Stitches?

The third birth I observed seemed normal enough to begin with. The mother was 27 years old and expecting her second child.

When we arrived, her contractions were strong and frequent but she seemed to be handling them well. Within no time, her water broke displaying a yellowish puddle of meconium stained fluid.

The nurse set up the room for the birth (which means she got a bed pan, some non-sterile gauze, and a birth kit and placed it at the foot of the bed). The bed pan was slipped under the mother's bottom and she was told to push.

She pushed for only 5 minutes for the head to be born. But then the nurse reached in and wrenched him out. The mother stayed quiet while the nurse literally pushed and pulled and twisted and turned his little body every which way imaginable.

Two minutes later, the nurse lifted his body free of the mother with a gush of more mec-stained fluid.

The nurse then injected her with oxytocin to precipitate the placental detachment, then started massaging her uterus.

She massaged and pushed on it externally until 4 minutes postpartum it popped out in a gush of clots and blood.

She placed the boy in his mother's arms and evaluated her tear.

There was a tear but it was not deep. At most i would have put it at a shallow 2nd degree. However, as the nurse considered it, I overheard her worry how she was 'out of stock'.

I thought nothing of it, until a few minutes later I watched her suture her up with 3-0 acrylic (aka: non-absorbable) suture material.

She placed interrupted stitch after interrupted stitch, burying the deeper stitched beneath the more shallow ones.

My jaw dropped in surprise and my legs snapped closed in horror... but I didn't say anything. How could I?

We were guests there. I could not make those kind of calls... nor could I criticize them in their work. But I confess, I worry still what those buried sutures might do. Perhaps her body just rejected them and the string fell out as they healed.

That is my hope at least.

The hole.

(Warning: story contains pictures that are graphic and disturbing. Caution.)

When I first glanced her direction, I couldn’t help doing a double-take. Resisting the urge to stare, I quickly itemized the concerns in my head.

Swollen face. Oozing sore. Bandages covered in dirt. Obvious pain. Sadness.

“What was wrong?” I wondered to myself, but I didn’t press it. She was Dennis’ patient. I had enough to do that morning. So, I finished consulting with Dennis about a prenatal concern (which was my reason for barging in on his consultation in the first place), and got back to my belly measuring. Dennis returned to the sullen and swollen patient before him.

I thought nothing more of her, until I needed another consult about an hour or so later. But this time, I found Dennis in the wound care room.

He warned me before coming in: “Prepare yourself Stephanie. I don’t want you to get sick.” That just piqued my curiosity more. What was he doing in there?

Even though, blood, pus, and fluids don’t bother me at all, once inside, I was glad for the word of caution. What I saw made me stare in horror-tinged curiosity.

The right half of a girl’s face lay open and exposed. It was the girl from the consultation room, but this time, the bandages were off and the wound was debraided.

Half of her lips and almost all of her right cheek were gone. White, pristine teeth sparkled through, and I watched in fascination as she ran her tongue casually across them. It was something out of a horror film.

She was so young and beautiful; how did this happen?

The story went that she had an abscess in her cheek which was lanced and drained by someone in the village. That was only 3 days before. In that short time, the infection took over, eating its way through her face until all that remained was teeth.

Hard to believe and even harder to look at, I watched Dennis put in the first suture. Drawing the would-be lips together to form the inside of her mouth, he steadily worked to give her some tiny resemblance of normalcy.

I couldn’t stay and watch, even though I would have happily done so-- I had too many prenatals waiting for me. So, I left him and Margaret to the work they do best, and went back to work.

I happened to come in just as he finished. Naively, I had expected her wound to be closed. But when I saw the raw, fleshy, gaping hole, it finally dawned on me-- she had no skin left to suture.

Pray for her. She’s in a lot of pain. Dennis mentioned her needing a skin graft. She’ll be coming for daily wound dressings. Thanks.

Trust~

Petite and round about the middle, her small frame wobbled with each contractions. Explaining the pain started the night before, she paused every few minutes to breathe, and then continued. No, the water had not come out. No, there was no bleeding. No, she had no urge to push.

Nevertheless, she was close.

I didn’t do an internal exam, knowing it wouldn’t change a thing, and told her that if she was comfortable standing, it would help her labor to progress. She got up immediately, and started wobbling around the room.

I also explained that once her water broke, things would progress quickly. She looked at me wide-eyed and asked: “Is there really water inside?”
-- “Yes. Your baby lives in water.”
-- “Really?”
Smiling, I just nodded and continued to check her in. Her curiosity and trust melted my heart.

Adorable.

Plus, she had the kind of energy that only teenagers display in labor. She was up and then down. Moving nervously around the room, she continued to wobble until her water broke.

Not long after, she was asking to go to the toilet. When she did, I smiled knowingly. Everything about her screamed it was time to push, but I didn’t tell her that. I just followed her to the toilets, and let her push.

When nothing happened, we wobbled back to the clinic together, passing dozens of preggos on our way. They smiled and cheered a bit in solidarity.

A half an hour later, she beamed in joy as she held her little boy.

Pushing with her was intimate and fun. She listened to her body and trusted the process. Her complete absence of fear was refreshing.

She was refreshing.

Despite pushing well, she tore. I told her about the tear, and asked if she wanted me to suture it.
-- “Will it hurt if you suture?” she asked.
-- “We use medicine so you won’t feel the pain.”
-- “But I live far away, if you put in string, I cannot come back to get the string out.”
-- “Oh. I see. But we use special string. This string doesn’t need to be taken out. It dissolves on its own.”

She discussed it with her friend for a few minutes in low voices. I couldn’t understand them if I had wanted to, since it was in Dinka, but they whispered nevertheless.

Honestly, I never thought she’d agree to it. I’ve had this conversation too many times over the last few months and each time they’ve declined. There seems to be some fear of needles involved or a belief that she’ll just tear agin next time. I’m not sure. 

When she agreed to be sutured, I couldn’t believe it. Really? She wanted me to suture? Wow. She really did trust me. Extraordinary.

I set up the room quickly and I was done in no time. Afterward, I heard her tell her friend that it didn’t hurt much at all. I couldn’t help but smile.

Once in the postpartum room, her family rallied around her. Three generations of women and two pubescent boys came to congratulate her. It was a party!

The fact that a first time mom, labored with me, let me teach her how to push and had me suture her perineum somehow tells me I’m accepted now. I don’t know when it happened, but the women are starting to trust me. What an honor! What a privilege!

She's the second from the right, in blue.

Thank you for your prayers. I’m seeing more women than ever for prenatals and deliveries. Some women come from five hours away to be seen. Keep praying though... this is when it gets busy! Pray for more laborers and great translators. Thanks.

8 1/2 Fingers.... left.

One of the men working on the new clinic got his hand caught in the brick-making machine today. And in a matter of seconds, he lost two finger tips on his left hand. The ring and middle  finger are missing from the first phalanges. The bones were exposed, flesh torn open and raw. The pinky was crushed but the bone remained intact.

Fortunately we have an emergency room doctor here on a short-term missions trip. His name is Dave. Originally, he wanted to transport him. He said the bones needed to be removed and skin drawn over to be properly sown together. However, it wasn’t going to happen so he did the next best thing. He sutured him up.

Here’s the thing. The man missing his digits never made a noise of pain. Not even a squeak. He didn’t hiss, cringe, moan or otherwise indicate he was in pain. I know part of it’s cultural but.... come on!! You’re missing part of your hand! It’s okay to cry! But he didn’t.

The only noise I heard him make was only after the bandages were firmly in place. I showed him a picture or two of what his hand looked like. Only then did he make a noise of compassion.

Oh, Sudan!

I’m told it’ll take 2 weeks to heal, assuming no infection sets in. However, it’ll be months before he can use his hand again.

Face Off.

Today I helped sow a man’s face back on. I’m not taking any credit. I’m saying I had the privilege of watching and dabbing away the blood from time to time. He was brought in unconscious after being thrown from a motor bike. It’s still unclear to me if he was driving or just the passenger.

His forehead peeled back like a trap door revealing the hard skull beneath. His left lower eyelid gaped at me, bloody and mashed. It looked like someone had taken a bite out of it, exposing the bloodshot conjunctiva beneath. I honestly wondered if he’d loose it all together.

His upper lip was ripped away from his nose, leaving it swollen to two times its size. And his chin had a gash a 1/2 inch deep that looked as if someone had drilled it with a screwdriver. Then there was the road rash all over his arms and chest.

Mercifully he didn’t gain consciousness until we were almost finished. I wonder what he must have been thinking when he woke. He seemed less inclined to lie there though -- confused and hurting. We had to restrain him to finish the job but it wasn’t hard. He did have much fight in him.

He will have a long road of recover ahead of him. Please pray that no permanent damage was done.

Baby #17 Gian Carl

Riza, Gian Carl's mother was already at the clinic when I got on shift. She was 8 cm dilated and the previous shift had broken her water in order to speed up her labor. She was very tired but was close to giving birth. Once she started pushing, her baby was born 19 minutes later. The placenta wasn't coming so my supervisor did a manual extraction. During birth, she tore a second degree tear and I got to suture her.

Gian's father, Glenn, was so attentive during birth, supporting his wife, rubbing her back and encouraging her. He was also the first one to bathe his son.