Labor of Love Booklet

   Labor of Love Booklet by  

Baby Maria

Baby Maria is sitting on the bed next to Trish Perkins.

Baby Maria wasn’t an orphan when she came to Maforga --not exactly. Her father is still living, but he’s old. Very old.

A month ago, he brought her swollen body to Roy and Trish and begged them to help. Her mother had just died of AIDS in the village and she was not far behind.

Afflicted with a severe case of kwashiorikor --a form of malnutrition due to protein deficency—she barely moved from the pain in her joints and the swelling in her limbs. It didn’t help any that she was also HIV positive.

When I first met her, she was sitting up and considerably improved. But even though the swelling from the kwashiorikor had subsided, she still struggled to gain weight.

But we were hopeful.

It was hard to tell her age by looking at her though. Had I gone by the look in her eyes, I would have guessed her to be well passed a hundred. But in actuality, she was about 10 months old. The thing was... she weighed little more than a newborn.

Only time would tell if she would improve.

We prayed for her daily while her caregivers pestered her hourly to eat even the smallest of morsels.

I checked on her from time to time. But when I did, I usually found her sleeping. Her eyes closed, her chin tucked, and her twig-like frame lay listlessly on the cot. When I stroked her face, she wouldn’t flinch. When I pressed her hand, she would not make the slightest acknowledgement.

Once she opened her glassy black eyes to look upon her aggressor, but quickly unimpressed she closed them again to rest. What little energy remained was focused on keeping her heart beating... and her lungs full of air.

Day after day, her caregivers spent hours getting her to swallow a few bites of fortified porrige, but even the will to swallow had passed.

She had clearly given up.

Life clung only to the frayed edges of her soul and stirred softly in the ever darkening expression in her eyes. It was clear she was trying to say goodbye.

Everyday she fought a little less. Everyday she drifted a little further away.

Yesterday she died.

Finaly.

Is it wrong of me to feel relieved? Do you think me heartless for it? I’m heartbroken she passed away, but I’m thankful her suffering has ended.

She is the very reason I want to work here –she and her nameless mother.

Why do we have orphans dying of AIDS in Africa? There is no trite and simple answer to that question. There just isn’t.

But roll back the calendar a year and a half to when Maria’s mother first conceived. How much different could her pregnancy and birth have been had she had a midwife to help her in the village? How much healthier could she have been had she taken the retrovirals... or had access to them in the first place?

What if during her birth, her midwife could have reduced the risk of transmission of HIV and Maria had been born free of this corrosive blood sucking virus?

What if... what if...

I’m not saying I have the solution to all the woes of Mozambique. And I’m certainly not saying that I can save them all.

But seriously what is the alternative... to do nothing? –to watch them die slow, emaciated deaths? --to plant their brittle bones in the ground and walk on?

Is that really an alternative?

Please pray with me today. I seriously need your prayers. Right now all the doors seems to be curiously closed to me and what I want to do. Please plead for God to open the doors and grant favor for me to discuss my ideas with the local powers that be.

I need to start somewhere. Why not here?

A Grief Observed.

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.

Neonatal death.

Nyiriak has been coming to prenatals for months. She has probably heard my lecture about the importance of delivering at the clinic a half dozen times at least.

In that lecture, I warn of the high infant and maternal mortality rate in Sudan and how by coming the clinic such losses can be prevented.

Nyiriak listened.

So when she went into labor on Monday, she came to the clinic. Her face shone in health and expectation.

Beautiful.

Expecting her fourth, I didn’t have to do a vaginal exam to know she’d deliver soon; her contractions were well underway. So I got her settled and asked her to call if her water broke or she needed to push.

Her baby was doing well and so was she, so I headed to devotions (we do a staff devotion each morning before the clinic starts). She promised to call me if anything changed.

Twenty minutes later, our guard called saying she was pushing. So I ran.

She was close but not fully dilated when I did a vaginal exam. Her baby’s heart was solid and strong. All was well.

So I called for Sarah to come help. I wanted her to get another ‘catch’ under her belt.

This month we’ve been using her as our pharmacist and she hasn’t been able to help with as many births as we would have liked. She came quickly, gloved up as Nyiriak continued to push.

Once the water ruptured, thick meconium oozed out. Not a good sign. So I got things ready for resuscitation and checked the heart tones once again. They toc-toc-toc-ed happily.

All was well. Or so I thought...

However, once the sweet girl was born she was flat. Sarah and I stimulated her and wiped her down in unison, but she didn’t respond. We cleared her airways, but she didn’t seem to notice.

Limp and growing paler by the second, she didn’t seem to want to live. 

What was wrong?

After a minute or two with no progress, I sent for Margaret, cut the cord and moved her to a table where I could work on her better.

Although we gave oxygen and pumped her heart for her, she didn’t take her first breath for over 10 minutes.

It was hard to watch her limp body turn blue then pink then blue then pink. When she finally breathed on her own, we rejoiced. But it was short lived. Her shallow breaths turned to gasps and her heart rate would plummet within minutes.

Not good.

We bagged her and did chest compressions for an hour and ten minutes in total. She couldn’t maintain her own breathing and died thirty minutes later in her mother’s arms.

Her pale frame lay peacefully as everyone gathered to weep.

I can think of no reason why she couldn’t breathe on her own. She was not premature; she did not appear to have aspirated any meconium; she had no indication of heart trouble antenatally. My best guess is that perhaps her lungs were not fully formed.

As I watched her family weep silently, I wanted to join them but I couldn’t.

I had no tears to offer.

Sure, I was grieving, but I could not seem to find even one tear. Why?

All I know is that this death felt very different than the others. This death was not marred with regrets. I gave my all and so did Nyiriak. In fact, the whole IDAT team worked tirelessly to get her to breathe. But in the end, she died.

Had Nyiriak delivered at home, her little girl would have died instantly. Coming to the clinic, her little girl lived just short of two hours. But they were hours spent fighting for life, giving our best and praying like mad.

I can live with that.

What I’ve learned is that grief is not always displayed with tears and it is somehow easier when not mixed with regret.

Please pray for all those involved in this terrible loss. Thank you.

Paper People.

A shadow of a waif that once was a woman, she wore her dress like a tent. It hung awkwardly on knobby shoulder, attached to rail thin arms. And in those arms, a tiny stick version of a child peaked out at me.

Six months ago, Amon started coughing and couldn’t stop. It got so bad, she explained, that blood came out at times. Each coughing fit shook her slender frame; Wet, deep hacks that bent her in half.         --Tuberculosis.

As I lifted the blanket and touched her baby’s skin, my hand burned with fever. Skin-and-bones set on fire, he weighed just 1.9 kg (4.2 lbs).          --Lord...?

But that was just half the problem. She also reported her uterus was coming out?     --What?

Tom and Benedict took the baby and started an NG tube (naso-gastric tube) to give the child some food and medicine, and Sarah and I took Amon to another room. I had to see for myself what she meant by her ‘uterus coming out’.

Was it prolapsed or inverted? No... it couldn’t be inverted. She’d be in shock... or dead. Right?

She moved with speed but obvious pain. Once on the bed I was able to see the full extent of the protrusion; a third of her uterus was visible. White with a fibrous brown-red patch near one end, it left no doubt; it had prolapsed.        

-- Amon, I need to understand. How long has your uterus been out like this?
-- It happens each time I deliver. It comes out after the baby, I go to the hospital, and the doctor puts it back in.
-- And the coughing?
-- Oh, it’s been six months.
-- And the fever?
-- Since the birth.
-- When was that, exactly?
-- Last month.
-- Last month? Why are you just coming now then?
-- My husband was caring for the cattle. I couldn’t come without him.

Her husband sat in silence as we moved between the rooms starting IVs and taking vitals. He looked like a normal person, thin but strong. But his wife and child looked like paper people --edges torn and wrinkled.

I guess I could have attempted to re-position her uterus. But I’m not ready to do that mentally. I’m not ready to cause her the pain. She’s sick but stable. They are able to make it to Wau; and I’m okay sending them there.

Please pray for them both. Pray for Amon’s tuberculosis and prolapsed uterus. Pray for their son, Dhuony. He’s getting food now, pray that he would survive this month of wasting fevers and pain. 



Post Script: As I finished this post, Tom knocked on my door to tell me the baby had died and they wanted to take Amon home. Her husband explained that he’d bring Amon back tomorrow for the procedure, but tonight she must attend the funeral.

How could I argue? She had waited a month; what was one night going to change? So I prayed for them, then watched them walk out with their precious paper child.

It’s hard for me to understand the nuances of life here. I confess, obligations and protocol surprise me almost daily. Was it truly impossible for her to come without her husband? Did she really have no other choice? I don’t know. I just don’t know.

Please pray she comes back in the morning. Now that there is little chance she’ll go to Wau, I’m ready to try and re-insert her uterus. Pray that it goes well and she’s able to seek treatment for her TB soon. Thanks. 
 
 


Heart-shaped perfection.

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

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

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

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

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

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

Her name was Abuk.

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

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

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

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

This had to be something more. Right?

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

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

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

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

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

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

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

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

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

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

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

I would induce.

While preparing the room, my heart sagged with questions.

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

Understanding never fully came, but her baby did.

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

Weighing just 900 grams, she never tried to breathe.

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

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

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

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

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

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

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

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

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

Culture Gap.

Tradition. Way of life. Cultural taboos.

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

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

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

Rituals. Beliefs. Superstition.

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

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

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

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

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

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

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

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

My heart sank.

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

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

Tradition? Superstition? Cultural taboos?

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

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

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

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

Why did this child die?

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

Let me explain.

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

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

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

This is what Cinteth experienced this week.

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

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

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

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

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

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

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

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

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

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

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

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

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