Aluak’s story.

Where do I start?

Do I start with the fact she was only 16 years old? Do I start with her scared eyes and obvious pain? Do I start with her partially blind grandmother who gnawed on her lower lip while telling me her story?

Seriously. Where do I start?

I think the best place to start is with the facts.

Age: 16 years old
G/P status: Primip (or first baby)
Village: Thiet (20 kilometers away)
Fundal Height: 31 cm, but irregularly shaped
Position: ROA
Fetal Heart Tones: 204 bpm
LMP: sometime in June 2011
Gestational Age: roughly nine months
Vitals: BP normal but running a low grade fever

Complaints: (according to her family)

• Baby is stuck, head can be seen but won’t come out
• Contractions for over 30 hrs
• Pushing for over 14 hrs after her water broke

As I gathered these facts, two things stood out above all the rest. She was exhausted, and her bladder bulged painfully above her pubic bone --which was the likely cause of the obstructed birth. The only way to find out, would be to catheterize her.

Her exhaustion was due in part to her long labor, but it was compounded by the fact she was denied food and water during labor.

-- “Aluak, are you thirsty?”
-- “Yes. Very thirsty.”
-- “When was the last time you took water?”
-- “A day and a half ago....”

I had her sit up while I gave her water to drink, saying, “You need water in labor. It’s very important... I know some people tell you not to drink. But that is wrong. Very wrong. You need lots of water for your muscles to work right. Do you understand?”

I was saying it more for her family than for her. I don’t think she was at a point of understanding much of anything. Too much pain... for way too long...

As I continued to review her I noticed that her baby’s head could most definitely be seen. In fact, a large caput had formed, and it protruded conspicuously from her body.

What worried me most though were the heart tones. When I first heard them, I could not believe they were actually the baby’s; they were just too fast.

The baby was stressed out and in pain... and his tiny heart sped chaotically in protest.

Fetal heart tones should be no higher than 160 bpm. His was 204, 208, 212 bpm.

-- “Aluak, your baby is alive. But he is telling me he is not happy.”
She looked at me in confusion. So I went on.
-- “What I am saying is... your baby is not well. He might die. Do you understand?”
She continued to look at me blankly, so I turned to her mother.
-- “The baby is sick. Do you understand? The baby could possibly die....”
She locked eyes with me, nodded briefly, but said nothing.

While I started an IV, Margaret catheterized Aluak. She removed about 300 cc of urine which instantly gave some relief. But there was still the issue of the birth. Would she be able to deliver now that her bladder was out of the way? There was only one way to find out.

Once we re-hydrated her, we decided it would be best to augment her contractions (which were frequent but short). It didn’t take long for the medicine to work, and what with her bladder no longer holding things up, she was able to deliver naturally a few minutes later.

Her boy was born flat and we started resuscitating immediately. Margaret worked on him with speed and determination. He slowly recovered, and by 15 minutes postpartum, was stable. (His Apgars were 3/5/7.)

We kept him on oxygen until his respirations and heart rate lowered to a reasonable range. He did not seem particularly interested in crying which concerned me, however not long afterward,  he started breastfeeding on his own, so I relaxed a bit.

He wasn’t my only concern however. Although Aluak lost little blood postpartum, she seemed to be leaking an unusual amount of urine. It was unlike anything I’d seen before. I fretted over it thinking it must be a fistula.... but did they form that quickly? I’m not sure.

All I know is I was doggedly determined to see her pee! This confused her and the rest of her family who incidentally wanted to take her home. Immediately!

-- “What? You can’t take her home now... it’s too soon,” I sputtered.
-- “But the baby is out. We take her home now,” one sister said in broken English.
-- “No. The baby is sick. She might have problems urinating, too. She must stay.”
-- “But we want take her home...”
-- “I don’t care what you want. It’s not time to go.”

This went on for awhile until I walked away in frustration, calling instructions over my shoulder for my interpreter, “Tell her to drink lots of water so she can urinate. And watch that baby closely.”

A little while later Albino, our compound manager, approached me about Aluak. “The family say they want to go home now,” he started.
-- “I know they want to go home... but the baby was born almost dead. They cannot go until the baby is healthy and she has urinated,” I explained.
-- “Oh. I did not know. Okay.”
-- “Don’t worry about them,” I continued, “I’ll go tell them again and check on the baby.”

As I went to get my stethoscope and thermometer to check vitals, her family approached me again about leaving.
-- “No. Aluak is not discharged. NO. You cannot take her yet,” I continued. I felt like a broken record. Why the hurry? Honestly.... what was so urgent that they had to go home?

Aluak sat up when I walked in. She had been sleeping. The poor thing looked exhausted, so I asked gently, “How are you feeling now, Aluak?”
-- “I’m okay. Just tired.”
-- “Have you urinated?”
-- “No.”
-- “Can you try?”
She nodded that she would but seemed too tired to move. I couldn’t blame her. After 30 hours of labor, I think I’d be out for the count.

Turning my attention to the small mound of baby blankets, I fished the thermometer out of my pocket. It’d been over 30 minutes since his vitals were taken.

He looked like he was sleeping. But as I uncovered his chest, there were no movements. He was warm but disturbingly still.

-- “When did he stop breathing?” I asked somewhat foolishly. How would they know? They too had thought he had been sleeping.

No one answered my question. They just looked around the room at one another in surprise.

I quickly put on my stethoscope and placed it against his chest.
        --Nothing.

I rubbed his spine. I flicked the soles of his feet.
         --Nothing.

Turning to Aluak, I explained, “Your baby has died.”
But again she gave me the blank look of exhaustion, so I repeated myself.
-- “Aluak, I don’t know when... but your baby has stopped breathing.”

She said nothing, but the women huddled around us all started talking for her. Their voices --some soft, some harsh-- filled the room with confusion. So I stood up and went for a translator.

Albino came to help. He was surprised by the sudden death as well. Everyone was. But even with him there, the other women in the room wouldn’t stop talking.
    -- Some days I’m glad I can’t understand all their words.

Fortunately, Albino was able to help me explain to Aluak that her baby had died peacefully. He was just too hurt after the difficult birth. She nodded that she understood but said nothing.

There was nothing to say.

Her tears spoke for her instead. They were tired tears --slow and weary-- which journeyed silently down her cheeks, then splashed in her lap. I sat with her while she cried, holding her hand and praying.

There were no words.

Now that the baby had died, they redoubled their efforts to take her home immediately. But I persistently refused. She needed to urinate before she could go. Plus, I was not about to send a 16 year old home to a distant village if she might have a vesico-vaginal fistula. Not a chance!

But with time she was able to void her bladder, and I sent her home as promised. Her little boy went with her, wrapped tightly in her arms.

So much of what happened to her could have been avoided if her family had known... 

• to give her fluids in labor, not withhold them
• to allow her to eat during labor so she would not be exhausted
• to encourage her to urinate before pushing
• to not push until the head was visible
• to seek help early if pushing was not progressing properly
• or... better yet to make her deliver in a clinic instead of at home

I talked to her about these things. I tried to explain, but I'm not sure she was in a place to learn. Please pray for her. Sixteen is just too young to learn these lessons --just too young. Thanks.

De-citizenized. De-valued. De-stroyed.

I read an interesting article in the New York Times today about the struggles of the Southerners living North of the border, and I thought you'd enjoy it. Plus, there is a must read article in the opinion section about what is happening in the Nuba region.

If you liked/read it, you might also consider these other links. They are very informative.

• Sudan Tribune article about Southern ethnic groups losing citizenship in the North.
• A video of what's happening in the Nuba region. 
• A long but excellent survey on the insecurity and violence against women in South Sudan. 

Five Boys! Six Girls!

I’ve delivered 11 babies in the last 10 days. It felt busy, but it didn’t occur to me that I had been that busy until I counted. I can’t help but smile though, as I read their stories and remember.

My Valentine’s day baby --a boy-- was born during staff devotions. I remember how quiet the clinic was for a change since everyone was in the meeting. What a delightful birth!

The next day, Ajer delivered in a grand total of 45 minutes! Both she and her son had fevers and required lots of care, but they recovered in time.

Later that night Adut also delivered in record breaking time, then walked home an hour later!

The following morning Amour arrived looking active. Even though she had never come for prenatals and lived in Juba, her family insisted she deliver with us since I had delivered her sister’s baby a few months ago.

They also explained that Amour’s first baby had died during the delivery because the TBA had “strangled the baby” on the way out. They did not want that to happen again. Why a TBA might do such a thing... I cannot say. But I was glad when she delivered without any complications a little while later.

The next birth was a few days later. Although only six months along, Adhar went into labor after contracting a viral infection. Her contractions had kept her awake the night before, but she did not think it was labor since “her months were not finished”.

Only when her water broke bringing forth more blood than amniotic fluid, did she come for help. But by then, there was little we could do. Her precious boy lived only a few minutes. He was just too small.

Later that night, Anhiem came in fully dilated with twins. My helper and I had just enough time to set up the room, when her little girl was born. The first twin weighed only 1.5 kg (or 3.3 lbs) and was small even for her gestational age (SGA) of 34 weeks.

However, her second twin did not want to come. Five minutes turned into ten, and the twin seemed no closer to coming. The heart tones were in the right position for the breech presentation, and when I reached in to check, I felt a knee.

Or so I thought.

After 15 minutes of pushing, we could no longer find heart tones and I called for back up. Margaret came and agreed that the baby must be dead.... but how? Why?

She redid the vaginal exam and pulled out and arm.

An arm!

Then it all made sense. The baby was not breech but transverse. The leg was an arm. There must have been some kind of cord compression... or prolapse. And the baby died.

We ended up transporting her to Wau for a cesarean, and she got her surgery the following morning. My heart is broken over this loss. Honestly, I can’t stop thinking about it.

The next morning, another boy was born just before church! His mom arrived fully and pushed him out within minutes.

However the following birth was not so lucky.

Nyankiir arrived at 9 cm but stayed there for 4 1/2 hours. The head descended but much slower than seemed normal for a G7 (aka woman expecting her 7th child). Since four of her previous babies died during the birth, I confess I got a bit nervous. What if she needed a cesarean? What if this baby was too big for her pelvis?

So we prayed, encouraged, did exercises, and then prayed some more. Eventually her girl made her debut though; she was born with both a nuchal hand and a tight nuchal cord. What an honor to be a part of her birth! (Kerri also wrote about her birth on her blog.)

What else? What else... ?       Okay. Right.

So last night I was called again by the guard to come quickly. I arrived to find Veronica sweating large beads of sweat, and the look she gave me meant business.

Remarkably she was able to hold off pushing until the room was readied. But then two minutes later her girl was born!

The laughter in the room when her friends arrived was priceless. Their happy chatter and excitement filled the room with joy, making the night feel like day. She too ended up walking home within an hour of so of birth. Remarkable.

Then today there were two more births. Atong delivered at noon after laboring all night at home. Her baby was small but healthy. And just as I was getting ready to transfer her to the observation room, Rebecca arrived.

I was surprised to learn that Rebecca wanted to deliver with us even though she’d never delivered any of her babies at a clinic... nor had she ever come for prenatal care. I didn’t have much time to question her about it though... as she started pushing almost as soon as she arrived.

Her little girl was born 5 minutes later!

Please pray for these moms and babies. Pray for health! Pray for salvation! Pray for healing! And ... pray for me. I think we are heading back into another busy season. Thanks.

Hearing Him in the Darkness

(Guest Writer: Bubba Hoelzer )

Every day I read My Utmost for His Highest.  It is one of my favorite devotionals and today’s devotion spoke to my heart:

Sometimes God puts us through the experience and discipline of darkness to teach us to hear and obey Him. Song birds are taught to sing in the dark, and God puts us into “the shadow of His hand” until we learn to hear Him (Isaiah 49:2).

“Whatever I tell you in the dark. . .”  — pay attention when God puts you into darkness, and keep your mouth closed while you are there.

Are you in the dark right now in your circumstances, or in your life with God? If so, then remain quiet. If you open your mouth in the dark, you will speak while in the wrong mood— darkness is the time to listen.

Don’t talk to other people about it; don’t read books to find out the reason for the darkness; just listen and obey. If you talk to other people, you cannot hear what God is saying. When you are in the dark, listen, and God will give you a very precious message for someone else once you are back in the light.

Yes Lord, when you bring me thru darkness in my life, complaining only defeats Your purpose for me. Talking to others about my struggles does not help my darkness—and more times than not it can drag them into my dark circumstances.

Yes, Lord, the wise thing to do is listen and obey. The only one I should speak to is You during times of darkness. Even if I shout to You it is better than a whisper to another. My heart and dependence must remain upon You and not the counsel of others. 

Listening and obedience are very difficult for us when we are feeling all alone and less than able to walk the steps You have called us to during in our everyday life. But Your power can only be funneled into me during these trying times as I focus all attention on you. This same lesson You taught to the children of Israel when they come to the bitter waters of the desert. Their nature was to complain, but You began to teach them the power of listening and obeying and having total trust in You. It was after they heard Your words to them that they found an oasis in the desert.

He said, “If you will listen carefully to the voice of the LORD your God and do what is right in his sight, obeying his commands and keeping all his decrees, then I will not make you suffer any of the diseases I sent on the Egyptians; for I am the LORD who heals you.” After leaving Marah, the Israelites traveled on to the oasis of Elim, where they found twelve springs and seventy palm trees. They camped there beside the water. Exodus 15:26-27 (NLTSE)

While reading the story of the two blind men in Matthew I realized they were living in total darkness—both physically and spiritually. As they were sitting in their usual spot they were listening to a large crowd passing by and heard that Jesus was coming. They began to cry out to Jesus and did not seek or follow the aid or counsel of those around them.

In fact, when the crowd told them to be quiet, they became more focused on Jesus and called all the louder. They had no way of knowing if Jesus had already passed them and gone on his way, but they continued seeking Him in their darkness until they personally heard the Master’s voice. Then in an attitude of obedience they were able to hear and in response to His question, simply responded, "We want to see".

This moved Jesus to touch their eyes and remove the darkness from them. The power to radically change their situation came thru listening for Jesus and then hearing His voice.  All of this was done with humble and obedient hearts. Light flooded their eyes and their hearts as they submitted themselves to Him.  See Matthew 20:29-34.

A grumbling, self-centered, self-pitying and immature attitude will never move the spirit world on my behalf. Praise and perseverance are the only way thru, but honestly I often feel that I am wavering deep within myself teetering to and fro.

One minute remembering the truth, the next hearing a lie. Why, Lord, do I struggle with raw emotions when others achieve more than I can? This should not make me feel as if I am less than, but it does. I know that it is only when I am secure in the fact that You love me and created me special for your purpose that these fleshly emotions will begin to cease.

Lord, I want to strive to remember all the great things you have done in my life. I choose to press on to remember all the great things I have seen You do. I will cling to the truth that you have been there and moved obstacles that were not possible for anyone other than You to move. I am listening, Lord, and need to hear my Master’s Voice to give me the strength to continue. I am willing to be obedient, but I must hear Your words in me to give me the confidence I need to be victorious. I am listening for You. 

I hear You say:
"I am the Lord, your God that opened the Red Sea, am I not powerful enough to open your mouth"?

"The words you will use, whether many or few will be inspired by me".

"The words will indeed come, but it is the heart from which they will spring that I am shaping now".

"My Spirit within you, when needed, will form the words of your tongue, as well as forming the example your life will portray".

Those who seek will find and blind eyes will see and deaf ears will be opened.  Tongues will be loosed and the lame will jump for joy. 

The next time you are struggling, and feel the darkness of life covering you, submit your life to Him, walk in obedience to His word, turn your ear to no other and you too will hear the Master’s Voice.

(Copied with permission.)

Post Script: Bubba and his wife Cathy are M-workers among our cousins here in Africa. Please pray for them to be used powerfully for His glory among the tribes. His insights have blessed me over and over this week. I pray they bless you all as well.
Love ~SW

Update: Transport

We saw Awut about a month and a half ago. You might remember that she was expecting her 10th baby and her labor was not going well. She had CPD and we ended up transporting her for a cesarean. (Her story here.)

Well, I’m happy to report she and her little girl are both doing famously. Her scar is healing nicely and she is determined NOT to have any more children!

I laughed with her about her decision while bouncing her bright-eyed babe in my arms.

It’s not every day we hear back from our transport patients. Too often we cannot follow up on what kind of care they received, or even if they lived. But when I do, I’m always overcome with gratitude at God’s abundant mercies to us.

They named their girl “surgery”. Yep, only in Sudan! Thank you for praying for them and for all of us here in Tonj. Your prayers make a huge difference. Thanks.

Aid Sudan Links.

Kerri is a missionary on staff with Aid Sudan. She arrived this week to do a little investigative research on health teaching topics for the upcoming radio broadcasts. But since she is a highly trained nurse, we've been using her at the clinic, too.

It's great to have another set of trained hands to help!

Anyway... she's a blogger too, and I thought some of you might enjoy her perspective on things. You can read her blog here.

Speed Birthing.

Prayer night had just ended, and I was settling in for the night when I heard a timid knock at my door and went to answer it.

-- “Moses needs you,” our new guard whispered. Moses, one of our health workers, was working the night shift.
-- “Is there a labor?” I asked.
-- “Yes. Mother in labor,” he continued quietly.

When a health worker is too busy to come himself.... there’s an emergency. When he’s calling ME... there’s a birthing emergency.

I didn’t bother changing into scrubs. If it was a birth, I’d never get there in time if I did. So I grabbed my watch, a pen, and slipped on my flip-flops.

I didn’t run though. I find that running in flip-flops in the middle of the night can be hazardous to my toes. Plus, you’ve got to take your time in scorpion season. You’ve just gotta!

I arrived a minute later to find a mother pushing so hard she trembled.
    -- No wonder he sent the guard to get me!

Moses was moving faster than normal to get the room set up, but it had only been a few minutes since she arrived. It still wasn’t prepared.

As I watched silently off to one side for her contraction to fade, I took note of her body language.  She was having this baby; and she was having it fast!

Jaws clenched in determination, she continued to push on the edge of the bed. And just as the contraction peaked, a clear jet of waters jumped across the room, splattering four feet away.

Moses was still gathering the basics, so I asked her her name.
-- “My name is Adut,” she grunted between contractions.
-- “Adut, where’s your booklet?”
-- “At home. Forgot it.”
-- “Do you have a file with us?” I continued. I’ve started keeping records at the clinic, for just such occasions.
-- “No. You did not give me a file....”

Humm... that’s odd. Her face was ober familiar. I was almost sure I had a file on her.

-- “Give me your full name... I’m going to look it up.”

She gave it to me through clenched teeth, and in between purple pushes. But then it occurred to me, I’d never have time to look it up anyway.

Instead I slipped a pad under her butt, and started looking for heart tones. They were low (100s, 90s), but that’s normal right before the birth, due to head compression.

All I knew about her was that she had been here before (because her face was so familiar), her name was Adut, and she really wanted to push.

So I let her.

-- “Push hard, Adut. You can do it!” I coaxed. The head was already started to peak out.
A friend supported her head while I supported her perineum, and Moses stood to one side, handing me things.

Three minutes later her precious boy was born!

She delivered exactly 6 minutes after arriving at the clinic! And it wasn’t another five minutes after that when her placenta plopped into my hands. It had an additional lobe, so I took the time to show it to Moses so he could learn. 

As I inspected it, Adut cocked her head slightly in disgust, but Moses came in closer for a better view. It’s not everyday a Dinka man is willing to get so close to a placenta. Kudos to his teachable spirit!

-- “Adut, your placenta is healthy. I’m just looking at it to see if it’s all there,” I explained.
She nodded she’d heard me... but the look of disgust didn’t fade.

Another five minutes later, she was breastfeeding her munchkin and asking to go home.

-- “Normally I ask you to stay for a few hours for observation. Can you stay the night and go home tomorrow?” I asked a little pleadingly.
-- “No. There is no one else to care for my kids at home. I cannot stay.”

I had suspected as much. Frankly, the fact she came at all was a miracle. She had stayed at home until the very last minute. And now that the baby was out she needed to hurry home... and soon.

Her bleeding was very slight. So I promised her she could go home early if no clots came.

They didn’t.

And an hour postpartum she was cleaned, dressed, and prayed for. I discharged her with a few mild warnings, and she was off.

She walked out without the slightest hint of pain in her gait. Her friend walked beside carrying her little boy in her arms.

Humm.... I’m still not sure what to think. All I know is the women around her are STRONG!

Prayer Project: Scoliosis

Sarah came for her first prenatal a few months ago. She stood out from all the other ladies though because she brought her own chair.

Born with congenital malformations and scoliosis, making walking impossible, she stands at roughly 4 feet tall and gets around in a wheel chair.

Early on we discussed the need for an elective cesarean, and she completely understood. Her family had already started saving money for her to deliver in Wau.

I was glad for this insight, but even more so when I heard a surgeon was coming on staff. I discussed her case with Dr. Mike shortly after he arrived, and he reviewed her in person this week. He says she would be an excellent candidate for surgery here.

It's hard to tell with her shorter-than-usual abdomen, but I'd venture to say she's 7 months pregnant (or roughly 30 weeks gestation). I know that means her due date is two months out, but I feel the need to cover her in prayer now.

Will you join me?

Please pray for her to carry her baby to term, and deliver without any complications --whether that's here or in Wau. Also pray that she would not be fearful. Every time I see her she seems more withdrawn and afraid. Thanks. 

Feverish.

Ajer showed up at 3:30 pm saying she was having a bit of bleeding on and off and was worried. She insisted there were no contractions, but as I checked her I noticed several mild ones in short succession.

“But Ajer... that is a contraction right there,” I argued, “Isn’t that painful?”
“Yes, but I’ve been having those for a few days now...,” she explained.
“Oh...”

When I touched her belly to palpate position, I was surprised by how hot she felt --even for such a blistering summer day. It could be simple dehydration... or it could be something worse.

“Have you had any fevers recently?” I queried, trying to pinpoint her diagnosis.
“Yes. I had one last night, but it went away this morning.”

This felt like more than simple dehydration, so I got out my thermometer. She was burning up with a temperature of 38.0 C.

Her baby’s heart tones were also high (168, 172). Not good. Perhaps the fever was causing the contractions, but I doubted it was the other way around.

She was sick... but with what?

She tested negative for malaria and complained of no other symptoms except contractions.
    --Humm....

The vaginal exam showed she was dilating; but with such mild contractions, I didn’t expect her to deliver any time soon. (For any midwives out there: she was 2 cm, 80%, 0 station, IBOW.)

So I started her on prophylactic malaria medicines and antibiotics --just in case-- then hung some IV fluids. The minute I hydrated her though, her contractions picked up speed.... and strength.

I had barely finished giving her IV antibiotics when she started getting grunty. Her fever soared higher (38.8 C), and her baby’s heart tones raced even faster (176).
    -- What was going on?

She felt something come out from between her legs, and I looked down to see water.
    -- Humm.... strange that she’d have rupture at 2 cm. Very strange, but okay.

I started counting contractions and measuring their strength. They were strong now, lasting 45 seconds... and happening like clock-work every 2 minutes.
    -- Seriously.... something was up.

Then she started pushing.

“Ajer... please don’t push. You are only 2 cm dilated. It’s not time now.”
“But I’m not doing it on purpose,” she promised. “I just can’t help it.”
“Please don’t push...” I continued. “Don’t...”

Then I looked down.

Her bag of waters was bulging, and the baby’s head was right behind.

“It’s coming,” she half grunted, half pushed.
        --Yes. It most definitely was.

My helper moved lightening fast to prepare the room for the birth, and I slipped a pad under her butt. The next push he was born.

She went from 2 cm to baby out in 43 minutes with a fever of 38.8 C!

Unfortunately my story does not end there. Even before the placenta was born, she started dumping blood. And by the time I got it out (15 minutes postpartum), she had lost over 1500 cc. Fortunately, oxytocin helped stop the bleeding, and she slept through the night.

This morning everything looked normal and I was about to discharge her when she reminded me about the tear.
    -- The tear? Which tear...? She didn’t tear during the birth.

She went on to remind me of how she got a severe 4th degree vaginal tear after her last birth at home. She came to us initially for help, but we referred her to Wau for an operation. She went but never got it fixed; she didn’t have the money.

However a few months later she got pregnant again, and was told she could not get the surgery until after she delivered.

As she explained, I remembered running into her in town a few weeks back. Yes, of course I remembered her. We had discussed the option of her getting surgery with our surgeon instead.

Dr. Mike reviewed her and said she was a good candidate for surgery; he wants to schedule her back for the beginning of April.
         --What a blessing!

It’s strange that she neglected to say anything during prenatals, or even during the birth. But I’m glad she reminded me of it this morning!

Her previous tear helps explains the unusual fever and lightening fast birth though. It helps explains a lot.

Praise God she got to us in time for a safe birth and quick antibiotics for both her and her new son! Thank God that she can now get the surgery in town! Please pray for them to heal quickly, and for her to have a successful surgery. Thanks.

Wild, Wild... South?

The white pick-up truck blasted its horn with annoying persistence as it sped up to the clinic doors. Urgent voices shouted instructions as a handful of soldiers waved their AK-47s about like sticks.

Another emergency, Lord? Really...? How many this time?

I wearily slipped on gloves as I watched the cargo being unloaded. Our staff had to fight to carry the broken soldier in our front door; each one held a limb.

It took four strong men to lift him; their hurried instructions and shuffled steps left a steady trail of blood as they went.

Once on the bed, everyone seemed intent on getting to him at once. Five of them attempted to cut off his shirt while two others turned in circles. Getting close enough to help was next to impossible.

Fortunately Dennis arrived quickly... and then Tom, so I stepped aside and let them do their thing.

In the next room, I found another soldier who had not been assisted yet; so I got to work. He’d been shot in the neck; and though he was in obvious pain, he was stable. Remarkably, the bullet had missed his carotid... and his spine. 

But as I worked to start an IV and get his vitals, crowds of looky-lous screamed through the window demanding to know details. I could not hear myself think.

Why, Lord? Why must these strangers harass us while we work?

I asked them to leave but they refused. Over and over, I told them I could not work with them yelling like this, but it made no difference.

Meanwhile, more gun shot wounds filtered in, and I turned to help them.

One man had a compound fracture and was losing a lot of blood. Another had his foot filleted open, exposing tendons and nerves. The last to arrive, stumbled in on his own. In obvious shock, he barely made it to the bed before he collapsed. His shoulder had been grazed by a bullet, leaving a gaping wound.

Five soldiers. Five gun shot wounds.

We had to lock and bar the clinic front door to keep people from walking in, but even that didn't keep them all out. And although the clinic gate was locked as well, people climbed over it, insisting they had the right to bother us. It was a constant battle to keep them away.

Thankfully, all the soldiers survived. Three were transported to Wau for surgery, but the other two were stable enough to stay.

When I asked what the fighting was all about, they explained there had been more cattle raiding. The soldiers had gone to protect them and a shoot-out ensued.

Honestly with all these cattle raids, I’m reminded of the wild, wild, West. But instead of saloons we’ve got tukels; and instead of cowboys, we've got soldiers.

Please pray for them to heal quickly, and for the cattle raiding to stop. Also pray for the staff here (me in particular). I can’t speak for the rest of them... but I am tired of trying to save lives while simultaneously shooing away demanding crowds.

Tired. Disgusted. And dangerously close to burned out.

There. I said it.

Please pray as the Lord leads. Thanks.

Lost and Found.

So yesterday after all our patients were stable, the commissioner and a few of his friends came to help identify the injured. Those who could not talk (unconscious, or dying), had been identified by other travel companions, except for one.

He had sustained neurological problems after a concussion; and although he was conscious, he could not speak. So our compound manager spent the afternoon allowing small groups of spectators to filter in, to see if anyone could identify him.

I watched the eager rubber-neckers come, click their tongues in empathy, talk over him with hushed excitement, then grow bored and move on.

Then a few minutes later, a new crowd would come, and it would start all over again.

Gawking. Clicking. Whispering. Bored.

Dozens came and went, but no one identified him. Eventually, the spectators grew tired and hungry and made their way home.

Our John Doe stayed on the back porch until this morning when a couple came by asking to see him. When they realized he was their missing son and that he was alive, they exploded in joyful thanks.

The father was some high-ranking military man. He had been informed his son was dead and had come to collect the body. But when he and his wife could not find it among the rest of the cadavers, they decided to stop by our clinic --just in case.

“What if... what if he was still alive?” they wondered.

When they realized he was in fact alive, they were thrilled! He was disoriented and suffering from partial paralysis, but he was alive!

They decided to take him back to Wau where he could get more specialized care. What a blessing!

Please continue to pray for these hurting families. Thanks.

Emergency.

Last Monday night a semi (yes, a semi!) drove up with patients in it. Thirteen to be exact.

Thirteen bleeding, broken, and seriously hurting men.

They said they had been racing down the road at top speeds when a front tire blew, sending them rolling.

And rolling. And rolling.

The worst case was a man with a dislocated jaw; all of his front teeth were gone, and he was having trouble breathing. Once stabilized, we transported him and a few others with worrisome head injuries and broken bones to Wau.

When the dust settled, bruised and bloodied men were strewn about everywhere on make-shift beds. Some snored loudly; others moaned for water.

It was intense.

Afterward, Dennis commented that this was the worst car accident we’d had to deal with to date.

That was true, until today.

Today as church ended, a few government officials asked to use our cars and ambulance. There had been an accident. They needed our help.

The reports said there were lots of injured, so some of the medical staff went to help. But it took over an hour for the first patients to trickle in.

The first batch had two expectant mothers, a three-year-old boy, and a semi-conscious man.

One of the mothers had bitten three-quarters of her tongue off and had a large gash on her forehead, exposing her skull. When she woke up in the clinic, disoriented and scared, she thrashed in confusion.

I asked for her name but she couldn’t speak; her bloody grunts were unintelligible. We tried to guess what she was saying, but gave up, figuring it’d come out in time.

When I asked how many months pregnant she was, her eyes flashed with the unspoken question, “Is my baby alright?” Immediately she started gesticulating wildly, then held up 6 fingers.

“You’re six months pregnant?” I asked to confirm.
She nodded slowly.
“Can you feel your baby moving?” I continued.
She grunted no, adding a slight hand shrug for emphasis.

She was the right size for six months. The baby could be easily palpated; but I couldn’t find the heart-tones.

Each time I asked her anything about the accident, she would shake her head in confusion. Finally it occurred to me that she’d missed it all. Only later, once her tongue was reattached did she explain: “I don’t know if my belly was hit. The first thing I remember was waking up here.”

The other pregnant woman didn’t wake up for over an hour. She was in shock, and needed massive fluids to stabilize her blood pressure. But once she came around, I was happy to inform her her baby was alive. Fortunately, she only sustained a small gash on her thigh.

The young boy had no visible wounds and appeared stable. He had suffered a blow to the head and we were watching him closely. But as the second wave of injured were carried in, we needed his bed and moved him outside for observation.

The next batch had a hip fracture which needed to be braced, two or three semi-conscious men with only minor injuries, and two severe cases.

The first case was a man in obvious shock. He labored for every breath, fluttering in and out of consciousness. Starting an IV on him was next to impossible, since he fought me every inch of the way. I had to stick him 5 times before I got it in. Dr. Mike suspected massive internal bleeding.

The other case had massive head injuries and needed intubation. We don’t have any laryngoscopes, so we made due with half a speculum. Dr. Mike got the tube in without much trouble and together we bagged him until his breathing stabilized.

The third batch of patients came back with our missing medical staff (which was half of us), and we were able to start move IVs, get more medicines, and stabilize a few more patients.

Our guard did a fairly good job at keeping the looky-loos out of the compound. But he didn’t stop them all. I constantly had to chase away random gawkers, even walking some of them out of the compound myself.

I felt like a broken record asking them repeatedly to leave. But if I didn’t they would literally stand between the doctors and the patients, trying to get the best view. What a nightmare!

We started prepping to send the worst cases to Wau once stable. The broken femur and the internal bleeding were high priority. They also insisted the young boy go, even though he looked fine. Dr. Tom kept saying, “I just don’t feel good about keeping him here.”

But as we waited for the patients to be loaded into the ambulance, he died suddenly, surprising us all. He just stopped breathing.

Around the same time, the man Dr. Mike had intubated also died. His injuries were just too severe.

Only then did I have time to ask what happened.

I was told that two SUVs, carrying about a dozen passengers each, had a head-on collision when one SUV inexplicably swerved into the wrong lane. They were both moving at high speeds; the impact was catastrophic.

Fourteen people died on the scene --five of which were trapped inside the wreckage. 

Those that were not brought to us were taken to the hospital in Rumbek. We lost two within an hour. That gives us an estimated total of 16 dead, and another 15-20 wounded.

I don’t know how many were sent to Rumbek. But honestly, I’m surprised there were only two vehicles involved. How did so many people fit in just two SUVs?

I’m proud of how well the staff worked together, but I’m sad at how many we lost. Please pray for these families. Pray as the Lord leads. Thanks.

Post Script: After the ambulance dropped off the first batch in Wau, they came back for two more. The pregnant woman with the missing heart tones went back because that’s where she’s from. And one more of the ‘less injured’ developed signs of possible internal bleeding. So we sent him as well.

Radio Tower.

Aid Sudan, an organization with a large focus on health education and evangelism, came to visit us last year to discuss the possibility of building a radio tower on the compound. The tower would broadcast the gospel and public health messages to small hand-held radios that would be distributed within the community.

Well, I'm happy to announce that two weeks ago, the first part of the tower was dug.

Yes, dug.

Two engineers, loaned out from a German NGO named Diguna, came to plan out the project and lay the foundation.

It took them longer than expected to dig the necessary holes (as the ground was more marble than dirt), but eventually they finished. Then they re-enforced the holes with rebar, and poured the concrete. I’m told it must settle for three weeks before the tower can be erected.

Sam and Daniel, the diligent Diguna staff.

It’s an exciting project, with a potential for much fruit. I can’t wait to see what God does with it.

A Very Different Birth.

A few months after arriving in South Sudan, a woman came in with antepartum bleeding. Her baby was dead, could I help her?

I hemmed and hawed, but eventually said I would try.

Her birth was the very hardest of my life --shaking me to my core --teaching me things I never wanted to learn.

I can still vividly remember sobbing hot tears into a staff member’s lap as she helplessly tried to understand my grief. She prayed. I thanked her, then walked back into the room where my helper quietly mopped up the pooled blood. 

Elizabeth had delivered. Finally.

But in that time, I somehow morphed into a different midwife --one that pulls babies out by their feet. I wasn’t sure I ever wanted to become such a midwife... but there was no going back.

Her birth changed me. 

Something else happened that morning. Something surprising. I came to love Elizabeth and her husband, Michael, with an intensity I find hard to explain. It rolls over me in waves, filling my lungs, making it hard to breathe.

So when I saw Elizabeth back in my prenatal line a few months ago I instantly recognized her. Love does not forget. Then I turned and saw Michael sitting beside her. He stood to shake my hand, bouncing as he proudly announced she was four months pregnant.

Could it be true? Was she really expecting another baby? Whoohooo!

She came faithfully to each prenatal visit with Michael always at her side. To date, he is the only husband who has come to every check-up.

Anyway. Long story short. Her due date drew near.

Then a few weeks back she started having contractions. Even though she was in early labor, I admitted her for observation, and watched her through the night. But her contractions stopped as suddenly as they started, and by morning they were ready to go home.

It was a false alarm. 

However, a week later she was back with more contractions. This time they were dilating her better, but barely. It was slow going.

Fortunately, it was a Sunday morning and the clinic was quiet. Since I was in no hurry, I watched, waited, and prayed; but her labor never progressed.
    --What was the hold up?

Eventually after waiting fourteen hours without any significant progress, it was time to take action. I started her on oxytocin, and she went from 4 cm to fully in about an hour.

As she labored, I listened in with the doppler. Each time the static warble found heart tones, she smiled. The steady toc-toc-toc of her baby’s heart, wrinkled her face in a toothy, contagious grin.

We were making new memories. Memories that didn’t involve silent wombs. Memories that were noisy with life --her baby’s life!

When it came time to push, Michael supported her from behind, and she got on her knees.

The pushing was slow for a G7 (or woman delivering her 7th child). Really slow.
     --Which explains a lot. 

As she grunted, pushed, and sweat, I silently prayed. 
    -- Lord, however you work this birth... please let the baby live.

I confess, the toc-toc-toc reassured me more than I let on.

Hard as I tried, I couldn’t shake the echo of that fateful morning from my thoughts. Here I was... in the very spot I pulled her last baby from her body.
    --Would this baby die, too?

Deep breath.

She continued to push, but the head would not descend. Finally, I had had enough of waiting, and I got out the vacuum. It took one tiny tug and another strong push, and she was born!

At the sound of her plaintive gasps, the room filled with laughter, and her parent’s eyes danced with joy.

She was alive!

It was a very different birth --one that ended in tears of joy rather than sorrow. Thank you Jesus! And thank you all for praying for her. He answered our prayers!

Elizabeth, Michael, and baby girl at 3 day check-up.