Update: Clubbed

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.

A Sudanese Christmas.

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...

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.

Clubbed Breech.

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.