The Doctor’s in the house!

This week we welcomed a new member to the team - Dr. Tom! He hails from the sunny state of Florida and plans on being here long term. He practices family medicine and brings with him years of experience, an amiable disposition and .... drum roll please... chiropractic services!

Halleluia! If God wanted to give me a bigger present, I don’t think He could have!

But all joking aside, it’s nice having him on the team. Things just get better and better around here all the time. FYI, we now have running water in some of the rooms and electricity too! Life is so good!

A boy named Southern Land.

Last night an 18 year old girl came in to the clinic in labor. She is one of my prenatal girls and I was thrilled to see her. This is her first baby and from the way she was acting... I think I did a poor job preparing her for the pain of labor.

She rolled on the floor. She screamed like a toddler and looked as if she was about to hit anyone who dared tell her to calm down. She was pissed!

The woman who came with her was her midwife (and friend) who had tried to keep her at home but she wasn’t having any of it! To her credit she stayed with Achol and labored with her but she wasn’t happy about her being there. I think she’d run out of patience with her antics.

The thing was, she was only 2 centimeters dilated and her contractions were abysmally short (15-20 seconds at most!). I didn’t want to discourage Achol but in my experience, this is not a recipe for a fast birth.

I told her she should try to get some rest, go home and come back when her contractions were stronger. She said her house was too far to walk at night and it was getting dark. She wanted to stay.         No problem.

I admitted them but prepared for a long labor. Her midwife/friend was walking her around the clinic. But for each contraction, Achol would stop and scream or fall to the ground. I kept an eye on her but I didn’t interfere. They had a system. I didn’t want to step on any toes.

The fetal heart tones were solid and she wasn’t exhausted so I didn’t argue when she insisted on walking and walking and walking. (What midwife would?) But I was concerned she’d get too tired, especially if she didn’t progress like we hoped.

I left her to labor so I could join in the Thanksgiving meal some of the ladies prepared for us. (So delicious!) But while we were going around sharing what we were all thankful for this year, we could hear her screaming at the top of her lungs across the fence. It sounded a bit like someone was being beaten to death.

I couldn’t tell if it was more drama or something significant was happening. So as soon as I could leave, I went to check on her. James, our community health worker on shift was trying to corral her into the prenatal room to check heart tones. But each step she tried to push.

I got in her face and told her not to push. I explained that she needed to listen. She needed to only push when the time was right. At first she ignored me. But over time and as I worked with her, she was able to calm down and breathe through them.

When I checked her again, I was surprised (shocked even!) to see that she was 8 to 9 cm dilated. It was only 3 hours later. She progressed so quickly. The waters were still intact so I asked her if I could break them. When I did, I saw lots of meconium staining.
It’s about this time that Dr. Dave (short-term missionary from Florida) came in to help with the birth. He’s an ER doctor and wanted to be a part of a birth. He was a great help all the way through but didn’t want to deliver the baby.

It’s at this point things started to change. She clung to me and together we heed-and-hawed and breathed through each contraction together. I rubbed her belly. We danced and did hip sways. I rubbed her back and reassured her over and over. The rest of her friends were happy (I think) to let me take over. They didn’t even try to come into the room.

James was quick to translate all my encouragements and she calmed down and stopped screaming. I taught her how to push properly and what to do when the time came. She was amazing. Strong and child-like at the same time. I loved it.

It’s been a long time since I’ve been able to ‘doula’ and ‘labor watch’ with a labor. Often, they come in fully and push their babies out in no time. Or they are complicated ones that need a different kind of care. This is the first ‘needy’ mom I’ve had in ages. It was nice.

In that short hour we labored together, she and I bonded beautifully. She trusted me and listened. She calmed down and pushed so well. It was empowering and wonderful. She was even able to breathe the head out while crowning and didn’t tear at all!

Truly I loved the birth. It gave me much to be Thankful for.

I’m thankful for the work I get to do. I’m thankful for simple births and babies that live. I’m thankful for this ministry here serving these beautiful people. I’m thankful I’m a part of it. I’m thankful for the strength God gives us each day to care for them and share Jesus. This is a beautiful land... full of promise. They are a beautiful people.

Post Note:
After the birth, I asked the father what he’d like to name his son. He said his name would be “Southern Land” because he is sure Southern Sudan will be its own country by January, when the referendum is passed. I pray that this hope comes true and that one day “Southern Land” grows to be a man of faith who lives to make this land a peaceful place to live.

Post-Post Note:
When I asked to take Achol’s picture. She looked confused and diverted her eyes. Her response didn’t make sense. She said, “I don’t know.” I asked her if she knew what a picture was and if she’d ever had one taken before and she said ‘no’. I showed her my camera, snapped off a few pictures and showed them to her. She was surprised... and confused. That couldn’t be her she was looking at could it? I couldn’t help but smile. She is such a little girl in so many ways. Yet, now she is a mother too.

Burning for revenge....

A few days ago, a woman brought in a baby that had been badly burned (over 20% of her face and body). We had to completely sedate the child to even clean the wounds. It was hard to hear... let alone watch. The little girl was obviously in a lot of pain.

The next day another child showed up in a terrible state. He had scalding burns all down his neck and shoulder. This is unusual. We normally don’t see so many burns. How strange.

Only later did I learn that the two burn victims are neighbors. The young girl was playing at the neighbors house. She was either pushed by another child or fell into a vat of boiling water. The mother of the child was irate. She blamed the neighbor for the accident, saying it was her responsibility to watch the child.

So while the neighbor was at the clinic checking on the little girl. The mother went to her neighbor’s house and intentionally pushed that woman’s child into the fire -- thus the second victim.

I can understand being angry but ... to push a small child into the fire? To scar him for life? That... I cannot understand. I just can’t.

So every day since, we have had two warring families waiting in line to get their babies’ burns treated. The tension is so thick you can taste it.

Pray for forgiveness and reconciliation, healing and love.

8 1/2 Fingers.... left.

One of the men working on the new clinic got his hand caught in the brick-making machine today. And in a matter of seconds, he lost two finger tips on his left hand. The ring and middle  finger are missing from the first phalanges. The bones were exposed, flesh torn open and raw. The pinky was crushed but the bone remained intact.

Fortunately we have an emergency room doctor here on a short-term missions trip. His name is Dave. Originally, he wanted to transport him. He said the bones needed to be removed and skin drawn over to be properly sown together. However, it wasn’t going to happen so he did the next best thing. He sutured him up.

Here’s the thing. The man missing his digits never made a noise of pain. Not even a squeak. He didn’t hiss, cringe, moan or otherwise indicate he was in pain. I know part of it’s cultural but.... come on!! You’re missing part of your hand! It’s okay to cry! But he didn’t.

The only noise I heard him make was only after the bandages were firmly in place. I showed him a picture or two of what his hand looked like. Only then did he make a noise of compassion.

Oh, Sudan!

I’m told it’ll take 2 weeks to heal, assuming no infection sets in. However, it’ll be months before he can use his hand again.

6 days and 6 nights.

Transporting her with our truck. Family looking on.

Nyibol came into the clinic in very active labor on Monday. I was so sure she was going to deliver, I set up the room for it while checking her in. Contraction after contraction moved across her abdomen in a lovely wave. I remembering thinking, “She’s going to deliver any minute.”

Of course... I couldn’t be sure until I did a vaginal exam. But she refused one and said she was going home to deliver. huh? I encouraged her to stay. Why come all this way, if you didn’t want my help? But she grabbed her things and rushed home.

This is fairly common here. Often, women come to ‘verify’ with me if labor has started and then go home to give birth. I don’t stop them but it breaks my heart. I figure there is something socially I’m still not clueing in on... perhaps I’ll understand better in time.

Well... this morning Nyibol came back still in labor!

She explained that she’d now been in labor 6 days. Her water broke 3 days ago (after seeing me Monday morning) and it was originally clear but then became brown. Her baby was alive (Thank God!) but she was exhausted. She hadn’t eaten in three days. Nor had she urinated.

As a result she had a painfully distended bladder which was likely one of the factors in her lack of labor progress. We removed 800-1000 cc of urine with a straight catheter and did a vaginal exam. She was fully but the baby’s head was swollen (3 cm caput). Her pelvis seemed adequate but the contractions had stopped last night.

As we started the IV fluids to induce her, she explained that her family had done fundal pressure and she had been pushing for days. But the oxytocin wasn’t working. We turned up the drip as fast as was safe but it didn’t produced even a twitch of a contraction. 

There was nothing left for us to do but transport. It was too late. I truly believe she could have delivered vaginally if she had stayed at the clinic.         Perhaps not.

The family was able to find money for a cesarean and the ministry truck was free so we took her to Wau. This afternoon she was taken into surgery.

So rejoice with me. This is a victory. A life saved -- two even. I’m just sorry it came at such a price.

Imagine, 6 days of pain... 6 nights of sleeplessness!

Update~
So I got some of my facts wrong. She got to Wau this afternoon but... when they checked her in, they discovered that her baby had died on the way. So she didn't get the cesarean right away, they have waited until this evening to do it. She is likely on her way to surgery right now. Please pray for her, her family and this precious child lost.

IUGR or Pre-term?

This morning one of my prenatal girls proudly brought in her precious little girl for me to meet. She was beaming! When I looked beneath the blankets though, my breath caught in my throat. She was tiny! So small in fact, I had to touch her briefly to make sure she was alive.

“When was your baby born, honey?” She certainly didn’t look like she just gave birth. She was too rested and relaxed.
“Last Sunday.” She said with a smile.
“Oh, you had her yesterday?” I offered.
“No. The Sunday before.” I must have looked confused, so she repeated herself. “You know, a week ago.”

I had to marvel at this little package of estrogen. Could she really be a week old, already?
“She is so small. Why didn’t you come before now?” I asked.
“Oh... we have a tradition in our culture. You cannot take babies out of the home for several days. If it’s a girl you must wait 4 days. But if it’s a boy then you wait only 3 days.”
“I see. Can I do a exam on your baby to see how old she is?”
“Of course you can. I’m here for a check-up anyway.”

I smiled and held back my concern. She certainly didn’t act like she was fighting to live... but she was so small. When I got her on the scale, flash backs of last weeks premature births blasted through my brain. In fact, the second premature baby weighed more than she did! She only weighed 1500 grams (3.3 lbs!).

But as I checked her out... all her vitals were stable and she seemed healthy in every way. So I did a Ballard’s Score on her. This is a test done on newborns to help determine if they are premature and, if so, how much. It tests reflexes, neurological development and physical maturity attributes. It’s only meant to give a general range but it can help differentiate between a small but term baby and a premature newborn.

When I checked her reflexes, postures and muscle tone, she passed with flying colors. Her neurological development was spot on. In fact, I didn’t see anything amiss except her size. At the end of the exam, it was clear to me I was dealing with a severely IUGR baby and not a preterm one.

For those who don’t know, IUGR stands for Intra-uterine Growth Restriction. It means the baby was unable to develop and grow at a normal rate in utero. Something hindered her. It could have been from placental insufficiency or maternal life-style (alcohol, drugs, cigarettes). It is also caused by poor nutrition and illness (chronic or infectious).

I’m not sure what caused hers... but it’s the most severe case I’ve seen to date.

Fortunately, she is fine and eating fairly well. I asked her mom to bring her in regularly so we can monitor her growth. She said she’ll come. I have a feeling she will.

Update: "... to save a life."

Today the girl I referred to Wau for the threatened abortion/stillbirth at 5 months came in for a follow up visit. I was SO relieved to see her again. So relieved.

When I saw her last, part of me wondered if she’d even go to Wau. The other part of me wondered if she’d live. I’m glad that both happened and that she is fine... well sort of.

She explained that she was able to get on the bus to Wau and stayed 3 days at the hospital before the baby died and they induced her. She delivered there and stayed 4 days postpartum before being discharged. That was two days ago.

She came in today because she wasn’t well. She had severe lower right quadrant pain (appendicitis?) as well as some supra-pubic pain (pelvic inflammatory disease?). I’m hoping it was just the PID and covered her with every antibiotic we had on the shelf! I also explained all the signs of an appendicitis. She promised to go back to Wau if they start happening.

So rejoice with me this small victory. Yes, she lost her child but she is recovering.

If you want to read her story you'll find it below on "... to save a life."

No-Man’s Land of grief

If each story of each woman that came through my door could be summed up in a tight little paragraph for all the world to read, would they read it? What if the story got complicated and long? What if it wasn’t as interesting as the last one? Would it then be less worthy of the telling?

This week three women came through my door. They had similar stories - all tragic. Some are more tragic than the next. But can heartbreak be measured? Can you qualify that one woman had reason to mourn more than the other, just because she might die?

The challenge I faced this week was how I was to cope with all the death, loss, grief and pain I saw. I kept trying to shut out the pain and sear my heart numb. And when I thought I had succeeded, God would slice it open again in a new area, and gently whisper, “Feel this pain, child. Let it break your heart. It breaks Mine.”

“If you deaden the pain or shut it out, you might survive a little while. But ultimately you will lose your tears, your compassion and start thinking this is normal. It is not.”

So as I write you these women’s stories... know that I only got a glimpse of their pain. I will show you that glimpse. Please don’t dismiss it. Let it break your heart and move you to prayer.

A silent grief ~
Alual has been coming to our clinic for months. She miscarried her last child to an unknown and untreated STD. So during this pregnancy we treated her with all that we could. But our strongest stuff wasn’t working. I don’t know if her husband was treated or not. But I do know she wasn’t sharing her bed with him anymore - now that she was with child.

I loved seeing her in my prenatal line. She was always so happy and round and red. (She wore the same dress each time - a red, cotton dress with white spots.) Her name actually means “red cow.”

Well, this week she came into the clinic complaining of lower abdominal pain but no contractions. So I sent her home to rest. She was only 6 months along, perhaps what she was feeling were the innocuous Braxton-Hicks contractions.

The next morning, however, she returned holding a cold but breathing little girl in her arms. I was horrified.

She had delivered at home unassisted several hours before. Her child was glacial but breathing strong. As a team, we worked hard to get her body temperature up (kangaroo care, hot-water bottles, heat lamp) and started an IV. She only weighed 750 grams. Her heart beat was so strong I could see it beneath her rib cage. Clack-CLACK. Clack-CLACK. There was just one problem. It kept beating slower and slower.

We resuscitated and monitored her for hours. She made some great improvements but we couldn’t keep her heart going. Eventually we explained to Alual that there was nothing left we could do. She asked to take her home to die.

I cried... but she didn’t. She calmly wrapped her baby in her arms and went home. She wasn’t bitter or angry. She was sad but this wasn’t the worst thing she’d lived through. She’d go on.

A raw hopeful grief~
The very next day, another of my regulars came in holding a child in her arms. She, too, delivered prematurely in the middle of the night. Her little boy weighed only 1600g and was estimated to be about 32 weeks gestation. He was alive but fighting to remain so. His lungs lacked the surfactant it needed to fully expand and when we listened closely it sounded like a door slamming shut each time. Gasp-KLUNK. Gasp. KLUNK. But he was a fighter.

We started an IV and talked to the family about getting him to Wau. Perhaps they could do what we couldn’t. I didn’t have much hope but... they were willing to try. And I was not going to steal their hope. It was early enough in the day for them to get a bus to Wau and they hurried off, IV still running.

But this mom, she was young. This was her first child. And as she prepared to go to Wau, she wept uncontrollably. The reality of her child’s fate sinking in, must have finally touched her heart. I wanted to weep but I couldn’t. I didn’t want to feel her pain. It was too fresh. Too raw.



A grief unspoken~
And again, the following day another woman came in. Except this time her baby was already dead and she was not far behind. She was carried in by her family. The smell alone screamed of infection and death.

I came late on the scene but I was told she had a retained placenta that was offensive and possibly gangrenous. Margaret got it out but she kept ‘bleeding’ a thin, white, foul liquid from her uterus.

Her family explained that she had delivered a full-term, macerated baby earlier that day. It was black and decomposing which explained the smell and her condition. She claimed that it had only been one day that she hadn’t felt the baby moving but I doubt it. A baby takes weeks to decompose like that.

In addition to the severe uterine infection and continuous flow of fluid, she had a ragged 4th degree vaginal tear. But it had been too many hours since the birth to suture and heck... what do I know about suturing a 4th degree tear?! I don’t. My heart dropped when I saw the size of it.

Fortunately, she didn’t have a fistula (that I could find) and was stable. We treated her with several antibiotics and kept her over night. The following morning, her family was able to gather the money needed and took her to Wau. Or at least... I hope they did.

She, too, was young. She, too, delivered her first child. But she had no tears to shed. She had to stay alive to cry. Perhaps, she’ll live. Perhaps, not. I pray she does and is able to one day mourn her loss.

So there you have it -- a glimpse at my week.

For those of you who tend to worry, let me reassure you. I am not carrying these women’s burdens. I am sharing their pain with you. I weep for them and pray you will too.

Pray for me. Pray that I would learn to live in this no-man’s land -- that place between the joys of birth and the anguish of death.  Pray that despite the sadness and overwhelming pain I see here, I would not be a casualty of this war but instead victorious... and able to lead others into new life.

Hope for the Broken hearted

Hope is a beautiful thing. The ability to hope is unique and wonderful and life-giving. When a person has hope, the natural ways of man fade and the supernatural becomes possible.

I am convinced with my every fiber that God -- and only God -- is the source of all hope and the creator therein. He tells us, “... hope does not disappoint.”

As Christians we have much to hope for. His promises are intense and wonderful. He does not lie. Therefore, our hope is not a ‘wish-i-may, wish-i-might.’ It’s a ‘Yes and Amen!’

That is exciting stuff!

When I think of hope... I’m reminded of a story I was told years ago. I may have some of my facts wrong... but the story is said to be true. So please indulge me this.

Scientists wanted to see if animals could hope. They devised a study and chose to use rats. (I’m all about rats being tested on, since they are about the nastiest creatures on the planet.)

They took a number of rats and put them in a container of water, the sides of which were slippery so they could not climb out.

Then they waited. It took something like 6 hours and 21 minutes for them to drown.

Then they took a new set of rats. They put them in the water and they swam. They swam and they swam... and they got tired. But just at the last moment --at 6 hours and 20 minutes -- they lowered a plank into the water. The rats scurried to safety and lived.

Then they put those same rats back in the water. And they swam. They swam and swam and swam. Six hours came and went. And they kept swimming. Six days came and went and ... would you believe it? They were still swimming. Why? Because they had hope. They had learned how to hope. They had something to live for. They knew that the plank would come and they would be saved.

In fact, those rats swam for over 21 days non-stop before they drown. Hope gave them the strength to swim 21 days when without it they would have lasted only 6 hours!

Often I look around and think, God you are taking so long. I don’t know if i can take much more of this. It’s hard to see such suffering. It’s sad to experience such pain. It’s tiresome and difficult. Come back. Please, come back now!

And yet, even when He tarries my hope is not lost. For His hope does NOT disappoint. He is its source. He has placed it in my heart. So I expectantly wait for his return. For in Him and through Him and by Him, I have all I need to go on one more day.

“For thou art He that took me out of the womb; thou didst make me hope when I was upon my mother’s breasts.” Psalm 22:9

If you are like me and need some extra reason to hope today... here are a few scriptures to lift your heart and fill it with new hope.
Psa 42:5   Psa 16:9   Psa 31:24  Psa 33:18  Psa 33:22  Psa 38:15  Psa 39:7  Psa 71:5  Psa 71:14  Psa 119:49  Psa 119:81  Psa 119:114  Psa 119:116  Psa 130:5  Psa 146:5  Psa 147:11  Pro 10:28   Pro 13:12  Jer 17:7  Lam 3:24  Lam 3:26  Rom 5:5  Rom 8:24  Rom 8:25  Rom 12:12  Rom 15:13  1Cr 13:13  Gal 5:5  Eph 1:18  Eph 4:4  Phl 1:20  Col 1:27 1Th 5:8  2Th 2:16  1Ti 1:1 Tts 1:2 Tts 2:13  Tts 3:7 Hbr 6:18 1Pe 1:13 1Pe 1:21  1Pe 3:15  1Jo 3:3

Broken and beautiful.

Last week during one of the basketball outreaches, a young girl came out to play. She is beautiful and has a smile that takes you by storm. My best guess would be she’s about 8 years old. She’s more fair skinned than some of the other girls in town and I was told her mother was of Arabic descent.

When they realized that Sabet (from Sabet’s Clinic -as the IDAT clinic is referred to by the locals) was there, they brought this girl to him. She lifted up her sleeve to show a bone sticking out of her shoulder -- pus filled and exposed.

They explained that two years ago she fell from a tree. The bone broke and came through. They couldn’t afford to fix it, so they did nothing. She lived and it started to heal a bit. And slowly, she regained some use of her arm.

He told her to come to the clinic the next day for a dressing. She came. And every other day, she returns. We cannot reset it without x-rays and are looking into taking her to Kenya to be treated. In the meantime, we see her regularly.

Yesterday, I saw her napkin keeping her place on the bench. It was so dainty and fun, I had to take a picture. She is all girl... needlework and nail polish!

Silence in the womb.

*Caution: This story isn't for everyone. It's a story of death and heartache but needs to be told.

I was told in Midwifery school once, that after a birth... you’ll always know why the birth went the way it did. If there is bleeding or fetal distress... or even death, it is often only afterward that the cause is made clear.

We cannot see inside the womb but it doesn’t mean we are blind. A watchful and attentive midwife will know when things are not going well. There are signs. There are precautions to take.

When Achol came in on Tuesday last, she was tired. She had been up all night in labor but was otherwise doing well. But I couldn’t say the same for her child. Her waters had broke at home several hours before, pouring out slimy, thick, brown amniotic fluid. And as I listened to his heart beat... my warning alarm went off.

They would go up and down with and without contractions. I had to keep moving her around to find a position which didn’t cause the heart beat to drop. I immediately suspected a cord compression of some kind, but which kind? It didn’t appear to be a prolapsed cord. But I wasn’t ruling it out. 

My heart bonded to her immediately and I have to admit, I smiled at her antics. This was her first pregnancy and as a teenager... she acted like it. (I’d guess her to be about 14-16 years old). As she moped about the clinic, she cried out loudly for God to “just let her die!” and for me “to give her a cesarean! Now!.”

I knew she was tired but I had to smile. She was just too adorable. I was strong with her though and warned her repeatedly that her baby wasn’t doing well. That she needed to listen carefully when I asked her to get in different positions. It was for her baby’s best. Sometimes she complied. Other times she didn’t.

As she labored that afternoon, some of her relatives explained a bit of her story. They said that her husband was a soldier. He wooed her and took her as a wife without paying the bride price. They ran away to Tonj together. And all was fine until six days earlier, he was killed in a car crash. She had just returned from his funeral. This was his only child.

It explained why her husband wasn’t there and her brother-in-law was. It also explained why she was so scared. Her family and friends lived very far away. She was alone in many ways.

She kept trying to push prematurely which caused some cervical swelling and a notable caput (swelling of the fetal head) to form. The thing was... each time she pushed prematurely her baby’s heart beat would drop. I begged her NOT to push. Everyone did.

In my head, I was pretty confident I was going to need to resuscitate this baby. I was prepared for it and so was the rest of the team. My hope (since I couldn’t get her the cesarean she needed) was to get her to breathe through her contractions until the very last moment and then push like mad.

She kept pushing each contraction so I did another vaginal exam. Finally, she was fully dilated and the heart tones were good, so I asked her to push. But as she pushed, the heart tones dropped. She moved in various positions and pushed. But since this was her first child, it took her time to figure out how to push exactly.

We worked feverishly to get the baby out. But I couldn’t get Achol to hurry. She had no sense of urgency. I don’t know if it was her age... or if my urgency was lost in translation. All I know is she dilly-dallied. (But as I look back at the chart she really only pushed about 45 minutes - which is short for a first time mom.)

Again, I found myself wishing for a vacuum extraction. Again, I did perineal stretching -- anything to get this baby out quickly. I had people searching for heart tones every few minutes. They were there for the first 15 minutes or so... then disappeared completely.

My hope was that the baby was just too low in the pelvis for us to hear them. But I wasn’t convinced. Ten minutes went by. I begged Achol to push with all her might. Another 10 minutes went by. Still no heartbeat found. I kept praying and with each passing minute I prayed even more.

It’s at this point I asked for the episiotomy scissors. I’ve never cut an episiotomy before. But the head was finally low enough for it to work. We hadn’t heard the heart in almost 30 minutes and the head was dusky.

I cut. She pushed. And he was born -- Limp, ashen and lifeless. Thick, sticky, meconium oozed from his mouth and nose. No breaths. Not even a grunt. No heart beat. Silence.

We started PPV and chest compressions but he didn’t respond. All the while, Achol watched in confusion. While resuscitating, I verbally walked her through what was going on. “Your baby isn’t breathing... we are giving him oxygen. Your baby’s heart isn’t beating. We are going to try to get it started.”

She seemed very confused and wildly looked from face to face in the room. Only after we gave up resuscitation efforts did she fully grasp her baby was dead. She wailed and mourned loudly, calling out to God. I cut the cord and she took him in her arms -- crying even louder than before. Desperate pleas of ‘Why!’ along with a warm, stream of tears filled the room... and the silence. 

I didn’t have to speak Dinka to understand her words. They were universal. Part of me wonders if her brother and mother-in-law didn’t grieve even harder. They were equally devastated holding that beautiful boy in their arms. He was all that remained of their son... and brother.

Afterward, I had to suture the episiotomy (almost) against her will. She kept insisting I leave it but I couldn’t. I couldn’t leave her deformed. She didn’t know what she was asking. Fortunately, she slept through it. It was just too much to handle. Too much pain. Too much sorrow.

The boy was taken home to be buried and I kept her over night for observation. We ministered to her in every way we knew how. But I think the most effective person was Sabet (ministry director/Dinka man). He asked to hear her story and he listened. Later he explained to me that he wanted to see if she blamed herself. Her answer was heartbreaking.

She confessed that she broke her father’s heart by running away with her husband. She knew it was wrong but didn’t care. Now she felt cursed by God for disobeying her father. First her husband dies... now her son. “God is punishing me,” she said. “I am cursed.”

He shared with her the truth of God’s love and prayed for her. He also challenged her to return to her family... and seek forgiveness. I pray that she does. But even more, I pray she finds the forgiveness of our Heavenly Father and is forever changed by it and His love.

Please pray for her. Also, pray for me. I can’t help reliving the birth in my head and trying to manage it differently. What if I referred her to Wau the moment she got to the clinic? Would she have gone? Would it have made a difference? What if I had been clearer, earlier on, that her baby was at such a risk? Would she have been better prepared? Would the family have been less shocked?

Yes. I know. Had she been in the States, she would have had a cesarean the minute her meconium stained fluid and erratic heart tones first appeared. Was I foolish to even let her stay at the clinic? Should I have just referred her? It’s hard not to second guess. It’s hard not to feel responsible. Please pray for me too.

And yes. Once he was born, I immediately understood why he died. He had a remarkably short umbilical cord which was wrapped tightly around his neck. In essence, the minute she pushed, he was strangled.

The sparkle of life ~

I was called out of devotions to attend Amel’s birth early Tuesday morning. She was in active labor and delivered within minutes. Afterward, she had a simple recovery which we spent adoring her beautiful baby boy! His eyes sparkled so bright he was mesmerizing. And we couldn’t help but giggle when he sucked voraciously both hands. 

They named him Acheil Aguak -- meaning "frog." I like to think of him more as a Prince-Charming-to-be! They were so pleased with the birth, they've asked me to give him his Christian name. They plan on baptizing him soon.

Any suggestions on good names for him... one that isn't about 'frogs'!

Twin update: Joy & Grace

We do weekly outreaches to a community called Malone. It’s a chance to offer simple medicines and care to a people even more remote than Tonj. It’s from this community that the twins are from. A week or so back, the twins came in for a review. They are about 4 months old now and going strong.

Read their story here. 

Labor of Love November 2010 ~ Newsletter

Newsletter: Labor of Love November 2010 

Thank you so so much for caring for me and loving me so well! This month has been full of blessings and pain. Here is my latest newsletter. I hope you like it.

12 years... ?

A woman came in today for a prenatal. She is 4 months into her 7th pregnancy and is almost (if not well into) her forties. The Sudanese sun hasn’t been kind.

She has a disarmingly sweet smile but it’s not the first thing you notice about her. 

When I was checking her in, I noticed a large growth on her side. It was well hidden by her wrap, so I couldn’t tell what it was exactly. But one thing I knew for sure, it was big.

Due to her age, I thought she’d be menopausal with some kind of abdominal growth. I was wrong -- twice.

Her growth was actually her right breast. It was roughly the size of a small cantaloupe melon with a 40 cm diameter. When I asked her how long she’d had it, she explained that it’d been that way for 12 years.

Apparently, after one of her babies her breast got very engorged. It increased to the size it is today within a few days. And at the time it was very painful. Ever since, she has been unable to breastfeed from it and after each pregnancy, it leaks “pus”.

When she walks it dangles mid-thigh and only hurts her chest due to its weight. She explained that she sometimes wraps it up over her left shoulder but it just gets too hot. She prefers to let it dangle to her side.

It’s symmetrical and non-fluctuant, even a bit fibrous. I’ve never seen anything like it outside of obscure medical books.

I asked her if she has ever seen a doctor about it. She explained that three years ago she went to Wau for a check-up but they said they (too) had never seen anything like it and couldn’t do anything for her.

I encouraged her to go back and get another opinion. I know of doctors (in the Philippines) doing full mastectomies in the jungle, why couldn’t they do something about her right breast in Sudan?

Things that go BUZZ in the night.

When the lights go down the crawlies come out and the flappers take flight. It’s positively chaotic at times. Most of the time the legions of bugs stay outside but once in a while they sneak in. Last night, a lightening bug came to bed with me. Two nights before a moth dive bombed me. Last week, a dragon fly the size of a small plane repeatedly chased me around the room.

But I think the biggest beast to barge through these doors is a bat. He came in with a flap of chaotic flittering and circled non-stop. My waving hands and erratic flinging of my shoe probably didn’t help. Eventually he found the door and was smart enough to not return!

Here’s a sneak peak at some of my assailants.

Skin and bones ~

 

For the past three days, we have had a ‘day visitor’ at the clinic. She’s brought in by her mother and spends the day in her arms, too weak to do much more than cry whenever someone draws near.

No one knows for sure how old she is. (My guess is she’s about a year and a half since her mother says she could walk up until recently and she has lots of teeth.) However, one thing is sure-- she’s sick and she’s been that way for some time.

Her clinical diagnosis is severe dehydration and malnutrition due to months of diarrhea and vomiting. The result is a condition called marasmus.

There are two main kinds of malnutrition: marasmus and kwashiorkor. The first is caused by inadequate intake of protein and calories and usually occurs in the first year of life. It results in severe wasting and growth retardation. The second is similar to the first but occurs often later on (after 18 months) and is complicated by severe swelling and water retention in the body.

Each morning her mother brings her in for a cocktail of IV fluids, antibiotics and Oral rehydration fluids. I’m not sure how long it will take for her to bounce back but I don’t think she will ever fully recover.

Some heart breaking facts on marasmus:

• Each year marasmus kills approximately 5 million children under five world wide. (According to the World Health Organization)

• The majority of children who suffer from marasmus never fully recover to weight and growth standards.

Please pray for a miracle. She isn’t past the danger zone yet. Thanks.

The Pumpkin Curse~

A woman brought her 2 year old girl in because of malaria yesterday. She was very sick... but it wasn’t just the malaria. Something was very different about this girl. Her head was outrageously large.

While taking this young girl’s medical history, I kept expecting her mother to mention the size of her head. She didn’t. I had to ask her about it directly.

I asked her if she had noticed her child’s head was larger than normal. She smiled sadly and explained that her girl had been cursed. Cursed? What do you mean cursed? 

This is what she said...
“When my girl was born, her head was normal. But not long afterward, one of my relatives was worshipping a pumpkin. However, someone then ate it and caused a curse to fall on my little girl and her head grew large -- like a pumpkin. That is why her head is so big.”

She added that her girl used to be able to walk and talk, but recently she grew too weak. Her head was just too big. Now she had to be carried everywhere.

My heart broke hearing her story -- for the girl, for her family, for the ignorance.

Placing myself in her shoes, a “pumpkin curse” would make as much sense as “water on the brain” -- even more so, really. Who has ever heard of “water on the brain” in Sudan?

But that is what she has. “Water on the brain” is a condition (congenital or acquired) in which there is an excessive accumulation of cerebral spinal fluid in the brain. It is known medically as hydrocephalus. (Hydro = water, Cephalus = head)

It’s treated by putting a shunt in the brain to draw the excess fluid off. And if done in time, the prognosis it good. However, if left untreated a person can die within a matter of years. Newborns with this condition rarely live longer than a year. If they do, there are always consequences -- neurological, physical, intellectual.

Looking at her, I couldn’t help but wonder if it was too late. Would her family value her life enough to sell a cow, take her to Wau and get the shunt? I’m not sure. But I told her mom that she wasn’t cursed (I know, bold of me!) but had a condition that could be fixed if they acted quickly.

With surgery, she might be able to recover completely. But without it, she would most likely never get old to marry. She would die before she could ever have children. Only then did she start paying attention.

She looked me square in the eye and said she’d speak to the men in the family. They were all in town for some reason. They would have a meeting.

I saw resolve in her eyes. It gave me hope. Please pray for her. And pray for the health teaching outreach I’m doing once a week. I have SO much I want to share with these women -- about health, about life and especially about Jesus!

Technicolored Wildlife!

Lizards in the Mohave desert (aka: where I’m from) are brown... a dull brown with horny spikes. But in Sudan, lizards are a fun kind of different. Technicolored different. In fact, they come in stripped blue with patches of yellow!

If you ask a herpetoligist (aka: lizard-geek) you’ll learn this lovely animal is called a Nucras Caesicaudata, better known as the Blue-tailed Sandveld. It is easily identifiable by its blue tail and hails from the land of sand and sun -- like Sudan.

I just call him beautiful! I'd love to have one as a pet... but I think the cats keep eating them. It's hard to say... They are pretty hard to catch! ha ha...

Sacrifice of Thanks!

This morning God chided me for my un-thankful heart. He said, “Hear, O Stephanie, and I will speak... I am God, your God. I do not rebuke you for your sacrifices but I have no need of them. If I were in need of anything, I would not tell you. The whole world is mine. Sacrifice instead thank offerings to God, fulfill your vows to the Most High and call upon Me in the day of trouble. I will deliver you and you will honor me.” (See Psalm 50)

It struck me to the heart that I think I can offer anything to God... my service, my days, my work here in Sudan... as if it is something important or grand. It’s not. Anyone can be doing what I do, yet He lets me do it. I get to be here!

He doesn’t want my good deeds of service but my heart of thanksgiving. That is how I can honor Him! So join with me in Thanks to the Holy One who was and is and forever will be. Thank Him with me for the work He is doing here and the small part I get to play.  I want to see souls saved!

“He who sacrifices thank offerings honors me and he prepares the way so that I may show him the salvation of God.” ~ Psalm 50:23

... to save a life.

A young woman came in this morning because she was 5 months pregnant and miscarrying. She had lots of bleeding and abdominal pain since last night. When I saw the amount of bleeding, I assumed the child was already dead. But he wasn't.

I could hear his heart ticking away at lightening speed. Tic-tic-tic-tic-tic-tic-tic-tic-tic-tic-tic! The rate was high of course (160-170s) but he was alive. She told me her water broke a full week before. It didn't look good. But he was still alive.

I told her family that she needed to get help at Wau, that we didn't have the means to help her. But her mother said... "I understand we should go to Wau. But it's better if the pregnancy ends now." Only then did it occur to me that perhaps this woman had tried to abort this child. I tried to ask if anything had been put inside the woman to stop the pregnancy? Did anyone give her special herbs to drink? They assured me that they hadn't. I want to believe them. Most of me does.

Understanding that she needed the care in Wau, the family rallied and found money. But before she left, I had to warn her not to let the bus driver know she was sick. In the past, the drivers refused to take sick patients or charged them 300 pounds (a months salary) to take them. Extortion.

When I explained this to the women they grew somber, immediately understanding the situation. It broke my heart to have to warn her not to groan in pain on the bus for fear they'd kick her off. But I did. I told them she'd have to change her clothes and hide the blood as well. They complied.

It's wrong to lie. It's wrong to deceive. And I told them so. But I think it's even more wrong to charge 100 times the bus fare to sick patients. I look forward to having an ambulance. I really do.

Pray she gets on that bus and is able to get the care she desperately needs. Thanks.

Health Teaching Outreach ~

This week has been a strange one. I started going on outreach the same day that I had my first stillbirth delivery. It doesn't surprise me that the enemy chose that day to tear my heart in shreds. Sadly, it worked for awhile.

But I went on outreach anyway -- still traumatized but ready to let God take me to the end of myself. I'm glad I did. Walking through town, meeting with women in their homes and asking them to come to health teaching discussions, was fun.

My interpreter is named Mary. She's 23, smart and the first and only girl to graduate high school in Tonj. She plans to go on to University next year in Wau. Together, we traveled to a few homes, found a good place to meet and spread the word that I'd be coming back once a month to talk to everyone.

One woman asked me if I was Sabet's (my ministry director) second wife. Ha ha. Another woman was so excited she said she'd spread the word too and get the ball rolling. It was fun.

I'll be going each Tuesday. Pray for God to guide my steps, speak through my words and actions and protect me from any trouble.

Death on a Tuesday ~

(This story is hard to write. It might be hard to read. Proceed cautiously.)

Mike our compound manager came to my door early Tuesday morning saying he’d got this call. Someone saw a pregnant woman being carried down the road on a home-made stretcher. They wanted us to pick them up. Would I come with him?

I quickly changed and ran out the door, wondering if I’d need gloves. Was she delivering on the road? 

When we arrived, fifteen people rushed her to the truck and loaded her in. She was quiet but moaned each time we hit a bump on the road... which happened often.

Once back at the clinic, I tried to get her history. Name. Age. Number of pregnancies. Her name was Elizabeth. As it turned out, this was her 8th pregnancy but only two were still alive. Two died during delivery. The rest died at various ages for various reasons which she couldn’t explain. They just died.

Meanwhile, I measured her, took her vitals and searched and searched for the baby’s heart beat. Nothing. She calmly stated that her baby wasn’t moving anymore. I continued to search. 

It was silent in there. Eerily silent. I couldn’t even hear placental sounds. Strange.

She went on to explain that her labor started the night before but after a few hours, lots of blood gushed out. Several hours after that, her water broke. At which point, her family and friends insisted she start pushing. She pushed all night. When the baby didn’t come, they finally decided to get help.

But by then it was too late for her child. When I explained her baby was likely dead, she turned her face to the wall. But she didn’t cry. In fact, she didn’t do anything. Her blood pressure was bottoming out from exhaustion and blood loss, so I pumped her full of fluids.

I asked her husband to explain again the sequence of events. How much blood did she lose? Did the water break first or the bleeding? How long exactly did she push?

I also did a vaginal exam to see what could be causing the problem. She assured me she had never pushed so long before. I couldn’t find anything significant. All I noticed was a very large caput (or swelling on the baby’s head) and a slightly contracted pelvis.
(For those midwives out there: She was fully, 0 station, caput at a +2 station. Her pelvis seemed somewhat platypelloid in shape but adequate. The baby’s head was extended but otherwise normal.)

Since her contractions had stopped completely, I started her on an oxytocin drip. I figured her uterus had just become exhausted. All that was needed, was a bit more oompf and the baby could be born. I barely opened the line, expecting the drugs to jump start things.

But nothing happened. Nada. Zip.

I opened the line completely and let the medicine storm in -- still nothing. Not even a twitch. This has never happened before. My magic solution failed. How was I going to get this baby out without a contraction?

I started talking about going to Wau. I told them that I would do everything in my power to help, but they might need to prepare to go for a cesarean. The husband, understanding the seriousness of the situation said, “I know that my baby is dead. Please, just save my wife. Do whatever you can.” I promised I would.

As I considered the situation, I realized I hadn’t tried EVERYTHING yet. I just wasn’t sure I was READY to try everything.  My everything included some painful and unpleasant procedures.

I told them that since the Oxytocin wasn’t working. The only way I could think of pushing, was fundal pressure. (*Side note: I’ve never done fundal pressure before. It’s dangerous. A lot can go wrong.) I didn’t want to do it, since it’s outrageously painful but I couldn’t think of anything else.

So I explained what it was, and told them that I’d try to flex the baby’s head and turn it in a more favorable position while they pushed. My assistant and her husband would both need to help do fundal pressure.

She pushed. They pushed. I turned. Nothing. An hour went by.

And when I say an hour, I mean a full hour of sweat, pain and intermittent progress. One minute the head would descend and I’d think we were in the clear, the next, it would be all for naught.

With each push, my heart would sink and I’d pray harder. This is not the sort of thing I learned in school. I’d look up and see her face contorted in pain. I’d look at the men pushing with all their might and think, “This is crazy. She needs a cesarean. Get her to Wau. And fast!” But then, we’d all take a deep breath and try again. I could actually feel the skull shifting and crackling beneath the swelling. Not good.

I was so stressed, worried and scared by this point that I yelled at anyone who barged in the room. And yes, I had people barge in -- translators, patients, looky-loos! And when I had reached the very end of my strength and patience, a pregnant woman stormed in and threw herself dramatically to the floor. Apparently, she too was in labor. But I had NO time for her -- no compassion, no patience, nothing. My hand was elbow deep in the middle of a stillbirth. She was making it worse.

I screamed for her to leave, but it took 8 more looky-loos to fix the problem. I was on my last nerve. What madness had descended on me? I continued to pray.

But I was running out of ideas. I had only one plan -- fundal pressure the baby out. It wasn’t working. I have no vacuum extraction. I have no forceps. I was running out of options.

Only then, did I remember a procedure called internal version. I had studied how to do it in school. But since I have yet to do an external version, why did I think I could do an internal version? I didn’t. Would it even help THIS situation?

For those who don’t know. Internal version is when a baby is repositioned (usually) from a breech position to a cephalic (head down) position by reaching inside the uterus and turning the baby. It is most often done when dealing with multiple gestations, etc.

But this case was different. I had the baby in a cephalic position. I was thinking of turning it breech. What if I delivered the body and the head still wouldn’t come out? Was I just making things worse?

But I didn’t think about it long. I acted. Some would say foolishly. I pushed the baby out of the pelvis (into her uterus) and was instantly splashed with a gush of bloody amniotic fluid. The baby’s head had been sealing it off. Now it covered me....  and the floor and everything in between.

At the sight of it, my assistant nearly lost it. I had to ask him several times to mop it up. He froze in horror.... and disgust.

Meanwhile, my hand was floating inside her uterus. Let me say that again. My. Hand. Was. Floating. Inside. Her. Uterus. (Slight, freak out moment.)

Slowly, I started identifying parts and pieces. I felt a hand. I identified a foot. Oops, that’s the cord. Yep, that has to be the face. My patient looked calm. She didn’t seem to even notice what was happening. It was strange, warm and horribly fascinating.

My assistant was still trying to figure out what a mop is for, so I called for more help. Dennis and Margaret came in to find me covered in blood with my arm lost inside my patient. Dennis reconnected her IV line, while Margaret managed to get some of the chaos re-organized. It was good to have them there.

I firmly grasped both feet and turned the child breech. I delivered the feet and then the legs. The body came out with relative ease but the arms got trapped behind the head. It took me several minutes to get the arms un-trapped. I prayed earnestly for God to remind me of all the steps I learned in school. I sighed and ... maybe even laughed, when they finally did come out. You can’t imagine my relief. But the head still needed to be born.

At this point I was so passed the point of exhaustion my hands shook. I was stressed, covered in blood and sweating like mad. “Lord! Please help me get this head out!” Images of me decapitating the child in the effort flitted through my brain. “Lord, by your grace. Help me.”

It took me several more minutes of maneuvering, suprapubic pressure and a lot of pulling before the head was born. I wanted to celebrate but I couldn’t. My heart hurt too much.

This birth was anything but gentle. It was flat out traumatic. Horrifying even. And yet, we all rejoiced. The father rejoiced that his wife was saved. The mother rejoiced that her pain was over. I rejoiced that God had answered my plea.

But as I stood there, holding this beautiful boy in my hands I couldn’t help but shake in exhaustion. It had taken every ounce of me... and I wasn’t even the one in labor!

I, then, rushed off to get out of my blood-soaked scrubs and shower. I had to take a moment and pray. I needed to cry. My first stillbirth. It was awful. Terrible even.

When I returned, my assistant had cleaned up most of the blood. The mom was recovering well. She even smiled at me, then went right to sleep.

So there you have it. It’s not beautiful. In fact, it’s not far from nightmarish except for one thing. She lived.

Some of you might read this story in shock and horror. Rightfully so. I’m sure you can find much to criticize. I did many things wrong. But I’m not sure what I would have done differently -- except barred the looky-loos from the clinic. Ha ha!

Side note: The woman who barged in and threw herself at my feet in labor, delivered soon afterward with Margaret’s help. In fact, I don’t even think she realized I had a patient in my room... let alone my hand inside of her! Ha!

Update: 
Both Elizabeth and her husband came in today for a check up. She is in pain from the fundal pressure but otherwise doing well. Please lift her up in prayer. Thanks.