Preterm Prayer Project.

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.

Twins... but Three!

Madit... Ngor... and lil' Adwel!

Monday was another day of madness at the clinic. Thirty-eight woman lined up like eggs in a carton awaited me, pink prenatal book in hand. 

I gulped and smiled quickly in their direction as I entered the clinic, lifting both hands in greeting as I walked. Some laughed and greeted me in return.

Turning to my translator in mock disbelief I asked how many there were.
“There is many many. I think 38 but others still coming,” he said not hiding the strain in his voice.
“Sounds great,” I volleyed back at him trying to lift his spirits, “Let’s get started.”
                --Thirty-eight? How will I get through so many? 

After teaching them briefly on the importance of coming regularly and delivering at the clinic, I warned them of the evils of malaria. Thirty-eight shiny black faces watched me politely do my schpeal, getting up every now and again to stretch or spit.
               --Do they believe me, Lord?

Afterward, I called in patient after patient, measured bellies, palpated parts, and counted out the steady rhythm of electronic heartbeats.

Sometime midmorning the steady flow of preggos was interrupted by my translator:
 “Excuse mad’am Akuac (my Dinka name) there is a woman outside. She is come for her babies to be check.”
“Did she deliver with us?” I quarried. I tend to only do baby checks if they deliver at the clinic.
“No. She is deliver at home,” he said hesitantly while trying to meet my eyes and adding, “She deliver twins ... but three!” The excitement in his voice bordered on awe.
“Twins but three?” I asked, “Do you mean triplets?”
He nodded.
“Bring me her book.”

He filtered through the masses to get her book while I watched on tip-toes from my screened off window. I couldn’t get a good look because of the throng.

I quickly finished with the lady on my prenatal bed, prayed for her, then sent her on her way.
           --Triplets? Really, Lord? Triplets... and I missed it?

My translator returned with her book and I laughed as I quickly flipped through it.

I had seen her just once. During that prenatal I’d guessed her to be breech with polyhydramnios (aka: an overabundance of amniotic fluid). I also assumed she was term since her fundal height was 37 cm. (For those who don’t know, a fundal height is the size of a woman’s belly in centimeters which helps determine gestational age, etc.)

Not once did I suspect twins... let alone triplets! Ha ha!

Then it was my turn to wade through the crowds.

Three men sat in a row each holding a baby wrapped in various scraps of cloth; they smiled proudly as I lifted the make-shift blankets to glimpse their tiny cargo.

Preterm but apparently strong, I smiled in relief and asked if they had breastfed yet. I was informed that two had sucked just once but the smallest one wouldn’t.

I did a slow survey of the crowd of expectant faces and instantly recognized their mother. Tired and squatting low, she had a belly-band cinching her waist --a dead give-away. (Cultural note: woman wear strips of cloth around their bellies postpartum to help control bleeding.)

“Three?” I asked her with a smile.
She just nodded slowly in response.
“Why didn’t you come to let me help you?”
“I didn’t know I was in labor,” She explained, “I had no pain.”
“Really? No pain?” I asked in surprise. “That’s great!”

The rest of the morning we monitored the babies and got them stable. But other than a weak suck, they were doing well. When I got around to doing a Ballard’s score (aka: a way to determine a preterm baby’s gestational age) they fell into the 33 weeks range. That’s roughly 2 months early.

Their mother, Yar, is young, and this is only her second pregnancy. She’s just barely 20-years-old and now has 4 kids! Pray for her! Pray that she’ll fight to keep these babies well fed and that her milk will gush in!

Also pray for these little ones --they are two boys and a girl.
Boy #1: weighs 1.4 kg (3 lbs) who they’ve named Madit. He’s the oldest.
Boy #2: weighs 1.2 kg (2.6 lbs) who was born second and is named Ngor.
Girl #3: weighs just 1 kg (2.2 lbs) who is the cutest thing ever! She’s named after her grandmother, Adwel.

Please pray that they’ll thrive despite having the cards stacked against them. We know a God who is able to do this and oh so much more! I so desire for them to live!

They are my first triplets; but I especially like them because we share the same birthday! Yep. It was my birthday yesterday. And for it, God sent me twins... but three!

He he he.... best birthday present ever!

Oh... and I did eventually get to the rest of my prenatals. But some of them had to wait, literally all day. I finished seeing them at 6 pm. Yikes!

What a day!

Update: Eye, Preterm

Preterm: 
So Amour came in yesterday with her preterm baby boy for a check-up. Both seemed well at first but then I realized she was showing signs of malaria; it may have caused her preterm labor.

But he was doing well and had actually gained a tiny bit of weight.

The best part was her milk was very well established, and she was no longer complaining "I have no milk."

I was so sick of hearing her say it after the birth that I warned her sternly that if I heard it again I'd charge her 5 pounds each time. She laughed but never said it again.

And during the check-up she told me that she believed me now; she has lots of milk. And she was right it was leaking profusely from her breasts! 

Thank you so much for praying for them. She promises to come back for visits; and I promise to let you know how things go with them.

Eye Team:
The eye surgery team was able to complete 172 cataract surgeries in the 5 days they were here. Some patients even got both eyes done.

On the last day a 31-year-old woman got both eyes corrected. She had not been able to see for several years, meaning she had never seen her youngest child!

Thank you so much for praying for this team. It was a great success, and many heard the gospel; many prayed and sang to God in worship. It was a wonderful time to see this community served and loved in Jesus' name.

Happy Endings ~

When she arrived telling me she was bleeding, my eyes flitted to the small protrusion around her middle and then to her face; she was serious.    
        -- Papa? Another stillbirth? Really....?

Bleeding this early means just one thing but I didn’t tell her that right off. Instead I motioned for her to lie down and describe her symptoms.

She reported large blood clots the size of her fist and copious frank bleeding. It all started two days ago.    -- Oh dear! Is this a placenta previa? Abruption? Lord... please help us.
-- “Two days of bleeding?” I asked a bit surprised, “Are you have contractions too?”
-- “Yes. Can you feel it right now?” She asked and motioned for me to touch her belly.

It was hard as a rock and small and she looked to be about 7 months pregnant. This was a almost play-by-play repeat of yesterday’s stillbirth. The only difference was I had time to ask her questions before the birth. Yesterday, the young girl arrived and before I could get her inside she delivered.

Shaking off that memory, I refocused on the woman before me. She looked remarkably calm.

-- “Can you feel your baby moving?” I asked. She just shook her head in response and I reached for my doppler.

I wasn’t expecting to find even placental sounds, so when the steady toc-toc-toc of a heartbeat blasted through the room I jumped; her baby was alive!         --Thank you Lord!

But my excitement was fleeting and I soon remembered such a small baby would probably die shortly after delivery. I steeled myself for the eventuality of it then informed her family of my suspicions.
They took the news with steady, knowing expressions but said nothing.

When I did a speculum exam, her cervix was dilated and it appeared to be either the head or the placenta. I couldn’t tell. So I poked a finger inside to see. It was soft but had hair. Not a good sign.
        --Her child would be premature for sure.

We set up for the birth and waited. But we didn’t have to wait long. Her contractions were strong and she pushed like the G4 she was!

Two pushes and a precious head was out. But then he wouldn’t rotate.
        -- Oh Lord, help him come out easily.

Fortunately he eventually rotated and the shoulders collapsed down below the pubic bone. But he was born with a tight cord coil around his neck and body --like a sausage chain.

He was alive but didn’t move or grimace for the longest time.
           --Apgars 3/4/5/7

I started oxygen immediately but he didn’t take his own first breath for several long minutes. I begged him to breath and prayed, but things didn’t take a significant turn for the better until Dennis came to assist.

Dennis was more aggressive with the resuscitation efforts. He made that boy breath!

Once stabilized he has improved remarkably. He’s maintaining his own temperature, he’s sucking a bit and his respirations and heart rate are solid. He is most definitely only 32 weeks gestation (or roughly 7 months), but I think he’ll make it.

Please pray with us that he’ll be able to breastfeed better. I’m determined to keep them at the clinic until he can. I so want him to live! Thanks.

9-Month Fast~

When I first saw her, I had a hard time believing she was pregnant, let alone in labor. She was rail thin and gaunt. I asked if she had ever been to our clinic before... perhaps for a prenatal. (I doubted it, since I would have definitely remembered her face!) She said she hadn’t, but was seen once at another clinic in town. When pushed a bit further, her husband added she was treated for hypoglycemia at the government hospital the week before.

She didn’t look well... but that was just half of her problem.

Strong, relentless contractions peaked and passed, every few minutes; she was definitely in labor, but I couldn’t tell if she was term.

Her belly was abysmally small-- barely measuring 27 cm. She agreed she was only 8 months along, but that wasn’t the only reason it was small. She had been constantly sick this pregnancy.

Pushing to understand why, she explained she hadn’t stopped vomiting since she conceived. It was merciless. Food and water, alike, made her sick. It wasn’t hard to believe. She was positively emaciated.

This was her 9th pregnancy. I tried to guess her age, but her withered state made that difficult. I considered it a minute, but ended up just writing ’40 years old’ in her book. Did it matter? Probably not.

I was tempted to refer her to Wau... but she was already 9 cm dilated.

Instead, I set up for the birth, and prayed. I prayed hard. I’d either have a premie on my hands, or an SGA (small for gestational age) term baby. Either way, it didn’t change the fact, she’d deliver shortly.

Sitting beside her, her husband was just as delicate and frail. Decades of slouching caused him to fold himself into a neat envelope with ease, legs drawn in. Origami in the flesh. 

But when it came time to push, he was instantly at her side. Still slouching and a bit unsteady with age, he comforted her well.              --It was very encouraging.

She pushed like a pro, but her baby didn’t handle it well. Small, limp, and blue when he was born, he looked more like a floppy porcelain doll than a baby; I worried to move him.

Rubbing his back in an effort to make him cry, I cheered him on: “Come on ‘lil guy. I know it’s cold and scary out here... but breathing’s fun! Just try it.”
He must have liked my pep-talk, because he recovered nicely.

Boney and long and weighing just 2 kg (4.4 lbs), he reminded me a lot of his dad-- all arms and legs and a bit shaky. So, I wrapped him up tight, and handed him over. The father smiled as his lanky arms, awkward and unsure of how to hold someone so small, engulfed him.

It was love at first sight!

Later on, when I did a full exam on this lean, mean, sucking machine, I could see no major signs of prematurity. His reflexes were good, his testes had dropped, and even the creases on his itsy-bitsy feet were deep. His Ballard’s score (exam done to determine how premature/term a baby might be.) was high, placing him roughly at 36 weeks gestation.

Conclusion: 9 months of vomiting makes for one tiny person, but it doesn’t make him premature!

When I discharged them, they promised to return for check-ups, but I haven’t seen them yet. I hope all is well. Pray they both thrive after this 9-month fast! Thanks.

3 lbs of life!

Yesterday, just as the twin birth was coming to an end, I met two sorrowful faces in the hall. They rattled on and on in Dinka, and gestured toward a bundle one held in her arms. My translator was off working elsewhere, so, I  unwrapped the stained sheet to find a very small and very cold baby. 

She was obviously preterm. 

The woman holding her was old, wrinkled, and withered. Was she the mom? I couldn’t tell.

Once my translator arrived, I learned that the mother of the child died a few minutes after birth due to a massive hemorrhage. She had delivered at home, unassisted-- except by family.

Despite her prematurity, she was breathing well. Her vitals were normal, except for her temperature. She was 34.3 degrees (94 degrees Fahrenheit). I had to take it twice before I believed it.

The woman holding the child was the grand-mother, and she looked every bit the part. Thin, sagging, and with puffs of gray about the edges, she must have been 60 plus. (Mind you, that is NOT old in the States, but here, it’s ancient!)

She had already tied the band of cloth around her middle in mourning. (This, I’m told is done after a death to signify mourning.) It was her little girl that had died in those desperate bloody minutes after birth. She was sorrow edged in despair, and slightly splattered in hopelessness. So, I prayed for her. 

As I examined the baby, I wasn’t surprised to see she weighed only 1.4 kg (3lbs). She was thin and had frail bones. I almost feared moving her. (When I did a Ballard’s Score, she was only 30-32 wks gestation, or roughly 7 months.)

Since she was so cold, glacial really, I continued to monitor her while the grand-mother did kangaroo care. Fortunately, in the span of only 45 mins, her temperature stabilized.

She, also, sucked enthusiastically at the sugar-water we gave her by syringe. This was a baby who wanted to live. I kept telling them that, but they didn’t seem convinced.

When I told them, all they had to do was find a wet-nurse or get formula, and the baby would live, they argued with me.

I think they decided to bring the baby to the clinic to die. I really do. Every time I told them she would live, so long as they kept her warm and fed her properly, they’d shake their heads in disbelief. I was confused.

I called Sabet in for help. Was I misunderstanding? Did they want this baby to die? If so, give her to me! I’ll keep her.

He laughed at the impracticability of such a suggestion while trying to reason with the women. They were hopeless. They could see no way of helping her. They knew no one who could give this baby milk. They had no money for formula. (A month’s supply of formula costs roughly $12 or two and a half days salary.)

They refused to go home. The grand-mother explained that she didn’t want to be there to watch her child’s burial. (I couldn’t figure out why, but I didn’t try to, either). She asked to stay at the clinic, and seemed to indicate that she’d stay until the baby died.

The problem was, the baby wanted to live. She had no infection, no signs of distress, and now her temperature was stable. All she needed was food to live. Wouldn’t they go talk to their family about feeding her?         -- No. We’ll stay here until she dies.

I went back to Sabet. I wanted to take the child from them and strap her to my chest. I wanted to feed her myself and help her live. Why were they giving up so easily?

Part of me understands that grief played a role in it. Another part of me imagined their confusion. I’m sure they have never seen a baby so small and frail, live before. They must have thought I was crazy for suggesting she would.

After Sabet spoke to them for the second time, he agreed that the women were planning on letting her die. So, he promised to get them formula if they would just feed her. They agreed.

Explaining the details of how to mix formula correctly took time, but I think they got it. They also promised to bring the baby back for check-ups. I’ll let you know how it goes.

Please pray for them all. Pray that this little girl gets the food she needs to not only survive but to thrive! Pray that as she grows, the family would see what a precious miracle she really is! God has put air in her lungs and life in her body; He has a beautiful plan for her life! May she one day grow to know His love! Thanks.

By the way, they named her ‘Akec’, which means ‘born to a dead mother’. 

Postscript:
During our conversations, I found out the the woman who died was apparently very sick all throughout her pregnancy. The family said she had 'yellow fever', but everyone claims that; it’s rarely the case. The symptoms they described were stomach pains, swelling, and green eyes. I think she may have been anemic, due to some underlying chronic liver problem. That is the best explanation I can come up with for her hemorrhage, and subsequent death. But then again, I’m guessing. They said the woman who died was seen only once, and that was at a different clinic. They told her she didn’t need medicine, and sent her away. Pray that the women of this community would all come for prenatal care, deliver at the clinic, and seek postpartum care. Pray that one day the name ‘Akec’ would never be given again. Thanks.

Preterm Sadness.

Another preterm baby came in today. His mom was in a lot of pain but didn’t look anywhere near as bad as her baby did. We did a Ballard’s score (to tell how preterm the baby is) which placed her at about 27 weeks gestation. She only weighed 1.8 kg.

It seems prematurity is epidemic around here.

The baby had a number of problems. Her breathing wasn’t good-- nasal flaring, chest retractions, apnea. Plus, she wouldn’t suck. She looked like she was barely hanging on. My heart went out to her. But I had hope.

Then something changed. As Denis was doing the physical exam, he couldn’t find an anus. He called me over for a second opinion. Nada. The baby had an imperferate
anus (in short: the anus is missing). In the states, this requires surgery and pretty quick.

But here?

Denis referred them to Wau but they didn’t look even remotely interested in going. Lord, may this tiny treasure find her way to Your precious arms soon. May her suffering cease.

Namesake.

Regina holding her little girl.

This week’s theme seems to be prematurity. Twice already we’ve had two mom’s deliver  preterm at home and then come in because of complications. Each time the baby died. Both moms were referred for different things-- One for a blood transfusion due to massive hemorrhage postpartum, the other because she was in a coma for some unknown reason and wasn’t improving. So when a young girl come into the clinic today in premature labor, I wasn’t sure what to think.

She was acting pretty melodramatic. I admit I thought she was exaggerating a bit... or I did until I saw the contractions. There was no doubt something was going on, but could it be labor? Maybe it was just Braxton-hicks contractions? She was 7 months pregnant by LMP and only measured 27 cm. Not good. Her belly was way too small.

The last time this happened, we tried to refer the mom to Wau, but she never made it. She just ended up having the baby at home. Fortunately, all went well. But we weren’t there for them in their need. I didn’t like that. So, this time, I decided to keep her at the clinic.

I thought keeping her here would be a no brainer but her family wanted to take her home. I cautioned them that if the baby was really  7 months gestation, it was better to have our help. To my relief, they agreed.

Baby Stephanie Akac, weighing in at 1.5 kg.

So when Regina started pushing, we were ready. We had resuscitation equipment set up and mentally, I was ready for another anything -- even another death. I know that’s pessimistic of me, but I had to steel myself for the possibility at least. Not one baby born that early has survived here in my (short) experience.

I prayed over her and left it up to God. The Creator of all life certainly knows how to preserve it. I prayed for His will to be done. Besides, He knows what I can handle. I’ve mourned these children all week. If I am meant to mourn another... He’ll walk me through it.

The birth went smoothly. Regina only pushed a couple of minutes -- surprising for a first time mom. And as the head passed the perineum, I was surprised to see a tiny face looking up at me. :- ) (She was born completely posterior!)

Although she was minuscule in stature, you wouldn’t have guessed it from her lungs. She screamed and wailed and made such a ruckus that Margaret and I couldn’t help but laugh... and sigh in relief. No resuscitation necessary.

But would you believe she is only 1.5 kgs and (by Ballard’s score) only 28 wks gestation. That is how old the baby boy brought into our clinic on Monday was as well. But he weighed half of that (only 600g). Dennis and I were so confused we did the test twice but the results were the same. This little one is only 7 months old.

The good news is that... by God’s abundant mercy and grace.... this little girl is doing great. She is vigorous and very interested in breastfeeding. Pray that continues.

Her father was so happy with the good news, he asked if he could name her after me. So I have my first namesake. Rejoice with me as I’ve discharged little Stephanie Akac this afternoon. Both mom and baby are doing great. But they need prayer... lots of it. The risk of complications and infections are higher with prematurity. Thanks.

600 grams Miracle

Please be in prayer for a very sick mom and her very premature baby. They were brought in this evening. The mom was unconscious but not from hemorrhage this time. She has been ill for the last four days, and today delivered prematurely in a matter of minutes. She went unconscious. It’s then that they decided to come in for help.

We treated her for a number of possible infections but she’s still unconscious. In reality we don’t know what is causing this. When she stirs, it’s groans and mumbles. It doesn’t look good. Her baby however, a little boy, is doing fine. This is the miracle of it all.

He only weighs 600 grams and according to gestational aging methods (the Ballard score) is only 28 weeks gestation. He’s tiny but able to eat. We’ve fed him by syringe, and the mother’s sister (who is currently breastfeeding her own child), is giving him expressed breast milk.

Please pray for them. I really want him to make it. We made him hot water bottles out of plastic soda bottles and have him under a lamp as a warmer. His main concern in staying warm enough.

The mom however, isn’t out of the woods. We don’t know what is wrong with her. Pray for wisdom for the staff and God’s grace and mercy for her family. Pray this little boy would one day be coddled at his own mothers breast. Amen.

Update (Aug 12)
The day after I wrote this (even though I’m only able to post it now due to internet issues), the little boy died.

We kept resuscitating him and getting his heart rate up, but he was no longer able to breathe on his own. Once we would stop resuscitation efforts, his heart would slow to a stop. After doing this repeatedly, we finally decided to let him pass.

His mom was referred to the hospital in Wau because she never came out of her coma. We are still unsure what put her in it in the first place. Pray she recovers.

Premature.

After lunch, I was quickly called back to the clinic because a woman had delivered prematurely and her placenta was ‘stuck’ inside. My translator looked worried and so I rushed. I told the rest of the staff (who had started lunch a bit later due to other emergencies) about it and they agreed to come soon.

However, Jessica (volunteer/Nurse) hurried after me, eager to learn as much as she could. I wasn’t told anything more than that the baby was preterm and the mom had a ‘stuck’ placenta.

The last time this happened the placenta was sitting in the vaginal vault and needed the slightest tug to come out. Today was a much different case.

When I walked into the room, the mom was covered in blood and motionless on the bed. A family member was holding her baby, wrapped in a blanket and gasping for air. The baby girl only breathed every 15 seconds or so and her heart rate was a cool 60 bpm. (It should have been in the 130 range). She was dying.

I started to resuscitate and Jessica was quick to help with chest compressions. The Ambu-bag we had was much to large (due to her prematurity). She had lots of secretions and was pale.

Caleb and Maggie came in shortly afterward. Caleb took over my job in resuscitation and Maggie helped me assess the mom.

All the while, I kept calling out for more information. When was the baby born? How long has she been bleeding? How much blood has she lost? How long was her labor? How many babies has she had? Which ones of them are alive? Has this happened before?

The story unfolded for me question by question as I continued to assess the young girl. This was her forth pregnancy. Each of her babies were born premature. Each of them died.

I remember looking over to the table where Caleb and Jessica worked tirelessly on the baby girl. She wasn’t breathing spontaneously. Her heart rate would jump from 30 to 100 depending on resuscitation efforts. It didn’t look good.

Meanwhile, Maggie was getting an IV started as we could see the young mom was in hypovolemic shock. Her blood pressure was bottoming out. Her pulse was through the roof. She had been bleeding non-stop since birth (which was 3 1/2 hrs earlier).

I could see her heart beating in her chest. I didn’t need to take a pulse to count it.

When I evaluated her placenta, it was partially detached (the reason for all the bleeding). What’s more, is it was very determined to stay that way. I had to do a number of maneuvers to knock it loose. But when it came out, all the membranes were still inside.

My only option then was to do a manual exploration for the membranes. This is not comfortable but it was the only way I could be sure the membranes wouldn’t continue to cause bleeding. Fortunately it worked. Her bleeding stopped.

A second IV line was started, as we flooded her with fluids. She got 5 liters before her blood pressure even remotely stabilized. She was pale as a sheet, desperately needing the one thing we couldn’t give her; blood. 

The baby died but she didn’t. I think the baby could have survived if she was born in the clinic. But even then, I’m not sure. Maggie tells me that babies born that early here rarely survive.

The young mom, turned her head from me in sorrow when I told her but she didn’t cry. So I cried for her. I cannot begin to fathom her pain. Four time pregnant. Four time heartbroken.

The only reason I can think of her premature labor is an incompetent cervix. I told her how to fix this problem next time she gets pregnant. But I’m not sure she believed me. I think she’s lost hope of every having a baby live.

Pray for her. She’s in desperate need of blood but her family doesn’t have the resources to get her to the hospital for treatment. I think she will recover. It might take months without the blood but it’s still possible.