Prayer Project: Scoliosis

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

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

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

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

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

Will you join me?

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 Every time I see her she seems more withdrawn and afraid.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

Prenatals!

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?

Heads or Tails?

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.

New Hope

My heart did a bit of a flip-flop when our eyes met.        --Could it be?
Smiling with excitement she understood that I recognized her and was please.     --Yes. It was her.

“You are the one I helped with the baby last year?” I asked stupidly. Honestly, I helped lots of women with babies last year. Duh!

She just smiled back and nodded, equally excited.

“And you are pregnant?” I asked rubbing my belly in case she didn’t understand my Dinka?

“Yes!” Her eyes sparkled in joy.             --- Yes! Yes! Yes! Yes!

Elizabeth is pregnant again everyone! Elizabeth is pregnant!

You might not remember her just now, but I assure you I’ll NEVER forget her. Her last birth was one of the hardest of my life. It taught me the realities of being a midwife in Africa.

It changed me forever.

And in the process, I came to truly love Elizabeth and her husband, Michael. I love them and want to see them holding healthy children in the future. I want them to know God's love!

So I cheerfully took her prenatal book (one she had kept for almost a year) and added it to the line. 

When it came time to do her prenatal, her husband joined her because he wanted to honor me with thanks and tell me all that God has been doing with them this year. I was delighted to hear it.

But as I checked her, I suspected STDs. So I told them that I’d need to treat them right away. They happily complied.

Please pray for them. She is 4 months pregnant. Pray this next birth may be healthy and easy. May God continue to shower His love and mercy on them in remarkable ways! Thanks.

Prenatal Prayer Projects~

Prenatal woman being checked in by our Sudanese staff.

Some days I open a woman’s prenatal book and I’m surprised by my own handwriting. Did I really write that down... and not cry?

One of my patient’s obstetrical history looks like this:

G8 P5 L4 A2 M1
1st baby: SAB (Spontaneous Abortion) at 2 months -- Clots.
2nd baby: Delivered --Alive.
3rd baby: SAB at 1.5 months.
4th baby: Delivered --Alive.
5th baby: Twins --Both alive.
6th baby: Delivered alive but died at 1 yr. old.
7th baby: Delivered preterm at 6 months but died at 1 yr. old.
8th .... she’s now 5 months pregnant.

She’s only in her early 30’s and yet she has already knows the heartache of two miscarriages and two tiny coffins. But would you believe it... her history is a happy one compared to the rest.

Three times this week I’ve had women sit on my prenatal bed and flatly detail their obstetrical history. And three times this week I have wanted to cry.

I am sharing their information with you with permission. They said it’s okay for me to tell you so you can pray.

So please pray....

Athnony -- age 30-ish (G6 P3 L0 A2)
She had two miscarriages and three live-births but all three babies died shortly after delivery or before they were weaned. She’s 6 months pregnant now. Pray that this baby lives and grows to be a gray-beard who loves Jesus!

Achuei -- in her mid 20’s (G4 P3 L1 A0)
She’s given birth three times but one died after two days when it didn’t breastfeed and the other died when crawling. She has only one baby at home that’s alive. She’s in her second trimester but I’m not sure of her gestational age. May this tot be a delightful pest to his mother and a prize to his father. May he grow up to have a large family of his own who all know and love Jesus!

Monica -- in her late 30’s (G5 P4 L1 A0)
Her first baby died at 3 1/2 months old, her second child died at 5 years old and her third child was born term but died after 7 days of labor during which she claims she was treated for meningitis by the local witch-doctor.

Well.. this WAS her obstetrical history until two weeks ago when her only remaining child started having breathing difficulties. She brought him to our clinic for treatment but he eventually succumbed to his infection and died. He was only 4 yrs. old.

When I saw her this morning and learned of her loss it took everything in me not to weep outright. But such displays of emotion are not permitted here... and I blinked back my tears.

Lord... she has suffered the loss of ALL her children. Only You can know her pain! Only You can comfort her in this dark time! Lord, please touch her and give her peace. Help her to grieve and yet still hope...

She is 7 months pregnant now.

Pray this baby lives. Thrives. Survives. And loves his mother with joy, bringing her laughter in her old age!

Thanks.

Busy-Busy!

Last month we had 19 births and roughly saw 500 woman for prenatals. That might not seem like much but let me tell you it is! If all of these woman came to deliver at the clinic, I’d have 50 births a month easily!

Perhaps I should be happy that they are not all coming to the clinic after all!

Think about these kinds of numbers. If I’m seeing on average 15 NEW patients a day then, many of the women are either coming only once for prenatal care, losing their prenatal books, or I’m on a run-away train to prenatal mania!

Aside from going a bit crazy from the sheer number of women seeking care, I’m getting tired. Margaret is helping me as she can, but the reality is there is just too much work for one midwife.

There is another thing influencing all this. HALF OF SUDAN got pregnant during the referendum in January. I kid you not, HALF of the woman I’m seeing for prenatals are DUE in October!

Something has to give.

My brain is swimming with fundal heights, malaria, STDs and heart beats! I break out in sweats just thinking about what October will bring.

Pray. Pray. Pray.

Third Trimester Malaria

On Sunday, Aguak arrived in a lot of pain. Even though she complained of everything BUT malaria, I knew she had it.

She was burning up. She was writhing in pain. She was pregnant.

I admitted her and started her on IV medications because she couldn’t keep anything down. At one point she said she had only been sick a day at most, but her symptoms seemed too severe.

Malaria will cause contractions, and she kept insisting she was in labor. I assured her that once her fever came down and the medicines took effect, her ‘labor’ would stop.

While the quinine slowly dripped into her system, I assessed her baby. This was her first pregnancy, and she was well into her third trimester. Perhaps she WAS in labor.

As I measured her belly and listened for the heartbeat, I was disturbed by the silence. Even though she insisted in a half-dazed malarial rant that the baby was alive since it was moving, I didn’t believe her.

I could feel no movements. I could hear no beating heart.

That was two days ago.

Last night as her medicines had finally worked their magic, she was well enough to understand her child was dead. She took it bravely but it was hard news nonetheless.

Normally, I’d be willing to induce her. But she is still so weak. I’m worried she won’t be able to handle the induction.

After informing the family of the death of the child and potential dangers it poses --the baby decomposing and causing her to get septic or her developing disseminated intravascular coagulation-- I asked them to take her to Wau.

At first I was hopeful. They have the money and even took her home this morning. But then they came back again this evening.

Apparently, despite all their searching they were not able to find a ride to Wau. They seem to be unwilling to go on the bus (I can’t figure out why) and private transportation is too expensive.

Perhaps they will go tomorrow. Please pray that they do.

Pray for Aguak and her child. May mercy, grace, love and peace surround them all during this difficult time. Thanks.

Slow Month of May~

One Monday, I had 32 woman waiting for me for prenatals. A record I think.

This month has been unusual for me. When I returned for my break, I thought for sure I’d be walking into busy-ness and chaos. But I didn’t.

Yes, I still had lot of prenatals and tasks to do at the compound, but the births I had been expecting, never arrived. We had only 8 births whereas the month before (April) we had 19 births!

Why?

It’s a question I’ve been asking myself a lot lately.

Do they not know they can come? Is there some obstacle in coming I haven’t identified? Do they really need to come, or am I just jonesing for a birth? What is it?

By mid-May, it finally occurred to me that the rain might have something to do with it; So, I asked Sabet.

He explained that most of Tonj left this month for the village. Apparently, once the rains start, people head to their land to plant crops. Any babies born this month were born in the fields!

The coming rains made for unusual obstacles for prenatals as well.

In fact, one woman came for a prenatal, explaining that she missed her appointment because she was building her house!

When I looked down to see an enormous belly, I chortled and snorted in laughter. What was a 8 month pregnant woman doing building a house?!

Once I stopped laughing, it dawned on me that the men weren’t going to do it (women build homes here not men); she had to miss her appointment, she needed a new roof!

Have to mentioned how much I respect and admire the women here?  -- Cuz, I do! Amazing!

The Stench of Ignorance & Neglect.

Her name is Biyana, and she’s 18. Her first child was born naturally, but succumbed to the dreaded ‘one-day-diarrhea’ and died at a year and a half old.

Her second pregnancy brought on four days of excruciating labor pains which ended in a cesarean.     -- The baby didn’t make it.

The scar of that day, marked her body with a keloid an inch and a half wide -- from pelvis to umbilicus. She had a classical incision; and when I asked her why she had to have surgery, she couldn’t answer me.

-- “Didn’t you ask the doctors what happened?” I prodded. 
-- “No.”
-- “Didn’t they explain?”
-- “No,” she repeated with the twisted sucking sound made my Dinkas to indicated a ‘no’. 
-- “I see. So, when did this happen?”
-- “Last July.” 

I continued on with the rest of the prenatal as if such an obstetrical history was normal.
    -- Which, here is.

We discussed LMPs (last menstrual period) and fundal heights (how large her belly was growing for her dates), and I re-assured her that this baby was doing fine. She seemed excited and happy to be pregnant again, but something was off.

Although obviously clean, her clothes smelled strongly of urine. It was overwhelming, and attracting flies.

I waited until the prenatal was almost over before I asked her about it.
-- “Biyana. Did you shower today?”
-- “No. I didn’t.”
-- “Well... Right now, I can smell a lot of urine on your clothes. Do you have urine leaking from your vagina, by any chance?”

Looking at me in muted surprise, she clicked her tongue in response. “Yes.” Click.
-- “Really? Does it come out only when you carry heavy things, or is it all the time?”
-- “All the time,” she said flatly. The lack of emotion in her voice was frightening. 
-- “How long has that been happening?” I enquired.
-- “Since July. It started after my surgery.”

I started counting back months in my head. If it’s May now, that would mean... 10 months!
-- “Really?” I said calmly, trying to keep the desperation out of my voice, “You’ve had urine leaking from your vagina for 10 months?”

She must have thought me stupid for asking such a simple questions over and over again. But she answered me each time I asked.
-- “Yes,” she explained, “In fact, I haven’t urinated since the surgery.”

When my translator gave me this information, I made him repeat himself several times. I couldn’t be hearing what I was hearing. I just couldn’t!
-- “Wh... wha... what do you mean?” I stuttered, “Are you saying you have not urinated at all in 10 months?”
-- “Yes. It just comes out of me all by itself.”

Knowing full well I had some kind of vesico-vaginal fistula on my hands, I called Sarah in to watch and learn. I was fairly confident she hadn’t seen one before.

(For those who don’t know a vesico-vaginal fistula (VVF) is when the wall between the bladder and the vagina is compromised, allowing urine to pass through it unimpeded. If you are interested in learning more about it click here and here.)

Pictures taken from this website.

Then I asked Bisaya if she’d allow me to do a vaginal exam to see if I could identify the size of her hole. She agreed, but seemed a bit confused on the purpose.
    -- Did she think her incontinence was normal? I couldn’t tell.

But in the end, the exam caused more questions than it answered.

Instead of finding a small tear or thinning anterior wall, I encountered a large mass of scar tissue about 6 cm long and 3 cm wide. She writhed in pain as I attempted to feel around it.

Fortunately, I had my trusty translator James by my side and he was able to calm her down and explain what was happening and why. Once she relaxed, I was able to assess it better; but honestly, it had no idea what I was looking for.     --It was a mess in there.

Frankly, from the amount of pain my exam caused her, I’m amazed she even got pregnant. When I asked her if it was just as painful during sex, she clicked her tongue loudly in confirmation.

Wow.

We talked in depth about going to Wau for a GYN consult, the possibilities of a repair, and whether or not another cesarean might be indicated.

Right now, she is five month pregnant. However, if her pain is that intense during a vaginal exam, how much worse will it be for the birth?      --Lord! How can we help this girl?

She promised to discuss things with her family, but I’m not sure whether or not she’ll go to Wau. She did sound hopeful though. I think, I’m the first person to tell her there might be a solution to this curse. I think she had given up hoping for a way out of the smell of her stigma.

Oh, the stench of ignorance! Imagine not urinating for 10 months!        -- Just imagine.

Imagine not knowing there was a way to fix it.
      --It breaks my heart.

Please pray for Biyana. I will hopefully be seeing her in the coming months. Pray that one day, we’ll get a surgeon out here to repair fistulas in this community. 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!

Even more Puzzling...

Today, Athong came in for a prenatal. (For those unfamiliar with her case, please read here first.)

Thrilled to see her in my prenatal line, I asked her quickly if her baby was doing well. She nodded excitedly and handed me her book.         --Hallelujah!

Since she hadn’t come the month before, I thought perhaps she had miscarried. I can’t tell you how relieved I was to see her. I kept thinking, “May this be the baby that lives, Lord!”

She positively glowed when I called her in to be checked. We exchanged pleasantries as she lay down and lifted up her shirt, exposing a perfectly round belly bump.             --Adorable.

Before I left on R&R, Athong had faithfully come for several weekly check-ups in order to get the full arsenal of our STD-fighting meds! She was eager to do whatever it took to keep this child.

Each visit, I expectantly searched for fetal heart tones but found none. I did find a growing belly, however, and so assumed either she was off on her dates or ... she’d miscarry very soon. We prayed it would be the former. but steeled ourselves for the latter, just in case.

So when she reported ‘no bleeding’ at all this morning, I was hopeful.

Already measuring 11 cms, her belly was firm but tender to the touch. She winced a bit while cautioning me to be careful; she didn’t want to lose the child.

Laughing lightheartedly, I continued to check her in.

My doppler picked up a number of blood vessels and whooshing sounds, but nothing resembling a heartbeat could be found.                         -- Not good.

Searching for much longer than I normally do, I sent for Dennis to consult. This was looking oddly familiar. As we waited for him to arrive, I reviewed all the basics with her again.

-- So, Athong. Tell me again when you think you got pregnant.
-- Well, it actually stopped bleeding in June of last year, but then it continued each month until February of this year. Then it stopped for good.
-- Oh, I see. So, you think you are only 3 months pregnant now. Right?
-- Yes.
-- But last time you told me that you got pregnant in December of last year.
-- No. I got pregnant in March.
-- Huh? So your last menses was in February and you got pregnant in March?
-- Yes.

Here’s the trouble: If she is only 3 months pregnant, why then this colossal belly-bump? What’s more.... why is it so hard? If she is 5 months pregnant, why can’t I hear the sweet toc-toc-toc of her child inside. Even at 3 months, there should be something... anything. But all I can hear is the soft wooshing of nothingness.

Palpating once again, I made mental notes: “It’s definitely a pelvic mass. Her ovaries are tender but not enlarged. Although no reported bleeding, her menses have been irregular. Plus there are no fetal heart tones. The fundus is growing (it grew 2 cms since last month), but it’s woody and hard. Could it be...?”

My brain trailed off as Dennis came in. Catching him up to speed, he nodded and palpated it all for himself.

Conclusion: She needed an ultrasound.

I can only think of three reasons for this state of being. One: she has a baby that is astute at hiding its heartbeat (unlikely); Two: she is only 2.5 months pregnant with large fibroids or some kind of uterine mass; Or three: she has a hydatidiform mole.

Personally, I suspect the hydatidiform mole. Horrified as I am to admit it, it just fits the symptoms best.

Unusual bleeding. HCG in her urine. Lots of nausea. Woody hard fundus. No fetal heartbeat.

Would someone please tell me I’m wrong? I would LOVE to be wrong.

I don’t want another hydatidiform mole. You all remember what happened with the last one. (If not, please read these stories. Story one. Story two.) Plus, she DESPERATELY wants a child.

Taking the news in stride, she nodded with possible INcomprehension as I explained the details over and over again.
-- “What you need is an ultrasound. We need to know what we are dealing with,” I said.
-- “No. I will go to the witch-doctor. I’m sure I have been cursed. The witch-doctor will fix it.”
-- “Actually... the witch-doctor will not be able to help. What you need is a picture on the inside which will tell us what is in there. Please don’t waste your money on a witch-doctor. Please get an ultrasound instead.” I almost begged. 
-- “Okay. I will go.”

Was she just telling me what I wanted to hear? I couldn’t tell. Please pray for her. If she has a hydatidiform mole and doesn’t seek help, she will start bleeding soon.

I’m very concerned for her.

Also... please pray that God would bless our clinic with an ultrasound machine. We need one desperately. It would be so great to not have to guess all the time.

Does anyone have one they want to donate to us? Does anyone have connections for a cheap retailer? I’m semi-desperate! ha ha.

Please pray for an ultrasound machine.... and a place for me to train how to use it. Thanks.

A Puzzle.

Athong on her first prenatal.

This week brought many new and strange cases to my door. Cases ranging from possible placental abruptio, to ectopic pregnancy, to placenta previa. None of which, could I properly diagnose (no ultrasound machine), so I quickly referred them to Wau.

Why my brain goes to all these worst-case scenarios eludes me. I must be tired. Perhaps, they were just having normal bleeding.... but when is bleeding and sharp pain ever normal in pregnancy? My point.

Plus, I had to tell, not one but three women, that their babies had died in utero. Definitely low points this week. 

But of all the women, who lay on my prenatal bed, one stands out. Her name is Athong.

(For the midwifery minded out there, she is a G6 P3 L0 A2. Not good.)

Her first baby died during delivery after a 3 hour shoulder dystocia. (Yes. Read that again. 3 hours.) Her second baby was born prematurely (at 6 months), and died a few hours after the birth. Her third baby also died within hours of his premature birth (also at 6 months). The fourth baby miscarried at 3 months. The fifth miscarried at 2 months.

She was now on my bed telling me she was 5 months pregnant... or maybe less. There was no baby bump and no fetal heart tones, so I ordered a pregnancy test. Honestly, I was leaning toward her NOT even being pregnant.

When it came back positive, I got hopeful.

What her history screamed to me was an incompetent cervix due to her traumatic first delivery. But that would only explain the two premature births, not the two miscarriages. Sigh.

Differential diagnosis made me think syphilis or some other kind of STD; but perhaps she had a Rh-negative blood type and became sensitized somehow. Wouldn’t that explain her history better?

She was a puzzle-- a sad puzzle where each piece brought tears and dashed hopes.

Fortunately, our lab can test for blood typing and syphilis, so I sent her for an evaluation. Her blood was Rh-positive and she didn’t have syphilis. (Both results pointed toward incompetent cervix.)

I asked if I could do a speculum exam to see if her cervix had any noticeable tearing or scarring. She agreed happily, saying, “Whatever you need! I will live here at the clinic if you tell me to, so long as this baby lives!” We laughed jovially. There was hope in her voice.

During the exam, I didn’t see any tears, but I did see extensive signs of STDs, which explained the last two miscarriages.

What that means is, if she is really 3 months pregnant now, then there’s time to do a cervical cerclage to help her maintain this pregnancy. Whoohooo!

(For those who don’t know, cerclage is when you sow the cervix closed to reinforce the pregnancy, until it’s term. The sutures are removed in the third trimester, so labor can progress naturally.)

I don’t know how to do this procedure, but I’m told Dr. Tom does. All we have to do is treat her STDs, make sure the pregnancy is viable, stitch her closed, then watch her like a hawk.

When I explained this possibility to her, she jokingly promised: “If you help me have this baby, and it’s a girl, I will name her Akuac! And if it’s a boy, I’ll still name him Akuac!”

We laughed heartily at the idea of a boy walking around named after a female cow, but I’m pretty sure she’s serious. Ha!

I warned her that I was not guaranteeing her anything. I was only promising to do everything possible to help, and pray like mad!

Will you join me? 

May this baby be the one that lives!

Poverty.

Poverty is relative.

Week after week, women file through my doors. Some are meticulously dressed with detailed henna tattoos and large nose rings. Others wear dirt caked underslips for dresses and smell of stale urine; calloused knees are the only things more used then their clothes. It’s very diverse, but I like it that way.

Mis-matched flip flops make no difference to me; I’m just happy they come.

Sometimes, those with the nice clothes try to skip the line by pulling in favors with the translators. I ignore them and put them back in line, recognizing there is some kind of rich-vs-poor pecking order here, but I chose to live outside of it. 

However, the only reason I can live outside of it is, I’m rich. (I’m not by American standards of course... Heck, the IRS wonders why I even filed this year!)

But to them, I’m stinkin’ rich. I wear a different scrub set every day. Imagine that, seven outfits! (Never mind I have countless others they never see.)

Plus, I’m fat or should I say... proudly plump. Let’s face it, it’s been a while since I skipped a meal. So, Yes. Comparatively, I’m rich. In fact, I’m filthy rich.

Like I said, poverty is relative.

mis-matched flip flops of a patient

However, this week, I overheard (and understood even though it was in Dinka) one of my translators asking a very poor and thus dirty pregnant woman if she owned any soap. He asked her twice, before I could stop him.

“What are you asking her that for?” I interrupted. He looked down like a two year old holding a bag of stolen cookies. “Are you asking her so you can give her some soap?” I continued bitingly. Again, he made no comment and continued to take her blood pressure in silence. “That was rude. You should not ask them such things. You should only ask them what I ask you to translate. Do you understand?” He nodded, but made no effort to apologize. In his mind, he had the right to insult her filth since he was clean.

It made my blood boil... but not for very long.

The reality is, poverty will always be an issue. The sheer fact of having or not having puts a person in a special ‘status’. It’s not just here. I’ve seen this on Fremont street in downtown Vegas while ministering to drugged-out homeless people. I’ve been guilty of it myself.

However, God tells us that we are to consider others as greater than ourselves. We are to esteem others and show them how valuable they are to us, and by doing so, to show them the love of God.

Did Jesus’ blood only flow for the rich and the clean?

Hydatidiform Mole~

Awen came for a prenatal yesterday morning, saying she’d been bleeding non-stop for 9 days. She was pale and worried and scared -- she had a right to be.

As I measured her belly and reviewed her vitals, the best conclusion I could come up with was a missed abortion and/or intrauterine fetal demise (IUFD).

For those who don’t know, a missed abortion is when a child dies in utero before 20 weeks gestation, (whereas a IUFD is after the 20 week mark), and the child is not expelled.

She had no idea when she got pregnant, but I thought she might be more than 20 weeks since her fundal height was 20 cm and she reported fetal movements before the bleeding began. If so, she had an intrauterine fetal demise (IUFD) which wasn’t being expelled.

The abdominal mass was alternately soft and mushy, then hard and rigid. There were no heart tones and no clots passed, and the bleeding was strange-- slightly foul smelling, and thin.

I conferred with Dennis and he agreed that the best course of action would be to induce her, lest the pregnancy become septic. I asked her if she had family to help her through this, but she didn’t. She spoke, however, of a sister in town who could help her with food, and she’d send word for her husband to come.

Once, the prenatals were through, I started her on an oxytocin drip. I titrated the dosage, bumping it up regularly to help the contractions take off. A few hours into it, I did a vaginal exam. She was completely closed, so I bumped it up some more.

Four hours later, she was still only 1 1/2 cm dilated, 50% effaced. I wasn’t sure if this was normal as I’ve never done it before. The books never said how long such things would take. But Dennis had done this numerous times before, so he was my reference.

However, several hours later, she started passing large clots. I called Dennis in because clots in ‘labor’ don’t make sense. He assured me it wasn’t normal and suggested we were wrong about the gestation age.

I agreed. Perhaps we were dealing with an early pregnancy (missed abortion) after all, and/or incarcerated clots. We were guessing, but they were our best guesses.

Dennis decided to do a manual vacuum aspiration (MVA) to remove the missed abortion and clots and I happily handed her case over. Margaret was taking over the shift, so I left them to it.

About an hour later, I was called to help them again; Tom was called as well. When we arrived, the room was full of IV fluids, bowls of blood and a pile of clots mixed with strange looking tissue that Dennis had removed during the procedure.

He had called us because she wouldn’t stop bleeding. He had completed the MVA and removed as much  tissue as he could get, but he couldn’t get the bleeding to stop. He also wanted us to weigh in on the tissues extracted.

The white, vesicled tissue was distinct and immediately apparent; what he removed was not a fetus but a hydatidiform mole. (For those who don’t know, a H. Mole is a rare mass or growth that forms in the uterus. It develops early in pregnancy, as a tissue that is suppose to become the placenta, goes rogue. What develops is a grape-like vesicle tissue that is NOT a baby but still produces pregnancy hormones.)

We discussed how to manage her case as she lay there bleeding. What should we do to stop the bleeding? To look at the amount of blood lost and the amount that kept pouring out, I was shocked Awen was even conscious! Afterward, we conservatively estimated her to have lost 3000cc. That’s about half a person's blood volume!

She was going into shock despite massive fluid replacement, but was still coherent. A miracle!

After discussing her case, I suggested I do an internal manual extraction of clots, since the MVA was not getting it out. Frankly, there was too much blood to even see the cervix. How Dennis was able to do it at all was/is a mystery.

An internal manual exploration is not something you normally do for miscarriages, but if you recall I did it on a incomplete abortion last year and it worked. I explained my reasoning to Dennis and he agreed.

So, I donned gloves and explained what and why to Awen; she agreed, and I reached in to extract what I could. It was painful-- there is no doubt. But once the clots were removed from her vaginal vault, I was able to extract a large piece of vesicles and tissue trapped in her cervix.

Instantly, her bleeding stopped as her uterus clamped down, and the room heaved a collective sigh of relief.

Wow.

Of the four of us in the room, only Dennis had ever seen a hydatidiform mole before -- just once. What a miracle we were able to get it out, keep her alive and stop the bleeding! What excellent team work!

She has been resting all day and is still dizzy for all the blood loss, but that is to be expected.
Pray for a full recovery and that this mole wouldn’t reoccur her next pregnancy. Thanks!

Pre-eclampsia Update:

My precious pre-eclamptic patient, Pour, came in today for a check-up. I’m always happy to see her and greeted her with a big smile. She smiled back and sat down slowly. My translator had just stepped out, so I asked her to lie down, so I could check her baby.

She shook her head sadly and said there was no more baby to check. My Dinka’s limited, but I somehow understood all her words. I instantly wanted to cry, (but culturally, crying is not an option), so I blinked back tears and waited for my translator to return.

My heart sank as she explained she’d delivered her baby 4 days before. She only had two hours of very intense contractions and her baby was born. He breathed twice and then died. She also explained that he was term but thin and had ‘burns’ all over his body.

I’ve seen one other macerated baby (a baby who dies in utero and starts to decompose) before and as the skin starts to peel, it does look like the child has been burned. It doesn’t make sense that a macerated baby would breathe, but I didn’t tell her that. If he was macerated, he’d probably died a day or so before the birth.

Her blood pressure was still high and her body ached. I wanted to wrap my arms around her and bawl; but again, such antics are not socially acceptable. Instead, I taught her more about pre-eclampsia and why her baby probably died. I also prayed for her to have peace about her child and to know Jesus’ comfort and joy in this hard time.

Should I have induced her last week? She wasn’t term (I’d have to check, but I think she was only 34 weeks last week), and her fundal height was only 22 cm.

I don’t know.

She’ll keep coming back each week for follow-up checks. Pray for her blood pressure to stabilize and her body to recover quickly. Thanks.

Dilemmas

Yesterday a first time mom (aka:G1) came to the clinic in “labor”, but her contractions were abysmally short (25 sec) and moderate at best. The trouble was, they were frequent (q 1-2mins).

The women here believe that if labor starts they cannot drink water or their contractions will stop. They are right and wrong at the same time. Dehydration will cause muscle spasms and colicky contractions and even exasperate false labor, making it seem like she in labor when she’s not. But if a woman is in true labor, water will just help her muscles contract better.

This woman hadn’t taken any water all day, and could have been simply having painful Braxton-hicks contractions.

Not wanting to assume she was in dehydration-induced-false or early labor, I asked if I could do a vaginal exam to see if she was dilating. I told her what it would require; she seemed hesitant but willing.

Everything in me was saying she was in early labor and not to bother with the exam, but I’ve seen women here with contractions like this, deliver within the hour. I didn’t want to mess up.

Seconds into the exam, she refused to let me continue. So I stopped, never having found her cervix.

Now, I have had several pelvic exams in my many, many years; not one of them was painful -- uncomfortable but not painful. I’m told however, that in labor, exams are painful, and I always try to be considerate of my patients needs.

She needed me to stop, so I did.

Here is my dilemma. Based on the little I knew of what was happening cervically, and the small contractions she was having abdominally, she was in early labor and should go home.

I was told home was a 30 minute walk away. If she went home, she most likely wouldn’t return. In her head, I would have sent her away without help. If she stayed, a G1 like her could go on like this for hours and who knows days-- especially if she was refusing fluids.


We don’t have room to house women in early labor. We don’t have food for them and cannot accommodate the crowds of family members that come to visit. Or do we?

During prenatals, I encourage these women to come and deliver with us, but then send them away when they come. This must be confusing to them.... thus my dilemma.

Do I just let them labor here in the future, even if labor could be the next morning? But if I admit them, then I feel conflicted as to who will take care of them.

This is hard to admit, but we are not equipped to handle long labors. The translators/health workers haven’t grasped the idea of monitoring women in labor. I could go back and forth from the compound to the clinic all day, checking on her myself, but then she is taking a bed that we many times need for emergencies.

Plus, I’m not on-call at night. If I admit her, Margaret would be responsible for her throughout the night. I know she could handle it, but... is it fair to her to add this extra load of work?

Right now, I am the prenatal program. Everyone else rallies around me when there’s a problem, but when push comes to shove, it’s just me.

Margaret (bless her heart) delivers the babies that come in at night and allows me to be rested for prenatals in the morning. But that’s it. She takes no ownership of the preggos; she has too many other responsibilities to worry about and the clinic is much more than just the prenatal program.

It hurts my heart to send these women away in early labor when it’s clear they want to stay.

I know that birth is different all over the world. I know that what worked in the Philippines and what works in the States may not work here. I just can’t seem to get a grasp on what is appropriate for this culture and this stage in the clinic’s growth.

Pray for me... my heart is to admit them all now, and just let the cards fall where they may. But if I do, am I opening pandoras box?

Hypertensive!

I have a girl coming for prenatals who has a fundal height of 21 cm at 30 weeks due to pregnancy induced hypertension (or possibly pre-eclampsia). Her belly has not grown since October when her blood pressure skyrocketed (as if overnight) to 185/130. (Previous it was in the 110/80 range.) Early December, we started her on BP meds but I guess she didn’t understand she had to stay on them permanently for them to be effective and didn’t return until yesterday.

Her fundal height and blood pressure combined, had me ready to refer her to Wau on the spot. But conferring with Dr. Tom, he pointed out the obvious. What could they do for her there that we cannot?

My brain stuttered as I realized how right he was. If she went to Wau, she would pay for all her meds, incur a huge bill and still deliver a small baby. Yes, she is at risk for convulsions and stroke, but we are aware of that. What’s more, God is aware of that! 

Quick! Somebody stop me from worrying like this all the time! S*i*g*h.

Pray for her please. She promises to come for weekly check-ups and to take her meds, and I promise to keep you posted.

STDs and Exhaustion!

This week I have done 84 prenatals. That makes for one exhausted midwife! Of those 84, half were new patients. Where are all these women coming from? Don’t get me wrong, I love it, but I’m not sure I can keep this up much longer. I try to give them my best but by the end of a long day, my brain twitches.

Plus, a large portion of these women have raging STDs. It’s great they are getting treatment, but come on! Why are so many of them infected? I asked my translator what he thought and he just shrugged. So, I pushed him a bit.

-- “When these young women marry older men, are they faithful?” I asked.
-- “Some go to any man that comes,” he explained, “but not all.”
-- “So is it the men? Are they unfaithful?” I asked, already knowing the answer.
-- “Yes. The men have sex with many many.” he explained.
I continued to pester. “But if they have ten wives, are they still sleeping with prostitutes as well?”
He just nodded uncomfortably.
-- “But why?” I badgered. I wanted him to say it out loud.
-- “Because they can,” he admitted, “that is the way of things here.”

Frustrated by constantly cleaning up after these unfaithful men, I have to admit that my translator is right. Socially here, it is understood that every man will stray. Monogamy is laughable to them. So what if they pick up a disease and cause their wife infertility and pain. That’s not their problem. If she cannot produce a child, he’ll just leave her in squalor and marry some new young thing.

One of those new young things was on my prenatal bed this week. She was two months pregnant and suffering from a long history of venereal symptoms. She was wife number five. Her last pregnancy ended in a miscarriage at 3 months which was most likely due to this infection.

Investigating further, she explained that three of the other wives were infertile. Even after years of marriage, they have never carried a child to term. So, I explained to her the role STDs play in infertility and miscarriage. Surprised but happy to learn this lesson early, she promised to take her medicines carefully and encourage the others to come for treatment as well.

This man, no doubt desperate for children, married five times. Did he know he was the problem? Probably not. Will he come for treatment? I don’t know. Will he allow his other wives to come? I hope so. I hope he gets a clue before it’s too late.

Sigh.

You probably didn’t think this post would entail me ranting and raving on the rate of STDs among the Sudanese. Ha! But there you have it. That is what you get from this exhausted midwife. Rants!

Pray for me to find socially acceptable ways to teach these families about STD prevention. I think some of the women will listen, but what about the men? There seems to be some kind of stigma; some men equate STDs with AIDS. They are ignorant that a few drugs can mean the difference between healthy children and pain free sex!

The good thing about all of this is... my translator gets it. I can safely say at least one Dinka man has learned this lesson well. Now for the rest of them!

Blood Transfusion?

Dr. Tom took over all the deliveries and prenatals while I was away. He delivered two babies and referred a woman with twins (one that died in utero) to Wau for a cesarean in the two weeks I was gone. I'm sure he saw a lot of prenatals as well.

One of those prenatal girls came in sick (initially testing negative for malaria) and was treated with a course of antibiotics. At that time, her hemoglobin was an 8. Anemic. In pregnancy, it shouldn't drop below a 12 or else even a slight amount of blood loss can cause her to go into shock. And a moderate hemorrhage, might kill her.

When I got back from my trip, I was told she had returned, still sick, and tested positive for malaria. She was treated, however in the week it went undiagnosed, her hemaglobin dropped to a 4.4!

Not good at all.

She needed a blood transfusion but we don't have the equipment for that. Dr. Tom looked up direct transfusions in his medical books and brain stormed the idea with Dennis and Caleb. They were all game to get her the blood she needed.

They started testing all her relatives for crossmatches and found two donors that would work. This was only made possible by George tirelessly working to screen them all in the lab. It was a lot of work.

The question was, could we actually pull it off before the blood coagulated? Nobody really knew. They tried a number of ways, using a variety of instruments and techniques, but none of them were working.

It was harvesting the blood that was the most difficult. 

Hours later we finally got a bit transfused without it coagulating -- but only about 30 ml. That's not enough to bring her around. It helped of course but she's not out of the woods. Our only option was to send her to Wau and hope that she goes.

The good news in all of this is we fine tuned our techniques and now know what works and what doesn't. And even though 30 ml is not anywhere near enough for an adult woman, it's plenty for a young child who might be suffering from anemia.

This gives us options we didn't have before. I'm excited.

Let's start praying for blood bank and transfusion section in this clinic! Anyone in?

Also pray with me that this girl is able to stay healthy and deliver well. Thanks.

"Crazy Mondays"

Tersa and her little girl.

(Long story... but hopefully worth the read.) ~

Mondays are always our busiest days. Loads of patients -sick since Friday- sneeze, cough, cry or vomit  their way to the front of the line. And prenatals that could have come at anytime, choose THIS day to get checked out. All the hustle and bustle makes things seem more urgent... more important. I think they like the show.

But to see it all, you have to get there early.

Tersa came in earlier than most however since she was in labor. When I first saw her, she was squirming in pain and clinging to my translator so tight he couldn’t move. It was endearing really. But since the contractions came every minute or so... it was impossible for him to do anything but stand there looking scared (and slightly annoyed). 

I took his place and comforted her through the pain. It was clear, she was close to delivering. Since this was her first child, I talked to her about how to push WITH contractions and not to do purple pushing. (Here they believe you have to PUSH-PUSH-PUSH at the very end whether you have a contraction or not. This wreaks havoc on perineums and babies alike. The first gets torn to shreds and the second gets less oxygen and becomes ‘depressed’).

So when Tersa started pushing, she had some ‘un-learning’ to do. She caught on quickly and a beautiful little girl was born just a few minutes later. She amazed us all with her strength and silence. Simple. Sweet. Beautiful. Strong.

For me the most memorable moment was when I placed her little girl in her arms. I looked from her little girl, to her and then to her mom who was standing beside her rejoicing. Three generations of resilient, beautiful women.

Sigh. Time to rest. Right?

Wrong. This Monday had just begun. I still had 20-some-odd ladies to care for prenatally. They patiently waited outside during the birth and smiled in solidarity when she shuffled passed to the postpartum room. But as this Monday would have it, I only got to three of them, when another labor came inching in. I apologized but knew I’d have to send them home.

They didn’t make a fuss when they saw the labor. She was almost too tired to walk. It was going to be a long one.

Her name was Amijima and she was expecting her 6th child. She had a basketball shaped belly that hung low, sad tired eyes and a solemnity that worried me to the bone. Something was wrong.

The TBA with her kept trying to help --bringing out supplies, instructing her and flittering about nervously. She had a sweet spirit and was Amijima’s friend, so I didn’t chase her from the room. But I was tempted a few times.

My heart sank as they told me her story. Her contractions started 4 days ago but hard labor had been torturing her non-stop for 2 days.  Her water also broke 2 days ago and was sticky brown. They did all they could but the baby wouldn’t come. The night before, they went to their local clinic in Thiet (a town 26 miles away). She was given an IV and then referred to us at first light. It took them all morning to reach us by car.

When I examined her abdominally something was amiss. Her baby was posterior/oblique -- and not budging. But most of all, her abdominal muscles were so lax, that even when lying flat, her belly stuck straight out -- unnaturally so.

(Midwives: think OP but with the head jammed in the maternal right iliac region. Vaginally the fetal head was felt only on the maternal right side, but at a -1 station. She was already 9 cm despite the fact, nothing was dilating her.)

I conferred with Margaret. How were we going to get this baby out? What could we do that hadn’t already been done? What was causing this problem? We vacillated back and forth and finally decided on me working vaginally to reposition the fetal head while she worked abdominally to do a modified version of external version.

What I discovered during this maneuver was very useful. It turns out, the head was extended and in a brow presentation. I was able to flex it and things somewhat improved. The head came down to at least a zero station and it was a little less oblique. But the baby still wouldn’t come.

I should note, the baby was still alive. Thankfully. But the meconium staining and high/low heart tones told me he hasn’t doing well. We were ready for resuscitation and kept praying that he’d have a chance to get that far.

Amijima was exhausted and only wanted to lie flat on her back. I could’t blame her. But I knew the baby needed to turn anteriorly. So, I put her in the hands-knees position and tied her belly tight. (Her lax abdominal muscles, I suspected as being the culprit for the malpresentation.) She didn’t like it and kept asking me to take off the belly binder. I kept explaining how it was helping and why it was important. She was almost to her limit. So was I.

“Will this baby come, Lord? Should I refer her?” I prayed.

He didn’t tell me to send her away. So I kept praying, encouraging and asking God for a miracle. And that is exactly what He did. In just 30 minutes of binding her belly and getting on her knees, she was able to deliver her little boy!

Margaret delivered him while I resuscitated. He was severely compromised and we worked on him for some time before he came around. (His Apgar score was 5/7/8. He had thick meconium aspiration and his breathing was so strained, it completely drowned out his heartbeat. Loud.)

We celebrated of course, but it was half-hearted. This precious boy was not handling the whole breathing thing like we hoped. He developed a high fever almost immediately (very unusual and indicative of some kind of intra-uterine infection) and his lungs screamed at me through the stethoscope. It actually hurt to hear... and watch. He was not well.

We treated him soon after with strong antibiotics (the perk of having doctors right there!) and watch him overnight. While they rested, I told Amijima that I was so glad we were able to help her. “You came in time. Thank you for coming early enough for us to help. Had you stayed at home even one day longer, you and your baby may not have done so well.” I said.

She nodded in weary agreement and explained, “Today, when I arrived. I thought to myself, “This is the day that I die.” I am glad I have not died. I am thankful my baby is alive, too.”

It is to His glory that we were able to help her. Neither of us had a clue what we were doing. Neither of us thought the baby was going to come out. She spent 4 days in pain -- convinced that each day might be her last. But God moved. He answered our prayers!

The next day: Since they live so far away, she asked to be discharged. I didn’t want to but she promised to give him his medicine properly and seek care at the clinic in Thiet. Dr. Tom says he only has a 50% chance of surviving (in his experience), even with the medicine.

Amijima and her little boy.

So pray with me. Pray that this boy one day is able to hear the story of his birth, remember how loved he is and how gracious God is for preserving his life. God must have a great purpose for this boy. Pray the medicine we gave them will work and for the family to recognize this as the miracle it is.

Post note: Margaret told me that after the baby was born, she went outside for something and saw Amijima’s father weeping. Men don’t cry here often. She asked him why he was weeping since she delivered and they were both alive. He said, “Because she didn’t die. My daughter didn’t die. I’m just so relieved.”

Frankly. So am I.