Update: Rape

The young rape victim’s family all came to church this morning. It was so good to see them again and learn she is doing better.

They also explained that the perpetrator was caught.

I’m told he’ll be incarcerated until she turns 18 years old or has successfully produced a child.

Apparently several years and heavier fines can be added to his sentence if she doesn’t menstruate at the proper time. It can get worse if she cannot conceive.

Strangely, I am more than satisfied with this arrangement. In the States, rapist are rarely kept in prison for longer than a year. This guy has a minimum of 10 years.

I was sad to learn it was a young man though. I don’t know how young, but obviously old enough to know better. Ten years in a Sudanese prison will not be easy. Please continue to pray as God leads.

May this boy repent and get saved. May this girl heal and one day know the love of God. Amen.

Overdrive.

This month has stretched me like never before. I’m made of rubber.
    --It’s a polyurethane miracle!

My silence does not mean I lacked something to say... just the strength to type the words.
    --Yes, it really has been that busy.

As I look back over just this past week, my brain swims in images of craziness. Each complication blurs into the next. Each patient’s face melts into a long line of others.

I’ve seen so many complications this month I now see them when they aren’t even there. It’s like my brain is on overdrive, revving at 160 rpms but not in gear. The stench of rubber fills my nostrils. Exhaust coats my clothes.
    -- Do I pop the clutch?

If you have been praying for us this week... this is why.

Not only have we been crazy busy with normal births by the droves, but we’ve also had a record number of complications come through.

This week alone, I’ve transferred or managed a placental abruption, placenta previa, meconium aspiration neonate, breech in a primip, and a case of pre-eclampsia.

Please pray for the staff. We are overworked and running on E. Pray for wisdom, strength and perseverance. Thanks.

More stories to come... once my engine cools a bit.

Family Tree.

An impish smile sprouted across Halena's face when she walked in the room for her first prenatal. She was due any day from the look of her waistband. What made her come so late?

I gathered her obstetrical history, measured and palpated, then set her up with a file since she said she wanted to deliver with us.

However as I went over her complaints, I was surprised she didn’t mention the very large rash-like growths on her body. Some were massive.

Were they pregnancy related? I couldn’t tell. So I asked her about it.

-- “This rash you have on your body, does it give you any trouble?”
-- “No. I’ve had it a long time.”
-- “Really? How long has it been?” The larger ones looked like extinct volcanos on the surface of the moon; the smaller ones bubbled up like molten lava.
-- “They started growing when I was a child. It’s because I’m related to the Rual tree.”
My health worker smiled sheepishly when he translated, anticipating my confusion.
-- “What? You are related to a tree?”
-- “Yes. That is why I have this growth. My family is a descendant of the Rual tree.”
-- “Oh... and this is your bark,” I half asked, half stated.

I could see the family resemblance.

The Rual tree & its fruit.

Other patients have come in with similar stories. Apparently among the Dinka, several families are related to the lion, the alligator, and the fish. But this is the first time I’ve met anyone related to a plant.

What was conception like? Was it cross pollination?

Reigning my brain back in, I finished her prenatal by noting in her book: “Patient says skin condition runs in the family because she is a distant relative to the tree.”

The next time I saw her was for her birth. She arrived fully and ready to push. And since her baby was showing signs of compromise, I called Margaret in as back-up.

Soon after, her water broke and a brown, gelatinous gook spilled out --Exxon Valdez in consistency and potential devastation.

With such murky fluids the risk of meconium aspiration (the baby breathing in the stained fluid and developing an infection) is high. So we prepared for the worse. But once he was born, there was little we could do to avoid it.



He came out ashen and limp. His rapid, shallow breaths told us everything we needed to know. He had aspirated. So we started him on oxygen and immediate antibiotics.

Although he didn’t breastfeed for many hours, we were able to stabilize him with time. His mother worried and fussed but by the following morning he was on the mend. I happily discharged them both this morning. Praise God for antibiotics!

I wonder what kind of tree he’ll become.

Rape.

A 7 year old girl was brought to us over the weekend. Neighbors found her in the bushes covered in blood and brought her to her family. They then brought her to us.

She had been raped.

Her attacker was so forceful that she was still actively bleeding hours later, and the doctors suspected internal bleeding.

Who rapes a 7 year old child? What kind of monster can do that? What level of twisted perversion must it take? What darkness must haunt him!

When I think of her tiny body being abused in this way, my blood runs cold. When I look into her expressionless eyes, my blood then boils.

I’ve been watching her on and off for days, and I’ve yet to hear her speak a word. It’s as if she is hiding in another world, detached from the monsters that live in this one.

Please pray for her. But also pray for her attacker. May he confess and repent, and pay the penalty of his crimes. More importantly, may she heal completely from this trauma.

Oh, the darkness of men’s hearts... is dark indeed!

“I would have lost heart, unless I had believed that I would see the goodness of the LORD in the land of the living.” --Psalm 27: 13

Suffocating Love

Thin, quizzical eyebrows framed her face in an arch. They spoke fear muddled with innocence. They screamed confusion and doubt. They betrayed her age.

Never having met before, I was surprised to learn she’d come to deliver.

-- “Really? You are here to deliver with me?” I asked through my translator.
-- “Yes. If I’m in labor I will stay here at the clinic.”
-- “Okay. Let’s count contractions and see if we need to do a vaginal exam.”

As I assessed her, she tried to look bored but her eyes gave her away. They flashed around the room, taking it in.

What did she see, I wonder.

Did she focus on the plywood walls stained in blood and spit that even bleach won’t touch? Or was it the pink bed sheet I use as a door? Perhaps it was the drawers of mysterious instruments and shelves of neatly lined IV bottles?

-- “You are definitely in labor,” I announced, “But it’s early still. Can you walk around a bit?”

She said she would, then melted back into the day-to-day commotion --morphing into just another big belly-ed teenager with quizzical eyebrows.

When I checked on her throughout the day, I often found her surrounded by friends laughing at her in solidarity. They were trying to cheer her up.

It couldn’t tell if it was working.

She sulked silently, but never left their side. She seemed to want their noise, to need their noise. They represented love --even in the form of playful mocking.

(More and more, I’m learning how woman care for each other here in labor.

They are cheerful doulas with sharp tongues. If encouragement doesn’t work they berate.... but only to help of course. They scream and yell only because they care.

But I get ahead of myself.)

Akutet labored all day, blending in with the sea of screaming toddlers and breastfeeding moms waiting for their turn with the doctors. In their chaos, her slight moans were never heard.

But as the afternoon wore on, there were fewer distractions for her pain; and the last patient left.

Only then did her closest friends rally.

It came in the form of silly banter and mocking. Their laughter bounced about like mag pies bathing, but Akutet never made a sound.

Sensing she needed to hear rather than speak, the flock chattered and chirped incessantly --encircling her with flapping wings of love. They entertained her with stories and ignored her pain.

She was getting active.

Each time I came to check on her they pulled me in to their circle. They loved on me and laughed at my Dinka. They told me stories in their limited English. They spoke of nothing, very loudly, as if noise could drown out contractions.

I think it was working. 

But eventually Akutet decided she needed a break, and wandered off to the birth room to lie down. I followed her in to check her, but she asked for silence and I gave it to her happily, then went to lie down too.

However, a few minutes later her water broke, and a small tsunami splattered across the floor. But before my translator could call for me to come, her friends kicked it into high gear.

I arrived to find one friend supporting her back, two standing on either side yelling for her to push, and a grandmother figure crouched in front with her hands posed for a football punt.

“Blue-42! Blue-42! Hut. Hut!” echoed in my head and I laughed.

Explaining I needed to make sure she was fully first, I asked them to step outside. They obeyed... albeit a bit reluctantly, and I did a quick exam.

Yep. It was time.

So I set up the room, then brought them all back inside. Grandma took her right leg, Maria took her left, and Mary supported her back. But this time, I was the one kneeling in front ready for the football punt!         --Hut! Hut! 

Two more friends stood behind me and watched while my translator bent low to get a better look. He seemed pleased to be a part of the fun (definitely a first!) and even laughed good-naturedly as he translated their banter.

Akutet was pushing like a champ but her friends didn’t think so. They yelled gruff commands with acid voices. Was something wrong?

-- “What are they saying?” I asked my translator, “Are they mad?”
-- “No. No. They say she needs to listen to you. She’s not listening to you. They say, you are helping her. She must push, they say.”
-- “Oh,” I smiled. They had my back.

Once the baby’s head peeked out with each push, Maria took her screaming and threats to a new level --suffocation.

Yep. She decided Akutet would only be able to push if suffocated properly, and subsequently covered her nose and mouth when pushing!

(This is a common practice here. It’s one that I’ve discouraged in the past but decided to roll with  on this occasion.)

Akutet didn’t argue. She recognized it as the ‘right thing to do’ and pushed like mad. Basically it turned her pushes into ‘purple pushing’ and reminded me of the ‘count to ten’ type of pushing sometimes done in the States.

However, as the contractions faded I encouraged her to breath and Maria reluctantly took her hands away from her mouth. She looked at me as if I were not playing by the rules, but did as I asked nevertheless.

-- “You can hold your breath if you like Akutet. But after the contraction, breathe so your baby can breathe, too. Okay?”

Akutet rolled her eyes and shifted one eyebrow up in response, but Maria nodded determinedly.

Then together all eight of us cheered and hooted, hollered and pushed that baby out.
... and a miniature squawking mag pie was born! 

Her birth taught me on a whole new level what it means to be a midwife in Sudan. I realize now that when I was trying to give them privacy, I was actually secluding them from their cheer squad. And what I thought was verbal abuse, is really just Sudanese tough love.

And the pushing... the pushing...

I must say, in Sudan love is a bit suffocating at times! 

I wonder if I will ever suffocate a woman in labor?
     ... to help of course. Only to help.

Prayer Walk

Today we gathered the troops, piled into the cars, and went to the air strip. It was time for our annual prayer walk.

The prayer walk is In Deed and Truth ministries’ annual fund raiser which takes place in So. California. Since we can’t join them there, we make a point to walk and pray here.

Last year we walked and prayed for an ambulance. We walked and prayed for South Sudan to get independence. We walked and prayed for peace.

God has been faithful to answer those prayers. We witnessed a miracle this year when Africa’s newest nation was born --peacefully. We also raised enough money to get the ambulance we so desperately needed.

It’s so good to look back over this year and remember.

The money raised this year will help run the medical clinic and cover other ministry expenses. It will stock our shelves with quinine and antibiotics. It will pay the Sudanese staff’s salaries. And it will help make this work possible on the day to day.

If you would like to be a part of this work, please prayerfully consider supporting IDAT’s ministry expenses. Large or small, every donation counts. You can find out more about this ministry by going to their website.

If you’d like to give, click here.

Thank you for helping make this work a reality.

Deep Transverse Arrest

 

Nunu’s first birth ended in a cesarean. She was in labor for several days by the time she got to Wau. The doctors explained the baby was transverse and performed a cesarean. The baby lived just two hours.

The evidence of her loss came in the form of a copper streak an inch wide which sprouted from her pelvis and pushed raggedly past her belly button --a classical cesarean scar. Tiny dots ran along each side like a fence post; it must of hurt to get those sutures removed. 

She had been coming to our clinic for several months before I met her. Up until then, Margaret or Sarah had done her checks.

I clearly remember meeting her that day for two reasons. One, she discussed her case in English. And two, she really didn’t like what I had to say.

At that time, her baby was breech. I told her it wouldn’t be safe for her to deliver anywhere but a big hospital. There were just too many risk factors.

She argued with me, saying that she wanted to talk to Margaret. When I called her in for a consult, Nunu broke down in tears and wept on her shoulder. She categorically refused to consider going to Wau.

Then together we explained the risks. She needed to prepare for surgery and consider going to Wau even to labor. She shook her head in refusal, flashed tear-filled eyes my way, then took her book and hurried off.

Fast forward another month or so, to earlier this week.

She arrived mud splattered and soaked to the bone in the middle of a storm. She was in active labor.

One look at her file and I was concerned. Why had she not listened?

I told her that since there was no way we could get her to Wau that night, we’d let her have a ‘trial of labor’, but ultimately if there was no progress she’d still have to go. 

She listened... but didn’t at the same time. Her jaw was set in refusal.

Since she was already 8 cm dilated with an intact membrane, I let her labor on her own. Progress was slow, but I remained hopeful.

But then again, I didn’t have many options. We couldn’t drive her in the middle of the night. The storm only made things worse. Plus... she wouldn’t even consider it.

Margaret took over her care that night. She explained that although she was well past fully, Nunu was not pushing right. Perhaps she didn’t know how or couldn’t.

I assessed her again and found the head to be at a zero station and slightly swollen. Her pelvic outlet seemed more than adequate. But he did palpate to be big.

Margaret continued to explain to them the need for a cesarean while letting her try and push a bit longer. Fetal heart tones were fine, and Nunu was determined.

But after a few more hours of no progress, Margaret told them she’d need to leave first thing in the morning for Wau. She went to get some sleep and left them to discuss it amongst themselves.

The translator working that night said Nunu’s mother was upset we were ‘giving up’ by going to sleep and took her home. Nunu and her family left in a hurry around 2:30 am.

When I woke for my shift, I expected to be greeted by a baby or a transport. But the clinic was empty. I couldn’t understand why they left.

There was little I could do but pray. So I prayed and prayed. In fact, I could do little else.

Had she gone home and delivered? Did they take her to another clinic? What happened?

I worked through my worry by doing prenatal after prenatal. I finished just after lunch then went to a staff meeting. By 4 pm, I was called away early because she’d returned.

Fourteen hours had passed since she’d been checked. Fourteen long hours...

I asked her what they’d been doing all this time but they were silent. I pressed them only to learn they’d simply gone home. They didn’t call a TBA. They didn’t go elsewhere in town. They simply went home and did nothing.

Digging deeper, I also learned her contractions stopped shortly before dawn.

However when I lifted her dress to check her baby, my heart jumped in my mouth. I couldn’t believe my own eyes. Bandl’s Ring had developed.

Bandl's Ring.

(For those who don’t know, Bandl’s Ring is when the upper uterine segment separates from the lower uterine segment, forming a band around the belly. It is a sign of severe neglect of an obstructed labor and proceeds uterine rupture.)

I asked if I could take a picture and told her that she needed to go to Wau immediately. She agreed to both. They realized she was dying and had gathered the money. They’d come back to ask to use our ambulance.

Thankful for this change in heart, I set the wheels in motion. The drivers had to be called, the ambulance needed to be fueled, and I needed to write her doctors a referral.

Although her blood pressure was stable, Nunu was deteriorating fast. Her baby was alive but  had developed a sinusoidal heart rate pattern. This is a serious indication of imminent death, and I told her so.

(For those who don’t know, a sinusoidal heart rate pattern goes high and then low and then high and then low again. There is never a stable baseline but it typically stays within a normal range and is a sign of severe fetal compromise.)

-- “Nunu, if you don’t get this surgery soon both you and your baby can die.”
-- “I understand.”
-- “I’m not saying this to scare you. I just need to know... Do you know Jesus?”
-- “Yes. I am a believer,” she said then turned away.

Fortunately, it didn’t take us long to get her on the road. But I had my doubts.

She’d be arriving at the end of the day. Most doctors aren’t working late night shifts I’m told. Plus, the last woman we referred for a cesarean was told to wait another 8 hours after arriving because her baby had died. That girl eventually got surgery, but died minutes later. Would Nunu have a similar experience?

Dark thoughts nipped at my heels. Yappity dogs. Fierce hounds. My only retreat was prayer.

Lord, may Nunu live. May her child somehow survive. You knit this precious one in her womb, now please bring him out. I’m begging for a miracle.

I woke the next morning to learn she’d not had the cesarean. At first I was nauseated, but again I prayed. There must have been a good reason.

Later that day, I learned that by the time she’d arrived the baby was dead and she was semi-conscious. She was too unstable for anesthesia and was pale. The doctors didn’t want to perform a surgery just to have her die on their table.

Plus, they wanted her family to donate blood. She couldn’t have the surgery until they had 2 or 3 units of blood standing by.

When I learned of this new rule I didn’t respond well. They were doing nothing! Why were they doing nothing? But again God reminded me that they must have good reasons and I prayed.

Lord, I’m tired of sending people to Wau for help and they never get it. I’m tired of hearing they have no blood there and that’s why this girl or that girl must die. Please, Papa, do a miracle!

I later learned that she has my blood type and volunteered to donate. But my going there was not an option. Instead we helped organize her family members in the area and got them there.

But it was all for naught. She died later that night, never having woken from her coma.

I understand why the doctors in Wau didn’t take her into surgery. I understand their need for blood. I even understand their anger with us. They thought we were wrong to keep her so long or allow the trial of labor.



What I don’t understand are Nunu’s choices. Why did she argue when we told her to deliver in Wau? Why did she come after a day of active labor in a rain storm? Why did she abscond in the night when we wanted to refer? Why did her family let her get so bad before taking action? Why didn’t she plan ahead and set aside the money? Why didn’t she listen?

I don’t ask these question in judgment. I ask them in genuine confusion. Why?

Perhaps with time, I’ll better understand the social and economic limitations of the women here. Perhaps with experience, I’ll be able to better help them maneuver any obstacles. Perhaps with time, fewer women will die. Perhaps.

Perhaps not.

Nunu’s death burdens me. Please pray for her family. She was well loved and known in this community. Her funeral is tomorrow.

Boy Oh Boy!

Akout came to the clinic on Monday in labor. She was 7-8 cm dilated but her contractions were mild and ineffective. I wasn’t there but Margaret told me that Akout labored for a few hours at the clinic, then just up and went home without an explanation. Margaret assumed that she’d decided to deliver at home.  

However, on Wednesday Akout was back... and still very much pregnant.

As I reviewed her book and asked her about the last few days, she explained that her contractions never really got any stronger. She couldn’t figure out why.

When I did another vaginal exam I laughed to learn she was still only 7-8 cms dilated!

Since she had never come for prenatals, I check her out thoroughly. Her belly was much larger than most of my prenatal girls, and there were tons of little parts when I palpated. I could feel one normal sized head engaged in her pelvis, but the heart tones were found in two separate places. 

This could only mean twins.

When I told Akout my suspicions, she didn’t seem too surprised. She did raise an eyebrow however and chuckle. Then she informed me that her husband had a strong family history of twins. 

Since both babies were doing great, I opted to augment with oxytocin. And boy was it effective!

She didn’t need much of the medicine before dilating to fully. In fact, she was ready to push in just 30 minutes.

Her first baby came out head first with a happy cry. He was term but small.

I barely had time to dry him off when she pushed again and the second bag of waters burst open, splattering me in hot, sticky fluid.

-- “Wait, Akout. Wait! Du chol! (Don’t push!),” I ordered.

She didn’t hear or didn’t care, and kept pushing.

-- “Please, Du chol Akout. Du chol! I need to get your first baby out of the way,” I explained.

She wasn’t listening.

Since she refused to wait even one minute, I double clamped his cord and cut it. Handing his pint-sized frame over to Margaret, I turned back in just enough time to help the second baby as he crowned.

He was born 3 minutes after his brother!

Both boys came out head first. They appeared to be identical (shared a placenta, and a chorion) and weighed almost the same weight.



Baby boy #1: Born 10:30 am, weighing 2.5 kg.
Baby boy #2: Born 10:33 am, weighing 2.8 kg.

Their father didn’t realize he could come inside the birth-room and therefore watched eagerly from the window. When I realized he was out there, I excitedly called him in.

The grin on his face was intense as he held his sons in his arms!

None of them suspected twins! And when I woke that morning... I certainly didn’t either!

Thank you Jesus!

Stillbirth.

I’ve only seen Achan since mid-September for prenatals. She came the first time because malaria was burning through her body. However the first treatment was not effective... or she was exposed to enough mosquitoes to get it again just 3 weeks later.

Either way, she came in again last week, but this time the malaria was worse. She was vomiting and had been for days.

I stabilized her with IV meds then sent her home with orals, but her recovery was slow.

So when I saw her in my prenatal line, I was worried. Perhaps it was something worse than malaria, and I’d misdiagnosed her.

She said she wasn’t having contractions but felt really bad. So I asked Margaret to look into it.

Margaret checked her out and laughed at me for not doing it myself. She was definitely in labor she said, and was already 8 cm dilated.

Since my hands were full with prenatals, Margaret promised to keep an eye on her. But just as she was getting pushy, another woman came in to deliver.

So Margaret took over her care, and I turned my attention to the gap-toothed mama on my bed.
She was very active, and before I had a chance to do a vaginal exam, she was pushing.

Not 15 minutes later her girl was born!

She hemorrhaged which took several medicines and maneuvers to control, but eventually things calmed down and I transferred her to the recovery room, cleaned up, and went to see if Margaret needed my help with Achan.

I found Achan trying to push as a friend supported her back. Margaret kept insisting she needed to push harder and longer. I wasn’t sure how long they’d been at it.

Picking up the doppler, I found the heart tones with ease. They were steady at 120 bpm but dipped when she pushed to 90s. I suspected head compression since the head was passing under the pubic bone, and wasn’t initially concerned.

However, as she pushed the heart tones continued to drop. Margaret kept trying to get her to push harder; I suggested new positions.

Achan’s eyes flashed wildly in fear, so I comforted her with gentle words. The tension in the room thickened the air; emotions were high. So I prayed.

As I listened to the heart tones again, I whispered to Margaret that they were dropping still. They were in the 60’s and 70’s. The baby needed to get out quickly if we hoped to have any chance at resuscitating him.

Although Achan pushed her best, the baby was slow to come. Five minutes before he was born, I could no longer find the heart tones. They had dropped to the 50s; then were gone.

My hope was that he was just too far down in the birth canal to be found, but my gut told me otherwise.

He was born pale and limp.

Margaret cut his cord immediately, and I took him to resuscitate. Though his color was pale pink, his heart was completely stopped.

Tom came to give rescue breaths, while I pumped his tiny chest. This went on for several long minutes, as the room silently watched.
    --Would the Kowajas get the baby to live?

After 10 minutes with no heartbeat, we pronounced him dead, wrapped him in a blanket, and handed his blue-tinged frame to his grandmother.

The grief in her eyes was too great to look at directly, and I furtively studied my shoes.

“Malesh mama. Malesh. (I’m sorry mama. Sorry.)” I said softly.

She nodded that she’d heard, reached for him, and sat down slowly on the edge of the bed.

I had to leave the room to breathe again --my chest, tight with grief, needed the sun, the air, the song birds. It gasped for it in panic, and I sobbed.

Fortunately, Nancy (a wonderful Christian woman here to help with the pastors) was near by and she let me blubber while she prayed.

Later the pastors and staff surrounded Achan and her family in mourning. We prayed and loved on them as best we could, and then they returned home.

This death was particularly hard for both Margaret and myself. Although I could see he was declining, there was no way we could get the baby out any faster. And once he was born, there was no clear reason as to why he died.

Please pray for Achan and her family as they grieve, and particularly Margaret. This death has rattled her severely. Thanks.

Quick Note.

I've so much to tell you all. So much. I want to delight you with the story of the first time mom and her sweet friends, as I was delighted. I want to wow you with details of the twins, as I was most certainly wowed. I want to empty my heart over the stillbirth, so I can let go and move on. And I want to describe the frustrations and heartache of the obstructed labor, as I'm not sure she'll live.

But honestly, I'm too busy for words right now. Well, at least too busy for any stories.

However, I beg you to be in prayer for Nunu who (hopefully) is recovering from her cesarean this morning. Also pray for Margaret and I as we are tired but joyful. Pray for all the ladies that walk through our doors. We need it.
Thanks.

Labor of Love October 2011 ~Newsletter

Labor of Love Oct 2011

Blue Nile Bombing

I've come across more information on the bombing in the Blue Nile State. Perhaps you are already aware of the skirmishes and indiscriminate bombing of civilians. Perhaps not.

Either way, please pray.

Article on the last remaining doctor in the area.

Read and Pray. Thanks.

Concrete?

Call me crazy but concrete is not meant for vaginas. Yet tonight that is what I saw. My brain is having a hard time registering this information. I’m honestly baffled.

Let me explain.

Earlier tonight, Tom called for a consult saying one of my old patients was back complaining of something hard prolapsing from her vagina. He investigated and quickly determined he needed a second opinion and gathered the troops.

As I walked with him  toward the clinic (the rest followed a few minutes later) he told me that she was the girl that had the prolapsed hand that miscarried. I couldn’t tell if he was talking about the girl with the incompetent cervix or Biyana. But either way, I’d find out soon enough.

I walked in to see Biyana writhing in pain as one of our health workers finished giving her antibiotics intramuscularly.

Biyana? It’s not possible. I just saw her a few days ago. She was fine. She would have told me if there was something prolapsing then. What was going on?

Donning gloves, I investigated for myself.

Tom was right. A hard, white mass was protruding; it looked like a prolapsing cervix made of concrete.

What in the world?

After the others arrived, we tried to determine what it could be. Tom suggested it was some calcified foreign object possibly left in after her cesarean. I’m inclined to agree.

Perhaps a tampon of some kind? Maybe a strip of gauze?
    --But what if it is her cervix? No... that doesn’t make sense.

Tom reached in and said it’s long, round, and the length of a finger. He tried to remove it but failed. Dennis also examined her. He also failed to dislodge it.

Apparently, the object is firmly attached to the left vaginal wall. They cannot remove it without causing her a great deal of pain and possible bleeding.

Admittedly, I’m at a loss for words. How do we help?

I’m concerned this will have a negative effect on her getting her fistula repaired in a few months. Please pray for her. This is just one more challenge in an already difficult journey.

We’ve started her on antibiotics for an infection that has developed. But tomorrow we refer her (once again) to Wau.

Pray for wisdom for the doctors and healing for her body. Perhaps she’ll somehow get her fistula repaired early. Perhaps.

Pray for her. Thanks.

To understand her background better please read here, here, here and here. Thanks.

Baby Season!

Adeng after the birth. Her son is in my arms.

Today is the first day in about a week that I’ve not been labor watching... or baby catching... or  running around counting heart tones on every preggo in sight!

I'm happy but thankful for the reprieve.

Am I tired?     --Most definitely.  
But am I fried?    --Not even close.

There has been a joy surrounding these births that can only be the Lord. These women are coming in answer to my heart’s cry! I couldn’t be happier.

Last night Margaret and I delivered three more babies --two boys and a girl. Each birth was unique and special.

The first one to deliver, Adeng, had been quietly laboring for three days (two of which she spent in the clinic) before she pushed her baby out!

She had two doulas with her --a close friend who never left her side and an aunt who quietly sat back and cheered.

Her husband came to check on her regularly. Young and proud, he watched everything closely (especially how I treated his wife!) but didn’t stay long each time.

But despite the sleepless nights, we were able to stave off exhaustion, and when it came time to push she gave it her all. She was so in-tuned to her body! What a delight to watch.

When he finally made his way out with that last gentle push, the room erupted in praise. Laughing in relief, I looked up at Adeng only to see the most radiant smile shining back at me. She then started crying for joy, and thanking us over and over in her limited English.

Her sweet friend clung to her neck and cried tears of joy as well, and for some time everyone in the room was overcome.

We wept. We giggled. We praised God for His goodness!

My necklace and sweet Giver. 

(Fun side note: Earlier that day, this friend had pulled me aside to give me a gift. Quickly taking a brightly beaded necklace from her pocket, she slipped it over my head saying, “Now you are Sudan!” with an admiring grin of satisfaction. We slapped hands in thanks and she shyly stole away before I could make too much of it. What a honor!)

The second baby born that night was to Ajok! She, too, was a superstar. But unlike Adeng, she came in ready to push.

She was a solid 7 cm dilated when she arrived but with very good contractions. So I encouraged her to walk.

Wordlessly she got up and marched the clinic grounds. Her friends followed close at hand encouraging her to endure.

Ajok breastfeeding her son.

At one point I found her kneeling in the dirt out front --her friends squatting before her. I thought she might be pushing so I went to investigate. As it turns out, her friends were just rubbing her belly with spit as a blessing!

Not 10 minutes later her son was born!

She went from 7 cm to baby out in 20 minutes!

The last labor to deliver was Hala. She, too, had an entourage of well-wishers and friends; they’d been following her around all afternoon.

Although I could not understand all they were saying, I could tell that they were annoying her immensely. She kept trying to hide from them, but they wouldn’t leave her side. They followed her like a gaggle of geese --quacking and clacking about.

Only 15 years old, she acted her age and pouted with the pain. Every now and again, she indulged in some self-pity, but it never lasted very long.

Her enormous belly poked straight out like an arrow as she waddled about, and every where she went her geese followed.

I caught her peeking during both of the other births and smiled at how jealous she looked.

In fact, after Ajok’s 20 minute birthing spree, I found Hala lurking in the hallway slacked-jawed and a bit horrified... or was it indignant.

Smiling I caught her eye and she stormed off to pout by herself. Her unspoken question ringing loudly as she left was, “When will it be MY turn?”

Although I suspected her to be fully, the baby’s head was still molding and she needed to labor-down. So I encouraged her to keep moving.

She walked, stomped, sulked, then eventually slept.

I laughed as her family questioned me about her progress.
-- “Are you sure she’ll deliver tonight?”
-- “Yes. Tonight. And soon.”
-- “But she’s sleeping...”
-- “Don’t worry. The baby is coming tonight.”

Her gaggle eventually went home to their families, leaving behind her closest friend. And she slept on. Frankly, I was excited to see her sleeping; it was the ‘calm before the storm’.

Since my shift was up, I handed her over to Margaret and tried to get some sleep. I was on-call as back-up, of course, but I was getting punchy from fatigue. I needed sleep.

Fortunately, I was able to get an hour or so before they called for re-enforcements. I arrived to find her pushing but not very effectively.

Although it was 1 AM, her gaggle had returned and were calling instructions through the window. But this time they brought the men.

-- “Shove a cloth in her mouth so she can push longer!” suggested her husband.
-- “Make her kneel!” cried another.
-- “Confess, Hala, so you can deliver!” encouraged a third.

She ignored them all and pushed again and again. Progress was slow, but with time she found her groove and a chubby girl made her debut.

Hala's precious little girl.

The crowd outside cheered! Hala was amazing!

Later that night when I crawled into bed, my body ached with the joys of the day, but I was happy. So many blessings! So many sweet answers to prayer!

Thank you for praying for us -- please keep it up. Baby season is just beginning!

Biyana.

Biyana has a vesico-vaginal fistula that desperately needs repair. For over a year, she has not been able to urinate on her own. Instead, a constant acrid stench leaks from her body and clings to her clothes.

She cannot escape the shame. It haunts her day and night. 

The fistula formed after several days of obstructed labor ended in a cesarean. A few days after her surgery, she was discharged from the hospital --grateful to be alive but damaged.

Remarkably, despite her condition, she conceived again several months later.

When I met her for the first time, she was just starting her third trimester. But I didn’t know that at the time.

Since her baby was transverse, I measured her belly and guessed her to be only about 5 to 6 months gestation. But I was wrong.

A month or so after that, she returned in labor with ruptured membranes and a hand presentation.
It was hard trying to determine the best course of treatment --fistulas and hand presentations were new for me.

But after trying everything I/we could, I finally insisted her family get her the cesarean she needed. And they took her to Wau.

I later learned that she got the cesarean but never had her fistula repaired; they didn’t have the money for both surgeries.

At the time I was shocked to hear her baby had survived since I had assumed he was preterm. But her family said all was well, so I rejoiced with them.

A few months went by and I ran into her family and inquired after them both. They explained that the baby only lived two days. He died before she was discharged from the hospital.

She’s not yet 20 years old and yet she has lost two babies, had two cesareans, and is haunted by the stench of her own urine.

I pray for her regularly. I think of her all the time. I try to imagine the depths of her shame and loss... but I confess, I can’t.

My mind just can’t... 

So when a friend informed me of volunteer surgeons coming to do fistula repairs in Wau, I jumped at the opportunity.

It took me some time to get a hold of Biyana, but when I found her she was very interested in getting help. As we spoke over the possibilities, she explained that her husband left her after her second surgery. She hasn’t seen him in months.

She is hopeful at the opportunity but I can tell she seems skeptical. Nevertheless, she asked me over and over again, “Do not forget about me. Please help me. Remember me.”

Honestly, how can I forget? I can’t get her out of my mind... or heart.

When I contacted the surgeons though to set it up, I was told the fistula campaign was pushed to next Spring. They have more training and preparation work to do before they can pull it together. But they hope to be ready by February or March, and will start the procedures then. They promised to let me know if and when.

I know that it is many months off, but I feel the need to start praying now. Please pray for her to not grow weary while waiting... and for God to bring others like her our way. I know they must be out there. May He bring many more who need this help. May they get it.

Sunday School.

Recently, it was my turn to teach the kiddos in Sunday school. When I saw the number of kids lined up for the lesson, I admit I was intimidated.
        --There were more than enough to trample me in a stampede!

But I took a deep breath, prayed, and started in on my lesson anyway. It was about God using Elijah to bring fire down from heaven out of 2 Kings chapter one. The kids were happy to listen and answer my questions. It was delight!

Please pray for these boys and girls to continue to grow in their faith. I’ve seen a real turn around in the Sunday school since Suzy took it over. The kids understand the lessons and are eager to know Christ more. It’s very encouraging.

In fact, this last wednesday five of the Sunday school kids showed up for prayer night! They came without their parents. I loved seeing them there and look forward to the day they start praying out loud!

Look at how high they can jump. It's so Dinka!

Please remember the youth of this nation in prayer. Pray that like the prophet Samuel they’d hear the Lord’s voice from their youth and be used to shape this nation for good. Thanks.

Month of Madness!

We’ve had a record number of births so far this month and there seems to be no end in sight! It gets even better though. Many of these births are coming to labor with us!

This is a remarkable change as often those that do deliver with us wait until the last possible moment before coming. These ladies barely have time to lie down on the bed before they push their babies out. Although it’s good they come... not having them labor with us leaves me a little sad.

Well, this week has been very different. They are coming to labor and deliver. And they are bringing their entourages! Frankly, it’s been a Preggo Party for the last three days!

Margaret and I have delivered 12 babies this week; and there is a 13th in the wings right now!

Yesterday one of our ladies delivered twins!

Everything went smashingly well --despite the fact the first one came out footling breech.

We thought his brother would come out breech as well but were happy to see a hairy head emerge instead! 

Their father was in the room for the birth and was so pleased he asked to stop and give thanks in prayer. Then removing his leather cowboy hat, he bent his head and prayed. It was a tender moment I won’t soon forget!

But it gets even better!

Because not two hours later he came back with another wife, saying she was in labor too!

At first I laughed thinking that he was playing a joke on me. Perhaps I misunderstood and she was really only his sister. But no. She was one of his other wives; and she was most definitely in labor!

Apparently when he learned she was getting active, he went to get her and insisted she deliver at the clinic, too. She delivered another boy 4 hours later.

Think of that! Three sons all with the same birthday!
    --Only in Sudan.

Also this week, I got another name sake. His mom walked 3 hours in active labor to get to me! I marveled at her dedication and love for her child.

When I asked if she really walked 3 hours to come, she nodded gravely and explained she wanted to be at the clinic in case of trouble. I’m so glad she did.

As it turns out, her baby was severely compromised when she arrived. His heart tones were all over the place. And when she delivered a few hours later, he came out flat.

Dennis helped me resuscitate as his parents watched on. By God’s grace, within a few minutes he was doing better, and we all let out a collective sigh of relief.

The father was so happy with the birth he asked if he could name his son after me. He wanted to give him my father’s name. I told him it was Steven, but ... such a name is hard to pronounce here. So I then told him it was Williams (my last name).

He jumped at that and decided his boy would be named William Deng. ‘William’ after me and ‘Deng’ (which means ‘rain’ in Dinka) since it was raining when he arrived!

I wish I could write each birth story out for you, but I’d bore you with the details. Suffice it to know that we are crazy busy, getting little sleep, and yet... I’m loving it!

Please pray for all the little ones born this week. Pray they thrive and these two lone midwives would somehow survive this month of madness! Thanks!

Triplet update:

Our triplets are in trouble. (Previous updates and stories.)

They have lost some serious weight and are already starting to waste. Yar, their mother, is worried but conflicted. She insists there is no milk --which doesn’t seem to be the case.

I admitted them this morning, and she’s been breastfeeding them hourly (at my insistence) and supplementing with formula. I’ve asked her to let them stay for a few days and see if we can get them back on track. She’s agreed but... seems irritated at all the trouble.

Her husband told me that his cows where taken in a recent cattle raid and they are in a bind financially. He was suppose to go to the village this afternoon in an attempt to find money, but didn’t. He went home and did nothing.

Earlier this afternoon, I also told Yar to let her babies stay in the clinic and go home to make herself food. She refused even though she lives a stone’s throw away, then repeatedly insisted I feed her instead. I then suggested the grandmother (who’s done nothing but hang out all day) should go make food. But no. Apparently, granny doesn’t know how.

Huh? I laughed out loud when it was translated. She doesn’t know how?

Seriously, there is NO way that’s possible. She’s probably been making porridge for over 40 years! The fact is she won’t.

The grandmother won’t cook porridge. The mother won’t breastfeed her babies. The father won’t go to the village and sell his cow for formula... and as a result, everyone is starving.

Can I just say this now... I’m confused. Apparently, I’ve met the one family in Sudan dead-set on starving themselves.

But what I really suspect is that they are looking for an easy-out. I cannot be sure, but I think they are waiting for me to swoop in and save the day.

Behind all their excuses, I really hear the saying: “Let’s just look pathetic, make her feel sad, then she’ll give it to us for free. Let’s show her three wasted tiny skeletons and see if she’ll let them die.” 

Bitter?

Yes... that was me sounding a bit bitter. I get that way when faced with half-starved babies.

In case any of you are wondering, this is NOT normal Dinka behavior. Our staff is equally baffled... and disgusted. More than one has insisted that this couple has the means and the connections to find help. They are just giving up and want their babies to die. That way they won’t have to think about it anymore.

So there you have it. I’m not sure what to think. I might just run off with her children in the night.

Don’t think I won’t...

No seriously. Pray.

Post Script: Not thirty minutes after writing this, I went to check on them again and they were gone. They absconded in the night... and the rain. I doubt I’ll see them again.

I’m baffled... as are the rest of the patients and staff.

I’m not sure how to pray. Do I pray their deaths are not drawn out and painful? Do I pray for their parents to regain hope and kick it into gear? I don’t know.

Pray as the Lord leads. Thanks.

Millipedes.

Our shower is of simple construction. It consists of a spout and nozzle fastened to a concrete walled cubicle with a door. A quick turn of the nozzle and lukewarm water sprinkles out, washing the day’s dirt away.

It’s nice --especially compared to the alternative (aka: the bucket bath).

One of the fun parts about showering here is you never know who’s going to be showering with you. Some days it’s the flying termites. Other days it’s the frogs.

Yesterday it happened to be a 7 inch millipede!

I washed the soap from my eyes, turned around... then jumped! I had almost stepped on him.

I confess he startled me, but not much more. Frankly, I’m confused when someone expresses a fear of the mini legg-ed beast.

He doesn’t move fast. He doesn’t bite. In fact, other than curl up in a ball when prodded, I have had little luck getting him to do anything noteworthy.

Let’s face it, he’s a boring bug.

So why write a post about him? Why, indeed!

I think it has to do with the fact, that I came across a fancy yellow stripped one the other day. His features were more exotic than his chocolate-brown brothers, so I took a picture.

He looks pretty good, doesn’t he? I wonder what he’d taste like?

Preterm Update:

Baby Sebet came in today and is doing great! You’ll remember him as our surprise preterm birth a few weeks back that needed a lot of help breathing. (Read his stories here and here.)

His family were all smiles as they proudly unwrapped him for me to see. He has grown considerably and is thriving!

They named him “Sebet” which means two things. It means ‘Saturday’. But it is also the name of our clinic which comes from our director.

In fact, I work at “Clinic Saturday” or “Panakiim Sebet”.

Anyway, as a thank you Sebet’s family brought me ground nuts (aka: peanuts) in a bright blue container. They couldn’t be happier for this precious boy’s health and wanted to show their appreciation! What a treat!

Just thought you'd all like to know. Thanks for praying for him!

Two Liters Too Few.

Her precious children.

Angueth came in barely conscious. But by the time I was called, my translator had little time to do much more than learn her name and get her to lie down on the bed. It was a busy night.

So I busied myself with fundal heights and heart tones while he asked her more questions.

“Ask her how long she’s been sick like this,” I instructed my translator.
She responded but I couldn’t understand her words. She was slurring them.
“Is she drunk?” I asked again, confused and not a little worried, “Or has she had a stroke?”

The man who brought her in, didn’t know so he asked her daughter. There was a brief discussion,  during which it became clear that this man wasn’t her husband. He may have been a neighbor or a random stranger. But he wasn’t family.

“The girl says she doesn’t drink,” I was informed.

Angueth was barely hanging on at this point. Every few minutes she’d slip from consciousness and I’d try to pull her back.

Limp and cold, her extremities were swollen and her mucosa was white. She was severely anemic. I screened her for malaria symptoms.

She’d had all the major symptoms for some time, but she’d not been able to talk right for three days.

“This is outside of my scope of practice,” I explained to my translator, “Please get Dennis. I need his help.”

He grabbed the flashlight and left in a hurry, leaving me with Angueth, the Good Samaritan and a handful of kids.

Three to be precise.

Her eldest looked to be about 10 years old; the other two were both under 5. And all three sat quietly on the bench in the hall.

I continued checking her vitals while I waited.

Search as I might, I found no heart tones and eventually gave up. She looked to be about 7-8 months pregnant.

“My lower abdomen hurts,” she mumbled softly while rubbing the spot.
“Is it a contraction?” I asked in Dinka.
“Yes, it hurts. It hurts.”

Although I could not see or feel any contractions, I suspected her body might be delivering in an effort to save her life. So I did a vaginal exam.

Sure enough she was dilating. She was already 5-6 cm along.

Dennis arrived and I filled him in. He assured me that she hadn’t had a stroke but was in the late stage of severe anemia. Surprisingly her blood pressure was stable. So we started her on antimalarials and admitted her for labor.

Late as it was, there was no hope of getting her to Wau for a transfusion. Plus the Good Samaritan had quietly slipped away, and we had no way of contacting her family.

When I told her that she was very sick and was delivering early, she wasn’t surprised. But when I told her that her baby was no longer alive it took her a while to come to terms.

“So my baby is coming?” she asked, bubbles forming at her mouth.
“Yes,” I said looking at her full in the face. Her eyes searched mine in an effort to understand.
“When he comes. Will he be alive or dead?” she continued on.
“Your baby will be dead.”
Whimpering softly in response, she closed her eyes.

I think she wanted to say more, but the effort to speak was too great. Staying conscious was a hard enough.

Margaret took over her care in the night. She told me that Angueth’s labor progressed naturally, and a few hours later she delivered a girl. She was dead but hadn't been for long. Fortunately, Angueth lost only the slightest amount of blood, and her blood pressure remained stable throughout.

The following morning when I went to check on her, I was surprised to find her fast asleep. But when I tried to rouse her, she was completely unresponsive.

Although she’d been assessed shortly before by our night staff, it was clear the vitals were off. So I took them again. And sure enough, I was right.

She was unconscious and in shock.

With cold extremities, high pulse, and blood pressure bottoming out, I called for re-enforcements. First I called Tom, who listened to her chest for the sound of heart failure in the form of fluid build up. But eventually announced that it was out of our hands, saying she needed a blood transfusion.

Yes. That was clear.

Then I called Dennis, who helped me elevate her legs and suggested I give her Hemosele (a blood replacement IV fluid) to see if her blood pressure might at least stabilize. It was 68/42.

Blissfully unaware of the seriousness of the situation, two of her three children napped on our porch while the eldest went to get porridge.

When she returned I asked her to find an uncle or an aunt. Anyone. I told her that I needed to speak to them urgently. Could she do that for me?

Eager to help, she smiled sweetly and left right away. And I returned to her mother. I continued to monitor her vitals, but the fluids didn’t help.

Her blood pressure continued to plummet, and her breathing became more rapid and hoarse. A choking rattle filled the room as I watched... and counted. She was up to 60 respirations a minute.

A few minutes later, she passed away, shedding two tears without waking. They streamed down her cheeks and onto the bed.

Then the rattled ceased.

At the sight of her tear-stained face, I couldn’t hold back my own. And I mourned for this stranger as if she were my sister, grateful no one was there to watch.

A few hours later, Albino was able to track down her brother and uncle. They hadn’t even heard she was ill. Apparently her husband left some time ago. She lived alone.

Her family gathered around and I told them the story of her death. They were sad but thankful to have a few answers. Then one of our guards walked her children home while the rest of us placed her in the ambulance.

Rigor mortis had already set in.

As I helped lift her body into the vehicle, I had to step over two shovels and a pick.
    --How long will it take them to dig her grave?

Lord, please teach us how to do blood transfusions and send us the equipment. I’m tired of watching these women die for the lack of two liters of blood. Better still... Lord, send them to us for prenatals.

And if by some miracle any reader out there knows how to do transfusions and can teach us what kind of equipment we need, I want to chat! Write me in the comment section.

I’m praying that God will send us the equipment and the expertise to do transfusions. Will you pray with me?

Welcome Miss Adorable!

Our compound manager, Albino, brought in his wife to deliver this week. Her last baby was also born here. I wasn’t there (of course...) but I was told she clung to our director’s neck, and bore down with such intensity that the baby was out before anyone could call for Albino to come!

Well, this time Albino didn’t stray far during her labor. He hovered wringing his hands in consternation and love as he watched her progress from smiles, to sweats, to grunts.

Even though I had more than a handful of prenatals to care for that morning, I checked on her every few minutes. I didn’t want her to deliver without me!

Fortunately, when it came time to push she was able to shuffle into the clinic and lie down. I sent one of the translators to get Margaret (as back-up) and Albino (so he could finally see one of his children born), but just as before she pushed like a superstar and out came Miss Adorable!

Weighing in at 9 delightfully pudgy pounds, she is the newest member of our church!

Welcome my dear, you are blessed to have such great parents!