Taller than the average...

Nyibol insisted she deliver on her back even though she was too long for the bed. When I asked if she wouldn’t prefer kneeling, she mumbled something about it being too late.

But she didn’t look comfortable at all. So I asked again.

“Are you sure you don’t want to get off this bed,” I asked, watching her push with her head hanging off the top of the bed.

She was tall. Very tall.

“Too late,” she whispered, “Cannot move.”

I didn’t argue. She was right. This baby would arrive in no time.

Slapping away the mosquitoes frantically hovering above her body, I spoke to her softly in my broken Dinka.

“Baby coming. Head there. Good job, Nyibol. Push!”

No one can accuse me of speaking Dinka well, but I’ve mastered a few key phrases. And it’s made all the difference.

At the sound of my words, she locked eyes with me and smiled, then let her head hang off the bed again. The contraction had ended.

I smiled back. I couldn’t help it. Her exhausted, gap-toothed grin was infectious.

A few pushes later and the head started to crown. However her position wasn’t ideal for restitution, and he stalled. I tried to move her a bit for the baby to come out with ease, but she couldn’t understand my instructions.
    -- Dang it... if only I spoke fluently.

So instead I put her in the McRobert’s position, and he was born the next push.

When I picked him up to place him on his mama’s belly, his massive legs kicked the air in surprise. It took both hands and my total concentration not to drop him.

He was a big’in!

Afterward as we tried to wrap him in a receiving blanket, he didn’t fit! It couldn’t cover both his head and his toes at the same time.

Truly this was his mother’s son!

Weight: 4.1 kg or 9 lbs!  Length: Future NBA star!

Thanks.

The turmoil I felt last week has passed. The burden I struggled to carry is gone. Instead I have sweet peace and satisfaction. And I am certain it is due to all your prayers.

You my sweet friends and prayer warriors. You... my delightful and curiously silent readers. You have been praying. I feel it. And it feels like peace.

Thank you.

God has given me new insight into the needs of this community. I no longer expect these women to fit my mold. My mold is too.... well.... I’m not sure what it is. But it’s not good here. So it’s back to the drawing board. And I’m okay with that.

This new understanding has freed me from the burden of disappointment. And I’m confident that this battle was won in the heavenlies.

Thank you. Thank you so much for praying. Please continue as God might guide you!

Specifically pray if you would...

• for joy to exude from my life and speech. May it only rival that of peace and contentment.

• for my health. Each time I think I’m in the clear... WHAM. BOOM. BANG.... I’m sick! This time it’s malaria... again. But surprisingly, it’s not too bad. Pray it goes away quickly.

• for the women in this community. I’m seeing a lot of women coming in physically abused. One came in with a black eye. Another crawled into (and I mean literally crawled into...) the clinic because of a beating 4 days before. It’s hard to see so much of it and not know what to do to help. Honestly, is aspirin enough?

• for the dozen or so ladies we have due this month. Pray their families allow them to deliver with us. And they are able to make it. Yesterday one of my ANC girls came in in labor. She so wanted to stay and deliver with us. She clung to me in desperation. But her mother wouldn’t allow it and forced her to go home. They promised to return... but never did. I hope it went okay.

Stillness.

Caution: This story is not for everyone. It’s about a stillbirth. I know that such stories are hard to read at times, however these are the realities of my work here.

It was the monotonous way in which she spoke that told me something was wrong. There was no urgency or fear in her voice. There was no hope.

“My baby is not moving,” she announced to my translator flatly.

This I’ve heard before. Most often it’s nothing but an overly anxious mother in need of a little reassurance. So I didn’t react.

“Okay... so she’s worried about her baby, right?” I asked, trying to determine if her ‘not moving baby’ qualified her to jump to the front of the line. She had arrived late; there were 25 woman ahead of her. I didn’t want to play favorites if all she needed was reassurance.

“Is there anything else wrong?” I asked again, wanting to hear her voice as much as know the answer. 

She answered in a slow cadence that unnerved me: “I was treated for malaria 4 days ago in the market. I think the medicines they gave me hurt my baby.”

She didn’t bother to look at me while she spoke. Instead she gazed off in the distance, trying to separate herself from something. What could it be?

It’s as if she was somewhere else and her words were spoken by another. Strange.
    --What wasn’t she saying?

Although nothing she’d said up to this point would have normally given her priority in line, I asked her to get up from the floor and follow me inside.

My translator thought I was being silly. He didn’t say so, but his exasperation said it all. He seemed irritated that she was jumping the line.

I was breaking my own rules, but I didn’t care. My internal alarm was blaring. Something was wrong.

Once inside, I asked her to lie down on the bed and tell me her story from the beginning. While she spoke, I measured her fundal height, then searched and searched for heart tones.

In the same monotone voice as before, she explained that 4 days earlier she had had a high fever. She’d gone to the market pharmacy and was treated for malaria. They gave her an injection and then pills and sent her home.

Her belly was small (28 cm) and as hard as a rock.
    --Was she in labor? Preterm?

She continued on with her story.
Two days later, she thought something was wrong so she went to the government hospital where she learned that her baby was dead. They gave her an IV drip and kept her for observation. But the next morning they told her she needed a cesarean and referred her to Wau.

She didn’t go.

Instead she went home, and later that night her labor started.

I interrupted her story at this point to confirm that I too believed her baby was dead. I could feel no movements and find no heartbeat.

She acknowledge my words with a slight nod as her eyes hardened with resolve. She knew it. She knew it long before she came for help. Her baby was dead.

I asked her about the contractions and was told that they were much stronger now. As I palpated them, I was surprised at their strength. But she didn’t seem to notice them at all.

Turning to my translator I whispered, “Please tell her I’d like to do a vaginal exam, then set up the room. I think she might be close.”

I quickly confirmed my suspicions. She was fully with an intact membrane bulging at a +2 station.

I explained that her baby was coming soon, and asked if she wanted anyone in the room with her. She asked for her friend, and a slender woman with a furrowed brow came in. She sat uncomfortably on a stool beside the bed and fidgeted with her nails.

Once everything was in place, she started pushing. Immediately the membranes bulged outwardly. Another push and they ruptured, spilling a burnt-brick fluid on the bed.

Two more pushes and he was born.

His tiny hands lay limp against his chest as I moved him about. His cord, swollen and red, looked very out of place. And his skin, though tanned, was starting to peel, confirming my suspicions.

He’d died several days before.

After cutting the cord, I asked if she wanted to see him. She again just nodded and I held his tiny frame up for her to inspect. She looked with interest but didn’t reach for him.

Then closing her eyes, she turned away --no longer able to look upon his stillness.

She spent the rest of the morning recovering from the birth with his tightly-wrapped body cuddled in her arms. Our pastors prayed for her and counseled her, then she slept some more.

She slept but didn’t cry. I discharged her later that day.

Please pray for them. Grief is always heavier than one expects. Pray that she would turn to Jesus and let Him lift this burden for her. Thanks.

Storms.

Gusts of grey carried them in, bags in hand. Behind them, black grumbling clouds glowered on the horizon, sending a steady stream of chilly air our way.

As I walked into the clinic, they followed with quick steps --eager to hide from what was coming. Then together we shook the wind from our clothes and smiled conspiratorially at one another.

We were safe.

Heavy drops thumped on the roof above as I asked them why they’d come. He handed me her book in response and sat down. She then crawled quietly on my bed and moaned.

After a few minutes, it became clear that she was in labor... but that she also had malaria. I started her treatment immediately as she looked preterm; I didn’t want her contractions to push her into labor.

But when I looked a bit closer, I realized it was too late. Her contractions were well under way. So I asked to do a vaginal exam to see if I was right; she consented with a slight grunt.

She was already 3 cm dilated.

I wasn’t sure when she’d deliver, but I knew it’d be soon.
“The baby will come tonight,” I informed them, “and since this is your fourth, it might come pretty fast.”
They clicked their tongues in agreement, then looked up at the skies.

I think if the storm hadn’t been raging, they’d have taken her medicines and left. But with night falling early, they resolved to stay.

Once settled in, I counted contractions. They were short but frequent. It was hard to tell how fast she’d progress.

“Abuoc, if your water comes out or you feel the slightest need to push, call for me right away. I won’t be far.”
She nodded but said nothing. So I informed the health worker on duty to watch carefully for any changes, and went to rest a few minutes; it’d been a long day.

A half an hour later the health worker was knocking on my door; her water had come out.

Watch. Pen. Gum boots. Umbrella.
        -- Check.

I ran out into the rain.

The storm was just above.  Howling angrily and pushing things about; it whipped my clothes and bustled my hair as I hurried.

As I stepped into the observation room --mud splattered and wet-- chaos greeted me with a wall of backs and loud voices. As I peeked through the throng, I could see a blue baby covered in goop, barely stirring in his father’s unsteady hands.

She’d delivered without me.

The room was filled with a half-dozen other patients and their families, who stared unapologetically while screaming for her to push even though the baby was obviously out.

When I asked them to step aside so I could help, they ignored me. Perhaps they couldn’t hear in all the commotion.

I also had to physically removed her husband from the bed so I could help. He just knelt there staring at me in horror and disapproval --his hands covered in fluids and blood --his boy not breathing.

The incrimination in his gaze was hard to miss, but I didn’t care. The baby wasn’t breathing!

“Out of my way! Move!” I screamed over their chaotic chatter, “I need to get to the baby!”

My translator was worse than useless. He stood there looking at me with nonchalance and haughty derision. I had to ask him to translate everything three times before he opened his mouth!

“Tell him to put the baby down and move. I need to get to the baby!” I asked, forcing the anger from my voice.

He translated and the father eventually moved. Only then was I able to resuscitate the baby.

Pale blue and coated in sticky vernix, his little frame moved slightly to my touch. I could see he was alive, but hadn’t taken a breath yet. So I rubbed him vigorously and spoke to him.

“Come on, little buddy!” I cooed, “Breathing’s fun.”
As I turned to my translator, I was surprised to find him doing nothing. I told him I needed the birth stuff (towels, gloves, cord clamp, etc.) but mostly the ambu-bag.

“Go get me the Ambu-bag!” I called over my shoulder.
“The what?” he asked.
“The bag used to give the baby air... to resuscitate.”
I was screaming by now. Frustrated.

The little guy before me blinked from time to time... but he hadn’t taken a serious breath yet. I continued to stimulate him and pray.
“Go now!” I screamed, “If you don’t know what it is... ask the doctor.”

It felt like ages before he returned, but by then the boy was on the mend; his color had improved and he was making shallow gasps. Every now and again, he’d whimper and whine.

Progress.

My translator returned with the Ambu-bag and I gave some rescue breaths. He responded quickly. Within a few minutes, he was breathing on his own!
    --Hallelujah!

Only then did I lift up my head and look around the room. Her husband was staring at me in horrified bewilderment, holding his hands up in disgust. They were still covered in gunk.

I ignored him and eventually he went to wash them outside with the hose.

The rest of the looky-loos had also quieted down. However one was still instructing Abuoc to push-push-PUSH her placenta out. He didn’t shut up until she did.

By this point, my translator was no where to be found. I waited thinking he must be just running for a few more things... but when 5 minutes turned into 10, I gave up waiting and screamed for him to come.

I had to scream louder than the storm since he was most likely in the main clinic, 10 yards away.
    --Where could he be?

He came running, mumbling something about a convulsing child that the doctor was treating. He looked annoyed that I had the audacity to call for his help. I was ready to beat him and chase him from the clinic with our guard’s AK-47... then I remembered that such things are not nice and I took a deep breath. 
       --Thank you Lord! Thank you that their son is alive despite all this chaos!

Once the dust settled and the room was once again in order, I stepped out into the storm and splashed though the puddles.

He was alive!

Sure... things hadn’t gone as I had hoped, but he was alive! It was time to celebrate.

I splashed away excitedly --my arms lifted high. I couldn't hold it in! What an awesome God we serve! He’d rescued me in the storm.
    --Thank you Jesus!

And as God would have it, their son wasn’t preterm after all. He was just small for gestational age. He and his parents recovered quickly from all the excitement and slept well. I discharged them the next morning... after the storm had passed.

Labor of Love Sept 2011 ~Newsletter

Labor of Love Sept 2011

Katydid.

Can you spot him? He's hiding very well....

He looked wildly out of place in our observation room. His bright Spring-green wings positively shimmered in the dim light and caught my eye. He was beautiful.

So after checking on my patient, I reached up on the pole used to keep the mosquito nets in place and cupped him in my hands. This made the women in the room titter in nervous laughter; but I’m used to that.

Fighting and flaying he tried to get away but his exoskeleton wasn’t designed for speed. Although he flew a few feet I was able to catch him again with ease.

Beautiful. Intricate.

Walking toward the compound with him in hand, I looked for a better home for my new friend --something with leaves. The vine covered wall of our dining hall seemed perfect and I let him free.

But not before I got a picture.

This guy is easily 2 inches long. When his wings opened for his escape it reminded me of a para-glider diving off a cliff.

Smooth. Steady. Strong.

Not sure what to call him, I looked him up on the internet. The pictures I compared with him say he’s a Katydid.

Any entomologists out there that would disagree?

When I admire his fine markings and his exact coloring for camouflage, I’m impressed. Truly God made everything perfect and good!

The heavens declare His glory... but so do the Katydids!

Blood.

“Adut went to Wau and died,” Albino informed me.
"Adut?" I asked.
"The woman who needed the transfusion," he explained.
Albino is our compound manager and was the one who arranged for their transport.
He continued, “They were bringing her body back for the funeral, and their truck broke down. They want to use our ambulance again.”
“She died?” I asked incredulously.
“Yes. She died in Wau. They are stuck on the way back...”
“Did she get the transfusion?” I asked suspiciously. “Because had she gotten it... it’s unlikely she would have died.”
“I don’t know. I didn’t ask them,” he explained quietly.
“And what is going to become of the baby? Is there a wet-nurse in the family?” I persisted.
“I don’t know... I didn’t ask,” he repeated.
“Please ask them. I have to know...” I said, thinking to myself that I’d take the baby before they let her starve.

Mothers who die in or shortly after childbirth are trouble for the family. I’ve heard of more than one child left to die. I told this to Albino who nodded knowingly and told me he’d find out for sure.

That was two days ago.

Today Albino knocked on my door inviting me to go speak to the family. He remembered my offer to help if the family couldn’t (or wouldn’t) do it and wanted me to join him for a visit.

Eager to get the details of her care in Wau, I went with him. Sam, a Kenyan pastor on staff, joined us.

When we entered their bamboo gate, three men sat somberly beside a tukel and several sets of female eyes peered out at us from inside. Everyone was hiding from the mid-morning sun which was hotter than normal for the season.

The men didn’t rise to greet us, nor did they smile; the pall of mourning was heavy. They did shake our hands, however, and gesture to three empty plastic chairs. We sat down.

A long, respectful minute ticked by before Albino spoke. He told them we were sorry for her death and asked for details of their time in Wau. What had happened?

After a long discussion in Dinka, he turned to me to explain:
“She never got the blood,” he started, “They try to buy but there was no blood to buy. So, many got the test to see if they can give. They not have right blood.”

He paused to ask a few more questions, nodded as the husband explained, then continued:
“She had O+ blood. One man, he had same blood. But this man, he refuse to give. So she die.”

As he explained, my brain raced with this new information. I have O+ blood. I could have donated. Had I known, I would have given it happily. Why would that ‘man’ not give his blood? Why would he withhold what could so easily cure?

Albino then kindly asked them about the baby. I needed to know the child was well. In response, they brought her out of the tukel.

She was sleeping the deep sleep of baby-bliss. She knew nothing of the burial mound just 15 feet away --a mound topped with all of Adut’s worldly possessions. A worn out mattress. A green plastic basin. A cooking pot. Several dresses. A shovel.

As I looked from the child to the mound, I wondered what I’d leave behind if I were to die today. But I was quickly pulled from my reverie when Albino said my name.

“Stephanie,” he started, “they are giving the baby milk from market.”
“What kind of milk?” I asked. “Could I see it?”
They brought me a canister of baby formula and I asked them how they were giving it. What kind of water were they using? Were they giving it with a bottle or a cup? How many scoops were they using for the fluid?

Their answers were spot on; everything was being given correctly, and I was told that Adut’s mother (the grandmother) was now sole caregiver of the child.

As I looked at her thin, strong arms and grave but determined expression, I was comforted to see she was still young; she could be no more than 40 years old. There wasn’t a gray hair on her head, and only the slightest of crows-feet nestled in the corner of her eyes. The child would be well cared for and loved.

Albino suggested we pray before going, but I wasn’t ready. I wanted to teach them on how to prevent this from happening again. They agreed to hear me out and the newly formed crowd followed us to a shade tree outside their yard. 

We sat in a circle and I prayed silently to myself before I began; I didn’t want to mess this up. I don’t remember all that I said, but it was a lot.

I explained the role of good antenatal care in preventing such sicknesses and the importance of delivering at clinics. They listened with rapt attention, eyes never leaving my face. I had a captive audience and was grateful for it. Perhaps this information will prevent any more women from dying in their family.

The women sat a bit further back but were equally attentive. They didn’t fidget or cough. They hung on every word.
        --Lord, may all these women live!

After some time, I finished and Albino asked Sam to share the gospel. Sam spoke on the a verse in Isaiah that calls men grass (Is 40:6), reminding us all how fleeting and short life is. He encouraged them to place their faith in Jesus. Then Albino shared again.

I don’t know what he said but the crowd listened carefully.

Then the patriarch spoke. I never asked his name, but I don’t think I’ll ever forget his face. His dark blue jalibia stood out sharply against is cole-black skin. His piercing ebony eyes gazed fixedly on mine as he spoke. In them I saw pain and grief but no condescension.

His questions were honest --his pain real.

He spoke about the difficulty of being a patriarch, but he didn’t complain. Instead he explained how in the village when his daughter got sick, he had to take her to the witch-doctor first.

He lamented the social pressure he was under that forbid him from going to the hospital first. He added that in the village, when someone gets sick they must first find out if it’s a curse. So he took her to the witch-doctor.

Only when she didn’t improve did the witch-doctor allow them to bring her to the hospital. That’s when they came. But when they learned she needed new blood he finally understood. But by then it was too late. They weren’t able to get the blood.

“... had I known she just needed blood, I would have brought her earlier,” he explained, “But I was told she was cursed.”

My heart ached more and more with each sentence he spoke. Albino translated his words but the grief on his face needed no translation.

“Why is God letting all my children die?” he asked us. “It must be because He is far and does not know our troubles. He must not care...”

I listened carefully, thankful for his candor. Here was a man who really did want to understand. When he finished I asked for permission to answer his questions. Even though I spoke directly to him, everyone in the circle listened attentively.

Then I shared the gospel. I spoke about how his daughter was cursed, but not in the sense the witch-doctor suggested. She was cursed by sin. We all are. I explained that death was the consequence of sin, but that God had provided a way for forgiveness.

He listened carefully. Respectfully. They all did.

I gave them the clearest gospel message I could and we invited them to church. Afterward they thanked us for sharing this information with them. They had never heard these things before.

We prayed for them and left, shaking each one’s hand in respect.

As sad as her death is, I pray that it will be the start of new life for the rest of her family. Please pray with me that the seeds shared would find good soil and bring much fruit. Thanks.

Also pray for us to find a way to do blood transfusions. This is now the 3rd maternal mortality I know about that could have been cured with a simple transfusion.

Uphill Battle.

I’ve not wanted to write for a few days. Personally if I could have hid under my bedroom rug and cried for a week straight, I would have done it.

Why so emotional? You ask.
Simple. I feel like a total failure.

I’m still struggling with the language after being here a year and a half. That’s the longest it’s taken me to learn a language while living in country, and I have to ask myself why.

I’m still confused by the social interactions, especially with my prenatal girls. How do I make connections with them? How do I build relationships with them? How?

Plus I’m seeing strange fruit... superficial fruit, and I don’t like it. Many of the women I witness to say they are believers but then cannot tell me who Jesus is. They believe because they heard about Him once or they were baptized as a child. Is that spiritually satisfying?

But if I’m honest with myself, this week’s emotional roller coaster has more to do with my selfish desire for ‘results’ than anything else.
... that and well, I’m feeling used.

It is just starting to dawn on me that all my efforts and all my struggling to keep these women alive and healthy is for naught.

I see a minimum of 500 women a month for prenatals. I wear myself out treating them for STDs, teaching them comfort measures, and evaluating their gestation.
--Some of them are grateful and take responsibility for their well-being. But more often then not, all they want to know is their gestation.

Here’s the rub.

When I inform them that they need to deliver at the clinic because of X, Y, or Z, they nod politely then don’t come.

Afterward they bring their baby in sick, or more often still are carried in on stretchers with outrageous perineal problems, insisting I do something about it.

Why? Why do they ignore my pleas for them to deliver at the clinic, only to bring me their (TBA or Family caused) problems?

These problems could have been easily avoided had they just come to deliver at the clinic.

Sigh.

This week one of my prenatal ladies came to tell me her baby died during her home delivery. She expressed regret for not coming for my help. She now understood why it was important, but it was too late for this child.

This week another woman came --not in our program-- needing a blood transfusion. As I watched her protractedly heave and vomit even the tiniest fluids we gave her while burning with fever, I knew that her severe anemia was a result of untreated malaria and postpartum hemorrhage. Her one month baby lacked the rolls of fat common to healthy neonates. Instead I was greeted by protruding eyes and a starved look of pain too severe for one so young.

This week one of my prenatal girls chose to deliver at home, even though she repeatedly assured me she’d come. She lives less than 10 minutes away by foot and was expecting her 4th child. But during her delivery, her TBA/Family decided to make her push and push and push... until her perineum swelled to twice the normal size. Only when they saw the damage they caused her did they come for help, demanding I do something. 

I told them how to fix it and gave some analgesics. But the time of ‘doing’ had passed. I could have done a lot (to avoid this!) had she just delivered with us.

Had she just come...

So much of my work is preventative. I’m trained to see warning signs and treat them quickly. I’m trained to strategically run ahead of a problem so that the mother and child won’t get ‘harmed’.

But if they won’t come...

Sigh.

They have to come to prenatals...
They have to take the advice I give...
They have to deliver with us...
... only then can I really help.

Like I said, 500 women stream through our gates monthly for prenatals. That means 500 should be delivering here, but only 20 actually do.

This uphill battle of begging them to come and scaring them with maternal mortality statistics has to stop. It’s not working.

Nothing is working.

How do I get through to this community? How do I convince them to come to the clinic to save their own lives? Honestly, how?

Pray for me. I love what I do, but I feel like a failure.

Heads or Tails?

Mondays always seem to bring the strangest cases, and this week was no exception. When I arrived at the clinic a G2 was in active labor. She kept insisting that she wasn’t sure if it was labor or not though.

“Perhaps it’s malaria,” she said then knelt as if to push her baby out.
After a quick (guilty) glance at the crowd waiting for prenatals, I chuckled to myself and set up the room for her birth.

When I did a vaginal exam, she was fully at a +2 station with her membranes intact. I told her that it was time to deliver and encouraged her to push when she was ready.

She wasn’t.

Instead we waited expectantly until I realized she needed some space and sent her for a walk. Meanwhile I finished taking vitals on my prenatal ladies and did my health teaching.

Thirty-odd preggos listened politely as I rattled on about the importance of monthly check-ups and delivering at the clinic. It’s a message many of them have heard before; but I don’t care. It’s a matter of life and death for some of them, so I don’t mind repeating myself over and over.

Half-way through however, my labor called me. I arrived to see her pushing well, and soon after she delivered a beautiful baby boy.

Once the dust settled, I cleaned her up and moved her to our observation room, promising to check on her regularly.



Turning my attention back to the preggos, the morning flew by. I was able to see the majority of them before lunch (with Margaret’s help of course!). But those that remained had strange complaints, so I gulped down my soup and hurried back.

I didn’t want them to wait too long. I never do.

My first patient after lunch was one of those strange complaints though. She was reporting leaking water for 2 days. Normally this is not something that I would ignore for so long, but I didn’t have a choice. Malaria trumps leaking water in my book and I’d seen almost a steady stream of malaria cases all morning.

Plus, there is no difference in Dinka for the words ‘water’ or ‘mucus’ in the vagina. In the past I’ve rushed a woman inside with this complaint thinking she had premature rupture of membranes only to learn she has a little extra discharge. Nothing more.

So when I finally got around to assessing her, I spotted the contractions with ease. They were every 10 minutes, but they were regular.         --Not good.

Her fundal height was only 28 cm and we had assessed her to be only 33 weeks pregnant. Plus her baby felt like it was breech by palpation and the fetal heart-tones were high in the abdomen.

This was too soon; and I told her so.

Did I have a preterm breech birth on my hands or a simple case of malaria-labor? I couldn’t tell.

When I reached inside during her vaginal exam, I was perplexed to feel itsy-bitsy parts.    
        --Could that be a foot?

As I explored a bit I discovered a soft smoochy bag which told me her baby was definitely male, and I smiled.        
        --Yep. This baby was footling breech. And he was all boy!

But since she was only 4 cm dilated I didn’t mess around in there for very long. I told her that she was most definitely in labor and that the baby was coming out breech.

She took the information in stride and decided to walk around to augment her contractions a bit. I told her about nipple stimulation and she promised to do it. Then I turned my attention to the rest of the girls.

I finished them within an hour then went to find her again. She had spent the time exercising just as I asked. And as a result, her labor was well underway with strong contractions every 2 minutes.

Plus she was showing me all the signs of transition. She was sweating profusely, grunting and baring down with contractions, and starting to tremble from the pain.

But it had only been an hour. She couldn’t be fully already. Could she?

So I discharged my first labor, sending them off with prayers and then waited on my second one.

But 15 minutes later I was convinced she was close and did another vaginal exam to be sure.

Lo and behold she was fully! And while I was in there, I couldn’t resist tickling his toes. They were so tiny.

I called for Margaret and told her what we were up against, and she helped to prep the room. Once we were ready, we suggested she start pushing.

Again I did the same breech guarding maneuver I was taught last Spring and it worked like a charm. The foot and then buttock pivoted on my hands, delivering with ease. Then the rest of his body came out without a hitch. It was seamless and beautiful!

When I wiped him down and suctioned his mouth, I was relieved to see that he was term --just small for gestation (SGA).

He weighed 2.4 kg and had the sweetest dimples!

The rest of the day, he and his mama bonded beautifully as her family came to lavish love on their newest member.

Before I discharged them they informed me that his name would be ‘Doctor’ in my honor. (Yes, they think I’m a doctor here.) I laughed and tried to convince them that Nathaniel would be a better choice.

But they couldn’t pronounce it and insisted ‘Doctor’ it would be!

At the end of this perfect day, I looked back in my notes and learned that this breech birth was the 5th one I’ve done this year and my 2nd footling.

I share this only to point out that this breech was by far the most rewarding. The fear I had during my first breech was burdensome and vexing. Even though it ended well, it didn’t go as smoothly as I would have hoped.

However, this birth was different in a good way. This birth was delightfully routine. I honestly didn’t think that a breech birth could ever feel routine. But I confess it’s nice that it does.

Have I told you all lately... I LOVE being a midwife!
      --Cuz I do! I really do.

Thank you so much for praying for these women to have safe deliveries. Please pray for me to grow into a culturally sensitive midwife with the skills that will bless them the most. Thanks.

Hemoglobin.

 

A month ago she gave birth at home to her second child --a girl.

Because of untreated malaria she was already anemic when she started to bleed postpartum. She bled a lot.

She bled and bled; but she lived.         --Barely.

A month ago she gave birth to a healthy child but she has been too weak to hold her. She nurses lying down between episodes of vomiting.

She is severely anemic; and the malaria that destroyed her blood cells still runs in her veins --a month later.

Only after her family realized she was at death’s door did they carry her in. Too weak to walk by herself, she stumbled in with two strong men holding her on either side.

Tom saw her and immediately recognized the signs. He started her on malaria medicines, blood replacement fluids, and tested her hemoglobin.

Not having a lab technician we were not sure of the results but they were better than nothing.

She was said to have a hemoglobin of 2.8 mg/dl!

A normal level for an adult female should be 12-16 mg/dl. Again... I suspect the reading could have been off a little (or a lot), as the person who did it is not professionally trained.

Regardless, she needs a blood transfusion.

Her family rallied and got money to pay for the fuel to Wau, and we took her by ambulance this morning. Please pray for her to get the blood she needs and to make a full recovery.

You may be asking yourselves why she didn’t come earlier for help...
I asked the same thing. As it turns out, she lives 5 hours away by foot. Such distances are not realistic for a woman in her condition. It took a month of family discussions and pressure for them to bring her. I’m so glad they did.

Please pray for her to live. Her name is Adut. Thanks.

Healing to Thy Bones.

Foul pus leaked from the open wounds on her legs, attracting a steady stream of flies and gnats. The stench permeated her clothes as the once white fabric lay stiff with dirt and pus. The acrid taste of death clung to her skin, filling the room with rot.

Osteomyelitis.

The decaying fetor of infection had been her cloak for 14 years, rotting her from the inside out.

Her knees, knobby and swollen, sat awkwardly atop her skin-coated shins; they mesmerized me. I tried to follow the emaciated thighs to their source, but they ended abruptly in the billows of her grey, stained skirt.

No doubt self-conscious of her legs’ effect on those in the room, she hesitantly tucked them beneath her fragile frame and expertly withdrew behind the folds of her cloak.

As she did so, her lanky limps secreted to their hiding place and she morphed into a child. Though easily in her late 20s, she looked no more than pubescent girl.

But her eyes gave her away.

Dulled by pain and constant rejection they reflected nothing. Absolutely nothing. Hope and joy were long gone. Peace and love were strangers.

She described the pain of walking with the insipid monotony of familiarity. She could only go a few yards before the ache forced her to the ground for rest.

How she found the will to breathe baffles me.
... but life is not easily quitted. One cannot will their lungs to cease or their heart to stop.

Yet life takes on dimensions altogether unexplored when pain sets in. These dimensions seemed banal to her --common and vulgar.

She didn’t plead or beg. In fact, she asked for nothing.

Instead she presented a letter from the government hospital requesting we transport her to Wau as they could do nothing more for her.

She just sat on Dr. Tom’s bed and waited for him to read the letter. The letter just spurred more questions.
-- What hope did she have of getting medicine in Wau if she couldn’t get it in the Tonj hospital?
-- Why were they sending her there when she had no money and no family to help?
-- How could they unload her on us... again!?

Yes, again.

A few months back she spent two weeks curled in a ball on our back porch or shuffled from bed to bed in our observation room while we treated her with every drug we had. Eventually, we realized we could not keep her for the months of IV meds that she needed and arranged for her to get the help in the government hospital.

And now... to have her returned to us with a note pinned to her shirt like an orphaned child. Rejected once again from yet another hospital....

“Is there really nothing we can do?” I asked Tom.
“She needs months of IV antibiotics or possibly both legs amputated,” he vented, “How can we do that here?”
I just nodded and listened, my stomach reeling from the stench of her situation.
“But the letter is asking for her to be taken to Wau, not for us to treat her,” he reminded me. “But what is Wau going to do for her. If we take her there... who will care for her?” he asked.

Nothing. No one. I thought to myself.

I didn’t have to say the words out loud for them to be any truer.
        -- Lord?

Although I understand his words and recognize our limitations, I’m heartbroken that we must send her away. I’m distraught that we can do nothing to relieve her pain or social ostracism.

But as I prayed, God reminded me of Proverbs 3:5-8

“Trust in the LORD with all thine heart; and lean not unto thine own understanding. In all thy ways acknowledge him, and he shall direct thy paths. Be not wise in thine own eyes: fear the LORD, and depart from evil. It shall be health to thy navel, and marrow to thy bones.”

Lord, may her trust be in You. By Your grace and love, heal her bones! Amen.

Please pray with me. Fourteen years is long enough! 

Triplet Update:

Yar brought her babies in today for a check-up. They are all still alive!    
    --Can I get a hallelujah!

The boys --Madit and Ngor-- are thriving but little Adwel is still having trouble. She isn’t nursing as much and still has a weaker suck. Lethargic and sleepy, she had trouble swallowing the expressed milk we gave her by syringe.

Although tired and a bit sleep deprived herself, Yar is doing well. I asked her again today if she thought her babies were going to live. She smiled and said that she did.
    --That’s progress!

She also informed me that her family threw them a traditional triplet blessing yesterday to celebrate their birth. I asked her what they did to celebrate and she said everyone showed up with food for a feast. After eating their fill, the remaining food was then scattered around the property as a way of warding off evil spirits and bringing blessings.

She also explained that if they live to be one year old, they’ll slaughter a cow and throw an even bigger shin-dig!

I’m looking forward to that day!

Please pray for them all. They are (understandably) tired. And especially pray that Adwel gains weight this week. Thanks!

Pilgrims!

Pilgrim: def. A person who journeys to a sacred place for religious reasons.

A few years back I spent a month walking El Camino de Santiago (aka: The Way of St. James) with a dear friend. For those unfamiliar with this 500 km trek, let me explain.

El Camino de Santiago is one of the last remaining holy pilgrimages dating back to the middle ages. There were originally four holy pilgrimages. And if a devout Catholic wanted to absolve certain sins he or she could journey to either Jerusalem, Rome, Istanbul, or Santiago de Compostela.

Almost everyone is familiar with the first three sites. But where in the world is Santiago?

Santiago de Compostela is in the North Western part of Spain in the region of Galicia. It is said to be the burial site of the Apostle James who, according to church tradition, brought the gospel to Spain.

Today a stately cathedral marks the field where he is said to lay and thousands journey there every year by foot or bike.

There are at least a half a dozen different routes to get there though. My friend and I took the most common one --the Camino Frances which starts in the French Pyrenees.

During our journey I was amazed at how several Biblical truths took on new meaning for me. It taught me to take life a lot slower, to look at the fields, and to contemplate the flowers. It taught me what it means to be a pilgrim.

In 1 Peter 2:11 we are reminded that we are not of this world. As foreigners, pilgrims and sojourners, we are to set our sights on heaven and journey on. That requires good shoes, light bags, and a heart set on pilgrimage.

“Blessed are those whose strength is in You,
who have set their hearts on pilgrimage.”
            --Ps 84:5

Are there any out there feeling a bit out of place?
                     --Take comfort stranger and keep traveling!

Are there any who feel like the journey is too long?
                    --Look to Jesus and let Him be your strength!

And remember, set your heart on pilgrimage.
                                                 ... for this is not our home!

Head Strong!

Aleu arrived on foot but in obvious pain; her friends had to hold her upright. Sweating and shaking with each contraction I wasn’t sure if she was in labor or having convulsions from malaria. Either way, it looked urgent.

But since I was mid-prenatal I let Margaret take care of her. I’d check on her when I could.

Five minutes later, I prayed for my prenatal and pointed her toward the pharmacy. I could hear excited voices in the next cubicle (achem... I mean room), and I decided it offer my help.

I walked in to find a very pregnant girl on her back frantically trying to push. Eyes jumping in confusion, her face was a mask of fear and pain. I stayed back and watched.

It seemed that Margaret was trying to do a vaginal exam. She did so despite Aleu's pushing and called over her shoulder at me: “She’s fully. Are you ready to take her?” 

Not wanting to seem too eager, I nodded and smiled. Touching Aleu on the arm, I assured her everything was alright but that I needed her to come with me.

“Can you stop pushing for a minute and move to the other room?” I asked quietly.
She nodded and slowly sat up. At the sound of my Dinka she seemed to melt. A good sign.

Once I got her into my room, I had her start pushing. She complied but couldn’t figure out how. After a few fruitless contractions, it finally dawned on me that she may have been doing this already at home.
-- “Has she been pushing at home?” I asked the room.
-- “Yes,” my translator explained softly. Apparently this was explained before I took over.

Duh, of course she’d been pushing at home. She showed all the signs. Frightened. Exhausted. Caput on the baby’s head. Vaginal swelling.

Only then did I take a step back and ask a few extra questions. How long? When did the water break? Was there any blood? How many babies has she had?

Normally I have all this information before pushing, but this was Aleu’s first time to our clinic. She hadn’t received any antenatal care at all.

But the story she told was not new. It’s one I’ve heard over and over again. Aleu’s first child died during delivery after 3 days of pushing. This was her second child.

She went into labor the previous evening, her water broke around 2 am, and she’d been pushing ever since. That was 11 hours earlier.

Knowing this information, I did my own vaginal exam and reassessed her pelvic outlet. Her ischial spines were prominent leaving less room for the baby’s head to maneuver. It’d be a tight squeeze.

No longer willing to dilly-dally, I got out the vacuum. It’s my go-to tool every time ‘one of these’ labors comes in --labors where the damage is already done --labors where the baby is still alive but the mother is exhausted.

But even with the vacuum and her pushing with all her might the head wouldn’t budge. In the States she would have been a very good candidate for a cesarean. I’ve rarely seen such a small outlet. 

Nevertheless, we persisted and prayed. The vacuum popped off a number of times but we kept putting it back on, each time hoping that the baby would come the next push.

Finally, frustrated that we were getting nowhere and fast, I placed the vacuum once again. I was determined to pull harder than the previous times. I put my back into it.

Yes, it was foolish. Yes, a cesarean would have been a better choice. You’ll get no argument here.    
-- I will say this however. I prayed. I prayed hard. And I pulled.

Would you know it? It worked!

The head slid lower and Aleu’s eyes widened in surprise. She could feel the difference and was eager to push once again. The next contraction the head was almost crowning.

The following one, he was born!

He had massive molding on his skull, plenty of caput (or swelling) and one large scrape from the vacuum. But he was alive!

I was horrified to learn the vacuum caused him damage but I seemed to be the only one to feel that way. Everyone else was amazed and thrilled he’d come out alive! So I dropped it and rejoiced with them.

Thank you Jesus for vacuums! Thank you Jesus for babies that come out! Thank you Jesus for everyday miracles!         
             -- I’ve seen my fair share!

Name That Fruit!

We have a number of fruit trees on the compound --most of which are easily identifiable.

Mango. Papaya. Banana. Lemon.

But there is one tree which produces a knobby, green, wart-like cluster that I cannot seem to identify.

Last year when they were in season I didn’t recognize them as food and thus didn’t pick any. However the Africans on the compound ate them with gusto.

I remember asking to try them but not being impressed (at the time). Eating it was too much work.

Why?

Well... the fruit is picked when green. Then it must ripen for several days. Once ripe it squishes to the touch and can be torn open. Inside is a treasure trove of black seeds covered in sweet, slightly-textured slime.    

Yum!

I asked its name but nobody seems to know for sure. The best guess I got was Custard Fruit.

Does that sound right to you all? Anyone out there know for sure? I’m in love with a new fruit and need to know its name! 

Twins... but Three!

Madit... Ngor... and lil' Adwel!

Monday was another day of madness at the clinic. Thirty-eight woman lined up like eggs in a carton awaited me, pink prenatal book in hand. 

I gulped and smiled quickly in their direction as I entered the clinic, lifting both hands in greeting as I walked. Some laughed and greeted me in return.

Turning to my translator in mock disbelief I asked how many there were.
“There is many many. I think 38 but others still coming,” he said not hiding the strain in his voice.
“Sounds great,” I volleyed back at him trying to lift his spirits, “Let’s get started.”
                --Thirty-eight? How will I get through so many? 

After teaching them briefly on the importance of coming regularly and delivering at the clinic, I warned them of the evils of malaria. Thirty-eight shiny black faces watched me politely do my schpeal, getting up every now and again to stretch or spit.
               --Do they believe me, Lord?

Afterward, I called in patient after patient, measured bellies, palpated parts, and counted out the steady rhythm of electronic heartbeats.

Sometime midmorning the steady flow of preggos was interrupted by my translator:
 “Excuse mad’am Akuac (my Dinka name) there is a woman outside. She is come for her babies to be check.”
“Did she deliver with us?” I quarried. I tend to only do baby checks if they deliver at the clinic.
“No. She is deliver at home,” he said hesitantly while trying to meet my eyes and adding, “She deliver twins ... but three!” The excitement in his voice bordered on awe.
“Twins but three?” I asked, “Do you mean triplets?”
He nodded.
“Bring me her book.”

He filtered through the masses to get her book while I watched on tip-toes from my screened off window. I couldn’t get a good look because of the throng.

I quickly finished with the lady on my prenatal bed, prayed for her, then sent her on her way.
           --Triplets? Really, Lord? Triplets... and I missed it?

My translator returned with her book and I laughed as I quickly flipped through it.

I had seen her just once. During that prenatal I’d guessed her to be breech with polyhydramnios (aka: an overabundance of amniotic fluid). I also assumed she was term since her fundal height was 37 cm. (For those who don’t know, a fundal height is the size of a woman’s belly in centimeters which helps determine gestational age, etc.)

Not once did I suspect twins... let alone triplets! Ha ha!

Then it was my turn to wade through the crowds.

Three men sat in a row each holding a baby wrapped in various scraps of cloth; they smiled proudly as I lifted the make-shift blankets to glimpse their tiny cargo.

Preterm but apparently strong, I smiled in relief and asked if they had breastfed yet. I was informed that two had sucked just once but the smallest one wouldn’t.

I did a slow survey of the crowd of expectant faces and instantly recognized their mother. Tired and squatting low, she had a belly-band cinching her waist --a dead give-away. (Cultural note: woman wear strips of cloth around their bellies postpartum to help control bleeding.)

“Three?” I asked her with a smile.
She just nodded slowly in response.
“Why didn’t you come to let me help you?”
“I didn’t know I was in labor,” She explained, “I had no pain.”
“Really? No pain?” I asked in surprise. “That’s great!”

The rest of the morning we monitored the babies and got them stable. But other than a weak suck, they were doing well. When I got around to doing a Ballard’s score (aka: a way to determine a preterm baby’s gestational age) they fell into the 33 weeks range. That’s roughly 2 months early.

Their mother, Yar, is young, and this is only her second pregnancy. She’s just barely 20-years-old and now has 4 kids! Pray for her! Pray that she’ll fight to keep these babies well fed and that her milk will gush in!

Also pray for these little ones --they are two boys and a girl.
Boy #1: weighs 1.4 kg (3 lbs) who they’ve named Madit. He’s the oldest.
Boy #2: weighs 1.2 kg (2.6 lbs) who was born second and is named Ngor.
Girl #3: weighs just 1 kg (2.2 lbs) who is the cutest thing ever! She’s named after her grandmother, Adwel.

Please pray that they’ll thrive despite having the cards stacked against them. We know a God who is able to do this and oh so much more! I so desire for them to live!

They are my first triplets; but I especially like them because we share the same birthday! Yep. It was my birthday yesterday. And for it, God sent me twins... but three!

He he he.... best birthday present ever!

Oh... and I did eventually get to the rest of my prenatals. But some of them had to wait, literally all day. I finished seeing them at 6 pm. Yikes!

What a day!

Lessons to Learn ~

I learned this week that the government hospital down the street employs a number of TBAs that run their ANC program. I can’t say how many of them there are but together they deliver about the same number of babies monthly as we do in our clinic.

After talking to a Kenyan nurse who just joined the staff I was happy to compare notes with her. She tells me that the main struggle for them is getting the women to deliver at the hospital too. It seems that the TBAs are using the hospital for training and free medicines then encouraging the women to deliver at home so they can charge them a fee.

I suspected as much for many of the women in our program, especially after one of the female translators left suddenly. I think she was secretly siphoning off business.

Nevertheless, more women than ever are delivering with us which is a huge success. A year ago this month only 5 women came to deliver at our clinic and all of them where major emergencies. Some of them put hair on my chest and steel in my veins, but if I recall correctly they were all the result of not getting help earlier in labor.

But a lot can happen in a year, and this month is proving to be quite different. I’ve already delivered 10 babies --none of which have been crazy emergencies.

In fact, it’s been ages since I’ve had a crazy birth. Why? It’s simple. The women are finally coming early enough for such nonsense to be prevented.

I love seeing these changes and hope to see even more of them. But the real question is how do I teach the TBAs? How do we get them to bring the women in to the hospital for delivery? How do we encourage them to accurately report their statistics?

Right now I am seeing about 400-500 women for prenatals each month but I’m delivering only 20-25 of them.

Something is missing. Something is very off. Something needs to change.

Any ideas?

Please pray for me. I need wisdom from above to know how to proceed. Please pray for these women. I so desire them to be healthy and live. I so want to see them strong and their babies thriving! Please pray for the TBAs to see the importance of getting these women the best care. Thanks.

His Nets ~

After Jesus was crucified and buried, He rose on the third day to the total shock and disbelief of His disciples. Never mind the fact He told them He was going to be killed. Never mind the fact He promised to rise again. They just couldn’t fathom it.
           --Can you blame them?

So when it happened, they were surprised --surprised He was killed and awed that He rose again. And today, this disciple is equally surprised and awed!

But that is not the only thing on my mind right now. This morning, I can’t help thinking about nets. “Why nets?” You ask. Why indeed!

“Simon Peter climbed aboard and dragged the net ashore. It was full of large fish, 153, but even with so many the net was not torn” (John 21:11)

In the 21st chapter of John we read a story of defeat and confusion turned to success because of Jesus. In it we learn that the very disciples who three and a half years before cast their nets aside to follow Jesus, turned back to them in the confusion after His death and resurrection.

Floundering in uncertainty they returned to what was comfortable. And Peter, James, John, Thomas, Nathanael, and two others hopped in a boat and fished all night.

They caught nothing.

But as they were about 100 yards out from shore they saw a figure on the sand asking if they had caught anything.

-- “Friends, haven’t you any fish?” He asked.
-- “No,” they answered.
-- “Throw your net on the right side of the boat and you will find some” (v. 5-6).

Experienced fishermen will tell you fish are not normally so close to shore, nor are they moving at dawn. The best catch is always at night out in the deep. But none of that mattered because it was Jesus doing the fishing through His disciples this time.

When they obeyed, they caught 153 large fish!

Only then did Peter recognize it was his Master and impulsively swam to shore, leaving the nets to be hauled in by the rest (v. 7-8).

But the nets... the nets... that is what blesses my heart the most. The nets didn’t break. They were able to bring 153 slimy, flopping fish to shore and the nets didn’t tear even a little! (v.11)

This comforts me.

At times I feel like I’m ready to tear --my heart rips; my body burns-- forcing a moan from my lips. “Lord, the strain is too much for this net of Yours,” I complain.

But when the fish are ashore and the fire warms my skin, search as I might I can find no holes in this net.

When Jesus is directing the work, his instruments are always preserved. So remember if you are feeling the stain of the load today, rejoice!         --His nets do not tear.

We are called to be fishers of men.      
             --Are you fishing? Are you even in the boat?

Update: Eye, Preterm

Preterm: 
So Amour came in yesterday with her preterm baby boy for a check-up. Both seemed well at first but then I realized she was showing signs of malaria; it may have caused her preterm labor.

But he was doing well and had actually gained a tiny bit of weight.

The best part was her milk was very well established, and she was no longer complaining "I have no milk."

I was so sick of hearing her say it after the birth that I warned her sternly that if I heard it again I'd charge her 5 pounds each time. She laughed but never said it again.

And during the check-up she told me that she believed me now; she has lots of milk. And she was right it was leaking profusely from her breasts! 

Thank you so much for praying for them. She promises to come back for visits; and I promise to let you know how things go with them.

Eye Team:
The eye surgery team was able to complete 172 cataract surgeries in the 5 days they were here. Some patients even got both eyes done.

On the last day a 31-year-old woman got both eyes corrected. She had not been able to see for several years, meaning she had never seen her youngest child!

Thank you so much for praying for this team. It was a great success, and many heard the gospel; many prayed and sang to God in worship. It was a wonderful time to see this community served and loved in Jesus' name.

Singing and Dancing!

 

The eye team kept telling me how excited the patients get when their bandages are removed; “Often they jump for joy and cry out in delight,” one team member said.

This I had to see.

So when I noticed we were uncommonly slow at the clinic today (due to the rain!), I took this opportunity to join in with the fun. 

When I got there, the patients were all lined up on a bench; half had already had their dressings removed, and the air was charged with joy and disbelief.

Clapping in surprise and elation, unstable hands shot in the air in praise!



Then the songs came...
One patient after another --the excitement too great to suppress anymore-- stood to sing a song of thanksgiving and joy!

They sang of God’s goodness and blessed those that came to help. They raised their hands in worship... for they could see! They could see!

Every outburst of song made us smile and laugh with them. The jubilation was contagious.

Oh, to be in the dark for so long.... Oh, to be blind and now to see!

One man was so happy he started dancing; and in true Dinka fashion ran back and forth before his friends while they clapped and sang!

It was a celebration! A celebration of sight!

Try as I might, I couldn’t contain my tears. They flowed so easily that I was briefly grateful for the rain.

I wish I could describe their faces as they looked around for the first time. I wish you could see the rapturous surprise as their world took on form!

It was moving. Very moving.

Snapping off pictures left and right, I tried to capture these moments for all to see. But I failed.

These photos only show the faces; they don’t let you hear their songs --songs that warbled with aged voices and wrinkled lips.

These happy songs still echo in my ears, bringing an instant smile to my face. And when I think of the man in white who danced for all to see, I can’t help but laugh softly to myself.

Thank You Jesus for You promised: “I have come as a light into the world, that whoever believes in Me should not abide in darkness.” John 12:46

May their sight be spiritual as much and physical!

Funny Cultural Side note:

The Spitter

One man was so grateful for his sight he spit on me!

Yes. He spit on me in joy!

As a thin mist of spittle spread across my face I was momentarily shocked in disgust. Then I remembered; here you spit on things and people as a blessing. Here spitting in someone’s face is actually good!

Those around me laughed when they saw me so defiled (achem.... I mean ‘blessed’), and I joined in.

Surprisingly I wasn’t horrified as I would have expected (as this was the first time someone has spit in my face). Rather I was honored.

Does that sound silly? It feels silly to write it down. But I was in fact blessed when he did it. When the crowd watching our interaction (all of them Dinka) saw my spit bath, their laughter brought one of the pastors. He asked me what happened.

-- “That man just spit on my face,” I said with a smile, unsure if I needed to wipe it off or not.
-- “Oh,” He laughed, “He bless you!”
-- “I know... I know...” I said deciding it was best to wipe it off discretely, “But in my culture we do not spit like this.” Then I laughed again shaking my head in disbelief.
-- He saw my confusion and explained, “Here. Spit is blessing. Here. Spit is happy.”
-- “Yes. He is very happy. Isn’t he?” I asked and then turned back to my blesser with an easy handshake not waiting for a response.

They all were very happy. So was I.

I still am.

Rumors of War...

I have friends that live in Sudan but on the Ethiopian border. They were recently evacuated.

Unfortunately, I cannot share their identities. But I'm moved by their experiences and hope you will be moved as well --moved to prayer.

Just know that parts of Sudan are being bombed regularly. 

The Deng Rain!

For those who speak a bit of Dinka, they will understand (and hopefully forgive) the pun.

Deng means rain in Dinka. And right now.... we have a LOT of it!

As a result of it, I have learned two new Dinka words today.
-- Tiop: which means dirt
-- Tiok: which means mud

Deng + Tiop = Tiok!    

And lots and lots of it as my gum boots can testify!

The rainy season has come very late this year and it’s caused a number of problems. People planted their crops at the regular time but since it stayed dry, the seeds failed to sprout.
And now it’s harvest time and the rain is upon us with a vengeance. Whatever crops did grow are being flooded out of the ground.

This rain will help the sorghum crops I’m told, but it came too late for the peanuts and pumpkins.

Please pray for the remaining crops to produce... or else we are going to see some hungry people come December. Thanks.

Happy Endings ~

When she arrived telling me she was bleeding, my eyes flitted to the small protrusion around her middle and then to her face; she was serious.    
        -- Papa? Another stillbirth? Really....?

Bleeding this early means just one thing but I didn’t tell her that right off. Instead I motioned for her to lie down and describe her symptoms.

She reported large blood clots the size of her fist and copious frank bleeding. It all started two days ago.    -- Oh dear! Is this a placenta previa? Abruption? Lord... please help us.
-- “Two days of bleeding?” I asked a bit surprised, “Are you have contractions too?”
-- “Yes. Can you feel it right now?” She asked and motioned for me to touch her belly.

It was hard as a rock and small and she looked to be about 7 months pregnant. This was a almost play-by-play repeat of yesterday’s stillbirth. The only difference was I had time to ask her questions before the birth. Yesterday, the young girl arrived and before I could get her inside she delivered.

Shaking off that memory, I refocused on the woman before me. She looked remarkably calm.

-- “Can you feel your baby moving?” I asked. She just shook her head in response and I reached for my doppler.

I wasn’t expecting to find even placental sounds, so when the steady toc-toc-toc of a heartbeat blasted through the room I jumped; her baby was alive!         --Thank you Lord!

But my excitement was fleeting and I soon remembered such a small baby would probably die shortly after delivery. I steeled myself for the eventuality of it then informed her family of my suspicions.
They took the news with steady, knowing expressions but said nothing.

When I did a speculum exam, her cervix was dilated and it appeared to be either the head or the placenta. I couldn’t tell. So I poked a finger inside to see. It was soft but had hair. Not a good sign.
        --Her child would be premature for sure.

We set up for the birth and waited. But we didn’t have to wait long. Her contractions were strong and she pushed like the G4 she was!

Two pushes and a precious head was out. But then he wouldn’t rotate.
        -- Oh Lord, help him come out easily.

Fortunately he eventually rotated and the shoulders collapsed down below the pubic bone. But he was born with a tight cord coil around his neck and body --like a sausage chain.

He was alive but didn’t move or grimace for the longest time.
           --Apgars 3/4/5/7

I started oxygen immediately but he didn’t take his own first breath for several long minutes. I begged him to breath and prayed, but things didn’t take a significant turn for the better until Dennis came to assist.

Dennis was more aggressive with the resuscitation efforts. He made that boy breath!

Once stabilized he has improved remarkably. He’s maintaining his own temperature, he’s sucking a bit and his respirations and heart rate are solid. He is most definitely only 32 weeks gestation (or roughly 7 months), but I think he’ll make it.

Please pray with us that he’ll be able to breastfeed better. I’m determined to keep them at the clinic until he can. I so want him to live! Thanks.

Cataracts ~

Patients waiting to have surgery.

Did you know that when a cataract is removed it is about the size of a flattened pea and is often milky-white or yellowish in color?

Were you aware that only the most mature cataracts become liquified upon removal?

Can you believe it only takes about 15 minutes to do a cataract surgery --even in such remote areas as Sudan?

I didn’t. I didn’t know any of this.

In fact, before this week I had a hard time figuring out the difference between the retina and lens. Oh wait... are the the same thing?

Okay. So I’m no eye specialist. Let’s just make that clear right off! However, I’ve met two very talented doctors and a fabulous team of scrub nurses and highly trained technicians from Kenya this week, and I’m impressed.

They have already performed 75 or so surgeries in the last few days; and I’m told they are prepared to complete 150 in total. Or at least, that is how many lenses they have brought with them.

When it was announced that surgeries were being offered this week, people came from far and wide.

The first official day was Saturday. The eye team flew in from Nairobi and immediately got to work. After setting up and coordinating staff, they were still able to complete a dozen or so surgeries.    
              --Remarkable.

But by Monday morning the word was out. Would-be patients were starting to line up at 2 in the morning. They sent 50 people away that first day and at least 100 more this morning.

Every day it seems more and more hopefuls are coming to see if they might be considered.

They queue up, wooden canes in hand and wait. And as a new patient is ushered in to be anesthetized and preped the queue happily slides forward.

Hopeful. Eager. Scared. Excited.

One woman came in shaking --her hands trembled as much as her voice. I couldn’t tell if she was nervous or had a bit of Parkinsons. Once on the table though it became clear. She was frightened.

It took two staff to hold her in place and constant reassurances for her to endure the 15 minutes to sight. I wasn’t sure she’d make it, but she did.

And this morning when her bandage was removed, I imagined she shook again --but this time for joy!        

I wish I could have seen it.

Those who were there tell me it was a celebration --a celebration of new sight!

Please continue to pray for us this week. These are long days with unique tasks but we are excited for it all the same. Pray that everyone that comes would hear the gospel with joy and be saved.

Thank you for praying...  and thank you Tenwick Eye Team for coming!

New Hope

My heart did a bit of a flip-flop when our eyes met.        --Could it be?
Smiling with excitement she understood that I recognized her and was please.     --Yes. It was her.

“You are the one I helped with the baby last year?” I asked stupidly. Honestly, I helped lots of women with babies last year. Duh!

She just smiled back and nodded, equally excited.

“And you are pregnant?” I asked rubbing my belly in case she didn’t understand my Dinka?

“Yes!” Her eyes sparkled in joy.             --- Yes! Yes! Yes! Yes!

Elizabeth is pregnant again everyone! Elizabeth is pregnant!

You might not remember her just now, but I assure you I’ll NEVER forget her. Her last birth was one of the hardest of my life. It taught me the realities of being a midwife in Africa.

It changed me forever.

And in the process, I came to truly love Elizabeth and her husband, Michael. I love them and want to see them holding healthy children in the future. I want them to know God's love!

So I cheerfully took her prenatal book (one she had kept for almost a year) and added it to the line. 

When it came time to do her prenatal, her husband joined her because he wanted to honor me with thanks and tell me all that God has been doing with them this year. I was delighted to hear it.

But as I checked her, I suspected STDs. So I told them that I’d need to treat them right away. They happily complied.

Please pray for them. She is 4 months pregnant. Pray this next birth may be healthy and easy. May God continue to shower His love and mercy on them in remarkable ways! Thanks.

Monica's Story

A picture I took of her shortly before her death... when I still hoped.

It was a busy clinic day with lots of preggos coming and going and two labors in various stages of dilation. So when a car pulled up I didn’t even notice.

But soon afterward there was a small tap at my door. One of the newest translators timidly informed me I had a labor. Sighing in mock frustration, I quickly went to meet my new labor at the clinic entrance.

Honestly, I was not ready for what I saw.

A small girl --looking no more than 12 years old-- lay pathetically against the entrance door. Beside her a woman with pleading eyes locked gazes with me; she was doing her best to hold the child upright.

“Is she pregnant?” I asked not believing someone so young could be ‘in the family way’.
“Yes, but she is sick,” one of the translators informed me.
“Bring her inside,” I said and quickly turned on my heels. I needed to inform Margaret of this new development.

Once we got her inside, I could see the small belly-bump low in her abdomen. Yes, she was definitely pregnant.

“How old is she?” I asked, trying to hide the disapproval in my voice.
“Fifteen,” I was informed by one of the many family members in the room. It’s as if half the village had entered my 10 foot by 12 foot cubicle.

“What are her symptoms?” I quarried while systematically checking her vitals from head to toe.

She was lethargic and barely able to stay conscious. There were no fevers and no reports of convulsions but I instantly thought of malaria.         --It’s always malaria.

Desperately fighting to breathe she gasped for air at the rate of 90 breaths per minute. That’s a breath and a half a second!

By this time Margaret had joined me and quickly looked at her eyelids to see is she was anemic.

“She’s a plus-plus for pallor,” she informed me then showed me her paper-white lids. I’ve never seen anyone so pale.

“She’s severely anemic,” I informed the family, “How long has she been like this?”

As we continued taking her vitals, the family informed us of the little they knew of her case. She was living with her uncle in Wau. Yesterday, she came home to be with her family. They brought her in to see us once they realized she was having trouble breathing.

“That’s it? That’s all they know?” I asked more than a bit confused. This girl has been sick a very long time. Why were they only now seeking help? I wondered. But that didn’t matter. Caring for her was what mattered now.

She measured to be about 7 months pregnant, but she could have been more. None of her family members seemed to know, and she was too exhausted to speak.

As I searched for heart tones with my doppler, I wasn’t expecting much. If this child was still alive, it’d be a miracle.
        --But I found none and eventually gave up.

How does a 15-year-old living in a big city get this sick? How?

After wavering back and forth on whether to give her IV fluids and consulting with the rest of the staff, we decided to test her for malaria. There had to be an underlining condition for it all.

She was positive. Malaria --that parasitic curse-- had struck again.

We gathered her family together and explained that she was desperately sick. She needed a blood transfusion immediately or she would die.

They listened.

“If she gets new blood she can recover,” I assured them, “But we are a small clinic. We have no blood here. You must get her a ride to Wau right now, so she can live.”

Four pairs of eyes searched my face as I explained. They could see she was dying. The only question was whether or not she could live.

“Get her a blood transfusion right away and she will live,” I went on. The steel in my voice was unmistakable but I realized I no longer felt the need to beg. They would either go or not.

Once I finished speaking the grandfather left without a word.

The girl’s mother and two aunts helped us to get her to the observation room and we started her on malarial medicines.                                  --I had hope.

Three hours later, her grandfather had (miraculously) returned with a car. I had even more hope. I even took a picture of her so I could ask you to pray.

Five minutes later she died.

She died with a few final gasps with her head on her mother's shoulder while her aunts prayed. One aunt left the rooms in deep wails. Another sat quietly knowing --too grief-stricken to speak.

They knew long before I would even admit it.

She was dead.

Dennis and Tom came to pronounce her because I was unwilling to admit it. I kept fighting for more hope. But in the end her heart just gave out.

Later on as the pastors came to minister to her family we learned more of her story.

The pastors praying for her family after her death.

Her name was Monica. She was 15 years old. She lived with her uncle in Wau. When she got pregnant out of wedlock he was furious and kicked her out of the home. She begged for months from friends and strangers. No one knows how she survived. When she got sick she had no money to seek treatment and no money to get home. Finally a stranger took pity on her seeing that she was very sick and let her hitch-hike back to Tonj. She died in our clinic the next afternoon.

She died of heart failure due to severe anemia caused by untreated malaria.

All of it could have been prevented had she known about us and come. Had she been able...

Pray that such senseless loss would end. Pray that we can find a way to get these women the prenatal care they need and deserve. Pray that no more 15-year-olds would be lost.

But just pray...