Burn Unit.

A few weeks ago a woman was brought into the clinic on a homemade stretcher. She was whimpering softly to herself in pain. I was busy with prentatals but I figured it had to be serious. Later I found out she was burned by boiling liquid and 27% of her body was covered in 2^nd degree burns, possible 3^rd degree in some places.

We dressed her wounds, got her pain killers and then took her home. What struck me the most was how elderly she was. She must be in her 70s – frail and grey haired. (grey hair is not common here.)

She was supposed to come back daily for wound care but five days went by and she didn’t return. Jessica (the nurse in the wound care room) confessed that she thought she was dead because she hadn’t returned. To us the possibility seemed likely. When you have severe burns staying hydrated is very difficult.

But after 5 days of no care, Sabet found her and drove her to the clinic. She wasn’t able to walk and so didn’t come for the care she needed. Her family had no way to get her to us and may have just given up.

When she came in most of my pregnant patients went as far away from her as they could get. She smelled so foul it was hard just to be in the same building let alone the same room.

Her burns had pussed over and become septic. She was seriously sick and Jessica and Margaret worked hard to get her wounds debraided and cleaned. It was agreed that Sabet would pick her up daily and her wounds would be changed twice daily and then she would be driven home.

This has worked well and two or three weeks later the improvement has been remarkable. This last week she was able to move herself from the wheelchair onto the bed. Before she was carried everywhere on a mattress.

So praise God with me for this great healing. She’ll be scarred no doubt but she’ll live. I’m impressed with her pain tolerance. She is stronger than I think I’ll ever be.

The birds of the air... the beast of the field.

Me and My Badger. Any suggestions for a name?

This land is full of exotic animals of every shape and color. I love living with so much variety of life. Some of them are dangerous – like the snakes and scorpions. Whereas others are just fascinating and fun.

Last week our hen hatched a few chicks who chirp and scurry in the cutest of ways. We put them in the kennel with the Dik-dik and together they seem content. The Dik-dik is admittedly a bit harassed.

Well, last week a hawk spied them and came in for a kill. Suzy was able to scare away it the first time but when it tried again later that day, it was caught instead. Sabet was able to trap it against the fence. It was beautifully sharp and wasn’t much happy with its predicament.

Suzy suggested we feed it to the dog because it’d just come back for the chicks. I asked to keep it instead (or at least until the chicks grew up enough not to be threatened) and Sabet agreed. So I put it in a cage in my room and dreamed of building an aviary, etc.

But by the time I got back from work, the chicken coop was reinforced and I was free to release the hawk. It made me happy to send it back to the wild but a little sad too. I was happy to think I might get to have a hawk as a pet.

Not long after (or was it before), little Jeddie (Suzy’s and Sabet’s boy) caught the resident hedgehog.

Yup. You read that right. A hedgehog! Hedgehogs are adorable! Pointy but adorable. I named him Horacio and was fully ready to keep him but he wouldn’t eat anything I gave him. I couldn’t let him starve. He’s just too cute. So we liberated him. We still see him hanging out around the toilets some nights. So I still think of him as a quasi-pet. 

Then today after church the kids were playing with a ‘skunk’. Skunk? I had to see for myself. For a skunk it had some strange markings – too many strips. It also had claws. Claws? That’s not right. Then of course the tail was all wrong as well. I’m no expert but I’m confident it’s not a skunk. It hasn’t sprayed us once.

But it’s small about the size of a kitten. As I considered what it could be I remembered seeing a badger not too many years back while living in Europe. It’s teeth are still nubs and it can’t bite or claw much of anything. It’s a baby something… why not a baby badger.

It hadn’t eaten in a day or two (according to Sabet), so I tried to give it milk by syringe. It fought me at first but then figured out it was food and ate its fill. He fell asleep in my hands immediately after—snuggling into me and making me smile.

This one I’m keeping because he’ll eat and I have no idea how to find it’s mom. Right now he’s asleep on my floor under a cage, snuggled up on a pile of leaves.

Badgers are noctural. I wonder what tonight will sound like. I hope he doesn’t do his screaming thing again. That would be just heartbreaking! He has a call/scream that gives me a chill.

Anyone want to bet I can teach him to walk on a leash?  He he he

Starving.

I found myself in a strange debate with a first time mom who came to the clinic because her baby ‘refused to suck’.

At first I believed her but then I watched her baby suck on anything it could get near its mouth- hand, blanket, syringe.

She had delivered at home two or three days before and the baby hadn’t eaten once. She was severely dehydrated and slightly jaundiced. More importantly she was lethargic… but still sucking.

Asking a bit more about what happened she complained that her baby just “refused to eat”. Maggie sent her to express milk but she came back saying she could only get out a drop or two.

So they tried to get the baby to take 50% dextrose. She wanted to but most of it came right back up.

Then they tried to get an IV in this wee little one but without success. Her veins were too small.

What to do? What to do?

Then I told the mom I’d like to express milk for her. I noticed she was engorged perhaps it was her technique. When I expressed it for her she screamed in pain, fighting me. All the while repeating how she ‘doesn’t have milk’.

I was able to express easily 100 cc of milk (much more than the baby could take at a time) but the mother still argued with me. She complained that she couldn’t hand express and feed the baby with a syringe because that wasn’t ‘normal’ and she had inverted nipples so the baby had difficulty latching, etc. She said only cow are ‘milked’ is such a manner.

Meanwhile the baby lay too hungry to even cry inches away. All the mother kept doing was complaining about how her baby ‘refused’ to eat.

And all we kept telling her was she had to express her milk (which she refused because it was too painful) and give it to the baby. Or she had to work to get her nipples better so the baby could latch.

We argued incessantly. “Would you prefer your baby die?”, we asked. She never answered. She would only repeat ‘she refuses to eat’. I’d say it’s more like her mother refuses to feed her. In the end we could do nothing more than refer her to the hospital in Wau. 

Lord forgive me but I wanted to steal that baby away from her. Even now I’d love to take that baby and nurse her to health.

I really don’t think she’ll live.

The race is on!

A week ago, Daniel (the younger brother I’m adopting into my family) and I decided to have ourselves a frog race. We’d catch a bunch of slimy jumpers and see who could run the fastest. The only problem was catching them in the first place.

I got distracted each night with something at the clinic so wasn’t as eager to go frog hunting at night (when they come out). But Daniel didn’t forget. And two days ago, he caught a whopping 6 frogs for the competition.

But I got again distracted with the clinic and promptly forgot about them. And in my hazy-eyed-up-all-night-with-a-labor look on my face he reminded me about the races over breakfast.

Oh yeah! I had forgotten. We decided to get the kiddos involved as anything to do with frogs and kids is an automatic scream! And we even roped in Dennis and Pretti (too Kenyan staff). Suzy jumped on board and Stacy agreed to help as long as she didn’t have to touch a frog.

Excellent. The true making of history!

Daniel brought a trash can he’d be holding the frogs hostage out of his room and we each chose out competetor at random. I picked a medium-sized dark green one with red streaks on the crevices of his thighs. As a thank you, he promptly peed on my hand.

Excellent. He’ll be lighter that way. Much faster too. :- )

We positioned the race course (my porch) and everyone gathered round. We got set with frogs in hands (which wasn’t easy since they were escape artists in a divine way) and boom the race was on.

We screamed. We chased. We goated them forward. Frogs leapt right and left. Kids scrambled to catch up. I crawled after mine who was hesitant to go, slapping the cement behind him. He moved forward to my utter and joyful satisfaction and was the first to make it passed the finish line.

Two out of the five disappeared in the chaos but we were able to recapture the remaining three.

Round two.

This time it was kids only. The adults corralled them as best we could. None of the frogs made it passed the line but the one that got the furthest was Hannah’s. And at last we freed them into the wild. I couldn’t stop laughing.

Harassing frogs should not be this fun!

His mercies are new every minute!

Friday started off like a rocket. I was called out of devotions because there was a woman in labor. When I arrived I met Adhel who has been laboring for 2 days with no progress and frank bleeding had begun. Her traditional midwife brought here in and neither of them looked happy about it – Adhel because (I suspect) she thought she was too good for such a ‘dirty dinka’ clinic. And the midwife because it would mean she wouldn’t get her fee.

But I so glad she came in. The baby was doing okay but the frank bleeding wasn’t good. When I did an IE she was 9.5 cm and I helped her the rest of the way while she pushed. She delivered in a matter of minutes but then the bleeding came.

Blood just kept coming. It was everywhere. There was blood coming from the baby’s mouth. She had obviously swallowed it. The baby would have aspirated it if she had been breathing – but she wasn’t. She had a VERY tight cord coil and was very blue.

I freed her from her noose and saw that the cord was also VERY short. It was roughly only 25 cm long. As a result the baby had developed an umbilical hernia. I didn’t stop to stare… blue babies… red mothers… I had other things to worry about.

Long story short, Adhel hemorrhaged but recovered well. Her little girl decided breathing would be reasonable. I guess she didn’t feel like arguing with me. Disaster averted. Sigh.

When I got a chance to look at the placenta I saw some of the reason for the long labor and bleeding. The placenta had a large jagged tear right now the center. It don’t know what caused it but she had a very serious placental abruption.

For those who don’t know, placentas tearing like this can spell disaster for both mother and baby.

I’m so glad God has been carrying me through these days. I feel like each time I turn around another disaster is averted another life saved. Thank you Jesus!

But the day was just beginning… It wasn’t even 10 am yet. Sigh.

They say His mercies are new each morning. But personally, I think they are new each minute. It’s certainly true for me.

More later.

Grace and Joy ~ My first Twin catch.

Friday night.... Twins.

After a birth, after arguing with a mother insistent on starving her child to death (see blog below), after a long line of prenatals and finally closing down the clinic for the week, I went home to rest and have dinner.

I kept thinking about the twins I had diagnosed earlier this week. I’ve seen a number of women with way too many fetal heart beats. I’m starting to think there’s something in the water. I’ve had at least one person a day this week who is suspected of carrying twins.

So naturally, I thought of Ajong, my mama from Maloney, I wrote about earlier (see blog called Dream come true? below). She is the one with the crazy large fundal height who delivered twins last pregnancy and is surprisingly pregnant with twins again… or triplets.

Well she (surprisingly) stayed pregnant another 2 weeks. Each day she seemed to do better even though she was still quite tired. She didn’t seem so anemic and had more energy. But her baby’s heart tones kept moving on me.

One would always stay the same. But the second baby kept going from the right to the left side. It was impossible to know if it was two babies that somehow were hiding from me or if it was just one baby that was dancing inside.

As time went on, I no longer suspected triplets. Instead I felt more confident on twins… but I confess I was never really sure.

The thing is, neither Maggie or I, have ever delivered twins before. Neither of us have ever delivered breech either. Even though it was a first for us,  fortunately we weren’t scared -- or we were too foolish to know any better. I’d like to think it was God just giving us grace for the day and peace for the task at hand.

I was thrilled to see her come in last night (Friday night) in labor. Could this finally be it? When I checked her she was squarely 4 cm dilated and contractions were solid – even if they weren’t very painful yet.

She was so cute waddling through the clinic in her stilted stride. She couldn’t go very far but I loved to see her labor standing up. The babies seemed to be doing fine but one of them kept changing the location of the heartbeat. What? I was thoroughly confused. That doesn’t happen this late in the game.

I kept a question mark constantly hanging over my head. I guess time would tell.

By 1 am she was making progress and at 2 when I did another IE she was ready to push… well almost. There was a bit of an anterior lip. I held it back and the membranes were ruptured. The first baby came not long after.

She came head first and did just fine despite her petite form. The second baby was then supposed to be easy to manipulate into the pelvis (according the textbooks that is!) but she wasn’t.

The fundal height was still enormous and I couldn’t feel a baby in there abdominally at all. Odd – very odd. Maggie was (I’m thinking for her here) just as confused as I was, “Where is this baby? Which way was the head?”

I could feel the membrane internally so I ruptured it. And the flood gates of heaven opened. Easily over 2 liters of amniotic fluid gushed out, soaking our shoes and splashing under the dividing wall into the next room. Yikes.

But immediately I found something soft and squishy coming out. It was a tiny foot and pointy bum. She pushed and the rest of this miniscule person made her way into the world. Blue as the stormy sea.

She moved a bit but made no effort to breathe. We resuscitated and within a few minutes she perked up considerably. But she was just so small.

Meanwhile I turned my attention to Ajong again to see Maggie handling things like a champ. The placenta with two cords not one was birthed not long after and the bleeding controlled.

I have to admit I felt strange looking around the room and seeing babies here and there. I was thrilled when the smallest went the breast without a hint of hesitation and cheered to know Mama Ajong wasn’t hemorrhaging.

Frankly… I just think God answered all your prayers (and mine).

Thank you for lifting her up in prayer. Pray with me still as tiny treasures head home to the village. Pray for health and Jesus to continue to provide and care for them all.

But know… there is another VERY pregnant mom who may have twins too. But she has polyhydramnios in a serious way (not good. Means she has too much amniotic fluid). Pray for her and the rest of the team God calls to deliver them.

Thanks. 

Death on a Thursday.

This week has blended into a month that feels like it’s been a year. Ask me my name and I might remember. Ask me where I am, you’ll be lucky to get more than a blank stare. Huh? Am I really in Africa?

Deep breath. I have to remind myself to breathe some days. I look around myself and see the hurting, the pain and the loss and I go numb. My heart is broken… it’s misfiring. It’s on the fritz. Quick get a stethoscope!

Breathe.

I don’t know where to begin in the last three days but I’ll try to go back until it hurts. I hope you don’t mind this being a long story…. Get your cup of tea. I’ll wait.

Thursday I was doing prenatals when I got called by a family to help their child. They were alarmed that his IV was almost out. I smiled thinking, ‘Big deal. Okay, I’ll got take out the IV tubing and then get back to prenatals.’ I go with my trusty translator, Natali, and sure enough the IV fluid is almost finish. So I wait.

As we wait, the family starts looking very agitated. Now keep in mind I don’t know anything about this case but we are short staffed so I stick around and ‘help’. But the family starts getting even more upset, moving in strange ways around the boy lying on the mattress laid out on our ‘in patient’ room (aka: back porch).

I look to Natali for some insight as to the cause of the commotion. He looks back at me and shrugs. He doesn’t know either. He is just as blind as I am as to why the child is sick.

So I start looking a bit closer. There is vomit on the mattress. Why? I wonder. The man holding his head stands up and in distress walks away. Then I see the child has stopped breathing.

I call for help… for Caleb the Clinic Officer and send for the resuscitation mask. Then I start resuscitating as best I can without any help. The translators are standing there trying to figure out what I’m calling for. What’s a bulb syringe? What’s an Ambu-bag?

Meanwhile I am doing chest compressions in hopes of keeping his heart beating. It feels like ages before the equipment gets to me. I have to repeat myself over and over to each new onlooker. When Caleb gets there he starts giving oxygen and we get the pulse and breathing to start again briefly. But then nothing.

No pulse. No breath. Silence.

Except for the wails that are starting from the women behind me. One woman is pushing me out of her way to get to the child. There is nothing left to do.

I stood and hand to walk away. I didn’t want to share my grief. I didn’t want to fall apart in front of this family.

Had we had crash carts and free flow oxygen would this child have lived? Caleb reassured me that he wouldn’t have. But it didn’t make me feel any better. I’ve never had a child die on me. I didn’t have a place for all the emotions it stirred in me. I still don’t.

Caleb explained that the child was a surgical patient. He was not going to live no matter what we did. He suspected an intestinal obstruction and there was nothing we could do.

So he died. A boy of 8 or 10 years old who only 4 days ago was running after a soccer ball and teasing his sisters.

Pray for his family. No doubt he is buried by now but how do you bury the grief of such a loss? By God’s strength … by His strength alone.

July Newsletter~ Midwifery Times

Check out my July newsletter by clicking on this link and downloading the pdf. Hope you like it.

The Water War!

You’d think in the heat of the day (average 80+humidity in winter) people here would be interested in drinking water. But they aren’t.


Often women come in for prentals complaining of severe and persistent headaches, painful urination and dizziness.


I ask them how much water they’ve had in the last day. They look confused at the question. So I ask again. After thinking awhile they say they can’t drink water and haven’t had any for a few days. (I’m starting to wonder if they are not part camel.) That’s when the Water War begins. It goes something like this:


Me: If you want to feel better, you must drink more water. Try to drink about 4 liters of water a day.
Them: That’s impossible.
Me: It’s possible. Because I do it. See, I’ve had 2 liters already and it’s only noon.
Them: No. I cannot it causes me bloating.
Me: So drink little cups all day long.
Them: But I don’t like the taste.
Me: Do you like headaches more?
Them: No. But can’t you just give me pain meds.
Me: No. The only medicine you need is water. Drink water!
Them: Impossible.


I’ll probably be having this conversation the rest of my life. I feel a bit like a broken record. Sigh.


However, I had one woman come back after one of these conversations. I asked her if she was drinking water and whether or not she was still having headaches. She told me with a big smile on her face that she hadn’t had a headache since starting her water-medicine.


Success!

STD Free zone?

For the last two weeks I’ve been doing a health teaching before prentals on sexually transmitted diseases. On the first day, I discussed it beforehand with my translator to see if I had to be culturally sensitive about any of the issues.

When I told him I was going to teach on STDs he cocked his head to one side and said, “But… there are no STDs in Sudan.” Dead silence.

Then it was my turn to be confused. I too cocked my head to one side and said, “Huh? Of course there are STDs. People have sex here don’t they?”

He shrugged as if to say I was wasting my time but agreed to translate for me all the same. So I forged ahead and taught them the signs and symptoms of the most common STDs, as well as the consequences of them.

Funny thing but over the last two weeks I’ve had a half dozen women tell me they have those symptoms… some have had them for years. They’ve been treated and have even brought their husbands in as well!

However, I’m pretty sure my translator no longer thinks Sudan is STD free zone.

Cats in a bag!

So procreation isn’t just among those in my antenatal care program. Those of the feline persuasion have been busy as well! Apparently, what started out as one cat, a year or so back, has multiplied to about 7 trash-raiding-scrangy beasts!

I’m told the main ‘mama’ is named Sasha. She has had a litter every six months or so. So now we are truly infested. They are on counters, eating out of dishes, turning over trash cans and meowing like mad when barred from the dinning hall.

I understand that a cat’s got to eat. But come on! If only the Sudanese considered them food like the Filipinos! (Wait. Do Filipinos eat cat? Or is it just dog?)

I’m on a campaign to gather them in a sack and drown them in the nearest river. I figure a watery grave is somewhat poetic and a VERY appropriate way for these mangy beast to die. But I’m getting a lot of resistance.

Even though they are feral and too nasty to even touch, we are suppose to somehow find them ‘adorable’ and call them ‘pets’.

Now lest you think me a heartless-cat-hating fiend, let me tell you, I’m a ‘cat person’. I love cats. I’ve had wonderful cats as pets and loved on them in style.

These are not cats. These are worm infested pests with fur that MUST DIE!

My new plan is to bag them and send them on our next outreach to Maloney (a town we do medical outreach to in the country). I figure we can release them in the country. That way we are not drowning them, we are freeing them from their dependency on our trash cans.

Perhaps they can be adopted by a nice family out there… or eaten by hyenas.

I prefer the latter.

I’m 3 weeks pregnant!

This past week has been a doozie – full of massive numbers of preggos wanting prenatals. At first it was great, then they started yelling at me for not doing it faster and for making them wait so long. Huh?

I did a total of 90 prenatals last week which to me seems like just the tip of the iceburg. I’ve come to learn that pregnancy is a much desired state in these parts and one lone ‘Kowaja’ isn’t going to cut it. Send in the reinforcements!

By midweek I realized my main problem was I kept doing prenatals on women who were NOT pregnant and at least a dozen or so were all of one month along.

One woman came in and proudly announced she was 3 weeks pregnant. I asked her how she knew she was pregnant since she hadn’t even missed a period and she answered, “I just know”.

I can’t argue with that… but the pregnancy test can. She wasn’t.

This week a new rule has been reinstated. Only pregnant women can get prenatals by the new ‘Kowaja’ and only after at least 3 months.

A new Brother!

This morning it was my turn to teach devotions. I had been struggling with God over which passage to teach on. I had felt strongly he was asking me to teach on the Ten Commandments and how we are not able to work our way into heaven. But this was somewhat debated earlier among some of the volunteers and I wasn’t sure if it’d cause waves.

But no matter how much I hesitated and argued with Him, He kept pointing me to Deuteronomy 5. So with a knot in my stomach I prepared. And with dread I began to teach. I couldn’t figure out why I was struggling with it so much.

I was a bit unorganized and went off on tangents but eventually said my peace. Afterward, Sabet gave an alter call and one of the translator/health workers raised his hand. Then I understood why all the internal struggle – it was spiritual warfare.

So rejoice with us as we welcome this new Brother into the family

Alal's Story...

(Guest Author: Jessica Leong- short term missionary/Nurse)
We’d been seeing a lot of pneumonia cases in small children here at the clinic.  I woke up this morning nervous for what the day was going to bring.  I didn’t want a repeat of Monday.  Seeing that one little girl die was enough for me.

The day had almost come to a close when 6-year-old Alal was brought in by her mother. She was feverish and had been convulsing before arriving at the clinic.  It seemed like another straight forward case of malaria…until I put my hand on her chest as she breathed rapidly.  Fluid in the lungs. 

Oh no, I thought, Lord please don’t let this little girl die. 

I had been fearing a Monday-repeat. After going through all the initial treatments for Alal, we laid her on a mat outside just feet away from the spot where Yom had passed away. After a few minutes, I noticed that her breathing was becoming more labored.  She was bringing up mucus and saliva with each breath. Not what I was wanting to see.  I ran for the bulb syringe, hoping that maybe I had caught it a little sooner with Alal than I did with Yom. 

After suctioning her the best I could, I kept a close eye on her.  Kids deteriorate much faster than adults do and I wanted to monitor Alal very closely.  For the next 2 hours I checked on her often and was very excited to see that her vitals were looking better and her breath sounds were much improved.  I had hope.  She was going to wake up.  

I returned to the clinic around 7pm to find her mattress empty.  I thought maybe she had been moved inside.  But then I was informed that they had left.  Alal too had died. 

Frustrated….  Frustrated because I know what could have been done in any US hospital.

Heartbroken…. Heartbroken because I knew another family was mourning the loss of a little child.

I sit here wondering why it had to happen like this.  Why did I have to be so closely involved with both cases this week?  I can only come up with 2 answers. 

1 – God will not give me more than I can handle. 

2 – I was able to pray for each child and their families. 

With each death this week there had been a pastor present who prayed in Dinka for everyone to hear.  Maybe through these girls’ deaths someone will be touched through the words prayed or the faith by which they were uttered.

Hyenas Bite! Literally....

At dinner one night, our guard called the staff for an emergency. The report was something about a hyena. Hyena? That got everyone’s attention. I decided I needed to find out.

When we got to the clinic, a man was splayed out on my prenatal bed, obviously in pain. He had made a make-shift wrap around his foot which was dirty from walking. He had a walking stick laying beside him- apparently for his ridiculous limp.

Unwrapping the bandage showed a foot gouged out on the top with two deep puncture wounds beneath. We could actually peel back the filleted layer of skin and see the tendons of his toes beneath.

It was over a day since his attack so we couldn’t suture. Instead we irrigated the wound, dressed and bandaged it. The man had to work very hard not to call out in pain. I wouldn’t have chided him if he had. It was painful just to look at!

The story told us was the night before he was tending his goats in the field. The men here sleep in tents out with their cattle and goats. They are rural shepherds much like I imagine King David was in his day. They are always ready to fend off predators – whether they are wild animals or cattle raiders.

Well, this night, he was asleep and a hyena came calling. It reached inside (supposedly for the goat) and got his foot instead. He was pulled several meters before the hyena gave up and went away. I’m sure he fought him off in every way possible too.

What a way to be woken in the night!

Guinea Worms Galore!

A man came in on Thursday with a Guinea Worm coming out of his right foot. This is my first experience with Guinea worms and I asked to take pictures. In a matter of minutes, Caleb, our trusty Clinic Officer had a hold of that sucker and was meticulously drawing it out. I watched in genuine disgust and horror as easily 10 cm stretched out before my eyes.

Guinea worms are nasty little parasites that breed in water. A person, unlucky enough to somehow ingest an egg, will soon have a worm issue. How it works is an egg lands somewhere in the body, hatches and then grows. Eventually, it finds its way to the surface by burrowing its way out!

Yikes!

Please Lord, don’t ever let me get one of these suckers! I hear they are terribly painful!

Yom’s story…

(Jessica Leong- short term missionary/Nurse)

Monday morning – bracing myself for a busy day. Many people wait until Monday to bring their sick family members even though they would qualify as an emergency case on Sunday. That was the case for 3-year-old Yom.

She lay limp and unresponsive in her mother’s arms as we rushed them to a consultation room. She felt hot and we immediately started with the usual treatment for malaria. IV fluids, anti-malaria meds, and Tylenol to bring down the fever. It was only after initiating this first round of treatment that I put my hand on her chest to feel her labored breathing. Something wasn’t right.

I could feel fluid in her lungs just by placing my hand on her side. Not a good sign. After then listening to her lungs, we started her on IV antibiotics to treat for pneumonia.

I must say, in the States we would have treated this girl very differently if she’d have come into an emergency room. She would have been intibated immediately and deep suction would have been performed (translation: tube placed in her trachea to help her breath and mucus suctioned from her airways) then moved to an intensive care unit.

But we are not in the States. We are in South Sudan. Nearest hospital – 3.5 hours away. The family wanted to drive her there, but we all knew she would not live.

In the meantime, it’s getting harder and harder for Yom to breath. Mucus and saliva are filling her mouth with each breath. How badly I wished at that moment that I could properly suction her. The best thing I could think of was a bulb syringe (the kind used to suction the mouth and nose of newborns). We tried it over and over, but the job wasn’t getting done.

Despite our best efforts, Yom went to be with Jesus just minutes after we laid hands on her and prayed for her. We had done all we could and even tried to resuscitate her.

What the heck is a Dik-dik?

Imagine a miniature deer with fir much like a wild hare. Make sure you keep it small in your head, sort of like an emaciated cat with ridiculously long legs -all awkward and skittish, skipping around daintily,barely touching the ground. Glue grape sized protruding orbits for eyes and a wee bit of fluff for a tail and there you have it… a dik-dik!

I mentioned to Suzy about how it must taste like rabbit and she cringed. I guess she has a soft bone for family pets. I figure it can be eaten if necessary but is unlikely to satisfy a child.

The resident Dik-dik here on the compound is named Bambi. She looks like something that stepped out of a fairy tale and has an infected eye. It oozes gunk and should come out. Any vets want to come out and do a little surgery? You could save Bambi!

Of Bats and Mangos.

On the north side of the compound tower two large mango trees, lush and regal. They are bigger than any mango trees I’ve ever seen before, easily standing four stories tall. Their branches are loaded-- but not with mangos.

Instead these trees house dozens of bats.

You wouldn’t guess it during the day, but come dusk they start to dip and dive. They dart spastically in a drunken feast on the mosquito and flying termites population. (Thank God!) But sometimes they get a little side-tracked.

The other day, one found its’ way into my room. This didn’t bother me much, as I have a tender spot for flying rats. But my bunkmate, Jessica, had a different view. She is not much for anything crawly or bug shaped. And I have recently assumed the role of ‘Bug-squasher’.

So when Dracula came calling, I had to reassure her somewhat. I refused to chase this ‘slightly larger’ bug away as he was ridding me of pests. So we tried to sit still and wait for him to find the door on his own.

He circled a few times and landed a few times. I think it was a lot harder for Jessica than for me to wait him out. But eventually we ignored him and went on with our reading. I was surprised to look up from my book a few minutes later to find the room ‘bat-less’. They sure are quiet.

I wonder if I’ll have to fight them for a proper mango when mango season starts. I guess I’ll have to wait until next February and see.

Childbirth Confessional

The other day, I asked Maggie (the senior Nurse-midwife and resident partner-in-crime) why so many of the women chose to deliver at home instead of coming to the clinic. Her answer was particular and I have to admit I wasn’t sure what to think.

She explained that when it comes time for a woman to deliver, the husband insists she deliver at home. She has little choice. But it was the reasoning behind it that caught me off guard.  She explained that here, a traditional midwives’ job aside from delivering the baby, is to illicit a ‘childbirth confessional’. Apparently, while the woman is in transition and especially as she gets ready to push, the midwife will yell at her. She will tell her that the labor is taking long because she slept with a man other than her husband. “Confess and you will deliver! Whose baby is this?!”

At first, I had to laugh at such a thought. It couldn’t be. Sure, promiscuity is the norm in this culture but really? Most woman I’ve seen in the pushing stage don’t have time to think, let alone make an intelligible sentence. So, I put it in the back of my mind to think about another day.

Then Bith came to the clinic to deliver.

She was a young mother expecting her fifth child and was evidently poor but oh so sweet and happy to be having her baby. She labored quietly and powerfully throughout the day and then barged into my prenatal visit sweating and ready to push. Not long after, she was squatting on the prenatal bed pushing with all her might.

She asked for her friend to come in and help with the pushing. Naturally! Her friend acted as a doula of sorts and immediately started massaging her back and encouraging her. “Chol! Push! Apathe Pei! Good work!” Everything was going well. Then all of the sudden the tone of her voice changed. It sounded like she was yelling at her.

I asked my mighty, mighty translator, Natali, to let me know what she was saying. He said that she was yelling at her to confess. Huh? “Whose baby is it? Who did you sleep with?” Yes. You guessed it. I was stuck in the middle of a ‘Childbirth Confessional’.

Naturally, Bith ignored her words and pushed with all her might. I, however, got all up in her business and told her to stop yelling such nonsense. I affirmed that the birth was not taking any time at all and that everything was very normal. This silenced her. She actually seemed happy to hear it.

No confession came but a beautiful baby girl was born minutes later - sweet and sleepy and calm.

Dream come true?

The night before last, I woke every few hours to check on a laboring mama. She was slow going and as a result I didn’t sleep much. But between checking heart tones and blood pressure, I’d sneak back to my bed and delicious little mosquito net for a little shuteye.

Twice I dreamt but it was all crazy stuff. One dream was of me being woken for a birth by one of the guards to attend a birth. I walked into the room and the baby was crowning. It wasn’t the birth of the laboring woman. It was a separate birth… that occurred only in my dreams. I woke a bit confused and trod back to the clinic for another check. Nope. No baby. It was just a dream.

I returned to my blissful bed and remarkably dreamt again. But this time, I delivered triplets. It was a happy birth with lots of my team members around. The babies were healthy and the mama was calm. I remember waking up again a bit disoriented. Such is life when you haven’t slept much.

I told my friends over breakfast about my crazy dreams and went about my day. It was a calm day as we decided to send all the prenatals home and just focus on the labor – who delivered a beautiful like girl later that afternoon.

Most of the team, however, had a busy day of outreach in Malony. Maggie, brought me back a surprise when they returned. She brought me a pregnant mama who had a wildly large fundal height.

After reviewing her for what seemed like ages, it was clear we were dealing with twins… and possibly triplets. She didn’t seem too surprised by the diagnosis. In fact, her last pregnancy was twins!

We watched her through the night since she had regular contractions but nothing progressed this morning. But even if she delivers later on in the week, we still have twins on our hands – and possibly triplets.

Do dreams really do come true? We’ll have to see. Lord! Please have mercy!

Girlfriend Bite!

(Post written by Guest Author Jessica Leong who is on a short term trip here in Sudan!)

A busy day in wound care. I seem to be the wound care consultant. I’m not too sure how I got that job besides the couple weeks I’ve spent performing wound care on the Sudanese people that come into the clinic. Anytime somebody comes in with a cut or bite or burn, I get the chance to participate in the decisions of how to treat it.

Melissa was working in registration that afternoon. She came into my room asking me to take a look at this bite that this man had on his ankle. I asked how it happened and she stated that it was from his girlfriend. I immediately thought how bad this could be because of the increased chance of infection that a human bite has versus an animal bite.

I walk outside to see a man pointing to his ankle. It looked a little bit swollen, but there were no teeth marks. So again we asked what happened and again we got the same response. The man was bit by his girlfriend.

“What kind of girlfriend bites a man’s ankle?” I thought. Anyway, I had to believe the man. So I looked down at his ankle again, convincing myself that I must have not seen the teeth marks the first time. But again, I see nothing except a small amount of inflammation. I tell the man that he must wait behind all the other patients due to the fact that his injury was not very serious.

We ask again, this time the men around keep saying “girlfriend, girlfriend,” or so Melissa thought. I finally figured out that they were saying “scorpion,” not girlfriend (the “p” and “f” sound very similar when spoken by a Sudanese). Oh, well a scorpion bite! That makes much more sense! Of course this man is hurting. Of course his ankle is swollen. Of course he wasn’t bitten by his girlfriend.

Come to find out, the Dinka language does not have a word for girlfriend, so they were not even understanding us when we kept repeating back to them, “girlfriend?”

Oh the misunderstandings that occur between two people groups and two languages.

Girlfriend? No. Scorpion.