Friday, December 31, 2010

... more than this!

The end of the year is here... at least the calender is telling us so. Who decided the year would end on December 31st? Whose idea was time anyway? It’s such a strange concept. Think about it. What would life look like if we had no calenders, watches or alarm clocks?

It makes me wonder. Did God create time, or just the objects by which we calculate it? (aka: sun, moon, stars...etc.) Is it an eternal or human concept?

The Bible tells us that we were created for eternity not time. Eternity exists outside the limitations of time and space. It is a whole new foundation which makes the time-space continuum look flimsy and frail.

God placed eternity in our hearts (Ecc 3:11). Meaning, we were created for more than this. That is clear to me. And each year it becomes even clearer. This world constantly tells us that ‘this is all there is’ and we ‘better grab it while we can’.  Yet, this myopic attitude screams of hopelessness and greed.

The world teaches that death is the final curtain and that we race toward it at neck-break speed. With time comes a start and a finish line. It brings in the concept of age, and with age the awareness of death. Death is the ‘great unknown’ and thus... the fixation on time.

What would life look like if the factor of time were removed? Would society as we know it be transformed? Does time tie us together or just give us the impression of cohesiveness? Is it reality or just the nail on which this flimsy world hangs?

Once I stepped into a new life with Christ, time lost its weight and wonder. Eternity seems more real to me than numbers on a calender. Eternity is now. It is in my heart. It is the framework on which my life rests.

One day in time as we count it now, my body will cease to work like it should. I will have run out of time but I won’t be dead. I will have stepped out of time's limitations... no longer being bound by it. That is all.

What then?

Freedom. What sweetness that day will be! Until then, I hold time open-handedly, looking forward to the moment when it becomes obsolete. Eternity is now. Remember that. Walk in light of this reality and live like there's is a tomorrow!  

Happy New Year!

Two Broken Legs and a Baby.

Last night I was called to the clinic to help with an emergency. Two women were in critical condition after being hit by a truck. To get to them, I had to walk through a dozen somber looking men gathered on the clinic porch. They pressed in to see but our staff barricaded the doors; the doctors needed space to work.

My patient was named Adong. She looked to be in her twenties and had a severe fracture of her left femur; it lay unnaturally swollen and twisted. When I lifted it back in place, I could see where her bones were no longer connected. It was a clean break -- No doubt a painful one.

While irrigating a deep gash on her foot and removing mud and sand from various wounds, I was able to piece together her story. She and her sister-wife, were walking alongside a road when a land cruiser hit them, sending them flying. The driver stopped, abandoned the vehicle and ran for his life. They knew both the driver and the vehicle well. There was no doubt who was responsible. 

Only then did she ask me if her baby was okay. What? She’s pregnant? I made her repeat herself. She explained she was five months along.
-- “My stomach hurts a lot. Is my baby okay?” She groaned in delirium as I palpated her belly.  “It hurts everywhere.” I could feel the well formed baby beneath her skin, perhaps she was more than five months.
-- “Can you feel your baby moving?” I asked. But she seemed not to hear... or understand. Instead she repeated how she was in pain and wanted to turn on her side.
-- “Your leg can’t be moved right now. Why do you want to turn?”
-- “I have to turn because my baby is uncomfortable in this position. I have to lie on my side.”
-- “Please don’t move. I’ll check on your baby. Just don’t move.”

Adong with Dr. Tom
As I got the doppler and ultrasound gel, I couldn’t help but wonder if we’d have a third victim on our hands. Relief rushed through me when I immediately found a solid heartbeat.
-- “Adong, your baby is fine.” I reassured her. “He’s fine. Meth Apoul. He’s doing well. ”

The room sighed in relief with me... but she moaned. The pain was intense. I took her hand and prayed. I couldn’t thank Him enough that they were all alive. It could have been much worse. I then went to pray with Amer, her sister-wife in the next room. Amer sustained a fractured right leg and several facial lacerations. She was stable and despite the blinding pain, would live.

The crowds continued to come and go. Among those pressing to get into the clinic were newspaper reporters and police investigators. Everything had to be documented. The man who hit them was a foreigner, an Ugandan. He worked for a Christian relief organization. Worse still, he attends our church and once worked with our ministry. We know him well.

As the reality of this news became clear, each face grew heavy in question marks and concern. Would their family retaliate? Would he be killed? Would he flee to Uganda? How will any good come of this? Answers would come in time. So we turned in for the night.
Amer after being stabilized.

This morning’s light brought more officials, commissioners and looky-loos. It took some time for the women to be moved to our vehicle. But by mid-morning all was arranged and they left for Wau.

I also learned that the driver was arrested (mostly for his protection) and is now being held in custody. Since no one died, his life is not in jeopardy but he will have to pay several fines. 

Please pray with me Romans 8:28 for our Ugandan brother. Pray for wisdom, peace, protection and grace. Pray for these women and their families; healing, life, forgiveness and mercy. May this little baby grow healthy and strong. Amen.

Thursday, December 30, 2010

Bongo party!

For a week, I’ve woken to bongo drums pounding out a steady beat as processions marched the streets, clapping and singing in unison. One of the celebrants owns an old bugle and plays it as loud as he can-- off-key but joyful. I heartily approve despite the sometimes early start (5 am is reserved for sleeping in my book!).

But hey... joyful noise is joyful noise. Right?

Early on, it was only Christmas songs. But now, I’m told they are singing to announce the Bishop’s arrival. As I type these words, I can hear the drums reverberating deep hollow echos of steady beats. Very African.

Yesterday, in a festive mood, Sabet gathered some of the staff to participate in one of the many celebrations going on around town. We arrived too late for one party, featuring special dancing. But we made it in time to another one. This one was a Bongo celebration.

Almost immediately, we ran into one of our translators, Dongau. He was thrilled we’d come to his tribes’ party and got us dancing in the circle. It was fun with the steady beats and relaxed rhythms.

In the center of the dance circle crouched three men bent earnestly over drums. A fourth blew melancholy wails into a hollowed tree trunk, a foot wide. It reminded me of the hypnotic echos of a didgeridoo and relaxed me immediately.

The Bongo tribe dances with slow, undulating movements. They sway and divot compared to the spastic jumping and constant stomping done by the Dinka.

Wednesday, December 29, 2010

Yellow Squishy Fruit.

Papaya season is here, meaning every papaya tree on the compound is pregnant with football sized yellowing fruit. Some branches still carry deep green bundles. But under the Sudanese sun, they don’t stay that way for long.

We try picking them just before they fully ripen. If we wait too long we can’t get them down intact. But when we do, they are well worth the effort. Their orange fleshy silkiness is divine.

To get them down from the tree tops, we have to prod them with a long pole and then catch them in a box. We had three attempts yesterday. All three missed the box and hit the ground.... oops! They were eaten anyway. Yum!

More than a statistic....

 (Warning: this story speaks of death and maternal mortality.)

Early Monday morning, I was called to attend a young woman in labor. It was her first and she was scared. As I checked her in and listened for the baby’s heart tones, I could hear a patient in the other room trying to breathe. A wet, gurgly rattle of a sound filled the clinic, distracting me. I pushed it to one side of my brain and refocused on my labor.

Her name was Debora and had been coming for prenatal care for months. I got her situated and set up for the birth. Everything was going smoothly, so I thought I’d sneak in a bit more sleep. She was only 4 cm and had three doulas monitoring her every move. I wasn’t needed just then. So, I told the health worker on shift, James, to keep an eye on her and call me if anything changed.

But before I left, I couldn’t help but peek in on the patient in room one. What was causing all that noise? James followed me into the room and showed me her chart. A man, somber and tired was holding her in a semi-recumbent position. She was unconscious and had been that way for over a day.

As I read her chart, I was startled to learn she had delivered two days before. A stillbirth. She immediately got sick and passed into a coma. They waited a day before they came for help. But by then, there was little we could do but watch her struggle to breathe.

And struggle she did. Foamy saliva formed in her mouth with each breath. She was drowning. An older woman sitting by her side, kept wiping it away. Brow knit in desperation, she studied me as I studied her chart. Dr. Tom had seen her. He had done all he could.

I went back to bed but her death-rattle haunted me. I couldn’t sleep. Questions kept taunting me. What had caused her baby’s death? Why was she unconscious? Why did they keep her at home so long? Would she live? No answers came.

It was only a few minutes later that I heard James knocking on Tom’s door across the compound. Murmured whispers exchanged. Doors opening. Gates slamming. Something told me she had died. I got up and James confirmed it. She had stopped breathing. The fight was over.

I wanted to go to the family but ... I also wanted to hide. What did I have to offer this family's grief? I tried to go back to sleep but God kept insisting. “Go now. Go talk to them,” He whispered. I obeyed but my heart in my throat. What could I say?

When I got there, I found the patient covered from head to toe in a blanket. The man was gone but the woman still sat by her side, hands clenched and pale. Tearless, she sat shaking uncontrollably and searched my face for answers. I called James in to translate and sat beside her. I asked her if I could pray for her. She nodded, still shaking.

As I took her hands in mine and prayed, my heart broke. This precious woman died in childbirth. She is the face of maternal mortality. A statistic -- but oh so much more! She is a daughter. A wife. A sister. A friend. Her motionless body, hidden under the blanket, couldn’t hide this fact to me.

Her name was Abuc.

After praying, I asked the woman to tell me her story. What had happened? She hesitated only a moment, then spoke for sometime without pause. My translator listened, nodding encouragingly for her to continue. This is the story she told.

Being of age, her daughter was married earlier this year. But her husband caught her cheating with another man, who impregnated her. Understandably upset, he retaliated by putting a curse on her and the child. This was the result of that curse, she explained. First the child died and now her. She added that this was her only daughter and she was too old to have others.

-- “How long was she sick?” I asked.
-- “Four or five days. She delivered a dead baby two days ago and then got really sick.”
-- “Did she get prenatal care?” I couldn’t help but wonder if this had been preventable. What medical reasons caused this death? Was it preeclampsia? Hypovolemic shock? Malaria? Pulmonary embolism? Stroke?... What?
-- “Yes.” She explained. “She went once to the clinic in Malualmok.” (A small neighboring town.)
-- “Only once?” I asked. She nodded.
-- “What was she complaining of before the birth?”
-- “Headaches, neck and joint pain. But that is all.”

That means it could have been anything-- malaria or perhaps preeclampsia. I couldn’t say for sure. The fluid in her lungs made me think it was a pulmonary embolism. I wanted to grill her with more questions but I didn’t have the heart. She didn’t need answers. I did. She already knew why her daughter had died. She was cursed. So I dropped it.

We sat in silence. Nothing more needed to be said. I wanted to ask her if she knew Jesus but her grief was so fresh. So I sat and held her hand instead. Her shaking slowly subsided and together we waited for the men to return. They had gone to get transportation. The body needed to be buried.

They returned with more men to help dig the grave. Abraham, a family member, asked in perfect English if we could drive them back to Malualmok. I got Mike (our compound manager) and he agreed to take them. It wasn’t even light yet when they drove off with her body.

I couldn’t get her out of my mind but I had to. Debora needed me. Turning my attention to her, I was happy to watch her labor so well. She handled the pain with slight moans, walking the baby down. She was tired but healthy.

In my mind, I couldn’t help but compare these two births. Both were first time moms in their teens. One had come for prenatal care for months, taking vitamins and getting her shots. The other was seen only once. One had delivered a stillbirth at home. The other was delivering with me in the clinic. Her baby was fine.

Later that day, Debora delivered a gorgeous little girl while surrounded by friends and family. It was beautiful watching her go from girl to woman; from pregnant to mother. And best of all she lived. I’m not saying that had Abuc come to deliver with me, she would have lived. I will never know that for sure. But I do think her chances would have been better.

Was her death preventable?

Pray for Abuc’s family and the superstitions that plague these people. Pray for these women to come for prenatal care and to deliver at the clinic. May there be no more preventable maternal deaths. May it stop here! Now!

This Christmas....

Staff party, we had a mini-service, gifts and cookies.
So I’ll catch you up a bit. This Christmas has been extraordinarily relaxing. It couldn’t have come at a more needed time. As a team, we decorated cookies, cooked fancy meals, reveled in eggnog and hot cocoa and sang Christmas carols (off-key) each night. It was great.

We even had a staff party for all the Sudanese, handing out Christmas bonuses, teddy bears and eating those very cookies. It was so great to meet the wives and children of the men I work with.

Christmas day came and went in a blur of food and gifts. In typical fashion, the triptiphane in the turkey put me in a semi-coma and I snoozed all afternoon.

Highlights for me though were all the skype calls I had with family in Europe and the States. It helped stave off some of the holiday blues and dissipated a bit of the homesickness I was experiencing.

So here’s a quick shout out to my family and friends! You know who you are. I love you and miss you! Merry Christmas!

Thursday, December 23, 2010

Culture Matters: Why maternal mortality is so high....

Not long ago, a friend posted an article on the realities of maternal moralities in developing nations on her blog (Midwife to the World). Each time I read it, my heart sinks and my skin grows cold. It is true -- horrifyingly true. I saw this happen in the Philippines and I know it happens here in Africa.

Please read the story of Mrs. Y and you will see what I mean.

May this NEVER be true of our clinic!

Wednesday, December 22, 2010

Seek the LORD until He comes.

“Sow for yourselves righteousness, reap the fruit of unfailing love and break up your unplowed ground; for it is time to seek the LORD until He comes and showers righteousness on you.” 
~ Hosea 10:12

Living in an agricultural society, the imagery of this passage stands out in new ways. Listen to all the agricultural words used. Sow. Reap. Fruit. Unplowed. Ground. Showers.

The message is clear. Sow righteousness. Reap unfailing love. Break up unplowed ground. Wait for the showers of righteousness from heaven. It is time to seek the LORD until He comes.

Come let us seek the LORD. Ready your soil. Sow in righteousness. Reap unfailing love.

Getting in the Christmas Spirit...

This week we (meaning all the remaining missionaries) have been celebrating Christmas Sudanese Style. That means Advent candles, Christmas stockings and two plastic trees. We have tried singing Christmas carols but it's comically atrocious. We can't seem to hit those high notes. We just end up rasping away and laughing it off -- at least we are singing.

To get in the mood we watched 'Christmas Vacation' and drank home-made eggnog! It was DE-lici-OUS! And today we made sugar cookies and frosted them for our staff Christmas party tomorrow. I wanted so much to start eating them now... but then what would we serve tomorrow?
I hope you are all having a wonderful Christmas... wherever you are in the world!

Labor of Love December 2010 - Newsletter

My latest newsletter: Labor of Love December 2010. Enjoy and Merry Christmas!

Tuesday, December 21, 2010

Sudanese Christmas.

Summer is upon us with a vengeance. With highs in the 90’s, I find any excuse to hide in the shade and siesta all afternoon. Doesn’t the weather care that it’s December and things should be cold, icy and white? Apparently not.

In fact, it’s pretty hard to believe it’s even Christmas. It feels like Vegas mid-June with gusty breezes that dry our laundry in seconds! Under its intense heat, everything withers and wilts -even my Christmas spirit.

I tried lifting those spirits by playing Christmas music. But it didn’t help. Brown grass, sweltering heat and tank-tops. That is my life right now. Not to mention, a thin layer of fine yellow dust coats EVERYTHING. I wake up to my face caked in yellow dust. It’s in my teeth. I cannot escape it.

And I am dry. Very dry. My lips. My skin. My eyes. My hair. One wrong move and I might chip off and flake away. And with these winds, who knows where I might end up! Uganda perhaps?

Christmas as I know it has been transformed. Gone are the cut out snow flakes. Gone are the thoughts of hot cocoa and wool mittens! Honestly, how do you sing, “Dashing through the SNOW, on a one horse open sleigh....” here without laughing? It’s totally ridiculous.

Even the traditional Christmas Carols start taking on whole new meanings. When I sing, “Away in a manger, no crib for a bed...”, I imagine a mud tukul surrounded by cows and goats. It, too, is covered in a thin layer of fine yellow dust and so is baby Jesus! Ha!

Christmas. Christmas in Sudan. *Sigh*

I do have to say there is one HUGE benefit in spending Christmas here. I am not ‘shopping’ or ‘running around’ or ‘holiday stressing’. I’m stress free. I feel no obligation to shop and not even a hint of stress. It’s pretty nice.

No. It’s REALLY nice.

So, if I can be so bold. I pray that you all are having a Sudanese Christmas -- stress free and hot! (minus the layer of yellow dust!)

Saturday, December 18, 2010

G6! G7! G8!

Akur with her new boy.
Three ladies have come to deliver in the last three days. The first one was a G6 (“gravida 6” meaning she’s pregnant for the 6th time). The second was a G7 and the last a G8. They are all prenatal regulars and I’m so glad they came in.

The first one, Akur, came just 30 mins after my plane landed. She delivered an hour or so later on her knees but tried to fundal pressure her placenta out. I kept insisting she not do it and she kept insisting she should.

(Fundal pressure for those who don’t know is the pushing on the top of the uterus to expel the contents. It’s painful and dangerous as it can cause hemorrhage and/or uterine prolapse. Risky.)

She explained she needed to ‘bleed a lot because the blood is causing all this pain. It must come out.’ I told her that the blood was keeping her alive and she should not do anything to her fundus (top of her uterus) and certainly NOT do fundal pressure in the squatting position as there is a risk of uterine prolapse.

We debated the benefits of not dying or hemorrhaging for awhile. Once it got a little testy but eventually we were able to come to an agreement. She wouldn’t do fundal pressure but I would do CCT (controlled cord traction) to help pull the placenta out. It worked like a charm and she was breastfeeding in no time. We were able to laugh about it later--Thankfully.

Once she was finished, Gai came in. She was expecting her 7th child. She has quick deliveries so I asked her to come in early labor. She did. I wasn’t sure how fast she’d go, so I got her settled in for the night. She quietly sat outside in a chair and watched the ‘goings-on’ at the clinic. (We were hustling around getting an anemic girl transfused - or at least trying to. Read her story here.)
Gai and her newborn Son and young son behind her.

I checked on her regularly but I couldn’t even tell she was in labor. She didn’t writhe in pain. She didn’t contort a face. She didn’t even breathe heavily. She just sat there calmly and watched the circus act.

She called me a while later saying the contractions were more painful, so I did a vaginal exam. She was already 9 cm dilated. So, we set up the delivery room and waited. Her contractions were short, so I encouraged nipple stimulation and they picked up like a charm. Within 30 minutes she was ready to push.

I asked her at one point during transition if she needed anything. She responded, “I don’t need anything because I’m going to die!” We all had to chuckle. She was far from dying. In fact, I was still having a hard time believing she was 9 cm along. She was the essence of serenity.

Not long after, she held her precious boy in her arms and we all giggled at how cute he was.

Then yesterday, I was called to another birth. Her name was Adhieu. She is beautiful and startlingly tall. The top of my head barely reaches her shoulders. But she didn’t labor standing up. In fact, she spent almost all of her time on her knees. She would walk off in the distance and kneel alone. She didn’t want to be disturbed.

This was her 8th child and she knew what worked for her. She was so quiet and calm. The only tell-tale sign she was in pain was the sweat beads on her upper lip and the occasional “very painful” murmured to anyone close enough to hear. She would look me straight in the eye and whisper it over and over, “Very painful. Arem Apei. Very painful.” I would nod and she would labor on.

She progressed quickly and an hour or so later, she came to find me saying it was time. My translator, Dongau, was a bit nervous since it was his first birth. But she didn’t notice. She just knelt on the floor and leaned against her friend. Two pushes and a little girl was born! She was almost born in the caul (meaning the membranes were still intact). But I ruptured them at the last moment.

After the placenta was born, the Sister-Wife came in and kept patting me on the back. She was SO excited for this little girl. She told me over and over again how happy she was and praised God with both hands raised in thanks. Her enthusiasm was contagious. She kept saying she would tell their husband how good of a midwife I was and that he would be very happy.
Adhieu and her oldest and youngest daughters.

I had to laugh. Even now, thinking about her, I can’t help but smile. She must have pat me on the back for over 30 minutes non-stop. I told her that when she tells her husband about me, make sure she tells him how strong and brave Adhieu had been during the birth. Make sure he knows how wonderful a wife he has. She just smiled a big toothy smile and nodded enthusiastically. She would!

So, there you have it. Three simple yet remarkable births. Two boys and a girl. They feel a bit like early Christmas presents.

Thank you for continuing to lift up these women in prayer. Thank you for praying for me. Thank you! 

Blood Transfusion?

Dr. Tom took over all the deliveries and prenatals while I was away. He delivered two babies and referred a woman with twins (one that died in utero) to Wau for a cesarean in the two weeks I was gone. I'm sure he saw a lot of prenatals as well.

One of those prenatal girls came in sick (initially testing negative for malaria) and was treated with a course of antibiotics. At that time, her hemoglobin was an 8. Anemic. In pregnancy, it shouldn't drop below a 12 or else even a slight amount of blood loss can cause her to go into shock. And a moderate hemorrhage, might kill her.

When I got back from my trip, I was told she had returned, still sick, and tested positive for malaria. She was treated, however in the week it went undiagnosed, her hemaglobin dropped to a 4.4!

Not good at all.

She needed a blood transfusion but we don't have the equipment for that. Dr. Tom looked up direct transfusions in his medical books and brain stormed the idea with Dennis and Caleb. They were all game to get her the blood she needed.

They started testing all her relatives for crossmatches and found two donors that would work. This was only made possible by George tirelessly working to screen them all in the lab. It was a lot of work.

The question was, could we actually pull it off before the blood coagulated? Nobody really knew. They tried a number of ways, using a variety of instruments and techniques, but none of them were working.

It was harvesting the blood that was the most difficult. 

Hours later we finally got a bit transfused without it coagulating -- but only about 30 ml. That's not enough to bring her around. It helped of course but she's not out of the woods. Our only option was to send her to Wau and hope that she goes.

The good news in all of this is we fine tuned our techniques and now know what works and what doesn't. And even though 30 ml is not anywhere near enough for an adult woman, it's plenty for a young child who might be suffering from anemia.

This gives us options we didn't have before. I'm excited.

Let's start praying for blood bank and transfusion section in this clinic! Anyone in?

Also pray with me that this girl is able to stay healthy and deliver well. Thanks.

Woman's Retreat!

IDAT's 1st Annual woman's retreat was last week. We went to Nakuru and stayed in a beautiful bed and breakfast. A lovely woman of God, Dina, came all the way from California to bless us with a study on relationship building. It was much needed and wonderful in so many ways.
The retreat was on a dairy farm which also holds a knitting project to help families effected by HIV. They had horses, dogs and cows (of course! ha!) and most of all.... they had beautiful gardens where we could wander at leisure.

One day we took off for Nakuru National Wildlife Preserve where we were able to enjoy gazels, water buffalo, warthogs, zebras and white rhinos. We drove close to the giraffes and even tracked down a lion but we couldn't get a good look at him. He hid lazily on top of a rock shaded by trees. All I really saw was an ear twitch.

All in all, it was unforgettable.

Wednesday, December 8, 2010

2nd Degree Missionary...

During lunch I found a bug baked into my bread. I quietly dug it out and threw it away.... then finished eating my sandwich. Big deal. A bug. It wasn’t alive or anything. It wasn’t hissing at me or trying to bore into my skin. I thought nothing of it.

But later, I told my roomie, Rachael, about it and she laughed. She said I was now officially a second degree missionary! Never having heard this term before, I asked her to explain.

She said that during her first missions trip to Africa, the director told her there are three kinds of missionaries.

~ A 1st degree missionary: Sees a bug in her food, gets grossed out, refuses to eat it... or at least the food it was touching.

~ A 2nd degree missionary: Sees a bug in her food, picks it out and eats on! You must eat to survive.

~ A 3rd degree missionary: Sees a bug in her food, decides it must be food. Eats it and smiles.

What kind of missionary are you?

Frankly, between us.... I’m not sure I want to be a third degree missionary... unless we are talking about deep fried crickets.... or chocolate covered ants.... or pan fried termites....  Yum!

Sunday, December 5, 2010

The 11 fingered beautiful dancer!

Yesterday morning, I was called to a birth again. (This is the 5th birth in five days! Woohoo! The women are coming to the clinic to deliver! I couldn’t be happier.)

Nyalou was expecting her 4th child and was going strong when I arrived. She was 8 cm dilated so I asked if she’d like to walk around the clinic to ‘labor down’. She had her trusty friend by her side (who obviously thought it was cold enough to merit wearing a down-feather snow jacket!) and together they walked the clinic grounds.

About an hour or so later, her water broke but she still didn’t have an urge to push. She didn’t seem to know how. She huffed and puffed for a while and then stopped trying and asked me to do fundal pressure. Both her friend and I just laughed at the idea. We encouraged her to keep trying and reminded her that fundal pressure hurt a lot! (In fact, thinking back, I wonder if she has ever pushed out a baby on her own.)

About 45 minutes later a HUGE baby was born. He weighed 4 kgs exactly. I gave him a quick “once over” and handed him off to his family. The placenta was causing some trouble and I needed to handle an unexpected hemorrhage.

But once the dust settled, I was able to turn my attention back to him. I asked his mom what he’d be called but she deferred to her husband. A few minutes later a very proud and elderly man walked into the room.

He was smiling ear to ear, chest puffed out and standing extra tall. Joy danced across his face and  made him look shiny. He just watched me chart and smiled. I found it strange that he would stare at me charting and not this new boy, so I asked him if he had a question.

He just grinned wider and said, “Oh, I do not have a question. I am here because I am told you need a name for this boy.” His English sounded stilted and proper. He was obviously very educated. I couldn’t help but smile at the business like manner of his words and his oh-so-official sounding voice. This must be the father I thought.

-- “Great,” I said, “What will be his name?”
--”Machiek. It is spelled M-a-c-h-i-e-k.” When he said it, the room stirred a bit with conversation but I couldn’t understand why.
-- So I asked, “What is the English meaning of ‘Machiek’?”
-- “It means the man with 11 hands!”
-- “Really? Eleven hands? Does your boy have 11 hands?” I asked, more than a bit confused.

He pointed to his fingers and said again, “Yes. He has 11 hands, go see.” His English was good but not good enough to make the distinction between hands and fingers.

I jumped up to inspect this 11 ‘handed’ boy and lo and behold there was finger number eleven, dangling from the pinky on his left hand!

I laughed and asked them, “Do you like it? Because if not, I can make it fall off.”
-- “Oh no, don’t do that. It’s good luck.” They all nodded in satisfied agreement. The finger would stay.

I smiled and nodded approvingly. Personally, I’d hate to have a floppy appendage but I guess it’s not so bad if you’re Dinka.

I snapped off a few pictures and returned to my charting. But he interrupted me and said, “There is another name for this boy.”

-- “Really? What is it?”
-- “Madheng. M-a-d-h-e-n-g.”
-- “Excellent. And what does ‘Madheng’ mean?”

He smiled again and moved his body back and forth in a wave-like dancing motion. “It means one who dances beautifully.”

So meet my new friend, the “Eleven fingered beautiful dancer.”

I wonder if I could get away with a name like this in the States.                   Unlikely.

Thursday, December 2, 2010

Nyibol's Tears ~

(Warning: This story is hard to write. It might not be for everyone.)

This morning started early. I was called out of bed - dragon breath and duck puddy galore - to attend a lady in labor. The strain in my translators voice when he called, put urgency to my steps.

The robot drone in my brain issued orders: Dress. Do NOT stop for coffee. Do NOT brush teeth. Go directly to birth. Go.

I obeyed. But as I was going, I woke up Racheal (my roomie) for help. Last night, the health worker on shift was up all night with 9 admissions. (yes. 9 admission. A record, I think.) He was sure to be too tired to help me much. Would she come? She dressed and was out the door even before I was.

I also met Dr. Dave on the way, and invited him and Dr. Tom to join in. For some reason, I knew this one would need a few extra hands. Even if not, more the merrier. Right?

We all arrived in unison and were greeted by a sweet girl named Nyibol. She was expecting her first and was obviously in hard labor. I was happy to see her. I’m always happy to see my prenatal girls. And this one has been coming for months.

Month after month, as I measured her belly and listened to the toc-toc-toc of her baby’s heart, we bonded. She was looking forward to this day. So was I.

She squirmed in pain as I measured her belly for the last time. She winced, then smiled, when I palpated for the head. The contractions were on top of each other. I smiled back knowing it was close and then reached for the doppler. 

Finding the baby’s back was easy... but I couldn’t find the heart. But then a contraction hit again. It was probably just the contractions... or the head was too low in the pelvis, I told myself.

I handed off the doppler to my assistant and put on gloves for a vaginal exam. I wanted to make sure she was fully before I asked her to push.

Immediately I could feel there was something amiss. Membranes. Fluid. Something sharp. Little things with bumps. She was fully dilated and her bag of waters was still in tact. But... I felt things in there that didn’t belong. Only after prodding a bit, did it occur to me that I was feeling a hand.

A hand?  -- not good.

Hand presentations can cause obstructed labor. My mind raced back over the catalogue of articles and research I’ve done on this. What I remembered was not good.            This was not good.

Only then did it occur to me, the hand wasn’t moving. “It should be moving,” I thought. I risked rupturing the membranes and pushed in deeper. What EXACTLY was I dealing with? I found something sharp and straight -- and very un-head-like.

I told the crew we had a hand presentation and possible fetal demise, de-gloved and grabbed for the doppler again. I was determined to find a heartbeat.

But I didn’t.

Nyibol, blissfully ignorant of my hurried whispers to the crew, labored on.

--“Honey, can you feel your baby moving?”
--“How long has it been? When did you feel your baby move last?”
--“I felt him move yesterday, before my labor began. But once it started, I didn’t feel him moving anymore.”

I then explained that she was close to delivering but that I wasn’t sure if her baby was alive. I told her the baby’s hand was in the way and I was going to have to push it out of the way. Did she understand?

It was a solemn few minutes as realization sank in. The room got crowded with question marks and whispers. “Do you understand what I’m saying, Nyibol?” I asked. She just nodded quietly.

Dr. Tom, eager to learn all he can about birth leaned in to say, “I’m so glad I’m not in charge. If I had to deal with a hand presentation right now...” And then shook his head.

Did that make me the expert? Am I in charge? Oh, Lord! Help me. Help me, please.

Not long after, her water broke and then the pushing. There was hair - lots of it. But the head was soft. Squishy. Swollen.

Hydrocephalus?    No.       Maybe.      Oh! I don’t know.

The skull was broken. Shattered. Sharp edges poked out beneath the skin.

“Where is the face?” I wondered. “Where are the ears?” The head just kept coming. “Lord, does this baby have a face?” So much was so wrong.

Minutes stretched out to hours. Moments lasted forever. Even now, as I think back, the birth felt like a movie played in slow motion. Frame by frame, it flashes through my mind.

Eventually, I found his face. An ear. The head was born - swollen and hopelessly deformed. The shoulder. The chest. The hips. His body lay limp on the bed, arms flopping to one side. Skin peeling in places, exposing white flesh beneath.

He was dead.

And from the state of his peeling, he had been dead for at least a day -- maybe longer.

Niybol, relieved the pain had stopped, sank back on the bed, exhausted. She was too tired to wail but not too tired to weep. Tears streaked her face. She made no attempt to hide them.

She had done all she could to be healthy. She came regularly for check-ups. She even came to the clinic for delivery. The kowaja delivered her child. What more could she do? What went wrong?

“Do you want to hold your little boy?” I asked. “He’s beautiful. So perfect in so many ways.” She wouldn’t even look at him, let alone hold him. “Are you sure?” She just shook her head.

After examining him and wrapping him tight, she eventually took him in her arms. But she held him away from her and refused to look at him. More tears.

Her family came in, heads hung low, eyes downcast. What should they do with the baby? (Here they bury the baby immediately. There is no hub-bub, no fuss and certainly no casket.)

A man, tall but slouching, stepped forward to take care of it all. I took her boy and placed him in his arms. He held him like a box of breakables-- delicate and fancy -- and walked out.

Nyibol didn’t say another word the rest of the morning. She answered my questions with nods and slight shakes of her head. I monitored her for a few hours and she recovered with ease. She was able to sleep and eat something, but didn’t find her voice. Her tears spoke for her.

As I went to discharge her, she sat sullen and dejected. Quiet. Her family looked on. She couldn’t speak so I spoke for her instead. I spoke loud enough for everyone to hear.

“Nyibol, I want to tell you the story of your baby’s birth. Can I tell you what happened? What I saw?” She nodded and looked at me, eager to understand why. But she didn’t speak.

“When you arrived, your baby was already dead. He was most likely dead since yesterday when your labor started.” She didn’t move. She just looked at me, remembering. “When he was born, I could see no reason why he died. He had no deformities. He was perfect in almost every way.” She nodded, hearing if not believing.

“The cord was not wrapped around his neck. There was no sickness that I could see. But I did notice something strange about his umbilical cord. It was very red and very swollen near his belly. Perhaps that is what caused him to die.” She looked at me, eyes brimming with tears that she could no longer hold back. She silently nodded, glad to know all that I had to share.

I continued, “I want you to know, Nyibol, you did nothing wrong.” The tears started to flow. “I want you to understand that you should not feel guilty.” The tears flowed so hard, she had to turn her face to the wall. “Do you understand, Nyibol? This is not your fault. You did everything right. You got good prenatal care. You took care of yourself and your baby.”

She looked at me relieved and broken. Her whole chest sighed with each sob. “Do you hear me, Nyibol? You did nothing wrong.” I was speaking as much for her family as I was for her. “I want you to know that this is not the result of a curse. And if anyone tells you that this is your fault, remember what I’m saying. You tell them that your doctor said you did nothing wrong. You explain to them that the cord wasn’t normal.”

She leaned her head on mine and we wept. There was nothing left to say. Nothing left to do. So I prayed. Her family silently watched on. And then she left.

I grieve for her loss and pray. Pray with me. For He is no doubt collecting many tears tonight.

“You keep track of all my sorrows. You have collected all my tears in your bottle. You have recorded each one in your book.” Psalm 56:8

Wednesday, December 1, 2010

Community Outreach & Teaching~

Yesterday was the official first day of the Community Outreach & Teaching (here forth referred to as COT). I anticipated warfare (as this outreach has been attacked in every way, shape and form from the moment it was decided on) but I didn’t expect it to be SO OBVIOUS. 

I have been having a difficult time finding someone to translate for me. The girl who agreed to do it, flaked after the second week. The days, I’ve gone out ‘all hell breaks out’ in the clinic leaving me frazzled and distracted. Some days I feel guilty for leaving the clinic at all.... yada-yada, etc.

Point is. The enemy doesn’t seem to like me doing this outreach much. Hum... I wonder why?

Well yesterday, I got slammed in a few directions before I was able to even step out the gate. As a result I got a VERY late start. It was almost 11 am before I headed out. But since I wasn’t able to get out last week (lack of translator), I decided to go do the ‘rounds’ again of the area and remind people the teaching was today.

Several said they’d come. But when we got to the designated spot (aka: mango tree), no one had come. So we waited. I asked my translator what he thought of it all. Was it too late in the day? Would they be taking care of their families? Cooking meals? Planting peanuts?

He told me earlier was better but assured me several women seemed interested. So we waited some more. A full hour later, a handful arrived. And when they sat down, even more arrived. By the end, about 40 people had come and gone.

I taught on what to do if there is a problem in labor, how to identify problems and what can happen if not caught in time. Some of the women listened better than others. Some people came because they thought I was giving free stuff. Men came and listened. Children played nearby. It was a bit chaotic... but fun.

I was encouraged. Many sounded interested in coming again next month. I will be going each week to a different part of town. Please pray for a permanent translator who has a heart for evangelism and a gift of languages. Pray God protects tuesdays from distraction and discouragement and I’m able to build solid, trusting relationships with the women in town.

"Crazy Mondays"

Tersa and her little girl.
(Long story... but hopefully worth the read.) ~

Mondays are always our busiest days. Loads of patients -sick since Friday- sneeze, cough, cry or vomit  their way to the front of the line. And prenatals that could have come at anytime, choose THIS day to get checked out. All the hustle and bustle makes things seem more urgent... more important. I think they like the show.

But to see it all, you have to get there early.

Tersa came in earlier than most however since she was in labor. When I first saw her, she was squirming in pain and clinging to my translator so tight he couldn’t move. It was endearing really. But since the contractions came every minute or so... it was impossible for him to do anything but stand there looking scared (and slightly annoyed). 

I took his place and comforted her through the pain. It was clear, she was close to delivering. Since this was her first child, I talked to her about how to push WITH contractions and not to do purple pushing. (Here they believe you have to PUSH-PUSH-PUSH at the very end whether you have a contraction or not. This wreaks havoc on perineums and babies alike. The first gets torn to shreds and the second gets less oxygen and becomes ‘depressed’).

So when Tersa started pushing, she had some ‘un-learning’ to do. She caught on quickly and a beautiful little girl was born just a few minutes later. She amazed us all with her strength and silence. Simple. Sweet. Beautiful. Strong.

For me the most memorable moment was when I placed her little girl in her arms. I looked from her little girl, to her and then to her mom who was standing beside her rejoicing. Three generations of resilient, beautiful women.

Sigh. Time to rest. Right?

Wrong. This Monday had just begun. I still had 20-some-odd ladies to care for prenatally. They patiently waited outside during the birth and smiled in solidarity when she shuffled passed to the postpartum room. But as this Monday would have it, I only got to three of them, when another labor came inching in. I apologized but knew I’d have to send them home.

They didn’t make a fuss when they saw the labor. She was almost too tired to walk. It was going to be a long one.

Her name was Amijima and she was expecting her 6th child. She had a basketball shaped belly that hung low, sad tired eyes and a solemnity that worried me to the bone. Something was wrong.

The TBA with her kept trying to help --bringing out supplies, instructing her and flittering about nervously. She had a sweet spirit and was Amijima’s friend, so I didn’t chase her from the room. But I was tempted a few times.

My heart sank as they told me her story. Her contractions started 4 days ago but hard labor had been torturing her non-stop for 2 days.  Her water also broke 2 days ago and was sticky brown. They did all they could but the baby wouldn’t come. The night before, they went to their local clinic in Thiet (a town 26 miles away). She was given an IV and then referred to us at first light. It took them all morning to reach us by car.

When I examined her abdominally something was amiss. Her baby was posterior/oblique -- and not budging. But most of all, her abdominal muscles were so lax, that even when lying flat, her belly stuck straight out -- unnaturally so.

(Midwives: think OP but with the head jammed in the maternal right iliac region. Vaginally the fetal head was felt only on the maternal right side, but at a -1 station. She was already 9 cm despite the fact, nothing was dilating her.)

I conferred with Margaret. How were we going to get this baby out? What could we do that hadn’t already been done? What was causing this problem? We vacillated back and forth and finally decided on me working vaginally to reposition the fetal head while she worked abdominally to do a modified version of external version.

What I discovered during this maneuver was very useful. It turns out, the head was extended and in a brow presentation. I was able to flex it and things somewhat improved. The head came down to at least a zero station and it was a little less oblique. But the baby still wouldn’t come.

I should note, the baby was still alive. Thankfully. But the meconium staining and high/low heart tones told me he hasn’t doing well. We were ready for resuscitation and kept praying that he’d have a chance to get that far.

Amijima was exhausted and only wanted to lie flat on her back. I could’t blame her. But I knew the baby needed to turn anteriorly. So, I put her in the hands-knees position and tied her belly tight. (Her lax abdominal muscles, I suspected as being the culprit for the malpresentation.) She didn’t like it and kept asking me to take off the belly binder. I kept explaining how it was helping and why it was important. She was almost to her limit. So was I.

“Will this baby come, Lord? Should I refer her?” I prayed.

He didn’t tell me to send her away. So I kept praying, encouraging and asking God for a miracle. And that is exactly what He did. In just 30 minutes of binding her belly and getting on her knees, she was able to deliver her little boy!

Margaret delivered him while I resuscitated. He was severely compromised and we worked on him for some time before he came around. (His Apgar score was 5/7/8. He had thick meconium aspiration and his breathing was so strained, it completely drowned out his heartbeat. Loud.)

We celebrated of course, but it was half-hearted. This precious boy was not handling the whole breathing thing like we hoped. He developed a high fever almost immediately (very unusual and indicative of some kind of intra-uterine infection) and his lungs screamed at me through the stethoscope. It actually hurt to hear... and watch. He was not well.

We treated him soon after with strong antibiotics (the perk of having doctors right there!) and watch him overnight. While they rested, I told Amijima that I was so glad we were able to help her. “You came in time. Thank you for coming early enough for us to help. Had you stayed at home even one day longer, you and your baby may not have done so well.” I said.

She nodded in weary agreement and explained, “Today, when I arrived. I thought to myself, “This is the day that I die.” I am glad I have not died. I am thankful my baby is alive, too.”

It is to His glory that we were able to help her. Neither of us had a clue what we were doing. Neither of us thought the baby was going to come out. She spent 4 days in pain -- convinced that each day might be her last. But God moved. He answered our prayers!

The next day: Since they live so far away, she asked to be discharged. I didn’t want to but she promised to give him his medicine properly and seek care at the clinic in Thiet. Dr. Tom says he only has a 50% chance of surviving (in his experience), even with the medicine.

Amijima and her little boy.
So pray with me. Pray that this boy one day is able to hear the story of his birth, remember how loved he is and how gracious God is for preserving his life. God must have a great purpose for this boy. Pray the medicine we gave them will work and for the family to recognize this as the miracle it is.

Post note: Margaret told me that after the baby was born, she went outside for something and saw Amijima’s father weeping. Men don’t cry here often. She asked him why he was weeping since she delivered and they were both alive. He said, “Because she didn’t die. My daughter didn’t die. I’m just so relieved.”

Frankly. So am I.