Midwife on a Mission!

Of Death and Blood.

2012-01-30T02:00:00.000+03:00

Yesterday was a difficult day. After the grieving mother was carried off by her family, the crowd thinned enough for me to see Ajulla. She stood quietly beside the clinic entrance, looking scared and in pain.

At first I thought it was the fierceness of the woman’s grief, but as I approached her water broke. The suddenness of it surprised us all, especially Ajulla. Her eyes widened in astonishment as she looked around her as if saying, “Is this normal?”

Her belly looked suspiciously small for a term pregnancy, but I couldn’t be sure with her dress. As I walked her slowly inside for a check-up, I peppered her with questions.

When did the contractions start? Has any blood come out? How many months are you now? Have you been coming for check-ups?

She tried to answer our questions but was too confused. Once we got her on the bed, I understood everything without a word.

Two tiny black legs hung from between her legs. Her baby was dead and coming out breech.

As we waited for her birth to proceed naturally, I asked her the rest of her questions. She did not appear the least bit surprised when I told her she was delivering preterm. She actually looked relieved.

It took us only a few minutes to get the baby out, but the placenta was a challenge. I could not pull on it for fear it would tear.

With time she delivered half of it, but a large portion remained inside. She was not hemorrhaging so I did not go in after it. Instead I waited and prayed.

About an hour after the birth, her placenta was born. Ragged like hash, it fell apart in my hands.

Just as I moved her to the observation room, another woman arrived covered in blood. She knelt in the dust wearing nothing but a bloodied sheet.

-- “Are you pregnant?” I asked.
-- “Yes.” she said. The crowd gathered in to get a better look.
-- “How far along are you?”
-- “I’m 4 months...”

The crowd was getting larger, so I lifted her to her feet and together we walked inside. The prenatal women waiting to be seen, watched quietly. They would have to wait again.

Hers was less of a birth and more of a miscarriage (or incomplete abortion). Even though she claimed to be four months pregnant, her body told me otherwise. Tom had to perform a D&C to stop the bleeding, but she recovered well.

So much grief! So much loss! So much blood!

Lord, thank you for bringing these women to us. May the work we do glorify you regardless of the results. Bless them with health and heal them from their grief. Strengthen us so we can serve you faithfully. Amen.

A Grief Observed.

2012-01-29T15:58:00.000+03:00

Yesterday morning I heard wailing coming from the clinic, and I knew. I knew from the strength of the piercing cries and the intensity of their sound that it had to be about the boy. The little cherub that I had prayed for the night before --the tiny toddler with pneumonia-- must have died.

He was very sick, struggling for every breath. We had put him on oxygen until we ran out of fuel to run the machine. But even when he was on it, he struggled.

His mother had come two days before, got medicine, and was told to return the next morning bright and early. Instead she stayed home, only coming late that night once the convulsions started.

She was frantic, wanting to take him to the witch doctor since our medicines were not working as fast as she liked.

Dr. Tom was not sure he’d make it through the night. But he did.

However by sunrise the shallow rasps coming from his chest finally stopped. He was dead.

When Tom pronounced him, the mother let out a guttural shriek that carried some distance in the dawn silence. It shook me from my bed.

When I arrived to check on another patient a few minutes later, I found her still shrieking and wailing sharply every few seconds. She punctuated her grief by throwing herself again and again on the ground --arms flailing --feet pounding.

Her family and friends sat quietly by and watched. Silenced by her grief, they did nothing to calm her.

Each wail eventually faded to a sob, then slowly she would stand again. Once standing, she would start to pace which eventually led to another wail more pitiful than the one before; and she would throw herself to the ground. Pounding. Stomping. Beating.

No one approached. No one comforted. No one joined in.

It was a difficult grief to watch --too fresh --too real. But eventually there were no more screeches to be uttered, and she quieted to a steady sob, prostrated in the dirt.

Only then did her family gather her up from the dust and walk her home. A friend followed with her child wrapped tightly in his arms.

The wails may have stopped, but the grief was just beginning. Please pray for her. I don’t know her name. But God does. Thanks.

Leopard Attack?

2012-01-29T02:00:00.000+03:00

The other night a man in his 20's was brought in from the village. His head was sliced open, his right arm was punctured, and he was bleeding excessively.

As Dennis sutured his skull, I causally asked what had caused his wound, assuming it must have been another motor bike accident. But it wasn't.
-- “He was attacked by a leopard,” my translator explained in disbelief.
-- “A leopard? Really? Are they even around here?" I asked stupefied and scared. I had heard of hyenas... but leopards? Honestly... a leopard??
Once I got over my initial surprise, I said, “Tell me the story in detail. How did it happen?”

By this time Dennis had already closed off most of the foot long wound on his head. A thick gauze bandage covered the man’s face leaving only right eye uncovered. He searched my face in fear but didn’t speak. So my translator asked his friends to relay the story, instead.

As they spoke, a half dozen people slowly inched into the room to hear as well.

He was fishing by a river in a far off village when he passed next to a large bush. He heard something and turned to see a leopard pounce on him, taking him to the ground. The beast swiped his head in the process cutting a wide, ragged wound from his left eye socket to the back of his skull. Then the animal turned quickly and sprang on him again. This time grabbing his arm he had raised it in his defense. Then without explanation the leopard left as quickly as he came.

Since he lives so far away, it took him all day to reach our clinic --all day with the muscles in his skull protruding and various holes in his body tied off with old rags.

I asked if I could take a few pictures and he nodded but still didn’t speak. After each picture, I flipped my camera around so he could see what we were doing. He had to lower the gauze to see them, but he did it readily and thanked me afterward.

I don’t know about you but if I had been twice attacked by a leopard, I would not have been so brave!

Dennis was able to sew the wounds closed leaving proper drainage to prevent infection. Please pray he heals both physically and psychologically from this attack. Thanks.

Update: Jan 29 2012
I saw him today and he's healing well. The wound on his head is not septic. Please continue to pray.

A Perfect Mess.

2012-01-28T23:26:00.000+03:00

Maguet said she was in labor but didn’t look active.
    --They rarely do.

As my helper readied the room, I tried to count contractions and ask her questions. She had never come for a prenatal, and I needed a few facts.

But getting her to talk was an exercise in futility. She just flat out couldn’t.

Only then did I see the first contraction. Saying it was strong just doesn’t cut it --intense to the nth degree --powerful the the power of ten. Okay. So they were strong!
    --How could she be so calm?

As I stood by her side trying to measure their intensity, a sudden rush of wet warmth gushed down my legs and hit the floor with a audible splash!
    -- Had someone emptied a bucket on me?

Maguet and I locked eyes in surprise, then looked down in unison. Black, murky fluid stained our clothes as if we had waded knee deep in a lake of amniotic fluid.

My first response was to laugh; but Maguet was a bit more hesitant. She looked embarrassed. Or was it horrified? Eventually she realized I was not mad and laughed timidly along with me.

I didn’t have heart tones; I had not measured her fundal height; and I still did not even know her gestation... but she wanted to push.

Did I have time to change? --Unlikely.

My warm, sticky pant legs clung to my skin, growing colder by the minute. My shoes squished loudly at every step. Eek.

I really wanted to go get changed... and perhaps take a long shower with bleach.
    --Could I risk it?

The midwife in me worried the murky fluids could mean a compromised baby. Heck, I still didn’t know if the baby was alive! However, the non-midwife in me was thoroughly disgusted and ready to run for a decontamination shower.

What is the protocol when a total stranger expels ink-flecked slime all over you?

My translator didn’t know what to do or where to stand. The horror on his face was evident. I had to tell him more than once to get the mop.

Only when I rolled up my pant legs and started moving her into position for the birth, did he push past his disgust and prepare for the birth.

He ran for the mop. I slipped a pad under her. She got in the squatting position.

Ten minutes later her little girl was born.

The baby came out with another splash of blood and water coating me in a second layer of grime. But I didn’t have time to notice.

Green-gray meconium coated the baby and sputtered from her lips. I suctioned her mouth and dried her off before handing her over to her mom. Then I took a long look at myself. A mess.

A. Cold. Sticky. Wet. Mess.

What a bad week for the water to stop working at the clinic!

Once the baby was stabilized and breastfeeding well, I ran off to the compound for a quick shower. A bar of soap never looked so great!

Her baby was initially fine, but by the second day she developed an infection --most likely due to meconium aspiration but also possibly due to untreated STDs.

We have her on antibiotics now. Please pray she recovers quickly. Thanks.

Labor of Love January 2012

2012-01-28T18:41:00.000+03:00

Labor of Love January 2012

Update: Clubbed

2012-01-27T21:53:00.000+03:00

Baby Yom is doing very well. His mother brought him in to be fitted for another set of casts for his clubbed feet. Admittedly he was not a fan of all the prodding, but he didn’t cry --instead he stuck his tongue out at me!

So cute!

Dr. Tom is pleased with how well his feet are turning back to normal. And although he has not reached full range of motion in all his joints, I’m seeing steady improvements.

Surgeon in the House.

2012-01-25T18:56:00.000+03:00

Dr. Mike is a general surgeon from Florida who has come to serve this community for the next 3 months. His happy manners and quick wit have already made him quite popular; and I’m confident his many skills will make him even more so in the coming months.

He will be working at the government hospital since we don’t have space in our clinic. Plus, the government hospital has a tiled room designed for just such surgeries.

The staff has been organizing the equipment and setting up the room for the last few days. Yesterday they did their first surgery --a hernia repair on a 7 year old boy. I’m told things went very well.

It sure is nice to have a surgeon in the house!

Friendly Farewell.

2012-01-25T02:00:00.000+03:00

Achan and me after her birth last August.

Achan delivered a few months back. She blessed me to no end during her birth with her serious promise of friendship.... if I could just stop her pain! When she delivered a few minutes later, she decided we’d be friends for life! (Read her story here.)

What an honor!

I’ve seen her a number of times since then. Each time she has greeted me loudly, while repeating over and over again the only English words she knows.

My friend! My friend! My friend!

I can’t help but just love her to pieces.

Well today, she came to say goodbye. Apparently, she must return to the village and can no longer come to visit.

She brought her doe-eyed daughter with her, and proudly handed her over for me to snuggle. Then through a translator and while continually repeating “My friend! My friend! My friend!” she told me that she named her baby after me.

When I expressed my happy surprise she explained, “Her name is Akuac Kowaja!”

You might recall that my Dinka name is ‘Akuac’ which means ‘White cow with black spots and uneven horns’.
-- Yep, I'm a Jersey cow.

However, you may not know that ‘Kowaja’ is the term used for anyone who is not Sudanese. Technically it means ‘foreigner’ but it is also the term most often used for ‘white person’.

She is the first baby named ‘Kowaja’ that I’ve met!

I was happy to see my friend one last time and hope that we’ll get to meet again soon!

A Transport.

2012-01-24T19:20:00.000+03:00

Last night, Judo, a 22 year primigravida was carried into the clinic by her family. Exhausted she fluttered in and out of sleep as I checked her vitals.

She is from the Luo tribe; and since no one else in her family could speak any Dinka, she pushed past her fatigue to explain her long and difficult labor herself.

Her contractions had started two days before. Everything looked good until her water broke and she started pushing. She pushed and pushed for over six hours, but her baby would not come. Eventually her contractions just faded away.

She had not had a contraction since dawn --roughly 16 hours earlier.

Gesturing toward the wrinkled woman at the foot of her bed, she explained “My grandmother was my midwife. She said she could see the baby’s head, but it went back inside.”

I looked back and forth from her grandmother’s worried face to her oblong belly while trying to process her words.

What? She was in labor? She didn’t look like she was in labor. Could they have been mistaken? Perhaps she had malaria-labor and just dreamed up the fact the head was poking out?
--Doubtful.

I needed more facts.

A quick vaginal exam explained everything. Not only was she fully dilated, but the presenting parts were at a +2 station. Her pelvic outlet seemed adequate despite her low pubic arch, but the real problem was the swelling.

It took me a long, breathless minute before I realized the squishy mass of swollen flesh was her baby’s head. It was so edematous I could not find any suture lines. None at all.

Not good.

All the signs pointed to deep transverse arrest due to cephalopelvic disproportion (or CPD).

She needed a cesarean.

The good news was an American surgeon just came on staff last week. The bad news was we are not ready to start doing cesareans yet.

After discussing her case with the rest of the staff, we decided to transport her to Wau instead of risking an ill prepared surgery.

When we explained the situation to her family, they didn’t hesitate. They quickly gathered the necessary funds and an hour later she was en route.

I’m happy to say that this was the fastest transport we have ever organized. Originally when I heard that she’d be transported, I assumed we’d have to wait until sun up like before. But I was wrong. Apparently, we have a new driver who can go at all hours of the day and night.

What a blessing!

Today I am genuinely grateful for cesareans, ambulances, and willing drivers. By now, Judo and her baby should be recovering from surgery. Pray that it was successful and that they heal quickly. Thanks.

And also pray for our new surgeon and the many families he will bless in the coming months. I’m told that he is doing a hernia repair today. Exciting!

More about him later.

Monsters.

2012-01-17T22:28:00.001+03:00

I have stories --lots and lots of stories-- but I can’t write. When I try to write, my mind races in circles silently screaming --arguing --raging, but nevertheless perversely mute.

Oh, to be able to write them down!

In all honesty, I don’t trust myself. I’m afraid once written, my words will grow into loathsome monsters that will shock, horrify... disappoint.

So I’m silent.

Please bare with me. I have many stories. Really, I do. But how can I write them when my words are mute, and my thoughts are monsters?

Please pray for me to master these monsters. Thanks.

“For though we live in the world we do not wage war as the world does... We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ.”
2 Corinthians 10:4-5

Prenatals!

2012-01-11T14:42:00.000+03:00

Now with the Christmas birthing rush behind us, we are back to only 2-3 births a week. --Sigh

I miss having so many babies to catch, but I'm not complaining; I don't have time!

Why?

Well, the rest of the staff got back this weekend and we are open again for consultations.

Margaret and I (along with our very tired translators) have done just over 100 prenatals in the last 3 days.

Yesterday was our busiest day. We had 40 prenatals and a labor.

The labor, Elizebeth, spoke excellent English and was older than the average G1 at 25 years old. Her progress was slow, but she was able to cope well with the pain.

When it came time to push, her gap-toothed mother stood by her side and cheered. She delivered a healthy little girl over an intact perineum after only 15 minutes of pushing!

What a superstar!

Also, I heard that in a few weeks another doctor will be joining our staff for awhile. He is a surgeon and will focus on surgical cases.

Perhaps he'll be able to help us with a cesarean or two while he's here. I pray that he won't HAVE to... but it'll be nice to have his skills if needed. Right?

200 Reasons Why.

2012-01-07T21:55:00.000+03:00

I'm one of those midwives that keeps statistics. I write birth stories. I keep logs.

I do it so I can remember. I do it so I can learn. But mostly I do it because it's fun.

Today as I was writing down the ridiculously short birth story from this morning, I realized I'd passed a milestone.

Yep, today I caught my 200th Sudanese baby!

It was a brilliant birth. The mother went into labor at 5 am, arrived at the clinic shortly before 7 am, and delivered at precisely 7:02 am.

I am glad she made it in time!

Side Note:
It's my 200th catch in Sudan, my 315th catch in total, and the 488th birth I've attended. But who's counting? :- )

Crying it out!

2012-01-07T10:23:00.000+03:00

Athieng was hard to read.

Her contractions said one thing (i.e. “We’ve got a long way to go.”). But her response to those contractions said another (i.e “Quick, catch this baby. It’s coming out right now!”)

Which was it?

Originally I waited and watched trying to avoid a vaginal exam, but eventually I caved in after another half hour of confusion.

She was only 3 cm dilated.

Normally I would have insisted she go home, but she didn’t look like she was coping well.

Tears. Sobs. Whines. Whimpers.

This was not the typical Dinka labor. Usually the women I serve are restrained to the point of stoicism.

She was different; she actually looked and acted like she was in labor. It was refreshing.

I told her it would be many hours before she delivered and that it was best if she went home to labor. However if she’d be more comfortable at the clinic, of course she could stay.

Shaking off the pain, mustering a half-smile, then wiping streams of tears from her eyes, she finally said that she preferred to labor at home. So I prayed for her and sent her on her way.

I half expected her to stay home, but she surprised me by coming back 6 hours later. But this time she was active. But as the hours progressed, so did her tears.

At the start of each contraction the flood waters would open, gush across her face, then drip off her chin. Yet the moment the contraction faded, she’d wipe her face, sniffle a bit, then go back to pacing the clinic grounds.

These were no ordinary tear drops; these were brewing geysers, raging tidal waves, gushing rivers.

In all my years, I’ve never seen a coping mechanism quite like this one. However, it makes the most sense. I mean... why not cry?

Before I go on, there is something you should know about me. I’m a cry-er. Some would even say a cry-baby.
--Heaven knows I’ve been called worse.

So when I saw her crying, I instantly understood.

You see, I cry when I’m happy. I cry when I’m sad. I cry when I’m stressed, pissed, depressed, blessed. I just cry.

I loved that she did, too.

Long story short, her crying eventually came to an end. The contractions led to her water breaking, which led to frantic pushing, which led to more crying. But this time it was her son making the noise!
--What a beautiful sound it was!

Personally, I think I’m going to be much like her in labor. I’m sure I’ll do my fair share of blubbering, sobbing, and crying. I mean, why not?

It just feels good to cry it out sometimes. Right?

Anyway. I’m happy to report that the word is out. Women are coming to deliver with us quite regularly. Last month we had 40 births. I wonder what this new year will bring.

Thank you for praying that they would trust us enough to come. Now please pray that those that come, would see Jesus in our actions and words. Thanks.

A Traditional Sudanese Birth?

2012-01-06T13:49:00.000+03:00

Akul first came for help two weeks ago. She was sure it was labor; but her contractions were unconvincing.

Although obviously painful, her contractions lasted no more than 15 seconds and weren’t bringing any progress.

Since it was her fifth pregnancy I admitted her for observation; and for the next 5 hours we watched and waited. But nothing happened.

Now, I’ll be the first to admit I’m cautious when it comes to Braxton-Hicks contractions. I used to educate women on them, reminding them that it wasn’t labor until there was progress, etc. But after a year and a half of malaria cases, I don’t like to risk it anymore.

Why? Because I cannot tell the difference between Malaria-Labor and Braxton-Hicks contractions.

Yes. It might only be Braxton-Hicks contractions. But what if it’s not? What if she has chronic malaria and the pregnancy is masking the symptoms? What if the paracheck gave a false-negative? What if...?

So when I have a woman like Akul --in pain with regular but short contractions-- I treat for malaria if I haven’t seen any progress for several hours.

This was the case for Akul; so I gave her the first line treatment and sent her home. When I didn’t see her the next day, I figured the medicine worked, or she’d delivered at home.
    --Follow-up on patients here isn’t as easy as you might think.

I didn’t see her for two weeks. Then two days ago, she returned with the same symptoms. In the course of her evaluation it became clear she did not take her medicines properly.

We were right back to square one.

More pain. More spastic-y contractions. More worrisome watching.

But since her symptoms were worse this time, I started her on IV medicines and kept her for the night. By morning she hadn’t dilated even a centimeter.

I gave her a new course of treatment and sent her home, warning that her labor could start at anytime and she’d need to come back if her water broke... or the pain got stronger.

She returned 12 hours later saying her water broke.

I wanted to believe she was in labor... but all I felt was irritation. Stupid malaria. Stupid, stupid malaria.

Grumbling under my breathe about the evils of this debilitating parasite, I watched her suffer under its torment.
    --Childbirth is painful enough without adding this nasty plague!

But when I re-evaluated her, she hadn’t dilated at all. However, her water had most assuredly broken. I wasn’t sure if she was in labor... but I figured it’d come soon enough.

I told her as much, then gave her the option of staying the night again or going home. She wanted to stay.

I didn’t argue. Even if she didn’t progress, at least she’d be close.

However her labor surprised me.

Her contractions got strong rather quickly, shaking her body like a ship in a storm. They went from being every 20 minutes to every 8 minutes in under an hour.

Another hour went by and she was pacing --pacing and moaning rhythmically.

It was close.

Her husband, a man who had faithfully sat by her side each step of the way, watched us pace together but made no comment.

His dark, lanky frame stood in shadows and watched. In the black of night, the only thing visible was the reflection of the clinic lights in his eyes.

Less than an hour later, Akul was asking to push. No... she was NOT asking; she was grunting, moaning, jerking, clenching, and whimpering.

It was time.

I asked her if she wanted to deliver on the birth bed or on the floor.
-- “The floor,” she whispered.
-- “Okay. Once this contraction is over,” I said as a strong wave of pain rushed over her, “we’ll help you get positioned on the floor.”

Nodding, she answered with another whimper.

Once set up, I invited her husband to join us. He had been sitting silently on the bench outside.
-- “Tell him that he can come in if he wants to...” I told my translator, “He doesn’t have to come in... but if he wants to, he should come now.”

My translator called for him over the thin wall, and he noiselessly entered and sat down.

Turning my attention to Akul, I said, “Only push when you have a contraction. Okay?”

She nodded determinedly but said nothing.

Her husband sat in the corner, firmly grasping his knees to his body in an effort to stay on the stool. It was a tight squeeze for his long legs.

After a few minutes, he spoke his first words.
-- “How do women deliver on a bed?” he questioned innocently.

It was child-like in tone. And I could see his mind whirling as he considered the plastic-covered birth bed in front of him. It had a hole at one end and a movable flap at the other. Very confusing.

He wasn’t asking me, but my translator, so I didn’t butt in until the conversation was over. I had understood a bit of it and asked my translator to help me understand it all.

-- “He cannot imagine how the woman earlier delivered on the bed,” explained my translator. (The previous labor delivered just an hour before and he had heard all the commotion. That labor had insisted on delivering on the bed.) My translator continued: “He wants to understand how it’s possible to deliver in such a way.”
-- “Did you tell him?” I asked, but then couldn’t wait for the answer.

She was pushing.

She delivered in the supported squat position a few minutes later. As her boy slipped out, a piercing screech filled the room --and then silence.

It was done.

Slimy and beautiful in every way, he complained as I wiped him down and placed him in her waiting arms. For several long minutes, we sat in silence enjoying the calm after the storm.

As we sat, I couldn’t help but think about his question. It was a good one. Very practical.

“How do women deliver on a bed?”

I’m willing to bet there are a large number of non-Dinka men (and women for that matter) out there wondering the very opposite question.

It could be equally asked: “How do women deliver on their knees?”

Ahh! Culture! Thou art a tenacious beast! You cling to our preconceptions like barnacles; you beat about our heads like waves; your flotsam and jetsam clutters our minds. How do we escape unscathed?

Underneath what we are really asking is, "What is the right way to give birth?"

There are just no answers, are there? There are just opinions colored by what is most familiar, comfortable, and common place.
           --Oh, the traditions we hold so dear!

I’m happy to report that Akul had a traditional Dinka birth.

She delivered in a supported squat with her husband’s knees in her back while malarial parasites raced through her veins.

Afterward Akul glowed with satisfaction, saying “I’m so happy. Ana chi pou mieth. I’m so very happy.”

Yes, Akul. So am I.    --So very happy!

Please pray for them. Pray her chronic malaria goes away quickly. Pray for health and love and joy and peace.

I invited them to church on Sunday, please pray that they come. Thanks.

Primip Breech!

2012-01-03T14:53:00.000+03:00

Last year a first-time mom was brought to me after several long days of labor. Exhausted and scared, she lay on the bed for an evaluation. But it was soon clear what was wrong.

Her baby was breech.

Now I’ve delivered my share of breech babies but this was the first time I had to deal with a primip breech (meaning one for a first-time mom).

In any industrialized nation, a primip breech would be an immediate (or scheduled) cesarean as the risk of the baby dying is quite high.

The worry is that the larger fetal head will not mold enough to be born after the smaller buttock is born. The head would then get stuck, leading to suffocation.

Although I’m sure we all know someone who knows someone who had a successful breech birth the first time around, more often than not, the birth can go wrong (or be mishandled) and the baby can die.

But I digress.

My point is that the young girl last year came to me fully dilated with her baby’s buttock already protruding from between her legs. We had no time to transport, so we informed the family of the risk of vaginal birth then prayed like mad.

The birth went horribly wrong. Everything that could have gone wrong, did. Everything. And her baby died. (Read her story here.)

Afterward I asked God to never give me another primip breech, and to always help me diagnose them early so I can get them the cesareans they need... and deserve.

I grieved that birth for many months. I was haunted by regrets. “If only I had done this instead of that... if only I had insisted on a transport... If only I had reacted better... faster... smarter. If only...”

In fact, I was still grieving it when I went to Switzerland to visit two midwifery classmates last Spring, and we talked about it in detail. One of them also introduced me to a midwife friend who had read about this tragic birth and wanted to encourage me.

Long story short, this midwife poured out sweet comfort coupled with years of wisdom. What is more... she taught me what to do if it ever happened again.

I listened to her words carefully, praying that it never would, but thankful to have options if it did.

Well, it did happen again. It happened last night.

This time, however, I handled the birth differently.

As I readied the room for the birth, her words rang out in my mind: “Make sure you go slow. Allow for the woman’s body to dilate properly. Don’t ever take your cupped hand away from the perineum. Once the buttock starts coming out, push the buttock back in with counter-pressure. Push hard. Make sure the baby does not unfold... that way the arms won’t fly up over the head and get trapped.”

Nyibol, my labor, wanted to push like mad and didn’t like the counter-pressure. She asked over and over for me to “just let her push harder”. But I was determined not to let this baby get stuck. So I explained my reasons again and again, insisting she breathe through her contractions as long as possible and to push only when she couldn’t help it.

She needed to go slow.

Tom came to assist, but since he wasn't needed right away, decided to sleep in the other room. Having him there was a huge comfort.

Meanwhile, Nyibol pushed on. And I supported the perineum.

The Swiss midwife’s words continued to echo in my head, “Make sure you never take your hand away. Not for one second. The baby must not unfold. Only remove your hand when most of the body is born... then deliver the baby like a normal breech.”

My hands cramped. My forearms ached. But it didn’t matter. The baby was doing well.

Plus, Nyibol was making good progress.

I called Tom in to assist once the body was mostly delivered, and he applied suprapubic pressure as the shoulders were born. I had to reach in to release the baby’s right arm, but the left came out on its own.

The following push the head was born!

Nothing went wrong. None of the emergencies happened. Amazing.

The difference between this primip breech and the last was night and day.

Night... and day.

Thank you Jesus for this healthy little girl. Thank you that she is alive. Thank you for sending me wise midwifery friends who taught me this simple technique. Thank You! Thank You! Thank You!

Nyibol did not get an episiotomy; she did not even tear. Her baby had decent APGAR scores (6/8), needed no resuscitation, and transitioned well.

Night and day.

I share this story with you so that if any midwives out there find yourselves in a surprise breech in a primip, you might remember... cup the perineum. Never let the baby’s body unfold. Basically, make your hands like a second-perineum so the baby stays in a compact position. This will dilate her body most effectively, permitting enough room for the head to emerge without delay.

I realize this is the OPPOSITE of what almost every textbook says on the issue of breech delivery. And for that, I would be remiss not to comment. I agree with the textbooks. Hands off a breech. Never pull on the body.

Never. Never. Ever.

What I am suggesting is that you PUSH on the body --not pull. Give counter-pressure as the baby descends. Provide a place (aka your cupped hands) for the baby’s butt to pivot naturally as it passes over the perineum.

I did not "touch" the baby (and never pulled on her) after her legs and trunk were born. I only assisted in the birth of one arm, so the head could emerge.

I hope that makes sense. If not... let me know.

Thanks for praying for these women. Thanks for praying for me. I could never do this without your love, encouragements, and prayers.

Placenta Previa?

2012-01-03T10:49:00.000+03:00

Two days ago, Adhieu started having contractions in her sleep. She thought it was unusual since she was only 6 months along, but there was nothing she could do about it. She lived too far away to get immediate help. She’d have to wait until light.

But as the sun peeked up the next morning, the bleeding started. Lots and lots of bleeding. She bled heavily until noon.

She said her baby kicked like mad during that time, but then suddenly stopped.

That was a day ago.

She knew something was wrong, but it took time to get the family involved. Someone needed to bring her to town. She couldn’t go alone. Who would come?

Eventually it was decided her father would accompany her.

By the time she arrived, her clothes and legs were crusted in dirt-stained blood. A large flap of membranes hung from her introitus but she was no longer in labor.
--Was this placenta previa?

(For those who don’t know, placenta previa is when the placenta presents first, causing painless bleeding. It can be life threatening for both mother and child, depending on the blood loss.)

There were no heart tones to be found. No movement. Nothing. Her baby was dead.
--Could she have had an abruption?

(For those who don’t know, an abruption is when the placenta detaches from the uterine wall prematurely. This is very painful and presents with bright bleeding. An abruption can be complete or partial. It is almost always life threatening for the baby unless delivered quickly.)

She wasn’t surprised when I told her baby was dead. And she didn’t cry, either. Instead she looked unblinkingly off in the distance, hardening her jaw. Resolved.

A quick speculum exam revealed a 2-inch chunck of placenta plugging up her cervix like a cork. Thick membranes dangled down the canal, but the bleeding had stopped. She was 2 cm dilated and had no contractions.

Ideally, she would have gone to Wau for a c-section, but I intuitively knew this was NOT an option.

Had you asked me how I knew this, I would have been hard pressed to give you an answer. And yet when Tom asked me to send them anyway, I gawffed, “That’s not going to happen. They don’t have the means.”

He insisted on it though, expounding on the potential danger of her bleeding to death if it was a previa, etc.
-- “If contractions start, her cervix can open and she can hemorrhage... maternal mortality.... too dangerous... must transport....” He lectured pedantically. He wanted us to warn them of the risk of her dying. Just in case.

I listened to his words --I even agreed with them-- but I knew they’d never go.

Her clothes were too worn. Her body was too lean. And neither of them wore shoes. Plus her only companion was a frail father with clouded pupils and trembling hands.

But the biggest clue was the fact it took her a day and a half to get to us.

No one with any sort of means waits a day and a half to seek treatment with this much blood loss. No one.

I respected Tom’s wishes though and talked to them about transporting. The discussion was disheartening short.

Conclusion: They had no money. His goats were back in Thiet. It would take time to arrange their sale --perhaps two days.

I listened and nodded, then induced her.

I had peace about this induction. Her bleeding was almost nil, and she was a multigravida. If the medicines worked... she’d deliver quickly and this would all be over.

Then no goats would need to be sold.

By God’s grace, the induction was effective and she delivered 2 hours later with very minimal bleeding.

Her baby weighed just 800 grams, but he was perfectly formed. Tiny ears. Delicate fingers. Two thin eyebrows neatly knit atop unseeing eyes.

He never opened his eyes to this world... but I believe he’s seeing something much more beautiful now!

Please pray for Adhieu as she grieves this loss. It was not her first. Pray that it is her last. Thanks.

Last week of 2011...

2011-12-31T23:30:00.000+03:00

My silence this week has stemmed from a fierce desire to stay sane despite a post-Christmas birthing spree.

Apparently, a large number of babies were dead-set determined on being born in 2011. Three of the labors were teenagers.

The first was only 15 years old, but she was strong and resilient. She awed me with her determination and trusting spirit. Although her labor was painfully long, she rallied at the end and pushed with all her might. When her baby girl was finally born the whole room sighed in relief. She was amazing!

Sweet baby born to, Elizabeth, the 15 year-old girl.

The next teenager was the exact opposite. She argued with me, ignored my advice, and fought me at almost every turn. Despite her attitude, her mother and I got along smashingly. We understood it was the pain talking, and found ways to laugh about it. When her baby boy was finally born, we laughed even harder at his enormous eyes! Apparently it’s a family trait.

What big eyes you have!

However, the third teenager to deliver brought much sorrow. She had only been in labor for 2 hours by the time she got to us, but she was already fully dilated. There was no way to prevent the birth.

Since we weren’t sure how premature she was, we prepared for the worst but held on to hope.

After the birth, her baby needed some initial help breathing, but her APGAR scores were good. We were hopeful she’d do well despite her 1.2 kgs.

Long story short, we had to resuscitate her three separate times and start intravenous fluids. Although her color was good while on oxygen, she couldn’t maintain her own breathing without it.

The preterm baby girl born this week. She lived only 5 hrs.

She quietly died 5 hours postpartum while we watched on and prayed.

Her young parents wept openly as I prayed for them. But by then, their family had gathered and was able to comfort them in their grief as well. They even comforted me. This might seem strange, but I’m grateful I had the opportunity to be a part of her life... if only for those few hours.

Thankfully the rest of the births were less complicated --but not by much.

This week I also had another severe hemorrhage. But fortunately I was on my guard after last week’s hemorrhage and I was able to control it much faster. Her birth was a blur to be honest as she arrived at 1 a.m. and delivered mid-REM cycle.

It was almost a full day before anyone thought to tell me that she was one of our translator’s wives! Thinking back, I thought it was strange that he’d showed up at 1 am for no apparent reason, but in my foggy, sleep-deprived brain it never occurred to me that it was because she was carrying his child!

Yes... I really am that slow. But it would have been easier to believe if someone had bothered to tell me he got married!

Peter Malok, his wife Akutet and baby girl.

So let me be the first to say (for anyone who has been to Tonj and reads this blog) that Peter Malok got married --there is still an issue with cows of course-- but he’s married, has a beautiful wife, and now a delightful daughter!

Let’s see... what else happened this week?

Oh, I also had to transport a woman for CPD (cephalo-pelvic disproportion) after an unsuccessful trial of labor. She arrived before dawn in a frantic state, saying she had been pushing for hours at home.

This was her 10th pregnancy --but only 4 were living. The rest died during delivery or shortly afterward. Fortunately, we had enough time to diagnose her situation and ready the ambulance for transport at first light.

Transporting for the CPD.

I’m happy to say she got to Wau and was taken to surgery almost immediately. Both of them are doing well, I’m told.

There were a few other straight-forward births this week with happy moms and healthy babes. But the most memorable of them was Arop’s birth.

I’ll end with her story.

Arop lives 3 hour away by foot. But after her first three babies died during delivery at home, she decided to see if we could help for this next one.

She was faithful to come for prenatal care and we watched her closely, encouraging her to deliver with us no matter what.

She took our advice and started walking to the clinic once she was confident her labor began. She arrived fully and delivered a precious little boy 40 minutes later. Her birth was delightful and remarkably simple.

Afterward as I watched her breastfeed for the first time in her life, I was overcome with joy. She has carried 4 babies to term; she has labored 4 separate times; but this was the first time she’s ever heard her child cry. This was the first time she’s ever held one to her breast!

Arop breastfeeding her baby. What a smile!

What a delightful way to end a year!

Happy New Year!

A Sudanese Christmas.

2011-12-31T09:47:00.001+03:00

Christmas morning started slow and easy. There were no children to wake me at dawn; there were no presents to unwrap; there were no babies to be born, so I slept late.

By the time I got out of bed, the sun was high in the sky casting a thick oppressive heat on all below.

Out my window off on the distance several dozen well-dressed church-goers marched and sang Sudanese Christmas carols to a beating drum. They were quite literally marching off to church. As they paraded passed they picked up people on the way, telling them it was time to celebrate Jesus’ birth.

They marched slowly allowing time for children to tag along. A white flag bopped up and down as they passed.

Later I asked a Sudanese friend about it. He told me that this is the ECS church’s (Episcopal Church of Sudan) way of informing people it’s Christmas.

He explained that they start beating the drums on December 20th, (Yep, they sure did!) to get everyone ready. Then starting on the 23rd, they march and sing each morning announcing the coming celebration. How else would those in the villages have time to make it to town?

I loved this explanation --not only for the festiveness of it all-- but also for how culturally appropriate it is. There are few calenders around here --especially off in the village. So why not drums, songs, and dances?

Since Dr. Tom and I are the only staff/missionaries left on the compound over the holidays, we were also the only ones left to perform church. That means we were alone in singing off-key Christmas carols interspersed with scriptures. It was a short service but it blessed me nonetheless.

Later that afternoon, I arranged to celebrate Christmas like a local. This entailed walking around from house to house, catching up on life and eating cookies. I invited Dr. Tom to join in on the fun.

I missed out on it last year, because I didn’t know I could do it. But this year I was determined to celebrate Sudanese style.

I arranged for my friend Mario to act as my guide. He knows the area well and happily took us to homes of babies I’ve delivered in the last few months.

Me holding Nyankiim, & her mom.

The first baby I saw was by accident, though. A woman stopped me on the street and handed me her toddler, saying “This is your baby. You delivered her. She is named “Daughter of the clinic” or Nyankiim in Dinka.

Holding her doe-eyed tot in my arms put a huge smile on my face. I thanked her for letting me hold her child, we slapped hands, and she walked off in the other direction. What a joy!

As we walked on, I asked Mario who we’d be visiting first.
-- He said, “We are going to see the baby with no knees.”
-- “What? The baby who has no knees?” I repeated, more than a little confused.
-- “Yes. He was born last week...” he added trying to clarify.
Guessing I asked, “Do you mean the baby with the clubbed feet?”
-- “Yes. Yes. The baby with no knees,” he insisted while indicating his own patellae.

When we got to her house, Akoot’s friends asked us inside while they went to get her.

Since the door was only 4 feet high, I had to bend completely in half to enter the tukel. Pink wall hangings covered the interior. Two plastic chairs and a bed with an intricately embroidered sheet made up the sitting room.

I sat on the bed, and Tom and Mario took the chairs.

Akoot breastfeeding & me.

Beads of sweat formed on my forehead, then gathered to stream down my face. Akoot was happy to receive us and came to sit next to me. As we talked, she proudly breastfed her son while her other children bounced around the room in excitement. One kept sneaking up to Tom to inspect his white-ness, then would run away in happy shrieks when seen.

Sweet laughter!

They served us fluffy sugar cookies as we talked about her son’s progress. I’m happy to say he’d doing well.

We didn’t stay long, however, as Mario wanted us to visit his sister.

Atong was a prenatal girl but ended up delivering elsewhere. Her labor started while visiting friends in Wau, and she delivered there.

Atong telling me about her birth.

As we sipped on orange Tang and enjoyed another round of cookies, she told us about the birth.
-- “You were right,” she started, “My boy came out with his legs first.”
Handing me her prenatal book, I read my notes. Her boy had been persistently breech each visit.
-- “Did you go to the hospital to deliver?” I asked, eager to know how it went.
-- “No. No. My friends helped me with the birth. He came out easily.”
-- “In your book it says this was your second breech,” I started then added, “It says your last breech baby didn’t breathe for a long time but is okay. Is that right?”
-- “Yes. But this baby breathed well right away,” she explained.
-- “Oh, good!” I said, bouncing his chubby body in my arms.

Tom & Mario at Atong's house.

Tom watched our interaction on from across the richly draped tukel, then teased, “The babies in Sudan... they come out feet first, hit the ground, and run off!”

He dramatically miming the various actions, causing those who understood English to burst out in fits of laughter. Even though she doesn’t speak any English, Atong chuckled hesitantly with us, knowing she should laugh but not why.

But once Mario translated she laughed very hard --genuinely amused at the idea.

It was a nice visit. I got to see what a middle-class Dinka family’s house might contain. Their wealth was obvious. On a nightstand, a black boom-box with a neat stack of cassette tapes picked up radio waves from Wau.

The DJ bounced from English to Dinka to Arabic with ease, as love ballads set to metal drums filled the air. Mario tried to translate one of these ballads for me. It was something about a woman doing a man some kind of wrong... and how very sad he was.

Kids watching us from the tukel door.

Behind the radio stood a rack with neatly folded wraps and skirts which served as a closet. To the left, dozens of drinking glasses stamped with fading Pepsi logos lined the shelves. Behind me tucked in the opposite corner, a black 1990‘s TV set with bunny-ears collected dust under a mess of bottles and trinkets.

Mario pointed it out and sadly stated, “It was working before... when we had a generator. But now it does not work. No power.” I nodded in understanding. Fuel prices are just too high for such a luxury.

What that television must represent to them though! It’s the first I’ve seen outside of our compound. Just owning one that works must be a powerful statement of wealth.

A baby I delivered 2 mo. ago.

Afterward we visited two other women and their families. Then Mario showed us his tukel and brought us home. It was a wonderful way to learn about my patients and build relationships. I’m so blessed to have gone.

I hope that all of your Christmases were as fun as mine! Merry Christmas... a bit late!

Updates: Triplets, Clubbing, Car Accident...

2011-12-23T16:25:00.000+03:00

Car Accident:
Kuac, the boy run over by a truck, had to wait almost 24 hours in Wau before he got surgery. But he eventually got it. Thank you so much for praying!

His family is running out of money, though. Please pray they obtain the funds needed to get the rest of the surgery he might need. The man who hit him will be held liable, of course. It’s just an issue of liquid cash. The hospital charges for each item used (i.e. gauze, gloves, IV fluids). They have to pay up front.

Clubbing:
Baby Tong, the boy born with severe clubbing, is doing well. His parents brought him in for a check-up today. He’s breastfeeding well, and his joints are more limber.

After several recommendations, I researched Arthrogryposis, a rare congenital condition that displays these symptoms. No one is sure how this condition develops. Nevertheless, I believe he has it.

If he has it, there is a 50/50 risk he’ll die within the first year of life (assuming he has one type of the condition). But it’s equally possible he’ll live a long, albeit disabled, life. There is no way of knowing for sure how severe it will turn out to be.

Please pray for his family to know how to care for him properly and that he’d one day have use of his hands and feet. If you are interested in learning more about this condition, I recommend this website.

Triplets:
The triplets are alive! Can I get a hallelujah?

Yar, their mother, came in because Ngor has a cold and needed medicine. I took the opportunity to check them all out. Each has gained weight since I saw them last, but they are not growing as would be expected for their ages.

Yar told me they eat only twice a day. She gives them cow's milk, even though she still has breast milk. Once again, I did a long teaching on what should be done to help them gain weight. But I don’t think she listened. She’s hard to read. I’m not sure what to think.

Anyway... please keep praying for them. Their names are Ngor, Chan and Adit. Thanks.

Preterm:
Since I haven’t seen our preterm baby for a check-up this week, I’m starting to think she may have died. She was just so small.

However, I reserve the right to be wrong. Perhaps she’s doing so well that her mom doesn’t think it’s necessary to come back for a check-up. Perhaps.

Pray as the Lord leads. Thanks.

Blood Loss.

2011-12-22T16:49:00.000+03:00

They aren't smiling... but they were happy. At least I think they were...

Apiu is one of my prenatal girls. Although she lives far away, she decided to move to town her last month of pregnancy. She explained that she had had 3 days of heavy bleeding after her last child and was worried it would happen again.

So when her labor started yesterday morning, she slowly made her way to us. She arrived quite active and delivered two hours later on her knees.

Her precious girl looks just like her. Same sparkling eyes. Same playful mouth.

Although she had some initial bleeding postpartum, I controlled it with fundal massage and oxytocin.

But just when I thought it was over, she started bleeding again. Clots. Heavy clots.

So I decided on intravenous oxytocin to keep things firm and had her breastfeed. This improved things dramatically and I figured we were through the roughest patch.

Once stabilized, I moved her to the postpartum room to rest. She’d only lost about 600 cc by this point and she wasn’t dizzy.

But during her recovery (roughly 2 1/5 hrs postpartum), she started bleeding again. Heavy, thick clots.

I got there to find her lying on the floor COVERED in blood. Several large blood clots lay beside her. And she was dizzy. Too dizzy to even sit.

In all my time here in Sudan, this is the first case quite like this. She’d lost at least another 600-800 cc by this point.

Something was keeping her uterus from clamping down on itself, leaving me with few options. There was just one thing left to do -a manual exploration.

(For those who don’t know, this procedure requires me reaching inside the woman’s uterus with my gloved hand and systematically removing anything remaining inside, i.e. placental parts, sequestered clots, etc.)

I hate doing this, but I couldn’t let her bleed to death either. So I readied the room, started more IV fluids, then reached inside her body.

Her screams brought looky-loos (of course), but it couldn’t be helped. She needed to stop bleeding. This was the only way left to do it.

I quickly removed several large clots, then massaged her uterus shut.

Painful? Yes. Anyone who has ever had this procedure knows it’s crazy painful. Some say it’s worse than giving birth.

Effective? Yes. It stopped her bleeding almost immediately.

It took me some time to convince Apiu that I didn’t hate her... and that I wasn’t an evil person determined to cause her endless pain. But I’m not sure she believed me.

“I didn’t want to hurt you, Apiu. I just didn’t want you to bleed to death, either. Can you understand that?” I asked pleadingly.

She just stared at me with hardened eyes. So I continued.

“If I had let you continue to bleed, you would have needed a blood transfusion,” I explained. “This was the only way I know how to help you stay alive...”

More hardened stares coupled with whimpers, but then a slight nod of her head.

Once the pain subsided and the bleeding finally stopped, I think she forgave me. But I’m not sure. She looked at me with fear-tinged suspicion the rest of the night.

But did I care? Not really... I did what I did to save her life. She might not get that now, but I do.

We kept Apiu overnight for observation, but by morning she was strong enough to be discharged. Please pray she regains her strength quickly. Thanks.

Afterward, all I could think of were my midwifery teachers in the Philippines who taught me this procedure. If they could see me now...

To all my teachers at Newlife School of Midwifery: I love you and thank you from the bottom of my heart! This women is well because of the countless hours you spent teaching me. I love and appreciate you ladies so much!

Lord, bless the faithful midwives who worked so hard to teach me these skills. Bless them for their dedication and patience. Help them remember when they are tired and frustrated that their service is quite literally saving lives half way around the world! May they never forget that. Amen.

Car Accident.

2011-12-21T16:14:00.000+03:00

Kuac is in bad shape.

About an hour ago, his ten year old body was struck by a speeding truck, then dragged 40 feet before stopping.

His chin and lower teeth are all but missing; his chest is rubbed three layers raw; and yet he's conscious.

There is a hole from his left molars through his cheek, ending at a stub that used to be an ear.

And both ankles are broken.

Although he's only ten... and in a lot of pain... he still took the time to thank us for saving his life. I mean, come on!

This kid is strong. Remarkably strong.

His family is gathering money for an immediate transport; the police are filling out accidents report forms; and the looky-loos have all come to gawk.

Now that his ankles are braced and his wounds are cleaned, we watch his tiny chest bounce up and down as he breathes, waiting for his transport to Wau.

Like I said... he's in bad shape.

But by God's grace he'll live. Please pray that he does. Thanks.

Clubbed Breech.

2011-12-20T14:02:00.000+03:00

Sunday was a blissful day of rest. After church I napped and read. It was nice not to have any labors to watch or babies to catch for a few hours.

However just before dusk drew an orange cloak across the sky, Tom told me about a woman with premature rupture of membranes who had just arrived. He’d checked on her, but she wasn’t having any contractions yet. What did I want him to do?

Since I was making dinner (and didn’t want to check her myself) we discussed her case briefly and decided to let her go home to labor. She didn’t live far.

Two hours later she was back.

Since Tom was the one who saw her originally he offered to take care of things again. But as I stood there hesitating on whether or not to go help. God pushed me to go.

I changed out of my pajamas, slipped on my shoes, and wandered over.

Akoot was in obvious pain.

As she lay on the bed writhing, she explained the contractions came fast and hard once she got home.

I measured her belly and counted heart tones. She looked small for a term pregnancy. Could she be preterm?

-- “How many months pregnant are you, Akoot?” I asked calmly.
-- “I’m eight.”
-- “Does that include your first month?” I asked knowing that most women don’t count it here.
-- “No. I’m nine months if you count the first month.”
-- “Okay... but your belly is small,” I pointed out between contractions. “Are you sure you’re really nine months?”

(For those midwives out there. She was measuring only 27 cm. And her baby’s heart rate was erratic --lots of variability but within normal range.)

I was about to do a vaginal exam... but quickly realized I didn’t have time. Thick membranes bulged between her legs, revealing a vernix stained fluid beneath.

Birth was imminent.

Instead I called Tom in to assist. If this baby was preterm, I wanted his help to resuscitate.

Tom took a seat in the corner while I told Akoot my concerns.
-- “Akoot, it looks like your baby is coming soon. But I think he might be too small...” She listened carefully to each word.
-- I continued, “If he is very small he might have a hard time breathing. Do you understand?”

I always hesitate in times like these. How much do I explain beforehand? Will telling the mother my doubts cause more fear than necessary? Should I refrain?

In the end, I usually always tell them. Hard truths take time to seep in. But mostly, it’s what I’d want. I’d want to know of problems earlier rather than later.

-- She listened, nodded that she understood, then explained, “I’ve been sick for one month. Very sick.”
-- “What have you been sick with?”
-- “Bloody diarrhea. Chest pain. Fatigue.”
-- “One month?” I asked again, “Why did you wait so long to come for help?”

Flipping through her prenatal book I saw various entries of where she’d sought treatments for various complaints. She’d been treated for a number of ailments, the latest being dysentery. But she’d only had that for 4 days.

In fact, Tom gave her very effective drugs for it earlier in the day.

Pushing her sicknesses aside, I turned my focus to her baby. Whatever the reason, he’d be born very soon.

Looking back at the bulging membranes, I was disturbed to note they had turned from white to black. Not good. Could this be blood?

No time to worry about that. Everything was set up for the birth, so I encouraged Akoot to push.

At first I thought the membrane-covered object was his head... but I was wrong.

Admittedly, I was surprised to see a tiny butt emerge instead. He was coming out breech. And he was in the caul (aka: born in the membrane sac).

When I broke open the membranes, I realized that what I had confused for blood was actually meconium, and I wiped it away.

This breech birth was different however. His legs were jammed tightly against his face, and I couldn’t release them.
    -- Strange.

Akoot continued to push and I called over the wall for Tom to come help.

Something was holding up the delivery of the legs though. So I reached up to draw then out. They wouldn’t budge.

So I pulled harder.

Eventually they came free but then hung awkwardly to the left of his body. Stiff as boards.

Both arms were tucked up close to his head. So, I reached in to release the right one first. It came on the first try. But the left arm wouldn’t bend.
   -- Strange.

I ended up having to deliver his head before his left arm.
        -- Very strange.

Once he was born it became clear he was not preterm. But there were other problems to consider.

His feet were severely clubbed and his knees were locked in straight line. His hips were unbending causing his feet to fall naturally at his chin. When I tried to move them his back arched in pain.

Later we realized his fingers were formed but clenched in boxing fists, impossible to open.

Seeing the confusion on our faces, Akoot tried to understand what was wrong.
-- “Is my baby alive?” she asked eagerly.
-- “Yes. Yes. Your baby is breathing well. And the good news is he is not preterm,” I started.

She nodded and searched my face.
-- I continued, “But there are some unusual things about his legs and hands. You will understand more later. Please don’t worry... I’ll explain it after the placenta is out.”
-- “His legs are bad?” she asked.
-- “Don’t worry. Your baby is doing well. You’ll understand more later.”
She nodded gravely then delivered her placenta.

This is the first time I’ve delivered a baby with clubbing. I wasn’t sure what to say.

I asked her about possible teratogens that may have caused this and she mentioned a fight she had with a family member at 6 months pregnant.
-- “No. That is not the cause. This does not happen at 6 months,” I told her. “This happens before 3 months.”
-- “Oh... well, at 3 months I got injected (vaccinated) by the traveling medical people...”
-- “Do you know what they injected you with?” I asked.
-- “No. They did not tell me.”

Could vaccinations have caused this? I don’t know. I suspect not.

I also asked her if any of her other babies came out breech, and she gawfed.
-- “Ehh..? My baby came out breech?” She asked incredulously.
-- “Yes,” I laughed, “He was born breech. Have any of the others come out this way?”
Shaking her head in disbelief, she looked to her friend for confirmation. They discussed it rapidly in Dinka.

Turning to my translator, I asked him what they were saying.
-- “She says no baby has come out butt first like this. First time.”

She was obviously surprised --almost even more surprised by the birthing position than the clubbing.
-- “Why is she so surprised?” I asked him.

They discussed it with fierce animation, interspersed with laughter, then he turned to me and said, “She says that in the village if her baby had come out with the butt like this they would have forced him back inside and given her lots of alcohol to drink...”
-- “What? .... I mean why?” I stumbled over my questions but smiled at the thought.
-- “They say babies die when born like this one. She is amazed her baby is alive...” he explained.

Only then did it all make sense. Yes. With all the troubles this breech gave me, I think he could very well have died if he wasn’t born at the clinic. He was not an easy birth. And he needed a bit of resuscitation right at the beginning.

When I told Akoot this she nodded enthusiastically, then looked down at her child in wonder.

Over the next day or so, Tom and I helped Akoot understand his problems, start physical therapy, and establish breastfeeding. It was essential to me that Akoot bond as well as she could with him.

He took some time to breastfeed properly but I am happy to report they are both doing well and were discharged this morning.

Tom decided to put casts on his legs to turn his feet outward. Seeing such a tiny tot with casts like this is new to me. It makes me smile.

Please pray for them. I think he might have signs of down’s syndrome as well. Thanks.

Preterm Prayer Project.

2011-12-20T07:36:00.000+03:00

This precious baby girl was born last week. Her mother brought her by for a check up a few days back and I discovered she has lost a lot of weight since birth.

Right now she's only 1.1 kg.

Her mom assures me that she is eating well. And her vitals are good.

Please pray for her. Pray that she would not only live... but thrive!

Thanks.

The Fantastic Five!

2011-12-19T23:24:00.000+03:00

(Warning: long but fun stories... grab a cup of coffee and get comfortable. It’s gonna take awhile.)

I arrived in Sudan after a long but uneventful flight to find Margaret elbow deep in a twin birth. Her wry smile couldn’t hide the frazzled look underneath.

-- “Have you been busy, Margaret?” I asked already sure of the answer.
-- “Yes, it’s been crazy. I’ve delivered 6 babies in the last week. Two sets of twins, two preterm and oh... by the way, the first set of twins were preterm and both died.”

She went on to explain some of the strange cases that had filled her days then asked, “Where are all these women coming from?”

I smiled knowingly. I knew Christmas would be a busy time. It’s simple math.

Just count back 9 months and you’ll see what I mean.

November, October.... skip a few.... July, June... keep going... May and April, then March!

March was a big month for South Sudan. Men journeyed here from far and wide to vote on the referendum. Every vote counted. A country’s future was at stake!

But while they were here... they made sure they did their part to populate this great country!

Thus the birthing surge.

So when I got the call the following morning that a woman was in labor, I smiled and marched over to the clinic. I walked in to find a huge smile on a very familiar face!

Rebecca used to work for us as a translator but quit shortly after getting pregnant. She has a happy laugh and playful spirit, and now she was in labor!

Rebecca and her son.

Although she was still very early, she insisted on staying at the clinic. I didn’t argue. If she was happy to labor here, I was happy to have her.

But morning melted into afternoon which faded into dusk, before her contractions picked up any speed. But by nightfall her labor was well under way. And by 1 a.m. she was fully.

But pushing wasn’t going well. She had pushed for an hour with very slow progress.

-- “You need to push harder than that, Rebecca, if you want your baby to come out,” I urged.
-- “I’m pushing... but I’m afraid,” she finally confessed.
-- “What makes you afraid?” I asked.
-- “I’m too small down there. My baby won’t come out,” she stated flatly.
-- “... but you’ve seen how this works. You know your body can open, don’t you?
-- “Yes. I know. I’ve seen it. But... I’m too small,” she argued, “I’m just too small.”
-- “You are not too small, my dear. Just push and you will see. Just push harder,” I pleaded.

Another hour went by.

As the minutes ticked past, I worried. How long should I let this go on before I get tough with her? Was the vacuum in order?

I chased away each worry with the facts. The baby was doing well. She was still strong. There was progress.

Even though it was slower than I liked, nevertheless, there was progress.

It’s moments like these that I wouldn’t mind having a midwife of my own.... You know, someone to remind me to be patient. Someone to speak encouraging words in my ear. “Don’t push her until she’s ready. Trust the process. Know when NOT to interfere...”

So I prayed about it and God assured me things would be fine. So I sat on my hands and waited.

Then all of the sudden, her pushing changed and she gave it her all; within minutes her boy was in my hands!

After the birth, Rebecca fell asleep as soon as she could with her boy snuggled close to her chest.

Equally tired, I tried to follow her example. But sleep evaded me for several more hours. By 5 am I finally dozed off.

Two hours later there was a loud knock at my door.
-- “Ma’m Akuac. There is a woman in labor.”
-- “Is she pushing?” I asked scratching the sleep from my eyes. (I always ask this so I know how fast to get dressed.)
-- “No, but her contractions are very fast...” he explained.
-- “Okay. I’ll be there in a minute.”

I arrived to find her squatting in the middle of the room.... pushing.

Glancing quickly at her book, I learned her name.
-- “Yar, do you need to push?” I asked.
-- “Yes. Yes. Baby is coming...” Her hurried voice was all I needed to hear.

I signaled for my translator to get the room ready for the birth while I did a quick vaginal exam. Sure enough, not only was she was fully, she was at a +3 station.

Yar and her daughter.

She paused long enough for me to get a pad under her butt. Then her mother came in to help hold her shoulders down while she pushed in a semi-squat.

This is a typical birthing position for the women here. It provides counter pressure for them to push against.

And boy did she push!

She pushed so hard that when her baby finally crossed the finish line, it stormed the judges, stole the gold medallion, and ran off with it!

Honestly had I turned away for a second, her baby would have hit the ground hard enough to bruise.
        -- Impressive!

Once she was cleaned up and ready to transfer to the postpartum room, my translator informed me there was another labor waiting outside.

She’d been there awhile in fact. Over an hour.

I invited her inside with an apologetic smile, and she smiled back. Her name was Mary and she was expecting her 7th baby.

She was calm and relaxed, so it came as a surprise that she was already 9 cm dilated. But since she wasn’t quite ready to push, I asked her to walk a bit. She happily complied.

Meanwhile another woman showed up in labor.

I asked Tom to check her in because I was feeling spread a little too thin. He screened her but found her to be having braxton-hicks contractions and sent her home.

A few minutes later, Mary started getting grunty and waddled back into the clinic. She tried to urinate in the chamber pot (aka: big wooded bucket with a toilet seat), but got nothing.

Then she started pushing while still on the pot.

All of a sudden her eyes flew wide and I instantly knew it was time. The problem was... my translator was off getting tea.

I tried to get her to a better position --as the chamber pot isn’t ideal for maneuvering-- but she couldn’t move. So instead I reached low and steadied her baby’s head as it eased out. Her little girl was born with one push!

Having no where else to place the tot, I slip her into her mother’s waiting arms and we laughed.                        --Priceless.

When my translator arrived with the tea a few minutes later. He couldn’t believe he’d missed the birth. He was only gone a few minutes!

Apologizing nervously, he kept asking what I needed and what he should do.

He’s new to the whole birth scene and had never seen a woman give birth on the toilet before. It was my first toilet birth as well.
   --I confess. I liked the easy clean up!

Mary got off the toilet to deliver her placenta, then sat down on the floor to breastfeed. As I was charting and monitoring her blood loss, one of the compound workers interrupted to say another labor was on her way.

Apparently this woman’s family had called for the ambulance. They had just gone to pick her up and I could hear the sirens wailing off in the distance. So we scrambled to set up the next room for her birth.

Mary smiled knowingly as I excused myself to go help.


Mary with her daughter.

The next labor stepped out of the ambulance gingerly. She moaned non-stop as we walked her to the birth room, peppering her with questions.

How long had she been in labor? Had the water come out? Had she been pushing at home? How many babies did she have.... oh, and by the way... what was her name?

-- “Akuch. My name is Akuch,” she whispered between contractions.
-- “Okay. How long have you been pushing?
-- “Five hours.”
-- “You’ve been pushing for 5 hours at home?” I repeated incredulously.
-- “Yes,” she moaned. Another contraction hit.

We soon learned that she was expecting her 5th child, had been in labor since dawn but started pushing from the very first contraction. She couldn’t explain why. No water had come out.

All her vitals were normal except she was in obvious distress. Was it fear?

After assessing her and finding her dilated to only 5 cm, I reassured her all was fine. With time I convinced her to walk around a bit, strictly forbidding her to push.

She promised she wouldn’t and wandered off with her sister.

By this time Mary --the previous birth-- had moved to the postpartum room and we cleaned up the main birth room.

I was about to go rest as well when one of the translators rushed in to tell me Akuch was pushing outside.

He’s the excitable kind but rarely wrong, so I went to check on her.

I found Akuch surrounded by three family members, all trying to hold her upright as she strained to push her baby out.

-- “Akuch, please stop. You are not ready to give birth,” I argued.
She trembled and grunted in response.

My translator informed me her water broke, and I looked down to see a steady flow of fluid running down her leg. As another contraction rolled across her body, she fell to her knees and pushed like mad.

-- “Akuch. Don’t push. Don’t push...” But my words were white noise in her transitional state.

After her contraction faded, I picked her up out of the dirt and walked her back to the clinic.
--Could she really be fully after only 15 minutes?

Akuch and her daughter.

She lay down on the bed for me to get a better look... and lo and behold the head was visible! We had just enough time to put an under pad beneath her before her little girl was born.

As I wiped her baby off, several family members smiled at us through the screened window; a few more peaked past the sheet we use as a door.
--Wow! ... I mean wozers! I mean gosh-golly-gee...

Four babies before lunch. Now that’s a record!

Tom kindly offered to take over any other births that might come in so I could get some shut eye, but naps don’t come easily to me these days. I tried and tried to sleep but I couldn’t.

By 2 pm I headed back to the clinic only to find another big-bellied mamacita pacing the grounds. Her name was Agum.

-- “Tom, do we have another labor,” I asked not wanting to know the answer.
-- “Yep, but she’s only 3 cm dilated. Don’t ya worry ‘bout her,” he quipped, “I got her covered.”

Covered? I didn’t doubt him for a second, but he looked pretty busy. He kept bouncing back and forth between a very sick man with malaria (who incidentally bit him in the butt while he inserted an IV) and another patient with massive road-rash from a recent motor accident.

Since I was more or less rested by this point, I assured him I’d look after Agum.

As the sun dipped low on the horizon, Agum got a bit more active. Her contractions were regular but unimpressively short. Was she progressing? I couldn’t tell.

Nevertheless, a few hours later she was sweating profusely.
--Could she be in transition?

Not wanting to do a vaginal exam, I waited and watched. Her contractions were still very short.

At one point, I left to grab a cup of coffee; my lack of sleep was starting to take its toll. When I returned, I crossed a friend of hers in the hall. She motioned frantically for me to go inside but didn’t say a word.

Agum holding her son.

I entered to find Agum lying on her side, soaked from the waist down. Her water had broken.

Knowing the drill, I readied the room and checked for progress. I was considering doing a vaginal exam, but didn’t need to. The head was visible.

She pushed with her next contraction and out slid a very handsome boy with a very happy cry.
--Woohoo!

After dinner, I didn’t linger long. Tom promised to look out for any labors or births in the night --Bless his heart!-- and I hit my bed like a rock.

There was in fact another labor that night... but Tom delivered her. I’m told she gave birth around 2 am. I was called to come if I wanted to, but I declined. I had nothing left to prove.

Five babies in one day! That’s a record for this midwife.

I wonder how many babies will be born this month...

Please pray for strong hands and deep sleep... when we can get it! Thanks.

Labor of Love ~ Nov & Dec 2011

2011-12-14T17:01:00.001+03:00

Labor of Love Newsletter Nov & Dec 2011

Swiss Delights.

2011-12-04T22:09:00.001+03:00

My first stop in Switzerland landed me in a stone railway station with arching windows and dozens of suitcases marching about like ants.

My train arrived two hours earlier than expected, and I wasn’t sure how to reach my friend. But since I was no longer in Europe (Switzerland opted out of the European Community years ago), I had to exchange some money and find a phone.

But once again I was in Swiss-German territory. Who would understand me?

If I had paid better attention in geography class, I would have known I could speak French to the locals but I didn’t. Instead I blabbered away in English.

Bea and Me in Basel.

It wasn’t until much later that I learned that Basel --Switzerland’s third largest city-- marks the spot where France, Germany, and Switzerland meet. As a result its locals are quite fluent in all three languages.

With time I found a phone, called my friend, and arranged where to meet. My dear friend and fellow Newlife graduate, Bèa, met me at the tram station with warm hugs; we dropped off my bags and immediately headed into the city center.

Basel has a beauty and tranquility that is hard to describe; its rich past bleeds through picturesque views of the Rhine; its worn, cobblestone steps hint at an antiquity full of lore.

We only had a few hours to catch up, so we set out at it with gusto. Bèa and I laughed and reminisced over pasta and pizza, then I sent her off to work while I tumbled into bed. She works nights.

The next morning, I climbed back aboard a train for Zurich where another Newlife graduate, Medea, met me with her 9-month-old belly. She’s due any day!

Meda and Andre near Zurich.

Together we laughed, took pictures, crocheted, and ate our way through her house. I kept hoping she’d deliver while I was there... but it didn’t happen.

Our time together was blissfully restful though, and I’ve come to realize that weary travelers and term preggos need about the same number of naps each day! --I love naps!

The following day after visiting another amazing Christmas market in Zurich, I caught the last train of my trip.

Now I sit at my sister’s house in Geneva, sipping on my forth cup of coffee and listening to the house wake up on this sleepy Sunday morning.

An fun handmade Advent calender.

I love my sister and her family so much. What a blessing to come to a home where hugs are meted out liberally, and the conversation bounces from French to English in the blink of an eye.

Their home is laughter and joy, warmth and love. Thank you Jesus for giving me such a wonderful family and so many extraordinary friends! I’m blessed... so very blessed.

Next stop... Kenya.

I fly out in the morning. Please pray for traveling mercies. Thanks.

Hamburg.

2011-12-03T14:27:00.001+03:00

I arrived in Hamburg as the sun was westering low on the horizon introducing me to a cold I’d long forgotten after my years in the tropics.

The sun set around 4 pm casting a pale gray over the city like a thread-bare shawl, allowing the unfamiliar chill to soak into my bones. But despite the frigid air, I was greeted with warm hugs and laughter as my friend, Stefanie, welcomed me to the city of her youth.

Stefanie and I first met over ten years ago when we both lived in Spain. We’ve kept in touch over the years, seeing each other as time and distance permits. Reconnecting with her after all this time was like stepping back in time.

The day I arrived, Stefanie still had a few hours to work; so I walked around the city. Once she got off, she drove me back to her place where I met her husband for the first time and got a better look at her pregnant belly.

She lives on a beautiful suburban street, but one that is still marked with war relics. Tucked between the off-white apartment buildings and mini-vans, sits a WWII bomb shelter. Gray and solid, it blends into all the other buildings on the street except for one thing --it’s windowless.

A square rock. A symbol of refuge. A fortress too strong to destroy.

Apparently dozens of such buildings dot the city. They were built to withstand direct bombs; they were built to last. Today, they serve no purpose... but are too expensive to dismantle.

A symbol of an era. An unmarked tombstone of the realities of war.

Each time I passed it, images of frightened children and trembling mothers flashed through my mind. What was it like to run for its shelter as the sirens wailed? Did its walls shake as they slept through the bombs? What did they wake to find the next morning?

But my mind did not stray too long on such thoughts. Seventy years have effectively hid the scars of war beneath towering trees and neatly trimmed gardens.

Stefanie took the day off to show me around town, so we toured the city on bikes.

As we sped along the Upper Alster’s shores, Hamburg’s beauty unfolded before us. The skyline of boat sails and church spires spread from East to West.

Taking it in while dodging joggers and mutts dressed in tiny coats, proved to be challenging but totally worth it. The twenty-minute ride downtown was one of the most picturesque of my entire trip. We crossed canals, weaved through parks, and meandered along river shores.

When we reached the city center we wandered through various Christmas markets and caught up on the details of life. But by 3:30 pm the sun was already starting to fade; we had to head home or risk colder degrees.

Later that night Stefanie had a swimming class, so she suggested I join her but go to the thermal bath part. I happily agreed forgetting that nothing in the building would be in English.

It was challenging not having my translator with me. Which bathroom was female? Was this the woman’s changing locker or the men’s? I hesitated, chose a door, held my breath, and entered. I sighed audibly to learn I’d guessed right and put on my swimsuit.

I had to ask a handful of people before I found an English speaker who could tell me where the steam baths were. But when I did, I happily flipped-flopped my way toward them and sat down.

Once inside I was surprised to learn they add special aromas to them --chamomile and camphor. As I breathed in their essences I could feel my body relaxing on a cellular level.

Afterward I returned to the pool for the jet streams which massaged my back. Then I saw a door with ‘Sauna’ written clearly next to it. It was the only word I understood, so I pushed open the door and entered. Suddenly 120 degrees of heat engulfed me, drawing me in like a hug. I breathed in shallow gasps and lay down, remembering Sudan.

A few minutes later two naked men entered and sat down.

I sat up in surprise and asked in English (the only language I could muster):
--“Is this the men’s sauna?”
The men hesitated in this foreign tongue, exchanged glances, but eventually answered me.
--“No. This is mixed sauna,” one stuttered in a stilted accent.
--“Really?” I asked trying to hide my shock, “Men and women share the saunas here?”
--“Yes.” More hesitant glances.
--“Oh,” I said flushing in confusion and lay back down.

But my mind could no longer relax; it raced round and round.
--Am I allowed to wear my bathing suit in here? I’m not about to strip naked... so why did I care? Were these guys as uncomfortable as I was...? What’s the big deal? It’s only naked men...

As a third naked man entered I closed my eyes tighter and concentrated on my breathing.
--What made white naked men any different than black naked men that I might see in Sudan?

But I couldn’t relax anymore; my skin was red as much from the blushing as the heat. So I decided to head back to the pool and leave the mixed saunas to the Germans.

Later when I shared my culture shock with my friend she laughed and reminded me that “this is Germany. People don’t worry about being naked here.”

I laughed with her.
--Yes. Clearly they don’t care at all!

Next on the agenda... Switzerland!

Winterzauber Wonders!

2011-12-01T16:40:00.001+03:00

With the crisp zing of winter come holiday traditions and flavors --and in Germany that means glühwein, poffertjes, and kartoffelpuffer. I was delighted to discover these treats for the first time at various Christkindmärkte (aka: Christmas Markets).

Glühwein and Feuerzangenbowle are both different kinds of spiced wine. The glühwein can be served with an extra shot of liquor --Amaretto, Calvados, or the like -- but it is lovely without it.

The Feuerzangenbowle, I’m told, has a stronger flavor since it’s made by pouring the heated wine through a funnel of crystallized sugar, infusing it with a slightly burnt sugar flavor.

Poffertjes are silver-dollar shaped potato pancakes topped with melted butter and copious amounts of powered sugar. Be careful though eating this dessert in the wind! If not you’ll look frosted yourself!

Kartoffelpuffer or what some call Reibekuchen, are deep-fried potato hash. Recipes differ somewhat. Some are made by mixing grated potatoes in batter and others are just potatoes hammered flat and cooked to a crisp. Either way, they are served with slightly sweetened apple sauce.

My favorite winterfest treat though had to be the cheese filled sausage, käsekrainer. It had to be folded in half to fit the bun! It’s sweet yet spicy flavor burst out in every bite! (I didn't get a picture of the sausage... I ate it too fast. Ha!)

Whether deep-fried, dusted in sugar, or oozing cheese, it’s delicious! Germans certainly know how to celebrate Christmas!

A Tale of Three Cities.

2011-12-01T00:10:00.001+03:00

I woke up in Paris, stiff from the sleepless night train but excited to gaze once again on the city I love. Paris is different than the rest of France; it has a rhythm all its own.

Its splendor is found as much in the smoke-filled cafés with whirring espresso machines and buttery croissants as in the primped poodles leashed and parading down the promenade. Walking through Paris is akin to walking into a Renoir or Pissarro painting.

Paris is living art. Paris is art in life. Paris is the art of living.

But my goal in coming was not to see L’Arc de Triomphe or Le Tour d’Effel but to reconnect with my friend and his family.

I first met Steven at my first job in the States when I was still a zit-popping, overly opinionated, punk teenager. Since he had grown up in France as a missionary kid and I had just come back from France... we had lots to talk about. Admittedly, I did most of the talking.

Steven with his children.

He was one of the first Christians I’d ever met that I didn’t hate on the spot. His quiet and gentle witness had a powerful impact on me, and even though I would not confess Christ for several more years, I have never forgotten the ways God used him at that time in my life. Seeing him again after all this time has been a real treat.

Since I arrived on a weekday, he took the day off to show me around. But instead we spent the day eating and catching up. But just as before I did most of the talking. He is a gifted counselor, dropping jewels of wisdom into my chaos and pain. Plus, he worked two years in Africa and could truly understand the intricacies of life there. What a blessing to have such a friend!

Steven and Karine, his wife.

Later that day I got to meet his children and catch up with his wife, Karine. I’m thrilled to see how God has blessed him and to know that he is doing so well.

But the next morning I was on a train again. I slept my way through Belgium, markedly achy from my ever constant journey. Fortunately by the time I landed in Germany I was renewed. A dear friend I met in the Philippines greeted me with such warmth the blistery winter’s day seemed like summer.

Kirsten and I laughed the night away, catching up on the details of life. Although we intended to go out and get to know her home town a bit, we ended up too engrossed in conversation to bother. Instead we talked until our eyelids drooped. What a joy to see her again!

Kirsten and me in Essen.

Early the next morning I was once again on a train --but this time heading to Berlin. Although it’s the first time I’ve visited this historic city, I wasn’t coming as a tourist. I came to meet a friend for the first time.

A while back a sweet German midwifery student named Ann-Jule contacted me on my blog. Her sweet encouragements have always been timely and Spirit filled; I needed to meet her.

When I told her I’d be coming her way, we arranged to meet in person. And although we are relative strangers, it didn’t feel that way. As we talked over a breakfast of ham, cheese, and creamy meat-salads, I was surprised to learn how similar our lives have been.

Ann-Jule and me in Berlin.

And later that evening she invited another midwifery student in her class for a classic German meal called Rollade and dumplings! We again spent the night chatting about all things birth and missions. What a blessing to make these new friends!

Now I’m on another train. This one takes me North to the city of Hamburg where I will meet up with Stefanie, a sweet friend I’ve known since my life in Spain.

Reconnecting with all these friends has been so... healing and restorative. I thank God for them.

Thank you for praying for me as I travel. My journeys are sometimes long but always worth it. I still have another three cities to visit this week. Please keep praying as God might lead. Thank you.

Night Train.

2011-11-27T20:18:00.001+03:00

Because I am a bit of a last-minute-lucy when it comes to catching trains, I had to eat my dinner in the dining car as we chugged along from Pamplona to Paris. My toasted sandwich of Camembert and Jamón Serrano was the perfect end to a perfect stay in Spain.

The dining car attracted other hungry, road-weary travelers; but once fed, easy laughter filled the room. A retired couple from Ireland regaled us with happy tales of their traveling woes. A young environmentalist with a lip ring joined in; her slight Spanish lisp was the only hint of her origin as we discussed the intricacies of her doctorate studies. Further down the bar, a long-haired Londoner and a timid Dutchman added their voices to the cacophony of laughter until I almost forgot to sleep.

When I returned to the cabin hours later the other ladies were already tucked in.

Before boarding the train, I had decided to indulge in a couchette (or bed) for the 13 hour trek. My previous night train experience in a reclining seat had left me exhausted.

Would a couchette provide the elusive sleep, I wondered. Well, it couldn’t hurt it.

When I first boarded the train, I met the three other ladies in my cabin --two doe-eyed American girls fresh out of University on a summer trip around Europe and a small entrepreneurial African woman from the Ivory Coast with more suitcases than space to put them.

The Americans were curiously timid; but the African was anything but! She oozed the familiar African warmth to the room, filling it to overflowing with laughter and noise. The Americans looked on her steady stream of accented French in amused confusion. They knew they were suppose to laugh but they couldn’t figure out why. What was the punch line?

I had to translate.

She repeated over and over again the outrageous misadventures of other night trains she’d endured. To her it was scandalous that the Italians allowed men and women to share cabins. It wasn’t so much the fact they were men... but when they took off their shoes you had to evacuate the room!

She attacked all topics with similar zest and humor making the small cabin large as a Broadway stage. Mixing blood-curdling tails of civic unrest in her beloved land with an uproarious re-enactment of a sleepless night due to a corpulent snorer she didn’t have the guts to kill in her sleep... although the thought crossed her mind after 8 hours of pitiless suffering.

Did any of us snore she asked?

We laughed politely and exchanged glances. Unsure if she was capable of killing us in our sleep if we dared to admit to such a crime, we quickly assured her that we were in a no-snore-zone.

She wasn’t the only one to sigh of relief at the happy news.

So later that night when I climbed into bed, I was rocked to sleep with only the sound of wheels grinding steel rails.

Admittedly, I did not find the sleep I hoped for... but at least it wasn’t due to any snorers.

Retiro Retreat.

2011-11-24T19:12:00.001+03:00

In the middle of Madrid sits a well manicured park called Retiro (which in Spanish means ‘retreat’). It’s several blocks long with a duck-filled lake in the center. On any given day dozens of love birds can be seen paddling out on this lake in rented boats, drinking up the beauty.

Each season of the year the park is beautiful, but the Fall brings a vibrant softness to it that is absolutely breathtaking.

As I strolled through its trimmed hedges, crunching orange leaves under my steps, my heart beat a little slower; my breathing slowed as well. The park lives up to its name. It’s a true retreat!

Among the sporadic joggers and baby strollers, sat gray-haired men in wrinkled suits reading the newspaper.

Crisp November light filtered through the autumn trees. Dogs ran and barked. Pigeons cooed and whirred.

On this particular day, one side of the lake was being used to film a movie. Actors dressed in vintage clothing stood by idly while a beauty in a green hat rehearsed her lines. What film was it? I didn’t ask. Who were these stars? I didn’t recognize them. But it was fun nevertheless to watch the cameras roll and the paparazzi clicked off picture after picture.

As I moved on through the park I found a smaller pond with black swans swimming to the jazzy tunes of off-key trumpet players. Beside them sat a Mexican artist selling jewelry. His stuff was lovely but not to my taste; it was all too bulky.

Nevertheless, I wanted to buy something to remember this day and I hesitated over a ring. As we chatted, I complained my fingers were too big and he offered to make me a ring to order. I loved this idea and promptly drew out a design I had in my head. Five minutes later, this creative man made it into a reality.

The Mexican artist who made my ring.

I waved goodbye and headed off happily to eat on the monument steps. My sandwich was great but my cake attracted wildlife. A dozen sparrows and one shy pigeon approached cautiously to see if I would share.

They were so familiar with humans I was able to feed them by hand. Watching them perch on my fingertips to get more cake was delightful. But once it was gone, they were not nearly as interested in my apple.

In the end I didn’t stay long; the afternoon shadows were growing long.

So, I gathered my coat and bags and headed for the metro only to meet up with a handful of squirrels. Some were as friendly as the sparrows and sauntered right up to my toes in search of goodies.

One little fellow was particularly bold and after sizing me up decided to climb my leg. He clung to my jeans with determination while fixing his hazel-brown eyes squarely on mine. When he saw no nuts, he ran away as fast as he’d come.

The day in the park was wonderfully restful. What an excellent retreat!

And tonight I take the night train to Paris. Pray I have no snorers on my wagon! Thanks.

Viva Espagña!

2011-11-24T17:54:00.001+03:00

Over the years many people have asked me of all the countries I’ve lived in which did I prefer. And always --without even the slightest hesitation-- I throw my arms in the air and shout “ESPAGNE!” This surprises most and they tend to ask why.

Estban and me enjoying tapas.

Why Spain?

Could it be the oaky wines and cured Manchego cheese?
           -- Maybe.
Could it be the ready smiles and loud greetings in the streets, the metros, the shops?      -- It very well could be.
Could it be the warmth with which the Spanish embrace life and family?
           -- Yes. That’s it.

But it’s more than that. Much more.

It’s the gray-headed men in slippers reading El Pais on a Tuesday mid-morning park bench. It’s the mothers strolling their newborns down the promenade at 2 in the morning for a little outing. It’s the passion with which futbol is discussed over café con leche and pan dulce.

Spain.

Flashbacks of sagebrush swept deserts and white sandy beaches flood my mind. The shrill laughter of children running in sleepy village streets still echo in my ears. Smokey pubs filled with suits and scarves screaming over bad 90’s music for their friends to order another round of tapas and vino.

This is Spain. And I love it.

Twice this week I’ve enjoyed the fun of friends in tapas bars. What a treat! Here are a few tapas we ordered. Yum!

Mojama de Atun


Chorizo de no se que...

There were other kinds of tapas... but I ate them up before I remembered to take a picture! Ha!

Thanksgiving Impromptu.

2011-11-24T17:37:00.001+03:00

This holiday week I find myself in Spain --lovely Spain.

Before coming I daydreamed about making a fancy Thanksgiving meal for my Madrileno friends. But as can be expected, I had no way of planning such an event while in transit.

So I resigned myself to a non-thanksgiving day. However, Tuesday morning I woke at my friend’s house to find myself with more than enough time to cook. I just needed to make sure they were willing to eat! --It wasn’t a hard sell.

And a few hours later the three of us sat down to a turkey meal and laughed the night away.

I am so thankful for my friends all over the world. I’m so thankful for my family both far and wide. I’m so thankful for a day to stop and remember all of God’s blessings to us!

So to all those States-side (or elsewhere in the world) cooking pies and whipping up mashed potatoes today... here’s a quick shout out from Spain.

HAPPY THANKSGIVING!

Fun little fact:
The word for ‘Thankful’ in Hebrew is yadah (pronounced: yä dä) which comes from the root word meaning to throw, cast, or shoot.

Enter His gates with thanksgiving and into his courts with praise:
be thankful unto Him, and bless His name.
--Psalm 100:4

As I read this verse I imagine believers throwing praises to God, casting love His way, and shooting darts of thankfulness to Him. Shout, O’ Nations! Shout out your thanks to Him alone. For He blesses and blesses and blesses again!

What Accent?

2011-11-22T14:57:00.001+03:00

My time in France was short but wonderful. But then again, it’s always wonderful to be in a country that values cheese so much.

Tome de chèvre! Gruyère! Roquefort!
-- Delicious.

But more than anything it’s a country and a people that are dear to my heart. I love their wild hair and ‘go-get-stuffed’ attitude. I admire their passion for food, friends, and foreign policy --typically in that order. I chuckle as I hear them ‘râlent’ (pronounced rah-LE) at the smallest inconvenience; it’s the soundtrack of France.

France understands me... never mind the accent!

And despite my foreign passport a few years back, dear friends made me a little bit more French by naming me “maraine” (aka: godmother) of their brown-eyed babe.

My dear friends, Luc & Estelle with my godson, Manoh!

He’s also dear to my heart and I had to go see him... and them, of course! This took me on a quick stop to the French Riviera.

Le Côte D’Azur (as the French call it) is miles of stoney beaches lined in pink plastered hotels selling beach chairs and overpriced lobsters. Year round beautiful people come to walk the promenade and gaze upon other beautiful people.

Basically it’s a mini-California... but with really great cheese!

Honestly Le Côte hasn’t changed much over the years. There is still a delicate taste of salt in the air and unseasonably warm breezes that envelop you in whiffs of bougainvillea and rosemary.

I remember this smell well as I lived on the coast almost 10 years ago while working with a church called Calvary Chapel Nice. Although I stayed just 9 months, they are months of powerful memories and experiences.

Pastors of CCNice, Pierre and Nancy Petrignani

And this weekend I was able to go back and reconnect with many of them. What a blessing to see all that God has been doing in and through them. It was startling to see how much had changed... but also what has not.

What a blessing to have been able to catch up with such great friends... and reminisce!

If you want the translation, look up Revelation 8:4

Next stop... Spain.

Milanese Charm

2011-11-19T21:18:00.001+03:00

My wonderful French parents!

As many of you may have guessed by now, I’m on break. I’ve decided to take this break in Europe again to catch up with old (and new) friends.

I started my journey in Italy where my French parents and I traipsed through the cobblestone streets of Milan looking for the Scala theater and the Duomo cathedral.

The Scala is one of Europe’s oldest opera theaters. Its crimson cushioned seats stack in a neat half-circle facing the stage. Its halls have heard the world’s finest voices; the echo of their memory hangs in the air.

The Scala theater.

Although we were unable to get tickets to see a show, we were able to enjoy its museum where Lizt’s piano sits next to a bust of Rossini and a portrait of Callas hangs beside encased props from operas gone by.

The Duomo cathedral.

The Duomo is a neo-gothic cathedral that took several hundred years to build. They started it in the 1300s but never really declared it finished. With reportedly over 3400 statutes and roughly 200 spires, this cathedral stands out as a modern beauty. Remarkably it has all of its original stain-glass work and its rose-tinted marble facade has recently been scrubbed.

We were able to climb the 250 stairs to the marbled rooftop and gaze out over the city. Its rosy glow at sunset took my breath away.

Italy --this enchanting land of miniscule espressos and parmesan-drenched pasta!-- this mystic city of bustling fog-coated fashionistas!-- this modern beauty rooted firmly in the past!

How to describe her elegance and charm?

Milan --though once famous for her music and art-- is now mostly known for her fashion. Large windows with sharply dressed mannequins line the streets. Clothed in intricately-knit wool dresses too fine to wear, these muted ladies stare on.

Oddly enough in Italy as winter fast approaches, fashionistas have painted themselves in dreariness. Everywhere I looked, blacks and browns in over-sized sunglasses stomped through the streets. A quick turn of the head and a sea of charcoal grays undulated past.

Before living in the wild yellows and florescent greens of Africa, I never realized the bleak palate of Europe’s most chic. What of color and life? What of vibrant patterns and geometric designs?

Gone.

Instead a sorrowful array of muted tones parade through neo-gothic marbled streets while well-worn gargoyles watch on.

These overcast colors need a bit of Sudanese inspiration... or maybe just I do.

Next on the agenda... France!

Maloney Outreach

2011-11-10T17:54:00.000+03:00

Last Friday I was invited on outreach to Maloney --a small cattle camp community lost in the bush.

It’s a 30 minute drive winding past sun-baked fields of brick clay hidden under a fuzzy layer of yellowing grass.

Since the rainy season is over and summer is inching the thermostat skyward, the roads are more than passable; they are concrete hard.

Miles of yellow stretched out before us as we inched along in the ambulance. Deep ruts carved by a smattering of traffic during the wet season still marred the route, making the ride more reminiscent of a roller coaster than a road.

Children waved in enthusiastic surprise as we bounced past. Some leaned against sturdy walking sticks while cattle lowed behind them.

Long-horns sauntered lazily beside us, callously ignoring the beep of our horn. Vultures circled above.

Off in the distance the smoke of burning cow dung hung in the air; its earthy odor wafted passed in the stifling mid-morning heat.

By the time we arrived at the Rual tree which doubles as medical clinic, there were already a dozen patients waiting to be seen.

They sat sprawled out on a green plastic tarp --their books in hand-- and greeted us with welcoming smiles.

We saw roughly 120 patients (one of which was the newborn with tetanus), but only a handful were actually sick.

I enjoyed getting out and seeing the country. It was a beautiful break full of beautiful people.

Funny side note:
One man chatted me up after staring at me all day. He complemented me on my toe nail polish then asked if I wanted to marry him.

My suitor was the one in orange.

Straight and simple. Gotta love that in a proposal.

He didn’t take it too hard when I declined the offer though. Instead he suggested that I must be one of the Catholic-nun-types as he walked away with his buddies.

Oh Sudan!

2.1 equals 1.1

2011-11-07T14:58:00.001+03:00

Yesterday a young girl came for help. Reported to be early in her third trimester, she complained of malaria symptoms. Fever. Chills. Pain.

Margaret saw her and called Dr. Tom to help evaluate. I’m told she was severely pale so they asked our new lab technician, Caroline, to check her hemoglobin.

She had a hb reading of 2.1 g/dl.
--Yes. You read that right. A hemoglobin of 2.1

(For those who don’t know, that reading is crazy low! Normal hb in pregnancy is 11-12 g/dl if you are moderately healthy.)

She needed a blood transfusion.

Remarkably, her baby was still alive. I was told Margaret and Tom were preparing to refer her to Wau for a transfusion while starting aggressive treatment of the cause --malaria.

Since church was starting soon, I decided to visit her after church. But once service ended, Margaret approached me saying she’d delivered.

What? I thought she wasn’t having contractions. When did she deliver?

Apparently in an effort to save her life, her body expelled the child spontaneously. He was born alive but severely preterm weighing just 1.1 kg (or 2.4 lbs).

Once I heard the news I went to check on him. He was breathing well but starting to show signs of distress. His mother looked sad and exhausted.

She explained that all her family was far away or in prison. There was no one left to help her get to Wau for the blood she needs.

Sigh.

With time Dennis was able to start an IV on this precious munchkin and we gave formula through an NG tube. He looked like he wanted to live.

After doing a Ballard’s score (a rating to help determine the gestational age of a newborn), we guess him to be around 31-32 weeks gestation. This explains his ability to breath well but not his size. I believe him to be small for gestational age (SGA) as well. Long term anemia will do that in a pregnancy.

Please pray for them. Her name is Ayen. She is family-less, severely anemic, with a tiny preterm baby. Please pray for God to keep them both healthy and alive. Thanks.

Update: Tetanus

2011-11-07T14:09:00.000+03:00

Last night the little boy with tetanus died. When I heard the news this morning, a muddled wave of grief and relief rolled over me.

All I wanted to do was cry.

I couldn't tell if the tears I kept blinking back were more of thanks (that his suffering had stopped) or remorse (that we were not able to do more for him).

I'm just glad his pain is over.

Although we couldn't save his life, I'm glad he didn't suffer any pain in the end. Please pray for his family --especially his young mom. Thanks.

Baby Teeth.

2011-11-06T02:00:00.000+03:00

Recently our resident doctor has morphed into a dentist. Yep. Dentist.

Saturdays are usually reserved for tooth extractions. And come Saturday morning I can often find Tom --chisel and pliers in hand-- pulling and prodding, coaxing and coercing a tooth free. He’s good at it and his willingness to provide this service has been a huge blessing to the community.

Weekly people come to see if they can be next.

This week however a new dental patient was brought in. She was 5 months old.

Her young mother bounced the effervescent toddler in her arms while pointing to her gums.
--“My baby needs her teeth removed,” she started to explain while rubbing her finger over the toothless gums.
--“I’m sorry I don’t understand,” I hesitated. “You want your baby’s teeth pulled?”
--“She is crying a lot because of her teeth. I want you to remove two on the top and two on the bottom,” she announced.
As I looked in her baby’s mouth, I could see bright pink gums but no tooth sprouts.
--“I’m sorry. But we don’t remove baby teeth at our clinic,” I explained patiently through my translator.

He was having a blast watching the exchange. He likes to laugh at my funny world view. But this time he was laughing at the mom. He thought it was silly of her to want to remove teeth that hadn’t even come in. Unfortunately, this mom did not appreciate his teasing and I asked him to stop.

“Tell her that she can have her baby’s teeth removed if she wants to... but not here. We won’t do that here. God gave her baby teeth for a good reason. Her baby needs them...”

After he translated, the mother smiled politely then answered: “I know your culture is different than ours but here we remove teeth. I did it for my first baby. I’ll do it for her too.”

I nodded that I understood and said, “I know I see things differently than you. You are a good mother and I’m sure you think this is best. But I can safely say our dentist will not agree to take out your girl’s baby teeth. Sorry.”

She nodded and walked off carrying her slobbering, teething toddler in her arms.

I wonder where she’ll get the procedure done. Is that something witch-doctors do? Or is there a local dentist who can cut out unsprouted teeth in toddlers so they won’t fuss?

Sigh.

This does explain why there are so many adults with gapped-toothed smiles around here though.

But hey... maybe they are on to something.

Teething can be troublesome for parents and painful for babies. Why not just pry them out early and get it over with? They’ll get a new set later on anyway, right?

Tetanus.

2011-11-05T09:40:00.000+03:00

Twenty-eight days ago his teenage mother gave birth to him in a mud tukel. Although small, he seemed healthy; but there was a problem. He wouldn’t breastfeed.

So the family walked to town and bought a plastic bottle and baby formula. They poured it down his throat to keep him alive because he wouldn’t suck.

“He cries a lot,” she complained, “and he isn’t passing stool.”

Dennis was the first to see her. After hearing her complaints, he asked me to review the child and see if there was some kind of bowel obstruction. “The babies abdomen seems rigid,” he said.

So I gathered the mother, her parents and a medley of relatives (who needed to watch) into the tan metal container used as a consultation room. We were on outreach caring for the small community of Maloney which is a 30 minute drive from Tonj.

The teenaged mother nervously set her baby down on the table for me to check, but she wouldn’t meet my eyes. She knew something was seriously wrong.

Drawing back the thin sheet which covered his skeletal frame, my eyes widened in surprise.
-- It couldn’t be... No, Lord... Not this.

His umbilical cord was infected. Swollen and cracked, it bulged out menacingly from his taut abdomen. Someone had recently painted it purple with Gentian Violet (a messy but effective disinfectant).

His face --a wrinkled mask of pain-- contorted rigidly. His arm flexed to his chest clenching tight little fists that I couldn’t extend. And his legs stretched ram-rod straight locked in attention but crossed at the ankles.

His boney frame was frozen in a pirouette of pain. I couldn’t touch him without inspiring tiny whimpers. Their feebleness made me want to whimper too.

Tetanus.

Oh, Lord. This child of yours is suffering. Papa, what do we do?

I called for Dennis and he agreed. The boy had tetanus. He asked me to prepare the family to come back to Tonj with us. They would have to go sell a cow so he could get the anti-tetanus serum in Wau... assuming it could be found.

Looking from Dennis to the boy then back to Dennis, my heart sank. His words did not make sense.
--“You mean we are going to take the boy back with us in Tonj?” I asked skeptically.
--“Yes,” he stated softly.
--“But we don’t have any anti-tetanus serum. What can we do for him there?” All hope had left my voice by then.
--“We can ease his pain while the family gathers the money for Wau,” he explained.
--“Oh. But... honestly... do you think there is any hope for this child?” I asked flatly. I didn’t see any hope in his eyes. I didn’t feel any hope in my heart.

He hesitated only momentarily then said, “I have seen babies like this recover...”
--“Yes... but after 28 days?” I worried out loud.
--“Stephanie... the boy is in pain. We must do something for him.”

Only then did my brain and heart connect. Yes. We had the ability to help his pain. Was I really suggesting that we send him home to die? What kind of soulless monster had I become?

This tiny little man was suffering. Imprisoned in spastic muscles and tetanic contractions, his short life had known only pain. We had a way to help. We had a duty to help.

I confess I believe his case to be helpless. I don’t know if I should pray for him to live... or die quickly. All I know is there is a 28 day old boy in our clinic who moans incessantly. All I know is there is a scared teenage mother in our clinic who must watch it. All I know is it hurts to see them suffer... and I want to run away from this hurt.

Lord, please help this family. May your will be done. Amen.

Please pray for us to know how to proceed. Pray. Pray. Pray. Thanks.

Achol’s Journey.

2011-11-04T21:27:00.000+03:00

She walked 5 hours over dusty roads in the heat of the day. She walked carrying a blue plastic bag which held a change of clothes, but no food. She walked in active labor.

40 kilometers.

She arrived after the noise of the day had settled to a low hum with only the bleating goats left to complain at her late arrival.

As I entered the birth room, she flashed a familiar smile my way. I recognized her square jaw and sparkling eyes immediately and we slapped hands in greetings.

It was Achol!

Achol had come for several prenatal checks over the last few months. Her gentle demeanor impressed me, but I never dreamed she’d come to deliver. She lived too far away... or so I thought.

I was happy to be wrong --for there she sat on my prenatal bed with contractions every two minutes.

But she was so calm I was having a hard time believing she was in labor. So I asked if I could do an exam. She agreed with a smile.

When I told her she was fully, her smile deepened touching the corners of her eyes.

It was time!

In fact, the only thing keeping the baby inside was her bag of waters. Did she want me to brake it?

Nodding excitedly, she consented and out gushed a warm wave of amniotic sea. Almost immediately the head dropped lower and she started pushing.

But the funny thing was... she wanted to keep walking.

So I stood aside and watched as she slowly pace the birth room floor. During each contraction she’d bare down for a few seconds then chuckle softly at the pain.

It was mesmerizing.

Pacing then pushing then pacing again, she let her baby settle even lower in her pelvis. But eventually she got tired and eased herself onto the bed with a sigh.

But that didn’t stop her from pushing.

Within minutes a fuzzy head emerged like a winter’s sunrise --calm and quiet and warming to the bone.

When I announced it was a boy, her eyes lit up the room and she asked to hold him. Long joyful minutes passed while she whispered softly in his ear and laughed. I couldn’t help but laugh with her.
--A son!

Her birth was different... but for the longest time I couldn’t figure out why. What had made her birth so different? Was it the joy and trust? No. Was it the intimacy and laughter? No. Those were amazing but not new.

What was it?

Then I looked around the room and it hit me; she was alone.

Not one friend had sneaked into the room during pushing. No one had asked to hold the child. No one had screamed for her to push.

Where was her cheer squad?

When I asked her, she smiled softly and explained that she had had no time to inform them when she got to town. Since she knew she was close, she didn’t want to risk delivering unassisted, therefore she didn’t stop to tell them the news.

But that meant she had no one to goo and gaw over her precious jewel. But more importantly... that mean there was no one to feed her.

Fortunately her family lived just a few minutes away, so we arranged for our health worker to go tell them for her.

He was there and back in a flash, and her family soon followed... bringing with them even more laughter and love!

Thank you Jesus for allowing me the honor of seeing such miracles on a daily basis. Birth... I’m awed at its beauty and mystified by its power. It is one miracle I hope to never fully understand.

The craziness continues.

2011-11-04T08:29:00.000+03:00

So as expected, October was a record breaking month in terms of births for the clinic. In all, 41 women delivered with us and three of those women had twins!

And November is gearing up to be just as busy. The other night, Margaret delivered three babies in about an hour and a half! Wow!!!

If every woman who plans on delivering with us actually shows up, Margaret will be delivering over 30 babies this month. Please pray for her to have the strength for the tasks at hand!

I’m told a volunteer clinical officer is coming to replace me and assist the rest of the staff while I’m on R&R. There is also a lab technician coming for a month. Exciting!

Margaret and the three ladies who delivered!

Please keep the clinic in prayer as God leads. Thanks.

Update: Rape

2011-10-31T02:00:00.000+03:00

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

They also explained that the perpetrator was caught.

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

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

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

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

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

Overdrive.

2011-10-30T15:44:00.000+03:00

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

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

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

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

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

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

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

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

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

Family Tree.

2011-10-30T02:00:00.000+03:00

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

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

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

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

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

I could see the family resemblance.

The Rual tree & its fruit.

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

What was conception like? Was it cross pollination?

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

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

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

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

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

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

I wonder what kind of tree he’ll become.

Rape.

2011-10-24T17:32:00.000+03:00

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

She had been raped.

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

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

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

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

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

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

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

Suffocating Love

2011-10-23T02:00:00.000+03:00

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

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

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

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

What did she see, I wonder.

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

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

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

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

It couldn’t tell if it was working.

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

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

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

But I get ahead of myself.)

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

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

Only then did her closest friends rally.

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

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

She was getting active.

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

I think it was working.

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

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

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

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

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

Yep. It was time.

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

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

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

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

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

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

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

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

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

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

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

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

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

And the pushing... the pushing...

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

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

Prayer Walk

2011-10-22T22:05:00.000+03:00

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

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

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

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

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

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

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

If you’d like to give, click here.

Thank you for helping make this work a reality.

Deep Transverse Arrest

2011-10-22T21:24:00.000+03:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bandl's Ring.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Perhaps not.

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

Boy Oh Boy!

2011-10-20T22:04:00.000+03:00

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

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

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

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

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

This could only mean twins.

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

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

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

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

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

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

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

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

She wasn’t listening.

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

He was born 3 minutes after his brother!

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

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

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

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

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

Thank you Jesus!

Stillbirth.

2011-10-20T16:16:00.000+03:00

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

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

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

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

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

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

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

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

Not 15 minutes later her girl was born!

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

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

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

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

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

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

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

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

He was born pale and limp.

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

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

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

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

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

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

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

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

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

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

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

Quick Note.

2011-10-20T07:18:00.000+03:00

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

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

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

Labor of Love October 2011 ~Newsletter

2011-10-17T10:00:00.000+03:00

Labor of Love Oct 2011

Blue Nile Bombing

2011-10-15T10:18:00.000+03:00

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

Either way, please pray.

Article on the last remaining doctor in the area.

Read and Pray. Thanks.

Concrete?

2011-10-11T22:27:00.000+03:00

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

Let me explain.

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

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

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

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

Donning gloves, I investigated for myself.

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

What in the world?

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

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

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

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

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

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

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

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

Pray for her. Thanks.

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

Baby Season!

2011-10-11T19:20:00.001+03:00

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

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

I'm happy but thankful for the reprieve.

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

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

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

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

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

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

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

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

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

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

My necklace and sweet Giver.

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

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

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

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

Ajok breastfeeding her son.

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

Not 10 minutes later her son was born!

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

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

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

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

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

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

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

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

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

She walked, stomped, sulked, then eventually slept.

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

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

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

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

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

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

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

Hala's precious little girl.

The crowd outside cheered! Hala was amazing!

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

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

Biyana.

2011-10-11T02:00:00.000+03:00

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

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

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

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

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

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

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

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

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

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

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

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

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

My mind just can’t...

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

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

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

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

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

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

Sunday School.

2011-10-10T02:00:00.000+03:00

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

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

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

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

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

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

Month of Madness!

2011-10-09T14:05:00.001+03:00

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

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

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

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

Yesterday one of our ladies delivered twins!

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

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

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

But it gets even better!

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

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

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

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

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

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

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

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

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

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

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

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

Triplet update:

2011-10-04T22:44:00.000+03:00

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

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

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

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

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

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

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

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

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

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

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

Bitter?

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

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

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

Don’t think I won’t...

No seriously. Pray.

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

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

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

Pray as the Lord leads. Thanks.

Millipedes.

2011-10-03T17:59:00.001+03:00

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

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

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

Yesterday it happened to be a 7 inch millipede!

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

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

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

Let’s face it, he’s a boring bug.

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

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

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

Preterm Update:

2011-10-03T14:58:00.000+03:00

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

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

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

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

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

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

Two Liters Too Few.

2011-10-02T10:01:00.002+03:00

Her precious children.

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

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

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

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

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

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

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

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

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

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

Three to be precise.

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

I continued checking her vitals while I waited.

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

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

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

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

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

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

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

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

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

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

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

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

She was unconscious and in shock.

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

Yes. That was clear.

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

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

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

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

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

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

Then the rattled ceased.

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

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

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

Rigor mortis had already set in.

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

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

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

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

Welcome Miss Adorable!

2011-10-01T13:43:00.000+03:00

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

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

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

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

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

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

Taller than the average...

2011-09-30T19:41:00.000+03:00

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

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

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

She was tall. Very tall.

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

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

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

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

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

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

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

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

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

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

He was a big’in!

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

Truly this was his mother’s son!

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

Thanks.

2011-09-30T02:00:00.000+03:00

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

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

Thank you.

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

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

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

Specifically pray if you would...

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

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

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

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

Stillness.

2011-09-29T17:20:00.000+03:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

She didn’t go.

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

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

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

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

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

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

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

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

Two more pushes and he was born.

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

He’d died several days before.

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

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

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

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

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

Storms.

2011-09-27T20:37:00.000+03:00

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

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

We were safe.

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

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

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

She was already 3 cm dilated.

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

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

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

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

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

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

I ran out into the rain.

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

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

She’d delivered without me.

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

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

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

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

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

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

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

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

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

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

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

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

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

Progress.

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

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

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

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

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

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

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

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

He was alive!

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

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

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

Labor of Love Sept 2011 ~Newsletter

2011-09-25T13:46:00.001+03:00

Labor of Love Sept 2011

Katydid.

2011-09-25T12:31:00.000+03:00

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

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

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

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

Beautiful. Intricate.

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

But not before I got a picture.

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

Smooth. Steady. Strong.

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

Any entomologists out there that would disagree?

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

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

Blood.

2011-09-24T14:28:00.000+03:00

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

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

That was two days ago.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

His questions were honest --his pain real.

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

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

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

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

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

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

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

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

He listened carefully. Respectfully. They all did.

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

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

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

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

Uphill Battle.

2011-09-24T10:03:00.000+03:00

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

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

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

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

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

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

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

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

Here’s the rub.

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

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

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

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

Sigh.

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

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

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

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

Had she just come...

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

But if they won’t come...

Sigh.

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

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

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

Nothing is working.

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

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

Heads or Tails?

2011-09-20T20:15:00.000+03:00

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

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

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

She wasn’t.

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

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

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

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

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

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

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

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

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

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

This was too soon; and I told her so.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He weighed 2.4 kg and had the sweetest dimples!

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

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

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

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

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

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

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

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

Hemoglobin.

2011-09-20T17:53:00.000+03:00

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

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

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

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

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

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

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

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

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

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

Regardless, she needs a blood transfusion.

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

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

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

Healing to Thy Bones.

2011-09-20T16:47:00.000+03:00

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

Osteomyelitis.

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

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

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

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

But her eyes gave her away.

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

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

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

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

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

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

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

Yes, again.

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

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

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

Nothing. No one. I thought to myself.

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

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

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

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

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

Please pray with me. Fourteen years is long enough!

Triplet Update:

2011-09-17T17:41:00.002+03:00

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

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

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

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

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

I’m looking forward to that day!

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