Tuesday, May 31, 2011

Slow Month of May~

One Monday, I had 32 woman waiting for me for prenatals. A record I think.
This month has been unusual for me. When I returned for my break, I thought for sure I’d be walking into busy-ness and chaos. But I didn’t.

Yes, I still had lot of prenatals and tasks to do at the compound, but the births I had been expecting, never arrived. We had only 8 births whereas the month before (April) we had 19 births!

Why?

It’s a question I’ve been asking myself a lot lately.

Do they not know they can come? Is there some obstacle in coming I haven’t identified? Do they really need to come, or am I just jonesing for a birth? What is it?

By mid-May, it finally occurred to me that the rain might have something to do with it; So, I asked Sabet.

He explained that most of Tonj left this month for the village. Apparently, once the rains start, people head to their land to plant crops. Any babies born this month were born in the fields!

The coming rains made for unusual obstacles for prenatals as well.

In fact, one woman came for a prenatal, explaining that she missed her appointment because she was building her house!

When I looked down to see an enormous belly, I chortled and snorted in laughter. What was a 8 month pregnant woman doing building a house?!

Once I stopped laughing, it dawned on me that the men weren’t going to do it (women build homes here not men); she had to miss her appointment, she needed a new roof!

Have to mentioned how much I respect and admire the women here?  -- Cuz, I do! Amazing!

Sunday, May 29, 2011

Labor of Love May 2011 ~ Newsletter

I'm still struggling with finding a way to embed my newsletters in my blog. So, I've given up. Instead, if you are interested, click here to read my May newsletter ~ Labor of Love. 

If you have trouble reading it in this format, click here.

Thanks for praying and encouraging me so well!

Love,
Stephanie

P.s. If you are not getting the newsletter directly and would like to be on the list, just drop me a note in the comment box. I'll keep any email addresses confidential.

Labor of Love May 2011

Saturday, May 28, 2011

A Reminder.

Not long ago, I got a special visit from a woman who birthed with me in January. Her name is Nyandit. I’ll never forget her or her birth.

You never forget your firsts, and she was my first footling breech. (Read her story here.)

At the time, I was scared out of my mind at how best to help her with the birth, but God walked me/us through it. In the end, it was transformational birth for me as a midwife.

She told me that her beautiful son is named Malong or ‘breech’ in Dinka because he came out foot first.     -- I wonder if I could get away with such a name in the States.

Holding him in my arms, I was reminded of why I’m here. This precious life. This gorgeous child. Oh, the privilege and joy!

I asked if I could keep him, but she looked at me sideways and wagged her finger to say ‘no’. Suppressing a smile, she said that he could be ‘moindu’ (my honorary child), and we slapped hands in agreement.

A good day. A very good day.

Four in twenty-four!

(Warning: this is a long story. You might want to get a cup of tea before starting. Oh, and it gets a bit complicated in the middle, feel free to take notes!)

To tell this story right, I have to explain that the day started at midnight with a knock on my door.
-- “Akuac, there is a woman in labor. She says the contractions started at 8pm, but water has come out.”

Gabriel, my translator for the night, looked as tired as I felt, but he didn’t complain. We marched off together toward the clinic. On the way, it occurred to me that Sarah (short-term missionary nurse) might want in on this, too. So, I sent Gabriel to wake her up also.

Sarah came quickly, and together we checked Adong in. Since she was in early labor, I decided to not do a vaginal exam and just let her labor through the night. This was her first baby and I wanted her to rest up for the hard work ahead.

Even though birth wasn’t imminent, Sarah wanted to do the hourly checks with me, explaining that she wanted to see what an unmedicated labor looked like; all her experience with labor has been with epidurals back in the States.

Ignoring the fact we’d be exhausted by morning, we got up hourly to monitor her progress.

I must confess, I enjoy night labors. The sleepy silence of darkness muffles the otherwise harsh tones of birth -- especially, here in Sudan.  And this night didn’t disappoint. It brought rain.

Dancing on and off all night, the rains chased the bugs away and inspired the frogs to sing. Plus, the wet drizzly curtain muted voices and footsteps alike, replacing them with an orchestra of sounds.

Drip-drip-drip. Cro-AK. Buzzz. Whimper. Ping-ping-drip-pang. CRO-AK. Bizzzzzzzz. Groan.


By first light, Adong wanted to push but didn’t seem ready. So, I did a vaginal exam. She was a good 5 cms and handling things well; so, I sent her walking instead. She happily complied.

I then sent Sarah for a nap --and tried to get one myself-- but it was hard. By 8 am, God woke me with a start. I grab some strong coffee and headed off to devotions.

However, within minutes I was called out of devotions for another labor. Another first time mom, Awang was looking active. She explained that her labor started the night before, but the rains had kept her from coming. 

Fortunately, she was already 8 cm dilated, so I sent her to walk around the compound as well. It was fun looking off the back porch and seeing two waddling ducks turning circles and squatting. It made me smile.

Guessing we’d have a few hours, I jumped right in to doing prenatals. However, one of my prenatal ladies had a serious problem. I couldn’t find her baby’s heartbeat. Even though, I searched every inch of her abdomen in a desperate hope, I never found it.

Eventually, I asked:
-- Can you feel your baby moving?
-- No. I haven’t felt him move in a month.
-- From the size of your belly, you are seven moons now. Is that right?
-- Yes. Seven moons.
-- Have you had any bleeding recently?
-- Oh. Yes. I’ve had bleeding for two months straight...

Alarms going off in my head, I poked and prodded some more. Was this another hydatidiform mole? (Unlikely. Her belly would feel different. Harder.) Fibroids or poly-hydraminos? (Neither made sense with the facts, but I wanted to rule them out, nevertheless.)

Eventually, I was clear. I had an intrauterine fetal demise (IUFD) on my hands. Her baby’s head was clearly palpable --as were his limbs-- but I couldn’t find a heartbeat. I couldn’t even hear her placenta.

Again, wishing for an ultrasound machine, I explained that I thought her baby was dead, and that she’d need to be induced soon before she became septic. It took a few minutes for my words to sink in. But even then, I’m not sure they fully did.

In the end, she refused to believe me and went home. I encouraged her to go to Wau for an ultrasound, warned her of the risks, and encouraged her to come back if she changed her mind.

It’s the first time a woman has refused to believe me about something so important; it was hard watching her go without help. But I didn’t get to dwell on it for long because Adong started pushing.

Adong with her family gathered around.
Rushing in to the prenatal room, Adong explained that the head was coming out. We scrambled to set up the room while she pushed. A few minutes later, a handsome vernix coated boy emerged! What a sight!

However, as I was waiting for her placenta, one of our health workers barged in saying that Aweng was pushing in the observation room now, too.

--“Come quick, you can see the head!”
-- “I cannot deliver the baby over there (other sick patients in the room, no equipment, lots of looky-lous), make her come to the wound care room to deliver.”

He ran off to do as I asked, and I looked over at Sarah and shrugged. Sarah had never delivered a baby before, I couldn’t send her. And plus, she had only seen two births so far here at the clinic. I would be unreasonable to ask her to do it.

The now breathless health worker was back in less than a minute explaining she was refusing to come. So I de-gloved and went to get her, leaving Sarah in charge of the placenta.

Once I got to the observation room, I found 10 people gathered at the door, Aweng lying on her back in the lithotomy position, pushing with all her strength. The sick man in the bed next to her watched unashamedly in interest.

-- “Aweng, you cannot deliver here. Please get up after your next contraction and come with us.”
-- “No. I cannot walk,” she insisted while pushing again. Fortunately, she was a first time mom so I knew that she could in fact move; the baby would not fall out as she walked.
-- “Yes, you can. I will help you,” I explained while forcing her to her feet.

Aweng with her precious boy by her side.
Although confused, she complied and together we walked hand in hand to the ‘second birthing room’.

-- “Sarah,” I called across the wall once I got there, “has the placenta come out yet?”
-- “Nope. Still waiting.”
-- “Okay. You take that, and I’ll try to get set up here.”

Aweng, determined and gutsy, pushed like a pro and in just a few minutes delivered a gorgeous little boy! He came out about the same time as Adong’s placenta in the other room.

However, after Aweng’s birth she wouldn’t stop bleeding. After loosing well over 500 ccs, I decided to do a cherry pop and help the placenta out with a little traction. It was delivered completely but the bleeding persisted.

When both oxytocin and fundal massage didn’t work, I decided to do an internal manual exploration. I hate doing them, but I think she hated having it done even more. However, once completed, her bleeding stopped nicely.

Once the dust settled, Sarah and I took lunch and then I finished up the remaining prenatals. I remember Sarah saying, “I just hope no other labors come in tonight; I’m tired.”

Nodding in exhausted agreement, I laughed and told her, “I should not have kept us both up all night. Serves me right that I’m this tired. Next time, I’ll know better.”

However, after lunch a new labor came in. I taught Sarah how to do a vaginal exam and suggested she be the main midwife.

I wanted Sarah to have an easy birth for her first. And since Mary was expecting her forth, I assumed all would go rather quickly. But I was wrong.

Sarah walking with Mary.
I sat at the clinic to supervise, trying not to get in Sarah’s way. Mary’s contractions were originally every 2 minutes but with time they slowed down. Sarah was starting to fade; we both were. That’s when the fourth labor arrived.

When I saw it was another first time mom, I smiled wryly at the cruelty of the situation. Would that mean we’d be up all night again?

Her name was Yar, and she was perhaps 18 years old.

Fortunately, she was already 7 cm dilated with solid contractions. Her friend, Debora, had delivered with me earlier this year and had encouraged her to come in. Together they labored on the floor in the other room while Sarah and I worked to help Mary’s baby descend.

After 4 hours of doing walking and nipple stimulation without results, I decided to rupture Mary’s membranes. After another hour Mary was fully but the head wasn’t coming down. I decided to take over for Sarah and do a vacuum extraction. It worked, but progress was still tediously slow.

In the midst of using the vacuum for the third time, my hand covered in blood, and Mary looking completely spent, Yar insisted on pushing, too.                  -- What? Again??

I was too tired to think straight. So, I sent my translator to get Dr. Tom for help. I couldn’t put Sarah in charge of either birth at the moment.         -- What a gong show!

Mary with her boy after the birth.
Mary, pushed while I pulled with the vacuum. Santino her husband stood by her side sweating bullets. Meanwhile, Yar and her friend Debora kept calling for me over the wall. “Akac, ba ten! Meth benbe! (Akac, come. Baby coming!)

If I hadn’t been so tired, I would have laughed at the deja vu scenario. Hadn’t we seen this already today? Didn’t I have two labors push and deliver within minutes of each other earlier this morning? It felt like I was trapped in some kind of birthing vortex and I was going under.

Tom arrived in time to help Yar calm down, and see that Mary had finally delivered her child --A boy!

The shape of her son’s head immediately explained the delay. He had the funnel shaped head that you often see in first time moms. Apparently, this little guy had quite the squeeze on the way out! 

Laughing in relief, I wiped him down and went to put him on Mary’s abdomen. But when I looked at her, I realized she had fainted! What? I tried to wake her, but she didn’t respond to words or pain.

-- “Tom!” I yelled, “My patient is acting strange. She looks semi-conscious.”

He was there in a flash, trying to wake her and assess the situation. He worried it might be malaria still (despite having treated her successfully last week for it), and started her on IV quinine. Within a few minutes, she woke up and delivered her placenta.

Meanwhile, I went to check on Yar who was still pushing. I wanted Sarah to catch at least one of these births. 

-- “Sarah, Yar will deliver soon. Do you still want to catch a baby today?”
-- “I do.”
-- “Then get over here and glove up. This will be your birth now.”

She hustled over with gloves and I walked her though the basic steps of delivering. But honestly, I think I was a bit of a basket case by then. I don’t even know what I told her, I think I said, “Just call when you need me. I’ll be right back.” and left the room. (What a terrible supervisor! I know! Right?!)

I just needed a minute to make sure Mary wasn’t bleeding too much. Fortunately, I found her sitting up and smiling at her dimpled boy. We laughed together and praised God for helping her through it all, and she started breastfeeding.

But then I heard Sarah calling, “Stee-pphhannnn--iieeee!!!” and I went running. Yar’s baby was out, and Sarah was wiping his mocha brown body down with a towel --another boy!

Yar with her son after the birth.
The rest of the night consisted of cleaning up and helping to control bleeding and establish breastfeeding. Both Mary and Yar, stayed the night and I discharged them the next morning.

What a day!

In the end, it was a first in a lot of ways. It was Sarah’s first time seeing a woman labor naturally; it was my first time supervising. It was Sarah’s first time catching a baby, and it was my first time catching three babies in a day!

So praise God for firsts -- First time moms and first time midwives! 

Oh, Sudan! Never a dull moment.

Update on Holes & Incompetence.

On Monday, Ayen’s brother came to see me. Ayen as you may remember is the woman with the incompetence cervix we have been praying for. (Read her story here.)

He came just as he promised, to take me to her house. However, as a typical Monday, I was still swamped with obligations and asked him to return in a few hours.

Agreeing to come back at 4pm, he reassured me that her labor had not progressed. There was no bleeding but still lots of fetal movements and lower abdominal pain.

Woohoo! She has not delivered yet!

But here’s the thing.... that was on Monday. Today, a full five days later, he has not returned again. I don’t know any more than that. He promised to return but didn’t. Does that mean she was taken to Wau? Did she deliver? I have no idea. Please keep praying. Thanks.

Also, this week I got to see the young girl with the hole in her face. Her name is Arec. It has been almost two months since she first came in and we are now starting to see real improvement.

Yes, there is a terrible scar but now she’s in a lot less pain. She also has more range of motion and function. So, thank you so much for praying. Please continue as the Lord leads you.

Monday, May 23, 2011

The Stench of Ignorance & Neglect.


Her name is Biyana, and she’s 18. Her first child was born naturally, but succumbed to the dreaded ‘one-day-diarrhea’ and died at a year and a half old.

Her second pregnancy brought on four days of excruciating labor pains which ended in a cesarean.     -- The baby didn’t make it.

The scar of that day, marked her body with a keloid an inch and a half wide -- from pelvis to umbilicus. She had a classical incision; and when I asked her why she had to have surgery, she couldn’t answer me.

-- “Didn’t you ask the doctors what happened?” I prodded. 
-- “No.”
-- “Didn’t they explain?”
-- “No,” she repeated with the twisted sucking sound made my Dinkas to indicated a ‘no’. 
-- “I see. So, when did this happen?”
-- “Last July.” 

I continued on with the rest of the prenatal as if such an obstetrical history was normal.
    -- Which, here is.

We discussed LMPs (last menstrual period) and fundal heights (how large her belly was growing for her dates), and I re-assured her that this baby was doing fine. She seemed excited and happy to be pregnant again, but something was off.

Although obviously clean, her clothes smelled strongly of urine. It was overwhelming, and attracting flies.

I waited until the prenatal was almost over before I asked her about it.
-- “Biyana. Did you shower today?”
-- “No. I didn’t.”
-- “Well... Right now, I can smell a lot of urine on your clothes. Do you have urine leaking from your vagina, by any chance?”

Looking at me in muted surprise, she clicked her tongue in response. “Yes.” Click.
-- “Really? Does it come out only when you carry heavy things, or is it all the time?”
-- “All the time,” she said flatly. The lack of emotion in her voice was frightening. 
-- “How long has that been happening?” I enquired.
-- “Since July. It started after my surgery.”

I started counting back months in my head. If it’s May now, that would mean... 10 months!
-- “Really?” I said calmly, trying to keep the desperation out of my voice, “You’ve had urine leaking from your vagina for 10 months?”

She must have thought me stupid for asking such a simple questions over and over again. But she answered me each time I asked.
-- “Yes,” she explained, “In fact, I haven’t urinated since the surgery.”

When my translator gave me this information, I made him repeat himself several times. I couldn’t be hearing what I was hearing. I just couldn’t!
-- “Wh... wha... what do you mean?” I stuttered, “Are you saying you have not urinated at all in 10 months?”
-- “Yes. It just comes out of me all by itself.”

Knowing full well I had some kind of vesico-vaginal fistula on my hands, I called Sarah in to watch and learn. I was fairly confident she hadn’t seen one before.

(For those who don’t know a vesico-vaginal fistula (VVF) is when the wall between the bladder and the vagina is compromised, allowing urine to pass through it unimpeded. If you are interested in learning more about it click here and here.)

Pictures taken from this website.
Then I asked Bisaya if she’d allow me to do a vaginal exam to see if I could identify the size of her hole. She agreed, but seemed a bit confused on the purpose.
    -- Did she think her incontinence was normal? I couldn’t tell.

But in the end, the exam caused more questions than it answered.

Instead of finding a small tear or thinning anterior wall, I encountered a large mass of scar tissue about 6 cm long and 3 cm wide. She writhed in pain as I attempted to feel around it.

Fortunately, I had my trusty translator James by my side and he was able to calm her down and explain what was happening and why. Once she relaxed, I was able to assess it better; but honestly, it had no idea what I was looking for.     --It was a mess in there.

Frankly, from the amount of pain my exam caused her, I’m amazed she even got pregnant. When I asked her if it was just as painful during sex, she clicked her tongue loudly in confirmation.

Wow.

We talked in depth about going to Wau for a GYN consult, the possibilities of a repair, and whether or not another cesarean might be indicated.

Right now, she is five month pregnant. However, if her pain is that intense during a vaginal exam, how much worse will it be for the birth?      --Lord! How can we help this girl?

She promised to discuss things with her family, but I’m not sure whether or not she’ll go to Wau. She did sound hopeful though. I think, I’m the first person to tell her there might be a solution to this curse. I think she had given up hoping for a way out of the smell of her stigma.

Oh, the stench of ignorance! Imagine not urinating for 10 months!        -- Just imagine.

Imagine not knowing there was a way to fix it.
      --It breaks my heart.

Please pray for Biyana. I will hopefully be seeing her in the coming months. Pray that one day, we’ll get a surgeon out here to repair fistulas in this community. Thanks.

Sunday, May 22, 2011

Three new blessings!

Pritty (pharmacist), Benedict, James (translator), Sarah, Stephanie
This week, several key IDAT staff went on break all at once. It was hard to see them go, knowing the work it would require filling their shoes. But we sent them off with smiles, nevertheless. They had worked long and hard and needed the rest.

Fortunately, the plane that took them out brought in three new blessings!

Benedict is our new clinic officer. He's a soft spoken Kenyan who looks a bit shell shocked by all the 'rurality' of Sudan. (Yes. I just made that word up!) I'm guessing he had NO idea what he was getting into when he agreed to help us out for a month. But I'm so glad he is here!       

The next big blessing is Sarah. She hails from the great state of Texas and has a heart of gold! She just graduated from nursing school, and wants to learn all about midwifery. She tells me she's hoping to do a masters in Midwifery someday soon. She'll stay for three months. Yippy!

(So thank you all for praying for me to get some help. I'm loving it. Now pray she stays longer... or another precious person comes to replace her in August!)

Our new oxygen concentrator.
The last big blessing is our new oxygen concentrator! Yes, some generous soul bought us oxygen on wheels! What's great about this machine, is we are not dependent on getting oxygen tanks refilled in order for it to work! Woohoo!

What lovely blessings that God has showered down upon us! What delightful answers to prayer! 

Now, start praying that God will drop an ultrasound machine in my lap! Thanks.

By the way, Sarah has a blog. Last Friday, she helped me with a wonderful birth. I'll let you read about it here, if you are interested.

Friday, May 20, 2011

Incompetent.

I met Ayen for the first time 4 weeks ago. She had a terrible history of untreated STDs and two second trimester stillbirths. Since she was already in her 5th month, she decided to see how I could help keep this baby healthy.

Suspecting several STDs, we threw everything in our pharmacy at her blindly.

Insisting that her husband get the same treatment, she brought him in the next day, but hadn’t explained to him why. Once he learned he had STDS, he refused treatment. 

Frustrating even my translator with his obstinate refusal, my translator explained: “He is stubborn. You know, those from the village, they don’t want to take medicine. They argue.”

Since he wouldn’t get treatment, I asked her not to have sex with him until after the baby was born. They both agreed and I sent her home.

She returned weekly for check-ups, and, yesterday, I was thrilled to learn her infections were gone. So, I was a little surprised when she returned tonight in pain.

Even though there was no bleeding, she explained that it felt like she was miscarrying. The pain was constant; it reminded her of the other births. Despite not having any contractions, she knew something was wrong.

Was she just afraid? Or was there something amiss?

Since her infections were treated, the only other thing I could think of was an incompetent cervix. Leaning towards her being more fearful than incompetent, I asked if I could do a vaginal exam. I was just trying to rule it out, so I could send her home re-assured.

She agreed saying, “Do what you need. That is why I have come.”

During the exam, it took me a minute to get my bearings. Soft and squishy, her cervix was hard to find at first, but when I did, I jumped.                -- What the heck was that?!  

Sudden movement startled me.     -- It couldn’t be... No. It’s not possible! 

Since she was already dilated, I tried to assess without moving things around. I didn’t want to make it worse. However, while checking for effacement, I got poked.
    --Her baby was playing with my finger!

Tiny digits rubbed against my index finger, flittering and jabbing me through the membranes. Momentarily speechless, I stood there, equally amazed and horrified.

She had an incompetent cervix.

Calling for Tom to consult, I gathered all the facts in my head in preparation.

    --- 70% efffaced. 2 cm dilated. Membranes intact. Tiny fetal parts palpable.

He came in a hurry, only to listen and shake his head in resignation. There was nothing we could do for them --not at 26 weeks. They needed to go to Wau.

Part of me was hoping he’d swoop in and stitch her up right then and there. I mean, isn’t that how it’s done on t.v.? The doctor does a quick assessment, takes out some nylon suture and saves the day.

But his downcast eyes made it clear. It was too late.      -- Sigh.

As he left, I called Ayen’s family in the room. Her husband --the same man who a few weeks ago argued he wouldn’t get treatment-- sat before me again, but this time he wasn’t arguing. He was scared.

Pulling no punches, I explained the whys and the hows. “Ayen’s cervix is starting to open. If it opens any more your baby will be born, and die. He is too small to breath on his own.”

An hour later we were still discussing the options and possible consequences. I was able to convince her husband to get treatment for his infections, but he did so grudgingly. The village in him resisted getting the penicillin shot (since it was an injection). The villagers fear needles.

I encouraged them to go to Wau, but was honest that the hospital there would not be able to do much for their child. They would unlikely be able to care for one so small, and doing cerclage is contra-indicated so late in pregnancy.

They opted to take her home on strict bed rest, instead. Explaining what that might look like, I tried to keep things simple, but it was hard. I kept saying, ‘if this happens, then do this. But if that happens, then do that’. By the end, Makom (her husband) looked dejected and sad.

Before they left, I prayed for them to see God moving in the miraculous. I prayed this child would stay inside and live. I prayed that Makom would see God’s goodness and be transformed. I prayed for the hope to remain in Ayen’s heart.

Will you join me?

I have no idea what God has in store. But their baby is alive and definitely kicking. Oh, Lord! Help this child live! Amen. Please pray for Ayen, Makom... and their little Poke! Thanks.

Monday, May 16, 2011

Bullets bursting in air...

Just after falling asleep last night, it started.    --Gunfire. Lots of it.  

Pop. Bang. Blast. Whir. Blam.

In an attempt to calm my racing heart, I chuckled weakly to myself and thought of Sabet's warnings earlier this week.

"Remember," he said while speaking to all the expats, "this weekend marks the anniversary of the SPLA (Sudanese Peoples Liberation Army). There will be lots of gunfire and celebrating in the streets. Do not be alarmed."

Then he proceeded to recount the night of May 16th, a few years back, when several visitors were staying at the compound. These hard-core military types, heard the shooting, took cover under their beds and prayed like mad. They stayed that way for several hours, until the bravest decided to crawl, military style, the hundred yards necessary to knock on Sabet's door.

"Hey, Sabet! We're under attack!" 

Apparently, the pounding on his tin door had the effect the bullets lacked, and Sabet jerked out of a dead sleep. Yawning and rubbing sleep from his eyes, Sabet told the man it was 'only SPLA day', and that he and his friends had nothing to worry about; it was the Sudanese way of celebrating!

To this day, they all still laugh about it.

This being my first SPLA day, I wasn't sure what to expect. What would it sound like to hear the whistle of bullets scream for the sky? Would I even notice over the drone of my fan?

Well, let me tell you... I noticed!

I noticed it at 1 am. It sounded like fireworks --No, like balloons popping. Then, I noticed it at 3 am, and again at 3:30 am.       

Bang. Boom. POP-pop-POP.

"Stupid bullets," I grumbled to my pillow, "stupid guns."

By 5 am, the sporadic pop-POP-pop of the AK-47, jerked me from a fitful dream and I rolled over angrily. "How do these gun-wielding wackos expect anyone to work in the morning?"

Sigh.

At 6 am, the gun blasts started anew. However, this time, it was right outside my window. All I could think was, "Whoop-dee-do, It's SPLA day! Now give it a rest."

By 7:30, when I was called for a birth, the gunfire was over, but my day had just begun.
          -- It was a 10 cups-of-coffee-before-noon kind of day.

Here's to hoping for a good night's sleep! 

To learn more about life and politics in Southern Sudan. 
Here are a few interesting link:
The official website of the SPLA 
SPLA found on Wikipedia.
The Sudan Tribune.

Saturday, May 14, 2011

Butt Surgery.


This week, Dennis and Tom performed surgery on a 5 month baby by removing a very large growth on her buttock.

When they told me they’d be removing this growth, and they wanted my assistance, I thought it’d be a few centimeters in diameter at most, but I was wrong.     --Way wrong!

Yom, being just 5 months old, had a tennis ball sized growth on her left buttock that had been growing progressively since her birth.

Understandably worried, her family brought her in to see what could be done; Tom and Dennis decided to remove it surgically.

Even though, I wasn’t much use to them, I was glad to watch the surgery. After sedating the tot, they infiltrated the area with lidocaine, cut, and tied off any bleeders.

It took just over an hour, but eventually, they were able to remove most of the scar tissue and close her up.

I can’t help wondering how such a growth can happen in the first place?

Knowing she was handling her surgery well, we laughed calling it a ‘Butt-ectomy’, and joked about her being the ‘youngest person to get liposuction’.
    -- I know. Corny, right?

Anyway, there is no doubt in my mind, this growth would have haunted her for the rest of her life if not removed. In Sudan, any unusual growths are thought to be demons or curses. To have them brings harassment and ostracism, I’m glad that Tom and Dennis could help her in this way.

Please pray that Yom would heal quickly and that it would not re-grow. Thanks.

Aid Sudan Mission Team

Kerrie teaching our patients on proper tooth care.
 This week we’ve been visited by a team of Texans and one Indianan! As short-term missionaries with an organization called Aid Sudan, their main goal is to evaluate how they might put up a Christian radio tower in Tonj, among other projects.

However, in doing so, they are visiting many outlying towns, leper colonies, and schools as well as helping out in the clinic.

Yesterday, they did a great health teaching on the importance of brushing your teeth, and then handed out toothbrushes to the clinic patients.
My prenatal ladies with their new toothbrushes.

They have brought much laughter and love to the compound. What a blessing to have them here!

Pray that God would continue to use them as they return home and tell the world what they’ve seen. May hearts be stirred to prayer and action.

Strong & Beautiful.

At the sight of her belly, my heart skipped a beat; it was huge. Round, corpulent, robust, stocky, she stood out in the sea of big bellies.     --It was mesmerizing.

Slumped low in a plastic chair, Ajok explained that her labor had started earlier that morning, and she had come to deliver.                                 -- Yippy!

Expecting her sixth, she obviously knew what a contraction felt like --so I didn’t argue-- but she didn’t look like she was in labor. Plus, she was having only two contractions an hour.

Nevertheless, multigravidas (woman expecting their second or more baby) can surprise you.

Knowing full well that she could go quickly, I asked if I could do a vaginal exam. I didn’t want to send her home and miss the birth.

Though soft and pliable, her cervix was closed. After explaining that she wouldn’t deliver any time soon, she went home, promising to return if the contractions picked up.

The next morning, she returned at daylight, insisting that the baby was coming any minute. I didn’t argue (even though she didn’t look like she needed to push), and quietly set up the room.

As we waited for that illusive ‘urge to push’, she slept. Her contractions were moderate and regular, coming every 2-3 minutes on the dot.

Since she had been up all night, I encouraged her to rest and push later. She was fine with that at first, but then got impatient.

“What was taking so long?” she worried.

Trying to move things along naturally, I encouraged her to walk, but she refused. And since both she and the baby were both doing great, I saw no need to force it.

Plus, I had help.

This week, several short-term missionaries from Aid Sudan are visiting, and one of them really wanted to assist at a birth. As young mother and wife, Ashley oozes compassion from every pore.

When she volunteered to be my scribe and doula, I was relieved, and left Ajok in her very capable hands. There were at least a dozen prenatals waiting for my attention outside. 

But after an hour or so without any progress, I finally broke down and did a vaginal exam. I needed to make sure I wasn’t way off on my guesstimate.

A quick review showed her to be 9+cm, 90%, with waters intact. All she needed to do was push, and the baby would be born.                         --And I told her so.

But each time she pushed, it was short and weak. Not having that ‘urge to push’, yet, I let her rest and wait some more. Why rush things?

A few hours went by.

She rested but started showing signs of impatience. Plus, her friends looked agitated. They wanted to take her home.

What?

With four pairs of eyes watching me like a hawk, I asked Ajok what she wanted to do.
--Do you want to go home, Ajok?
--No. I just want the baby out.
--Then push. The baby will come once you push.
--No. I don’t need to.
--Okay. Then, let’s wait.
--No. Give me medicine to make the baby come.
--I have medicine, but it’ll cause you lots of pain. Why don’t you walk around a bit, instead?
--I’m too tired to walk. I want the pain.

She was tired --that was clear-- so I gave in and started an IV to augment her labor.

Once the cannula was placed, and the drip was in route, she instantly got uncomfortable. Two minutes later she had a strong contraction... and she pushed.

She pushed hard!

One minute later, the head was visible; and seconds later, the baby was out!

As I wiped him down and placed him on her belly, she smiled and thanked me for causing her the pain. She even chided me for not doing it earlier, and we laughed.

The placenta was born with ease, and her 9lb 2oz boy breastfed with gusto. He was a sucking machine!

Once the bleeding was controlled she asked to go home. Living just a few minutes away by foot, I didn’t argue for her to stay. We didn’t have a free bed for her to properly rest in, and a storm was coming.

Promising to return if her bleeding got bad, or any infection started, I prayed with her and sent her home.

Not long after she left, a low, grumbling pall of clouds swept our way. I can only hope she made it home before the deluge.

Oh, Sudan!

Your land is beautiful. Your women are strong. May your children be blessed!

Wednesday, May 11, 2011

Baby Dolls!

In the last 11 months, I’ve had the following conversation at least once or twice a week. Sometimes the variables change a bit... but it almost always goes like this: 

(Me speaking to a woman who thinks she’s pregnant but is not.)

--So, how many moons pregnant are you?
--Eight.
--Eight? Are you sure? But you have no belly.
--Yes. I’m eight moons pregnant....but it’s strange, my baby isn’t moving.
--I see.... when was your last period?
--My last period was (insert month 8 months previous to conversation).
--So, 8 months ago you had your last menstruation. Did you have any bleeding since?
--Yes. When I was 2 months pregnant, I had some bleeding. Then I’ve had bleeding every month since then.
--I see. Do you know that if you are bleeding it’s almost impossible to be pregnant?
--But I AM pregnant because I haven’t seen the baby come out yet...

When I explain that they wouldn’t be able to see the baby at two months, they argue. When I describe how small babies are at that time, they shake their heads in disbelief. Sometimes they even leave in a huff, irritated that I could be so dull.

Don’t I know anything? The baby didn’t come out! Therefore, she MUST still be pregnant!

(Side note: This belief does explain why some women insist they are 4 years pregnant. Ha ha. But it doesn’t help when I have a woman coming back month after month, insisting she’s pregnant when she’s not.)

Well, last month, I mentioned this dilemma to my dear friend in Switzerland. At the time, I was just venting about not knowing how to teach these women properly... but my friend got an idea.

“What if...” she said, then let her voice fall quiet.
“What if what?” I wondered in response.
“Nothing. Oh.... I just had an idea. I’ll see if I can get it to work, then I’ll let you know,” she responded, eyes sparkling in mischievous delight.

Even though I tried to pry it out of her, she wouldn’t budge. Then a few days later, she sweetly brought me little fetuses made of modeling clay.

They were perfect!

She had hand carved and molded little fetuses at one, two and three months pregnant! They are to scale and really look like little babies!

When I came back to Sudan, I wondered how long it’d take before I used them. Well, I didn’t have to wait long; I’ve already used them 4 times!
I overbaked my versions of the babies and now they look African!
Having such simple props to hold, makes my job so much easier. All I say is: “Since your baby was this small at two months (holding the miscarriage doll in the palm of my hand), do you think it was possible he was in one of the clots that came out?”

The women's eyes have lit up with understanding immediately. They get it! What a blessing!

Thank you, MTw! It’s such a fabulous teaching tool!

...and I’ve made more, just like I promised. Ha ha... but I baked mine too long and now they look African! Bonus, right?

Update: Culture Gap

Cinteth has come in twice since last Saturday. Each time, we’ve treated her with more powerful drugs. Each time, her uterus has failed to involute (aka: reduce in size postpartum). Each time, the infection has persisted.

(For those who are unfamiliar with her story, please read here first.)

Today, at 9 days postpartum and after seeing only a slight improvement on the infection front, we decided to do a MVA (Manual Vacuum Aspiration); perhaps there were placental parts trapped inside.

However, none of us were ready for what we found.

Instead of finding incarcerated clots or placental fragments, we found necrosis of the vaginal tissue lining the wall. Dennis had to debraid it.         --It was bad.

How such an injury could even happen is a mystery to us all.

The only thing that makes sense, is that she had several lacerations during the tramatic birth which subsequently got infected due to unhygenic conditions. I suspect the TBA helping her didn't use gloves and reached inside her in an attempt to deliver the child.

Cinteth’s improving, but not as quickly as we expected. Please pray that this infection doesn’t get worse. Pray she recovers completely and quickly. Thanks.

Tuesday, May 10, 2011

Heart-shaped perfection.

A heart-shaped face perched atop elegant shoulders, drooped slightly in despair as she explained; there was bleeding. It started at noon. It was getting worse.

At first I didn’t know what to think, but then I saw it --Dark red stains and clots. Oddly, there were no contractions.

Painless vaginal bleeding tends to indicate placenta previa (when the placenta grows over the cervix causing bleeding during labor). There was just one thing... she wasn’t term.

Her brown taut belly only measured 25 cms, and the child palpated to be about 6 months along.

Questions raced through my head.   
--Previa? Stillbirth? Preterm? SGA baby? What?

Checking for heart tones, I was surprised by a steady thuk-thuk-thuk-thuk that echoed throughout the room.       
--Her child was alive and remarkably NOT in distress, but for how long?

Her name was Abuk.

Studying her chart, I learned that she had come to see me once several months ago, and then again came last month to be treated for STDs. She said the medicine she got hadn’t helped. She still had many of the symptoms.

While calling for a consult, I set up for a speculum exam. I needed to know exactly what I was dealing with. I would be able to see the if the placenta was in the way... or if she was even in labor.

Dennis arrived quickly, and we stopped to discuss her case at length.

Even though her LMP put her at 22 weeks GA (or 5 months), she was obviously more; her fundal height clearly indicated more like 6 months. But if she was having a simple preterm birth, why was there so much blood loss? Why the clots?

This had to be something more. Right?

Since night had already fallen, we could no longer safely refer them to Wau. And even if we could, what would Wau do for them?     --Nothing. Not at 6 months.

Dennis went to talk to her husband while I did the speculum exam.

Once past the obvious bleeding, I was able to clearly see her cervix. She was almost completely effaced and was well passed 4 cm dilated. Tinged blue, the bag of waters glistened under the flashlight’s yellow glare.         --She’d deliver soon.

Abuk listened carefully as I outlined the options:
“One, you could go to Wau right now, since your contractions were so far apart, but getting there at night is tricky. Two, we could admit you to our clinic, make you comfortable, and wait for your child to be born. Or three, we could induce you... but induction is painful... and well, it is hard on the child, too.
Piercing black eyes flashed from me to the floor, to her hands, to her blood, as I spoke.

“Think about it, talk to your husband, and I’ll be back in a few min...” I barely had the words out when she interrupted: “Just help me stay alive.” Only then did it occur to me she thought she was dying.

“Abuk, I promise you. You are doing fine. No matter which choice you make, you will not die. Please, don’t be worried.”
Nodding at my words, she sat there studying my face. Could I be trusted?

“Please... talk to your husband. Decide together what is best.”
“No. I don’t need to. Why wait? My child is going to die no matter what. I want to be induced.”

As the truth of her logic settled in my heart, my tongue went numb. I had no more words.

“Still, think about it a bit more.”
Nodding, she curled in a small ball on the bed and rested, and I called for her husband to join her.

“Abuk, can I invite my friend to come pray with you?” I asked.
“Yes. I would like that.” Her face softening a bit at the thought.

Suzy, my director and prayer warrior, came to pray with them while I discussed her case with the rest of the staff. We all agreed. There was no stopping this birth. There were no drugs we could give. It was inevitable.

I would induce.

While preparing the room, my heart sagged with questions.

Why the hurry? Why not let the child come naturally? Was I doing more harm than good? Was I killing this child? Was I saving her life?

Understanding never fully came, but her baby did.

An hour later, a beautiful little girl was born. She had the same heart-shaped face of her mother. Beautiful.

Weighing just 900 grams, she never tried to breathe.

After examining her perfection, I wrapped her in a blanket and asked the father: “Do you want to hold her?” He didn’t hear at first, so I asked again.

I had to ask several times before he lifted his head from the table. The day’s events were too much for him; they weighed him low.

“Why don’t you hold her. She is so beautiful,” I said gesturing towards the beauty.
“Yes. I want to hold her,” he said softly, and took her in his arms.

He unwrapped her, once or twice, for a closer look, and then tenderly balanced her tiny frame on his knees.

“Will you name her?”
“Yes. She will be named after my mother,” he said hesitantly, then later added, “No. I can’t name her that. I can’t name her now that she’s dead...”

Abuk returned to a fetal position on the bed -- too tired to cry.

Six months of hopes. Wrapped in a blanket. Breathless but perfect.

Suzy and Sabet came together afterward, and we all prayed again before taking them home. It was a sad birth, but one showered in prayers.

Please continue to pray for them as the Lord leads. Thanks.

Sunday, May 8, 2011

Mother's Day Message~

"Behold, children are a heritage from the LORD, The fruit of the womb is a reward."  Psalm 127:3

Guest Author: Suzy Kuj, IDAT Ministries Director
       Sitting under the grass banda to escape the horrendous heat in rural Tonj, South Sudan, I realized Mother's Day was here and I needed to appreciate my mum living now in Florida. More and more each year, I treasure my mum, who raised four children.  And each year, while working in South Sudan, my appreciation and wonderment is also for mothers worldwide and especially those here in Sudan.

      Our soon-to-be-independent nation holds one of the worst maternal mortality ratios in the world at 2,054 deaths per 100,000 live births. That means that 1 out of every 48 babies who are born alive loses their mother at birth. In the United States that statistic is 8 deaths/100,000, or 1 out of every 12,500. That the average woman in South Sudan experiences 7 pregnancies in her life makes this reality even more dire, statistically, 1 of every 7.5 women will die due to pregnancy or delivery complications. Take a moment to think of 8 women you know. If you lived in South Sudan, chances are one of them would die from hemorrhage, sepsis, or obstructed labor.

      It's a grim reality. So why tout these dismal maternal health statistics on Mother's Day? Because even in the face of seemingly insurmountable odds, there is progress, offering hope for South Sudan's future.

      Warrap County has only 10% of births attended by a skilled attendant.  Our clinic has a full-time African nurse midwife and a missionary midwife from USA even though we seriously lack available medical personnel.  Most health facilities in South Sudan are run by community health workers who have only nine months of training and few clinical skills to handle complicated cases, we have an American volunteer doctor and Kenyan Clinical Officer.  We are blessed more than others and have much to be thankful for.  Every day our clinic saves the lives of these precious women.  Our clinic also has JESUS!  And HE brings the greatest hope of all. 

Suzy with her children on Mother's Day.
     If you are a Mum, our Mother's Day gift to you this year is letting you know we commit to reduce the number of mothers who die during child birth, through using our trained staff and trusting in the Lord Jesus for hope.  We will work and pray so other children will have a chance to treasure their mums a little more deeply each passing year. We promise to bring the hope of Jesus Christ to each mummy and celebrate her choice to come to our clinic and allow us to help her.

Happy Mother's Day to all the Mum's reading this.

Saturday, May 7, 2011

Culture Gap.


Tradition. Way of life. Cultural taboos.

Why do we live the way we do? What makes us tick? What do we value most? Each society would answer it differently.                                  ---So. Very. Differently.

Rites of passage. Social mores. Old wives’ tales.

What one person would claim as a foundational way of life, another might call witchcraft. What one person would do without thinking twice, another might run from in fright.

Rituals. Beliefs. Superstition.

When cultures collide and tectonic rifts emerge, how do you bridge the gaps? Personally, I tend to flap and flail like a spastic fish until someone has mercy on me and explains. Today, was one of those days.

Her name is Cinteth and she was pregnant... until a few days ago.

Coming for prenatals, she listened to me teach on the importance of delivering with us, but couldn’t come when her labor started 4 days ago; her husband and his brother forbid it.

Three days of painful contractions brought the baby’s head low, but then he got stuck. The midwife then took some kind of ‘hook’, placed it under her baby’s scalp, and delivered him by force.

He lived just over a day, then succumbed to his injuries.

Lying there wreaking of foul, purulent blood, she explained that something was wrong with her belly. It was so big and painful.

Palpating her abdomen, I could feel a bloating gas festering internally; plus, there was a thin, oozing discharge the seeped out continually.           --Infection.

She was in a lot of pain. Did I have any drugs to help her?

My heart sank.

Yes. I had drugs to help her. Yes. I would do everything I could. Yes.

She suffered needlessly and her baby died.... all for what?

Tradition? Superstition? Cultural taboos?

Why are there so many women and babies dying in Sudan?

I can’t give you a bald answer. There are no easy explanations. Trite simplicities don’t live here.

Layers upon layers of social mores and stigma, closely knit together with power plays and ignorance, mesh to make old wives’ tales and curses seem possible. Here, rites of passage and rituals weave a stark fabric for these women to wear. It chafes just looking at it.

If I pull on a thread will it give way to understanding... or just more confusion? If I peel off a layer, will I find hundreds more... or a raw naked truth hiding shamefully?

Why did this child die?

I believe he died because of fear, ignorance, and social power plays.

Let me explain.

The Dinka believe that every young bride has automatically slept with every man in town before getting married. So naturally, the first child is suspect.

Assuming as much, her husband makes her deliver at home with a traditional birth attendant (TBA) who can properly illicit a ‘childbirth’ confession.

It is widely believed that if a woman confesses those she slept with, her birth will be faster and less painful.

This is what Cinteth experienced this week.

When her pain started, she endured-- day after day. When the baby got stuck, he was removed with hooks. (Better the child die than she, right? Plus, who knows if it was his child anyway.)

Later that day, he succumbed to his injuries, and she developed a severe uterine infection.

How much of this could have been avoided if she had only come to us for help?

Is it presumptuous to say.... all of it?

Afterward, my translator Santos (the one whose wife delivered her first with us a few months back. Read their story here.) tried to explain the social ramifications of this situation when he saw me so discouraged.

The problem was... I’d heard it all before.

Afterward, I asked him, “Do you think if I invite all the first time moms to come WITH their husbands AND their mothers-in-laws, so they can illicit a confession during the birth, that they will let them deliver here?”

Pausing to think a bit before speaking, he looked away pensively and nodded. “I think so. If you tell them ALL to come, it might happen.”

This, spoken from a man who broke tradition and made his wife deliver with me, was encouraging. He knows that had his wife delivered at home, his little girl would most likely have died.

That’s one man. Now, how to tell the others?

Please pray for Cinteth quick recovery. Pray for the whole family’s loss and pain. Also, please pray that I’ll somehow find a way to bridge this cultural gap, teach these TBAs, and bring lasting change to this community.

It’s not my goal to transform tradition... but save lives. It’s not my heart to reform ritual but show God’s redeeming love.        

Come back Lord Jesus... and bring an end to all this death! Maranatha!

Friday, May 6, 2011

Simply the Story~

This week a team of missionaries are here to teach our pastors. They specialize in teaching the ‘Simply the Story’ Bible method which emphasizes story telling, much like Jesus did, to communicate the gospel.

For a people group that loves stories, like the Dinka, this approach to teaching is very effective. I have literally watched the pastors come alive this week, and their excitement is contagious!

No longer bogged down with complicated exegesis and theoretical applications, these pastors are laughing and clapping at how simple it can be. It’s fresh and radically liberating for them.

Yesterday, in an effort to make this method even more memorable, the pastors were given some homework. They had to create skits from selected Bible stories and act them out for us.

Instead of being studious and serious all day, these guys had a chance to hang loose and think outside the box. Their dramas were inventive and inspiring.

Pantomiming the story of Blind Bartimaeus  (Mark 10:46-52) while one of their colleagues told the story, these pastors really shined. Who would have guessed so many of them were actors? Ha ha.

I’ve rarely seen anyone so excited to receive his sight, as the pastor playing Bartimaeus! He threw his arms in the air and started jumping for joy... literally! He jumped as only a Dinka man can-- 4 feet in the air! Ha ha.

There were four skits in total. After each one, the pastors laughed and clapped enthusiastically. It was childlike and genuine. I loved it. They had such a great time watching their classmates ‘on stage’.    

May this new method of teaching help these pastors communicate the gospel in powerful and inspiring new ways. Amen!
Missionaries: Jon, Richard, Emanuel, Bromwell

And thank you Jesus for gathering these missionaries from so many places (Kenya, USA & Uganda) to bless our pastors here!

Twin update...

Mary and her mom, holding the twins.
The twins I delivered a month or so back came in for a check-up today! (Read their story here.)

It was so great to see them, and to goo and gahh over their cuteness! It was even better to hold them in my arms and rejoice over their sweet lives! 
I didn't inform you all, but the day after they were born, they both came down with high fevers. They really gave us a scare since the day they were born we had a serious meningitis case at the clinic. We treated them quickly and they recovered...  no worse for the wear. Praise God!

Check out how adorable they are!

April Showers bring... Malaria.

One of my patients with her new mosquito net.
The rains are late this year... or so I’m told.

Normally, the glowering grey nimbostratus clouds start in April, but this year they just now arrived. Smotheringly low, these mantles of would-be water threaten showers but rarely satisfy. Occasionally they breathe small gusts of chilly delight, causing this blistered land to shiver in momentary hope; and then it’s gone.

More heat. Sweat. Heavy air.

The only ones truly happy about it are.... the mosquitoes.     

Yes, we’ve traded the dry, merciless days of summer for mosquitoes. We’ve escaped the 120 degree weather only to run into the arms of bloodsucking beasts.

Malaria season has begun!

Honestly, the annoying high-pitched hum of my would-be assailant sets me on edge.

But slapping my leg at the slightest movement, covering my limbs in greasy DEET, and meticulously tucking my mosquito net in at night, seem useless. By the end of the day, I still end up bit to pieces. Am I just wasting my time?

Last year, I got malaria twice.

Fair enough, I wasn’t as anal as I could have been about protecting myself. I didn’t take the antimalarials prophylactically, and I only slathered myself in DEET when it tickled my fancy. But still...

Don’t get me wrong, malaria sucks! But... it’s such a hassle. (Insert pathetic whining voice here.)

I hate having to remember to take antimalarials. I don’t want to wear DEET (it’s so nasty). Plus... sleeping under a mosquito net can be stifling.

Sigh.

Okay, rant over.

Please pray that this year, the malaria won’t be so bad. Pray for all the women and children in this community that have to face malaria without prophylactic medications, mosquito nets or even that nasty DEET!

Fortunately, we have free mosquito nets to give all our preggos again. Thank you GOSS (Government of Southern Sudan). Pray that the women will actually use them... even though they can be stifling.

Also pray that the rain clouds would actually start depositing their oceans of blessings on this land. I’m ready for things to grow again.

Wednesday, May 4, 2011

Even more Puzzling...

Today, Athong came in for a prenatal. (For those unfamiliar with her case, please read here first.)

Thrilled to see her in my prenatal line, I asked her quickly if her baby was doing well. She nodded excitedly and handed me her book.         --Hallelujah!

Since she hadn’t come the month before, I thought perhaps she had miscarried. I can’t tell you how relieved I was to see her. I kept thinking, “May this be the baby that lives, Lord!”

She positively glowed when I called her in to be checked. We exchanged pleasantries as she lay down and lifted up her shirt, exposing a perfectly round belly bump.             --Adorable.

Before I left on R&R, Athong had faithfully come for several weekly check-ups in order to get the full arsenal of our STD-fighting meds! She was eager to do whatever it took to keep this child.

Each visit, I expectantly searched for fetal heart tones but found none. I did find a growing belly, however, and so assumed either she was off on her dates or ... she’d miscarry very soon. We prayed it would be the former. but steeled ourselves for the latter, just in case.

So when she reported ‘no bleeding’ at all this morning, I was hopeful.

Already measuring 11 cms, her belly was firm but tender to the touch. She winced a bit while cautioning me to be careful; she didn’t want to lose the child.

Laughing lightheartedly, I continued to check her in.

My doppler picked up a number of blood vessels and whooshing sounds, but nothing resembling a heartbeat could be found.                         -- Not good.

Searching for much longer than I normally do, I sent for Dennis to consult. This was looking oddly familiar. As we waited for him to arrive, I reviewed all the basics with her again.

-- So, Athong. Tell me again when you think you got pregnant.
-- Well, it actually stopped bleeding in June of last year, but then it continued each month until February of this year. Then it stopped for good.
-- Oh, I see. So, you think you are only 3 months pregnant now. Right?
-- Yes.
-- But last time you told me that you got pregnant in December of last year.
-- No. I got pregnant in March.
-- Huh? So your last menses was in February and you got pregnant in March?
-- Yes.

Here’s the trouble: If she is only 3 months pregnant, why then this colossal belly-bump? What’s more.... why is it so hard? If she is 5 months pregnant, why can’t I hear the sweet toc-toc-toc of her child inside. Even at 3 months, there should be something... anything. But all I can hear is the soft wooshing of nothingness.

Palpating once again, I made mental notes: “It’s definitely a pelvic mass. Her ovaries are tender but not enlarged. Although no reported bleeding, her menses have been irregular. Plus there are no fetal heart tones. The fundus is growing (it grew 2 cms since last month), but it’s woody and hard. Could it be...?”

My brain trailed off as Dennis came in. Catching him up to speed, he nodded and palpated it all for himself.

Conclusion: She needed an ultrasound.

I can only think of three reasons for this state of being. One: she has a baby that is astute at hiding its heartbeat (unlikely); Two: she is only 2.5 months pregnant with large fibroids or some kind of uterine mass; Or three: she has a hydatidiform mole.

Personally, I suspect the hydatidiform mole. Horrified as I am to admit it, it just fits the symptoms best.

Unusual bleeding. HCG in her urine. Lots of nausea. Woody hard fundus. No fetal heartbeat.

Would someone please tell me I’m wrong? I would LOVE to be wrong.

I don’t want another hydatidiform mole. You all remember what happened with the last one. (If not, please read these stories. Story one. Story two.) Plus, she DESPERATELY wants a child.

Taking the news in stride, she nodded with possible INcomprehension as I explained the details over and over again.
-- “What you need is an ultrasound. We need to know what we are dealing with,” I said.
-- “No. I will go to the witch-doctor. I’m sure I have been cursed. The witch-doctor will fix it.”
-- “Actually... the witch-doctor will not be able to help. What you need is a picture on the inside which will tell us what is in there. Please don’t waste your money on a witch-doctor. Please get an ultrasound instead.” I almost begged. 
-- “Okay. I will go.”

Was she just telling me what I wanted to hear? I couldn’t tell. Please pray for her. If she has a hydatidiform mole and doesn’t seek help, she will start bleeding soon.

I’m very concerned for her.

Also... please pray that God would bless our clinic with an ultrasound machine. We need one desperately. It would be so great to not have to guess all the time.

Does anyone have one they want to donate to us? Does anyone have connections for a cheap retailer? I’m semi-desperate! ha ha.

Please pray for an ultrasound machine.... and a place for me to train how to use it. Thanks.

Sunday, May 1, 2011

Table for Four.

Yesterday, shortly after landing, figuring out my visa-fiasco, and doing a bit of grocery shopping, Sabet, Albino, Awad, and I decided to have lunch.

Pulling up next to a place that Sabet said had ‘the best beans in town’, reminded me instantly of Tijuana. I don’t know why. Flash backs of crispy fish tacos sprang to mind and I started drooling.

But this place wasn’t Mexican. It was Ethiopian.

“What would Ethiopian beans taste like?” I wondered. I guess it was time to find out.

The shop was slow, as it was two in the afternoon. The lunch crowd had apparently come and gone... or quite simply had never come. We were the only customers.

Empty tables --decorated with salt trays, toothpick dispensers, and flies-- were scattered randomly around the room. On the left, five men sat in a semi-circle next to an un-used outdoor grill; they talked softly as we washed our hands in the buckets provided. Behind them, a number of large aluminum pots sat humming over a low heat.

In the back of the main room, a young man rested obliquely in a white plastic chair --one leg up on the handle. Apparently, it was his job to guard the icebox.

Choosing a lop-sided table to his right, Albino and I sat down, whereas Awad and Sabet sauntered over to a man-behind-the-desk; they had to order.

After discussing dishes and prices, Sabet pulled out some money.

-- Albino, are they ordering for us?
-- Yes, here you pay. Then you eat.
-- Oh. So they don’t have menus.
-- No.

Albino is a man of few words, and I think he had just run out.

He’s the kind of son-in-law every mother dreams of-- Kind, patient and great with kids. (He should be though.... as he has so many, I’ve lost count.) He has done a number of jobs for In Deed and Truth over the years. Right now, he translates at church and does the odd job around the compound. His English is excellent.

Once the order was paid for, Sabet and Awad made it back to the table. We had the right to a soda. What kind did I want?

The options were: apple flavored sugar water, mango flavored sugar water, a cola imitation or Vims. Sabet said Vims was similar to Dr. Pepper.

I chose the mango flavored sugar water, and smiled at the first sip. It definitely tasted like mango.... and it was cold.  --So double bonus!

Lunch was served family-style. 

We had yellow sop, brown sop, chunks of fatty meat and chopped, raw onions. In the center, a fried omelette swam in a half-inch vat of oil. And then there was bread... lots of bread as silverware.

We prayed, licked our lips, and dug in.

The yellow sop turned out to be lentils, and the brown was pinto beans -- neither of which was salted. In fact, none of it was salted or seasoned, so I added the white gold liberally. It was palatable after that.

I think I like the goat meat the most. Despite seeing its other half still hanging in the middle of the room, I have to admit it was tasty. But then again, I don’t mind bones and gristle.

Once we had downed our oily eggs and salted sop, and nibbled all the meat off the bone chunks, it was time to go. Washing our hands, we made our way back to the truck. It was time for the ride home.

I wish I could describe the road from Rumbek to Tonj but I don’t remember much. By then, I was doggedly tired; I fell asleep a few miles into it.
When we hit a large rock... checking if tires were still good.
The seventy-five mile trek normally takes five hours, but they have been fixing the road. The potholes that usually make it unbearable have been filled in... all but a few miles of it. However, those last few miles sure give you a beating!
Mounds of dirt they are using to fix road.
Remarkably, it only took us 2h30 to return.

Now, I’m home.

While I was away, I’m told that the antenatal program... and the clinic, had a doozy of a month. There were 15 births -- three of which died-- two women came in with eclampsia and one woman with a stillbirth.

Yesterday, one baby was born with a crushed skull. She was the same woman who was hit by a car four months ago and had a broken leg. There is some confusion as to whether or not the baby’s death could be due to the car accident. Read her story here and pray for all involved.

I also learned that a young boy died after being bit by a poisonous snake, and a girl of 15 was diagnosed with a imperforate vagina!

Oh... and Mary, the woman who got the mastectomy, delivered a healthy boy at home. They named him Thomas (after Dr. Tom who did the surgery)! Woohoo!

Please pray for all these strange cases. Please pray for all the heartaches involved. Also, lift up the staff, and pray for strength in these coming weeks.

Pray for me too... pray for wisdom in how to move forward in evangelism and service to this community. Thanks.

Deported?

Awad, one of our beloved staff in fatigues.
The flight home was a bit like stepping through the looking glass. I had to keep telling myself, “You are in Switzerland. And now you are in Turkey. And this, my dear Stephanie, is Kenya. You are going home.”

Those who watched me do this mental check at each country must have thought I was nuts. But do I care? No. This is how I handle the changes. This is how I transit through culture shock. Just follow the White Rabbit with the stop-watch! Right?

I know. I know. It’s strange... but it somehow works for me.

However, once semi-settled in Kenya, I realized I didn’t have my Sudanese visa yet, (because one of our staff recently resigned). In the hub-bub, my papers were forgotten or misplaced. The problem was I couldn’t leave without it, and my flight was scheduled early the next morning!

Normally, this sort of thing would have stressed me out to the max. But oddly, I just laughed.

(Here’s the skinny: If I missed my plane, I’d be out a lot of money-- non refundable tickets and all. If I landed in Sudan with no visa, I might be deported, then I’d be out three times the amount of money. Why? Well, I’d have to pay my return ticket... then another flight again later this week when I have the right documentation.)

In a mad flash of texts and long-distant calls, my directors were able to procure the visa I needed in Tonj. The plan was to bring said documents to Rumbek and hand them over when I landed.

But when I arrived at the airport in Kenya the next morning, the flight company wouldn’t let me on the flight. Yep. They didn’t want to risk having issues with the government. But when I pushed them further, it came down to money.         -- lots of things do in Africa.

Plainly put, if they allowed me on the plane and I was deported, they might have to bare the cost. They needed some assurance, I’d pay my plane fare back.

Oh.

Frankly, the idea hadn’t occurred to me. In my mind I thought, 'Of course, I’d be responsible for paying my flight back. It would be my fault and I’m the one taking the flight. Duh!'

When I told the airline employee this, he just looked at me warily under half-slit eye lids. Had he heard this story before?

He wanted me to call my director so he could then present my visa to his director who would then call him, and confirm I could get on the plane. Simple right?         -- Ha ha... only to Kenyans.
There were just a few obstacles to this plan.

One: it was 6:30 am and my director was sound asleep. Two: my director lives more than three hours away from the airport. Three: my plane was to leave in an hour and a half.

I told him I’d be willing to make the call, but couldn’t there be a simpler way?
-- “What if you gave me a blank piece of paper where I write a ‘promise-to-pay’ statement and sign it? You could then sign it, too, as a witness. It would state that I am responsible to pay for my plane ticket back, in the off chance I’m deported. Would that work?” I proposed.

I could see the cogs in his brain slowly turning. This was obviously not how things are done in this country. But did I know that?

Standing there in jeans and a bright red hoody, my sleepy no-make-uped-self smiled with that dogged American optimism (or naive ignorance -- not sure which). I’m guessing he didn’t know what to think of my plan. Perhaps he was trying to decide if I had the funds in my bank account. I certainly wasn’t giving him much proof that I did!

Slow, eager seconds ticked by while he sat there looking at his papers-- probably thinking worst case scenarios in his head.

But honestly, what was the worst thing that could happen? I could miss my flight and the frozen dog food I was hoofing in for the compound mascot would melt? Oh... and the fact, I’d be out hundreds of dollars? That too.

(Yes, flights into Sudan cost the ‘peau de fess’ as the French like to say. There is no easy translation for that.... It literally means it would cost ‘butt skin’. Sounds better in French. Right? Ha ha.)

After taking a few long seconds to pause.... dramatic drum roll please..... he gave me a piece of paper and I wrote a very official sounding paragraph promising to pay for all expenses if deported.

I, Stephanie Williams, promise to incur all financial responsibility for any flights..... yada yada.

After reading it, he smiled wryly and gave a slight nod of approval. He wasn’t convinced they would let me off the plane in Sudan... but at least this way he wouldn’t get in trouble with his boss.

(Mental Note: When flying to Sudan, dress better so you don’t have to write a financial promise-to-pay statement at the airport. Better yet, get a visa on time!)

Boarding the plane an hour or so later, I was given a small paper bag with my ‘in flight meal’ of unsalted peanuts and a bottle of water. Oh... and don’t forget the peppermint candy tucked in the bottom!

There were about a dozen passengers, most of which deplaned in Loki, our first stop. Loki is the Northern-most city in Kenya. It’s a dusty stretch of land tucked in between a few mountain ranges. Not much can be said of it, really.

It’s home, however, to a handful of NGOs with large warehouses near the landing strip, a few mud huts, and one overpriced concession stand.

Since we were running late, the lay-over there wasn’t long. The second leg of my flight would take me to Rumbek where I planned to meet my director.... and my visa.

Climbing back on board, I found a seat quickly, and waited for the rest of the passengers. Two other heavy set men boarded with me and made their way to the very back. One was talking loudly on his cell phone.              --Annoying.

But then, the pilots boarded and closed the plane door. Huh? There were only three passengers on this leg?

The pilot (who doubled as a flight attendant) asked the loud Kenyan on his phone to hang up because ANY form of frequency would interfere with the flight. Somehow I believed him. We couldn’t leave until he hung up. He had to ask three times before acknowledged, and then a fourth time, before he actually obeyed.

Looking around I was a bit taken aback by the plane. Empty. Old. Dirty. Packed with boxes marked ‘unattended’ where people should be sitting. This is not your typical commercial flight.

Plus, my outside window pane was chipped in numerous places; I imagined it shattering causing this metal bird to plummet to a crinkly, mangled death. Tragic. At least there would be only 5 reported deaths... the two pilots, me, Mr. Cell Phone and his friend. Would we be missed?

Laughing at my overactive brain, I finished off my peanuts and tried to sleep.

Once we landed, they searched my bags (definitely a first in Sudan), and asked for my paperwork. Fortunately my director, Sabet (who is referred to by his wife Suzy as ‘the King of Rumbek’) met me with the right papers.
A view of Rumbek from behind.
He argued on my behalf, and I quietly left to wait in the truck with Albino and Awad (pronounced OW-wad) --two of my favorite staff members. (They had come because we needed to pick up groceries for the compound on the way home.)

Awad greeted me in his fancy blue military fatigues. He even proudly pointed out his new AK47 resting haphazardly in the back of the truck. It seems like every time I see him these days, he’s decked out in some new military outfit. 

After all the proper hellos and handshakes, I asked them how things had been lately at the clinic. Awad, always the talker said: “Oh, so busy. Busy-busy. You know, the pregnants is waiting for you. You will see, on Monday there will be sixty coming to see you!”
-- “Sixty! How will I see so many?” I laughed to hide my apprehension. (I was sure he was right. They told me they’d be waiting for me.)
-- “Yes, the clinic so busy. Margaret so tired. Everyday many many patients. So many. You will see. The women they say, ‘Go to this clinic. There is no cost. You can have free medicine. You can deliver no cost. That is why they come from East Tonj... they even come from Thiet.”

As he spoke, I realized I was walking back into the craziest season of my time here. (I don’t know if I should be afraid or excited.)

Not long afterward, my director Sabet joined us in the truck. The customs officers wanted me to pay a large sum for not having the right papers, but The King of Rumbek talked his way out of it.  New papers will be arranged this week, but fortunately... I won’t be deported.

At least not this time.

So thank you all for praying for my time off, and for my flights home. I’m back enjoying the hot humid afternoon rains.

But please pray for the clinic and staff. There is more work than ever. Pray for laborers. Pray for midwives. Pray for nurses. Pray for doctors. Pray for missions-minded hearts to serve... starting with me.

I’m also told we are going to be desperately short-staffed this summer as our Kenyan staff takes their much-deserved breaks. Please pray that I would not be overcome by all the need, or spread myself too thin. I don’t want to burn out. Pray that I would find rest in Him alone, and that He would be my strength and song. Thanks.