, sending her into a spiral. She began hanging out with 30-year-old meth users. Without even realizing it, she had begun an addiction.

Stephanie remembers visiting Jessica's home, watching her zoom around the house with a vacuum cleaner, sweating up a storm, zonked out of her mind. Stephanie opened one of Jessica's makeup kits and found a meth pipe.

"That's when I realized that we're probably not on the same path," Stephanie recalls.

They drifted apart in high school. Jessica became unrecognizable. She was manipulative, cunning, deceitful. She pushed away everyone who loved her.

Her mom had always been her rock. But Jessica wrecked that relationship. She had an unplanned pregnancy when she was 20. Her mom has essentially raised the boy. By 22, Jessica's relationship with her mother "was gone."

"She was so scared that she was going to get that phone call," Jessica says, crying.

Her meth addiction had only grown. She'd take anything she could get her hands on.

Three years ago, she underwent back surgery and got hooked on opioids at warp speed. She'd go through a month's worth of prescription pills in a week and scramble to feed her habit for the rest of the month. She couldn't hold down a job.

"I couldn't do anything but be strung out, pretty much," she says. "It just grabs a hold of you, and you lose sight of reality -- and before you know it, it's just too late."

The opioids provided a high like she'd never felt. Like many who get hooked on painkillers, she eventually graduated to heroin, overdosing twice.

"I just wasn't me. You could look at me and see I wasn't there," she says. "They took my life away. They took my soul away."

She ended up homeless and, at one point, was raped. "It was just horrible," she weeps.

Jessica has worked to repair her relationship with her mother -- something "that I've missed since I was 16 years old." Her mother is supportive of the pregnancy and says she's excited for the birth of her granddaughter. "She's my No. 1," says Jessica.

Jessica has restored her relationship with her son. She wears a necklace he gave her; on it hangs an infinity sign and the word "Mom."

"I put him through so much, so much. My mom pretty much had to raise him because I couldn't step up."

She hopes that will never be the case with her daughter.

At one of her son's football practices last summer, she ran into Stephanie. They realized just how much they missed each other. Their old friendship was rekindled.

Jessica was in Stephanie's garden when she learned that she was pregnant. Jessica cried, thinking there was no way she could care for the child. Stephanie, who has a son about the same age as Jessica's, reassured her that the child would be her greatest blessing.

Stephanie accompanied Jessica to the first ultrasound. When the two heard the heartbeat, they knew they couldn't abandon the pregnancy. She and Stephanie would make the journey together. "I see this baby as mine, too," says Stephanie.

Stephanie says Towers' work has been transformative: "I have my best friend back, and I would just like to keep her."

The two got tattoos on their feet not long after Jessica began her journey to get clean. Their choices reveal the yin and yang of their friendship.

"You keep me safe," says Stephanie's tattoo.

And Jessica's: "You keep me wild."

'You got to want it, too'

Jessica sits down in a small office with Katz to have a heart-to-heart talk.

The nurse stays in near-constant contact with 80 women in the high-risk unit. They text, email and talk by cell phone at all hours.

"We're not going to judge them for their past," she says.

Katz tells each woman about her brother, who died in 2009 from an overdose of methadone and other drugs. He left behind an 18-month-old boy. The pain of that memory still brings tears eight years later. She promised her young nephew that something good would come from his father's death.

When she heard that Towers needed help, she knew she had a new purpose in life.

"I treat each one of these girls like they're my sister, like they're my best friend, like they're my daughter," she says, "because we have a common denominator.

"Every day, this is my passion that I get to sit before these girls. I share my testimony, and they get to share theirs. That relationship builds trust more than just nurse to patient. It's more than that."

Jessica confides that she took 2 milligrams of Subutex the day before. "I wish I wouldn't have even broke down yesterday, but I just couldn't do it," she says.

Katz looks her in the eyes. "I know, it's hard," she says.

Stephanie braids Jessica's hair to pass the time. They tell the nurse they've been friends for more than 20 years, with major ups and downs. "It's good now," Jessica says.

She hoped to avoid a cesarean section, but in the end, a vaginal birth was not an option. The C-section has been planned for shortly after noon. Jessica can't contain her giddiness. "I've been picturing what she might look like," she says.

"I'm nervous. I'm just ready to see her," Jessica says. "It's been hard, but it's probably one of the best things I've done. For sure."

There's a chattiness about the room. Jessica debates her mom: What football team should her son play on?

There's paperwork galore to be signed, too.

Katz pops into the room. Jessica greets her with a joke: "Where's Dr. Towers at? I was about to yell at him if he didn't let you come."

The two laugh. The night before, they weren't laughing. Consumed by an overwhelming sense of impending motherhood, Jessica freaked out. She called Katz from a different phone than usual. Katz was at dinner and let it ring because she didn't recognize the number. Immediately, a text pinged Katz's phone: "This is Jessica. Call me."

Knowing that a fragile state can lead to relapse, Katz stopped what she was doing. "I can't do this," Jessica told her. "I'm not ready."

Katz spoke gently and talked her down. She told Jessica that she was ready and that she could do this. It was mostly a fear of the unknown -- a vulnerable expectant mother needing someone to speak with in the moment.

Says Katz: "I told her, 'You're not going to back out now.' "

A stream of nurses and medical professionals comes and goes in Jessica's room. She'd hoped that both Stephanie and her boyfriend could both be in the operating room for the delivery. But Towers breaks the bad news: She must choose only one. "I tried, but there's not enough space," he tells her. "You can be mad at me."

He encourages her to pick the most supportive person. Smiling, Jessica says, "If they fight about it too much, then my mom is going."

She ultimately chooses her boyfriend, saying she can't deny him the right to see the moment his daughter is born. Soon, Dad-to-be is a ball of nerves. He has to leave the room when her IV is inserted; how's he going to handle when her belly is sliced open?

"You better not pass out," Jessica warns.

The nurse tells him a drape will block the view. "Just sit there and look at her, not to the left or right," she advises.

He nods, climbs into Jessica's bed and kisses her. Mom and Stephanie crowd around, and a final selfie is snapped.

At 12:44 p.m., Jessica learns that it's time.

"I'll see you in a minute," Towers says. "You're going to do good."

Her mom says, "You got this, honey."

"Good luck," adds Stephanie.

Jessica gets wheeled down the hall to the operating room. On a whiteboard is a message stating today's goal: "Healthy mom & baby!"

Welcome, Jayda Jewel

Towers paces outside the operating room, dressed in blue scrubs and a surgical cap. He removes his wedding band and ties it around the drawstring on his pants. He tapes his surgical mask to his face so his glasses won't fog up.

Inside, Jessica has been given a spinal tap to numb the pain. Surgical drapes cover Jessica's body, and the room is abuzz with organized chaos.

Katz pauses outside the room. She prays for God to be with Towers and to give Jessica the strength to get through the surgery and for the child to be born healthy. Then she heads into the room.

"You're doing great, Jessica," says Dr. Kim Fortner, a member of the medical team. "We're all right here. It's almost over, OK?"

A look of excruciating pain spreads across Jessica's face.

"Think about her sweet baby cheeks, Jessica," says nurse Kirby Ginn.

Moments later, at 1:32 p.m., a beautiful baby girl with chubby cheeks and a patch of brown hair emerges. Jayda Jewel Hill lets out two loud screams.

Towers and his team quickly clean her up and swaddle her in a blanket adorned with teddy bears. She weighs in at 6 pounds and stretches 17 inches.

"Are you ready to see her?" the nurse asks.

"Yes, ma'am," Jessica replies.

Her daughter is placed across her chest. Jessica cradles her with both hands, her right hand patting her back.

"Aww," Jessica says.

"She looks great," Towers says.

The baby coughs a few times, worrying Jessica.

"Why is she coughing like that?" she says.

Caught up in the moment, the father seems to miss the question, asking a nurse to take a photo of him with his daughter.

He clutches the swaddled newborn and leans in next to Jessica's face -- the birthing room in the era of social media. "Hi, little gorgeous. Hi there, beautiful. Look, there's your momma," the gleeful father says.

The baby coughs a few more times. "Is she OK?" Jessica asks.

Towers explains that the baby sucked in amniotic fluid during surgery. The fluid will be removed from her lungs; it's nothing to be worried about, he assures her.

Katz leans in and holds Jessica's right hand. She tells her to stay strong, that her daughter is healthy. She tells her the baby is going to be taken away to be observed in the neonatal intensive care unit.

Just before stitching Jessica up, Towers uses a non-opioid drug similar to novocaine to dull the pain for 24 hours. Jessica also receives Tylenol IV and an anti-inflammatory drug, Toradol.

"She's hoping to not need any pain pills," he says. "It is major surgery. Your abdomen is open, so it hurts."

Anything to avoid relapse.

Bucking the trend

Less than 24 hours after the birth, more than 150 doctors, nurse practitioners and other health officials from across East Tennessee gather in an auditorium at the UT medical center.

On stage, Towers steps through a slideshow presentation of opioid use disorder in pregnancy. He reels off stats from the CDC: From 2000 to 2015, more than half a million people died from drug overdoses, including 183,000 people from prescription opioids. "Unfortunately, we're only getting worse," he says.

In Tennessee, he notes, three people die from overdoses every day. He talks about his findings, of the women who've detoxed in his program. "We're bucking the trend," Towers says.

"I'm passionate because I just believe it's the right way to do medicine," he says. "We don't always succeed. I don't know anyone who succeeds all the time when dealing with addiction. But my passion comes from the ones that we've delivered that don't have (withdrawal) and the look in the mother's eye when they say, 'You saved my life.'

"I don't think you can get any better response from a patient."

Shortly after the speech, he takes an elevator to the third floor and visits Jessica and her baby. Jessica sports a pink T-shirt that says "Don't want to be here."

"We want to be home," she says.

Jayda Jewel, nicknamed JJ, looks like the perfect child, with big eyes, content in her mother's arms. She shows no signs of withdrawal, although symptoms can take a couple of days to appear.

Jessica hugs the doctor. "I couldn't have done this without you and Emily," she says.

Outside Towers' presence, Stephanie repeats that sentiment, telling Jessica, "You're so lucky you got him."

"If it weren't for this baby, you might not have got off Subutex ever."

Over the next several days, Jayda Jewel exhibits no signs of withdrawal, but Jessica's pain intensifies. She's given three Vicodin pills, an opioid painkiller. The typical C-section patient gets 10, Towers says.

Jessica had hoped to be given an opioid blocker called Vivitrol, which can resist the urge to use for up to a month. But to get it, her system must be clear of opioids for seven days. Towers expects to be able to give her the medicine in her followup appointment. "She felt bad about that," he says.

But still, she succeeded. Her baby was born healthy.

Four days after the birth, Jessica straps Jayda Jewel in a car seat in her hospital room and then climbs into a wheelchair to be escorted out of the facility. Mom and daughter head down an elevator and out the front door.

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Towers and Katz meet them at their car. Jessica places her baby inside and turns toward them.

"We made it," Jessica says, wrapping her arms around her "Nurse Barbie." "I love you."

"I love you, too," Katz responds.

Then Jessica hugs Towers again.

The car soon disappears around the corner, onto the highway and off to their hometown. Together, mother and daughter begin new lives.