Witch doctor charlatanism!

The other day, a woman was carried into the clinic acting very strange and fighting her care takers. She foamed (literally) at the mouth and walked in stilted, jerky motions. It took her family a number of minutes to even get her in the door.

Such behavior is common for severe malarial patients and she was no exception. The doctors worked to get her the medicine she needed and monitored her all afternoon. As she recovered on our back porch -- Achem. I mean our in-patient room-- her family explained they first sought help from the local witch doctor.

Under his care, she didn’t improve even though he “removed” a shard of coal, a sliver of black wood and a dead beetle from her body. They even had proof. Untying her “sickness” from a plastic bag, her brother didn’t seem the least bit flustered as he showed us what they took out of her. Did he really believe that was what caused her malaria? I couldn’t tell.

The beetle, coal and wood.

When they told us how much it cost to get these things “removed” from her, I was simultaneously shocked and horrified. It cost them a weeks salary-- or 60 Sudanese pounds ($25). Charlatans!

My horror makes sense only when I explain that we charge our patients 2 pounds. The money they pay is just a one-time fee for a patient book.  All medicine and consultations are free. Knowing this, why go to the witch doctor first? I just can’t understand. I just can’t.

By that evening, she started acting normal again. And by the next morning, she was sitting up and brushing her teeth as I passed. Sane. She even smiled shyly in my direction. Not long after, we sent her home to the relief of her family. Healed.

I overheard Dennis (our clinical officer) encouraging them ‘to save their money next time and just come here.’ Her husband and brothers nodded in agreement, evidently pleased. I don’t want to speak ill of any of the witch doctors here. I don’t know any to speak ill of them. I just can’t help but wonder what they do when they get malaria....

Hopefully they take their own medicine and die!

Brother holding "sickness", sister behind him.

Update: 8 1/2 fingers... left.

The other day I ran into the worker who lost his fingers in our brick making machine. (Read his story here.) I got pictures of how it's healing and thought you might be interested to see. He says one finger has a bit of the bone protruding but flexibility is better. I'm happy to see his pinkie is healing up well. What is more, he doesn't seem the least bit bitter about the whole thing. Do you think fingers are just fashion accessories here? 

Too old for this?

Last year, the first day we opened the clinic after the holidays we were slammed. They said that it was a mass chaos, so I prepared myself mentally for anything. But this year, with everyone at the polls we found ourselves blissfully quiet instead. It was really quite relaxing.

Preggos filtered in all morning and I spent lots of time caring for them. It was fun catching up with faces I hadn’t seen in weeks. I even got a visit from a baby I delivered in September. She was all sparkly-eyed and smiles. It was a good morning.

But at noon a labor came in to stir things up. Martha, my labor, appeared bone tired, making her look much older than her years. Had you told me she was 50, I would have believed it. She never came for any prenatal care, so I had to get her story on the go. She was 39 years old and expecting her 6th child. Labor started three days before but something was wrong.

Her husband carried a large wooden cross everywhere he went, much like a very short walking stick or an incredibly large good-luck-charm. He held it tight while answering my questions about her history. Yes, there had been a lot of blood. No, it has never taken this long before. The worry, love and concern in his eyes clouded his face and sobered his voice.

As I assessed her, I was excited to find her in good health, despite her exhaustion. Her baby was in a good position, contractions were effective and labor was progressing well. I had to reassure her husband that she’d deliver within the hour at least three times before he believed me.... and even then I’m not so sure he did.

So I prayed for them all, tied her belly (which was lax and possibly causing some of the delay) and got her in some good positions. Twenty minutes later she was asking to push. Four solid pushes after that... and he was born.

Once he was out, he instantly started peeing a fountain of urine for all the world to see. It made my translator laugh and clap for joy, saying “This is very good. Very good!” over and over again. I think he was more excited the baby was peeing than the fact he was even born!

The husband was overjoyed as well, and repeatedly thanked me. Personally, I don’t think I did anything but remind them that God is in control. But I guess that was enough to make his day. 

I, too, was encouraged though. I’m not sure if it was the big wooden cross, the peeing bambino or the fact that this strong Dinka woman would have a little boy to comfort her in her old age. Perhaps all three.

Before discharging them I asked to take pictures and pray. The father was happy to have me blessing his family and stood over us, glowing in satisfied pleasure. Beside him was a pregnant girl. She seemed wide eyed and innocent... and very young. I asked if she was a second wife (as having young wives for very old men is not uncommon), but they laughed and explained she was his daughter-in-law.

Only then did it hit me. Her oldest child was married and expecting a baby of his own! Ha! Their son and future grandson will grow up as best friends, no doubt. A happy time indeed.

Husband, Daughter-in-law, Martha and Bambino.

Voting Begins on the Sudanese Referendum~

This morning I woke to the sound of drums beating out a steady rhythm, waking the world with the good news. It was time to vote.

At church we spent the service in prayer for this nation’s leaders and especially for peace. It’s a historic moment. I’m glad I get to be a part of it.

This afternoon, I was able to visit the voting stations and see history unfold for myself. In spite of the afternoon heat, dozens queued happily for their chance at the blue inked ballot. Since most of the Southerners are illiterate, they are casting their vote by putting a fingerprint beside one of two images. If they want to stay a part of the North, they must choose two hands clasped together in unity. If they want independence, they must put their mark beside the hand waving goodbye. And as they leave the polling station, they must dip their finger in permanent blue dye, to prevent them from voting over and over again.

Snapping off a few pictures of the crowds, I could feel excitement and hope hanging in the air. The day had finally come....and it only took 55 years.

Polling station at neighborhood school.

As we drove from one polling station to another, Sabet, our Sudanese director, explained the history of his home country and why today was so special. Fifty-five years is a long time to wait for independence. Many had to die for this day to come.

He explained that the Southern Sudanese wanted independence in the 1950s but it was denied them. In 1955, a group by the name of “Anyanya” (Rebellion in Dinka) declared war and started fighting the North for freedom. War continued until 1972, when a peace agreement was brokered.

In that agreement, the South was awarded semi-autonomy and a budget to run its own affairs. For this concession, they agreed to remain a part of Sudan and not insist on secession anymore. However, it only lasted 10 years.

Women waiting in line to vote.

By 1983, Sudan was miserably in debt and could no longer afford to let the South govern itself. The nation’s leaders reneged on their agreement and war broke out again. This is when the “Rebellion” resurfaced, calling themselves the SPLA (Sudanese People Liberation Army). Years of bloody skirmishes tore the South apart, leaving generations of widows and orphans. It was ugly.

In 2005, a powerful and well educated SPLA director, John Garang negotiated another peace agreement with the North. But this time the South refused to settle for autonomy. Independence and nothing but independence would do. They would put it to a vote -- thus today’s referendum.

Excited to cast their votes in this historic event.

Garang became Southern Sudan’s first president. Six months later he was killed when his helicopter crashed. The investigation into his death was officially declared an accident, but if you ask anyone in the South they’ll laugh at the thought. It’s widely believed he was assassinated for his political clout and radical ideas.

I’m told he was not asking for independence as we see it today. He was pushing for Sudan to remain one country but with a new constitution that protected religious freedom. He no longer wanted Sudan to be considered a ‘Muslim’ country; but one where even a Christian could be president.

Hanging around after the vote, holding registration cards.

Many believe that had he lived, the South would be in control of hotly disputed lands; The blue Nile region, Abeyie and the Nuba mountains. Had he lived, I wonder if Sudan would be splitting like this. I wonder if the North would be threatening to adopt Sha’rai law. I wonder...

A nation’s hopes, fears and future rest on what happens this week in the polls. Everyone believes independence is assured, so long as Bashir keeps his word. Pray that he does. Also pray that with independence strong, godly leaders will carry this neonate of a nation toward peace. May it one day be called a Christian nation.

Here is an inside peak at the voting process...

Police guard monitoring that voting goes unmolested.

After voting, he dipped his finger in blue dye.

Evidence that his vote is cast.

Scorpions Suck!

Not the original offender, he died. Ha!

Last week I was asleep under my mosquito net when suddenly two sharp pains shot through my right index finger. I moved my hand away in aching surprise and rummaged for my flashlight. It reminded me of the searing pain I had when stung my hornets... earlier this year. (I was stung 4 times in less than a half hour. It was awful.)

Unfortunately, hornets were the least of my concern. Instead, my flashlight revealed a brown scorpion, 3 inches long, furiously trying to get out of my net. He had somehow squeezed his way inside (since my net is tucked in at night) and was spitting mad he was trapped. But he couldn’t have been more mad than I was at that moment of realization.

I slowly pushed him to the side, slid out of my bed and then wacked him till he convulsed into a pile of brown mush on my floor. Stupid scorpion. I wanted to squish him even further... and who knows maybe light him on fire, but the throbbing in my hand distracted me.

Instead, I dressed and rushed across the compound for Dr. Tom’s help. It was two in the morning but I had to wake him. Tears of pain trickled down my face as I explained I was stung by a scorpion. Twice.

He jumped up, awake in seconds but just stood there looking at me bent in pain outside his door.
-- “Umm. What do you do to treat a scorpion bite?” He asked. “I’ve not seen one yet.”
-- “Lidocaine!” I almost screamed. The pain radiated to my shoulder. I couldn’t help but worry I’d die of anaphylactic shock from an allergic reaction. “Numb my finger with lidocaine!”
-- “Ok. You got it kiddo. You are gonna be okay. I have some in my bag right here.”

The few minutes it took him to fill the syringe and jab me with lidocaine, I spent on the floor bent in frustrated pain. It was intense. I thought I was a toughy until this. Wowzeers.

Within minutes my hand was numb; I couldn’t feel it at all. What bliss! But the radiating pain persisted in my arm. I thanked Tom behind embarrassed tears and quickly rushed away. I didn’t want to appear to be the sissy that I was. Imagine that. Crying over a stupid scorpion bite.
I guess I’d live after all.

Once back in my room, I took a paracetamol and Benadryl cocktail and was able to fall asleep within the hour. The next morning, my hand was stiff and very tender but by the end of the day was working just fine.

Conclusion: Scorpions suck.

Picture taken from this website.

Update: Blood Transfusion?

A few weeks ago, I wrote about an 18 year old pregnant woman who had a hemoglobin of 4.4 after a case of severe malaria. We attempted to do a direct blood transfusion to improve her condition. (Read her story here.) But we failed. We just aren't set up for this kind of thing.

In fact, after several hours and many 'learning curve' situations, we were only able to infuse about 30-40 ccs of blood. She spent the night at the clinic and we discharged her to Wau the next day, so she could get a transfusion there.

Well. Today I learned she died.

I was surprised to think a grown woman could die for something so preventable, let alone a pregnant one. What happened? What went wrong? Didn't she go to Wau? Didn't she get the blood transfused?

One of our translators, Wilson, (who happens to be her cousin) told me the rest of her story today. She was too weak to travel so he (Wilson) went to Wau instead and inquired if there was any blood available. He was told they had no B+ blood but if someone came in to donate they'd do the transfusion. He came back, told his family the news and together they stopped trying.

She died two days later. (Three days after our attempt at a transfusion.)

I asked him why the two men (that we cross matched to her in our lab), didn't just go and give their blood; They still had plenty. He looked at me confused and said, "But they had no blood. Don't you remember? We couldn't get any from them."

Instantly my heart sank. Yes, I remembered. But I remembered it much differently than he did. We couldn't get blood from them because we didn't have the correct materials -- not because they were out of blood. (!#$%!@!)

I asked him if he remembered learning in class that a person has over 5 liters of blood in their body on average. He nodded and said he remembered. "Well, if a person has 5 liters, don't you think that they can give much more than 30 ccs?" He just cocked his head to the side and looked at me sadly. He didn't appear to understand.

"Wilson, your friends still had blood to give. She could have gotten the transfusion with their blood." I struggled to keep the incrimination out of my voice. He explained that the 'Fathers' decided that they shouldn't give anymore since they had tried and failed...

I tried to teach him more about how blood transfusions are (normally) done and how much can be given. I didn't want him to feel bad, just to know so this didn't happen again. But I cut my lecture short, seeing he wasn't listening.

He was tired. He was sad. He had done all he could... all he thought best in fact. So, I shut up and started lecturing myself instead. "He did everything he knew to do... He was trying by going to Wau, by talking to the 'Fathers'. He was fighting for her life and failed... just like we did."

The conversation moved on but my heart sank further down. What more could I say? I failed.

I failed to explain to them that a person cannot 'run out of blood'. I've failed because... this isn't the first time I've heard this excuse. I just never thought it could hurt anyone.

Generally when someone says they have 'no blood', I ignore them. I don't try to explain to them that it's impossible to live without blood, that we have liters and liters of the stuff... yada yada. I just move on with a prenatal or check-up or whatever. But now I see the damage this ignorance can do.

Another face of maternal mortality. Another needless death. Lord please don't ever let this happen again. May her death teach me to teach them better. May I never forget this lesson. Amen.

Recent Article on Sudanese IDPs and Referendum.

I was interviewed this week by a French journalist for Observer24, an online news journal, about my recent post A nation in Flux: IDPs and the Sudanese Referendum.

Here is a link to her article. Millions of exiles head to Southern Sudan for Referendum. And for those who are French speaking click here. (Achem... Oui, ca veux dire vous D & R! Finalement, j'ai mis quelque chose en Francais uniquement pour vous. :- )

Won't my baby drown?

 Yesterday, Rosa came into the clinic saying the baby was on its way. This is her third baby and I believed her. She didn’t need to push yet, but she assured me it would be soon.

As we worked to set up the birthroom and check her vitals she writhed a bit on the bed. I went through all the basics; When did they contractions start? Any water come out? How about blood?

Focused intently on her pain, she shut her eyes with each contraction and softly answer our questions. Her contractions were just minutes apart. Heart tones were good, so I asked if I could do a vaginal exam.

She was fully with the head at a + 2 station while membrane bulged at the introitus. I asked if I could rupture her membranes to prevent a big splash, explaining that the baby would be born very soon.

She looked at me worried and a little confused so I reassured her that it would not hurt her or the baby at all. She still looked concerned so I told her that the membranes would break on their own in a few minutes anyway... but if she didn’t want me to do it, I most certainly wouldn’t.

Only then did she explain what was on her mind.
-- “But if you break the water, won’t my baby drown in the water?”
Huh? Drown? I made my translator repeat her question.

-- “Oh, you are worried the baby will drown?”
-- “Yes.”
-- “Your baby is living in that water and has not started breathing yet. I promise, your baby will not drown if I break it.”
Sighing in relieved pain, she agreed.

Her baby was born 5 minutes later -- A beautiful bundle of estrogen!

As I cared for her afterward, I couldn’t help but mull over her question. It actually makes sense. I can see why she would think it possible for her baby to drown. Perhaps that is one of the reasons they believe babies die in childbirth. I’ll have to ask more questions about this when I do the community outreaches.

Anyway, rejoice with me that another little blessings was born-- healthy and strong.

A Nation in Flux: IDPs and the Sudanese Referendum

January 9th voting begins. That’s in exactly one week. That means in one week this nation’s future is going to be decided. We might not know the results of these votes for months... but the whole course of this nation will have been decided.

Pray. Pray. Pray.

In anticipation of this historic event, and as a consequence as well, the leaders of Tonj have been preparing for an influx of people. People are on the move.

The referendum has Northerners fleeing south in hopes of security and a chance at a new start. Buses headed for Rumbeck (a town 5 hours south of us) passed through last week. It was quite the sight to see; buses lined the main square for blocks, loaded down with baskets and bundles.

An exodus of sorts.

Tonj is expecting 700 internally displaced people (IDPs) in the next few days. They are already en route. That’s 700 mouths to feed and bodies to bed. The town leaders have been preparing schools and fixing outdated wells. They have begun discussing latrines and water rights in anticipation of the chaos. Much has to be sorted before they arrive.

I’m told they will be supported and housed for 3 months by the Southern Sudanese Government. During that time, they will be required to reconnect with relatives and/or find lodging and land. Then they are on their own.

Change is coming and with it potential-- Potential laced with a hint of fear and a lot of the unknown. Pray for this nation. Pray that God’s perfect will would be done among the leaders and in this nation. Thanks.

... more than this!

The end of the year is here... at least the calender is telling us so. Who decided the year would end on December 31st? Whose idea was time anyway? It’s such a strange concept. Think about it. What would life look like if we had no calenders, watches or alarm clocks?

It makes me wonder. Did God create time, or just the objects by which we calculate it? (aka: sun, moon, stars...etc.) Is it an eternal or human concept?

The Bible tells us that we were created for eternity not time. Eternity exists outside the limitations of time and space. It is a whole new foundation which makes the time-space continuum look flimsy and frail.

God placed eternity in our hearts (Ecc 3:11). Meaning, we were created for more than this. That is clear to me. And each year it becomes even clearer. This world constantly tells us that ‘this is all there is’ and we ‘better grab it while we can’.  Yet, this myopic attitude screams of hopelessness and greed.

The world teaches that death is the final curtain and that we race toward it at neck-break speed. With time comes a start and a finish line. It brings in the concept of age, and with age the awareness of death. Death is the ‘great unknown’ and thus... the fixation on time.

What would life look like if the factor of time were removed? Would society as we know it be transformed? Does time tie us together or just give us the impression of cohesiveness? Is it reality or just the nail on which this flimsy world hangs?

Once I stepped into a new life with Christ, time lost its weight and wonder. Eternity seems more real to me than numbers on a calender. Eternity is now. It is in my heart. It is the framework on which my life rests.

One day in time as we count it now, my body will cease to work like it should. I will have run out of time but I won’t be dead. I will have stepped out of time's limitations... no longer being bound by it. That is all.

What then?

Freedom. What sweetness that day will be! Until then, I hold time open-handedly, looking forward to the moment when it becomes obsolete. Eternity is now. Remember that. Walk in light of this reality and live like there's is a tomorrow!  

Happy New Year!

Two Broken Legs and a Baby.

Last night I was called to the clinic to help with an emergency. Two women were in critical condition after being hit by a truck. To get to them, I had to walk through a dozen somber looking men gathered on the clinic porch. They pressed in to see but our staff barricaded the doors; the doctors needed space to work.

My patient was named Adong. She looked to be in her twenties and had a severe fracture of her left femur; it lay unnaturally swollen and twisted. When I lifted it back in place, I could see where her bones were no longer connected. It was a clean break -- No doubt a painful one.

While irrigating a deep gash on her foot and removing mud and sand from various wounds, I was able to piece together her story. She and her sister-wife, were walking alongside a road when a land cruiser hit them, sending them flying. The driver stopped, abandoned the vehicle and ran for his life. They knew both the driver and the vehicle well. There was no doubt who was responsible. 

Only then did she ask me if her baby was okay. What? She’s pregnant? I made her repeat herself. She explained she was five months along.
-- “My stomach hurts a lot. Is my baby okay?” She groaned in delirium as I palpated her belly.  “It hurts everywhere.” I could feel the well formed baby beneath her skin, perhaps she was more than five months.
-- “Can you feel your baby moving?” I asked. But she seemed not to hear... or understand. Instead she repeated how she was in pain and wanted to turn on her side.
-- “Your leg can’t be moved right now. Why do you want to turn?”
-- “I have to turn because my baby is uncomfortable in this position. I have to lie on my side.”
-- “Please don’t move. I’ll check on your baby. Just don’t move.”

Adong with Dr. Tom

As I got the doppler and ultrasound gel, I couldn’t help but wonder if we’d have a third victim on our hands. Relief rushed through me when I immediately found a solid heartbeat.
-- “Adong, your baby is fine.” I reassured her. “He’s fine. Meth Apoul. He’s doing well. ”

The room sighed in relief with me... but she moaned. The pain was intense. I took her hand and prayed. I couldn’t thank Him enough that they were all alive. It could have been much worse. I then went to pray with Amer, her sister-wife in the next room. Amer sustained a fractured right leg and several facial lacerations. She was stable and despite the blinding pain, would live.

The crowds continued to come and go. Among those pressing to get into the clinic were newspaper reporters and police investigators. Everything had to be documented. The man who hit them was a foreigner, an Ugandan. He worked for a Christian relief organization. Worse still, he attends our church and once worked with our ministry. We know him well.

As the reality of this news became clear, each face grew heavy in question marks and concern. Would their family retaliate? Would he be killed? Would he flee to Uganda? How will any good come of this? Answers would come in time. So we turned in for the night.

Amer after being stabilized.

This morning’s light brought more officials, commissioners and looky-loos. It took some time for the women to be moved to our vehicle. But by mid-morning all was arranged and they left for Wau.

I also learned that the driver was arrested (mostly for his protection) and is now being held in custody. Since no one died, his life is not in jeopardy but he will have to pay several fines. 

Please pray with me Romans 8:28 for our Ugandan brother. Pray for wisdom, peace, protection and grace. Pray for these women and their families; healing, life, forgiveness and mercy. May this little baby grow healthy and strong. Amen.

Bongo party!

For a week, I’ve woken to bongo drums pounding out a steady beat as processions marched the streets, clapping and singing in unison. One of the celebrants owns an old bugle and plays it as loud as he can-- off-key but joyful. I heartily approve despite the sometimes early start (5 am is reserved for sleeping in my book!).

But hey... joyful noise is joyful noise. Right?

Early on, it was only Christmas songs. But now, I’m told they are singing to announce the Bishop’s arrival. As I type these words, I can hear the drums reverberating deep hollow echos of steady beats. Very African.

Yesterday, in a festive mood, Sabet gathered some of the staff to participate in one of the many celebrations going on around town. We arrived too late for one party, featuring special dancing. But we made it in time to another one. This one was a Bongo celebration.

Almost immediately, we ran into one of our translators, Dongau. He was thrilled we’d come to his tribes’ party and got us dancing in the circle. It was fun with the steady beats and relaxed rhythms.

In the center of the dance circle crouched three men bent earnestly over drums. A fourth blew melancholy wails into a hollowed tree trunk, a foot wide. It reminded me of the hypnotic echos of a didgeridoo and relaxed me immediately.

The Bongo tribe dances with slow, undulating movements. They sway and divot compared to the spastic jumping and constant stomping done by the Dinka.

Yellow Squishy Fruit.

Papaya season is here, meaning every papaya tree on the compound is pregnant with football sized yellowing fruit. Some branches still carry deep green bundles. But under the Sudanese sun, they don’t stay that way for long.

We try picking them just before they fully ripen. If we wait too long we can’t get them down intact. But when we do, they are well worth the effort. Their orange fleshy silkiness is divine.

To get them down from the tree tops, we have to prod them with a long pole and then catch them in a box. We had three attempts yesterday. All three missed the box and hit the ground.... oops! They were eaten anyway. Yum!

More than a statistic....

 (Warning: this story speaks of death and maternal mortality.)

Early Monday morning, I was called to attend a young woman in labor. It was her first and she was scared. As I checked her in and listened for the baby’s heart tones, I could hear a patient in the other room trying to breathe. A wet, gurgly rattle of a sound filled the clinic, distracting me. I pushed it to one side of my brain and refocused on my labor.

Her name was Debora and had been coming for prenatal care for months. I got her situated and set up for the birth. Everything was going smoothly, so I thought I’d sneak in a bit more sleep. She was only 4 cm and had three doulas monitoring her every move. I wasn’t needed just then. So, I told the health worker on shift, James, to keep an eye on her and call me if anything changed.

But before I left, I couldn’t help but peek in on the patient in room one. What was causing all that noise? James followed me into the room and showed me her chart. A man, somber and tired was holding her in a semi-recumbent position. She was unconscious and had been that way for over a day.

As I read her chart, I was startled to learn she had delivered two days before. A stillbirth. She immediately got sick and passed into a coma. They waited a day before they came for help. But by then, there was little we could do but watch her struggle to breathe.

And struggle she did. Foamy saliva formed in her mouth with each breath. She was drowning. An older woman sitting by her side, kept wiping it away. Brow knit in desperation, she studied me as I studied her chart. Dr. Tom had seen her. He had done all he could.

I went back to bed but her death-rattle haunted me. I couldn’t sleep. Questions kept taunting me. What had caused her baby’s death? Why was she unconscious? Why did they keep her at home so long? Would she live? No answers came.

It was only a few minutes later that I heard James knocking on Tom’s door across the compound. Murmured whispers exchanged. Doors opening. Gates slamming. Something told me she had died. I got up and James confirmed it. She had stopped breathing. The fight was over.

I wanted to go to the family but ... I also wanted to hide. What did I have to offer this family's grief? I tried to go back to sleep but God kept insisting. “Go now. Go talk to them,” He whispered. I obeyed but my heart in my throat. What could I say?

When I got there, I found the patient covered from head to toe in a blanket. The man was gone but the woman still sat by her side, hands clenched and pale. Tearless, she sat shaking uncontrollably and searched my face for answers. I called James in to translate and sat beside her. I asked her if I could pray for her. She nodded, still shaking.

As I took her hands in mine and prayed, my heart broke. This precious woman died in childbirth. She is the face of maternal mortality. A statistic -- but oh so much more! She is a daughter. A wife. A sister. A friend. Her motionless body, hidden under the blanket, couldn’t hide this fact to me.

Her name was Abuc.

After praying, I asked the woman to tell me her story. What had happened? She hesitated only a moment, then spoke for sometime without pause. My translator listened, nodding encouragingly for her to continue. This is the story she told.

Being of age, her daughter was married earlier this year. But her husband caught her cheating with another man, who impregnated her. Understandably upset, he retaliated by putting a curse on her and the child. This was the result of that curse, she explained. First the child died and now her. She added that this was her only daughter and she was too old to have others.

-- “How long was she sick?” I asked.
-- “Four or five days. She delivered a dead baby two days ago and then got really sick.”
-- “Did she get prenatal care?” I couldn’t help but wonder if this had been preventable. What medical reasons caused this death? Was it preeclampsia? Hypovolemic shock? Malaria? Pulmonary embolism? Stroke?... What?
-- “Yes.” She explained. “She went once to the clinic in Malualmok.” (A small neighboring town.)
-- “Only once?” I asked. She nodded.
-- “What was she complaining of before the birth?”
-- “Headaches, neck and joint pain. But that is all.”

That means it could have been anything-- malaria or perhaps preeclampsia. I couldn’t say for sure. The fluid in her lungs made me think it was a pulmonary embolism. I wanted to grill her with more questions but I didn’t have the heart. She didn’t need answers. I did. She already knew why her daughter had died. She was cursed. So I dropped it.

We sat in silence. Nothing more needed to be said. I wanted to ask her if she knew Jesus but her grief was so fresh. So I sat and held her hand instead. Her shaking slowly subsided and together we waited for the men to return. They had gone to get transportation. The body needed to be buried.

They returned with more men to help dig the grave. Abraham, a family member, asked in perfect English if we could drive them back to Malualmok. I got Mike (our compound manager) and he agreed to take them. It wasn’t even light yet when they drove off with her body.

I couldn’t get her out of my mind but I had to. Debora needed me. Turning my attention to her, I was happy to watch her labor so well. She handled the pain with slight moans, walking the baby down. She was tired but healthy.

In my mind, I couldn’t help but compare these two births. Both were first time moms in their teens. One had come for prenatal care for months, taking vitamins and getting her shots. The other was seen only once. One had delivered a stillbirth at home. The other was delivering with me in the clinic. Her baby was fine.

Later that day, Debora delivered a gorgeous little girl while surrounded by friends and family. It was beautiful watching her go from girl to woman; from pregnant to mother. And best of all she lived. I’m not saying that had Abuc come to deliver with me, she would have lived. I will never know that for sure. But I do think her chances would have been better.

Was her death preventable?

Pray for Abuc’s family and the superstitions that plague these people. Pray for these women to come for prenatal care and to deliver at the clinic. May there be no more preventable maternal deaths. May it stop here! Now!

This Christmas....

Staff party, we had a mini-service, gifts and cookies.

So I’ll catch you up a bit. This Christmas has been extraordinarily relaxing. It couldn’t have come at a more needed time. As a team, we decorated cookies, cooked fancy meals, reveled in eggnog and hot cocoa and sang Christmas carols (off-key) each night. It was great.

We even had a staff party for all the Sudanese, handing out Christmas bonuses, teddy bears and eating those very cookies. It was so great to meet the wives and children of the men I work with.

Christmas day came and went in a blur of food and gifts. In typical fashion, the triptiphane in the turkey put me in a semi-coma and I snoozed all afternoon.

Highlights for me though were all the skype calls I had with family in Europe and the States. It helped stave off some of the holiday blues and dissipated a bit of the homesickness I was experiencing.

So here’s a quick shout out to my family and friends! You know who you are. I love you and miss you! Merry Christmas!

Culture Matters: Why maternal mortality is so high....

Not long ago, a friend posted an article on the realities of maternal moralities in developing nations on her blog (Midwife to the World). Each time I read it, my heart sinks and my skin grows cold. It is true -- horrifyingly true. I saw this happen in the Philippines and I know it happens here in Africa.

Please read the story of Mrs. Y and you will see what I mean.

May this NEVER be true of our clinic!

Seek the LORD until He comes.

“Sow for yourselves righteousness, reap the fruit of unfailing love and break up your unplowed ground; for it is time to seek the LORD until He comes and showers righteousness on you.” 

~ Hosea 10:12

Living in an agricultural society, the imagery of this passage stands out in new ways. Listen to all the agricultural words used. Sow. Reap. Fruit. Unplowed. Ground. Showers.

The message is clear. Sow righteousness. Reap unfailing love. Break up unplowed ground. Wait for the showers of righteousness from heaven. It is time to seek the LORD until He comes.

Come let us seek the LORD. Ready your soil. Sow in righteousness. Reap unfailing love.

Getting in the Christmas Spirit...

This week we (meaning all the remaining missionaries) have been celebrating Christmas Sudanese Style. That means Advent candles, Christmas stockings and two plastic trees. We have tried singing Christmas carols but it's comically atrocious. We can't seem to hit those high notes. We just end up rasping away and laughing it off -- at least we are singing.

To get in the mood we watched 'Christmas Vacation' and drank home-made eggnog! It was DE-lici-OUS! And today we made sugar cookies and frosted them for our staff Christmas party tomorrow. I wanted so much to start eating them now... but then what would we serve tomorrow?

I hope you are all having a wonderful Christmas... wherever you are in the world!

Labor of Love December 2010 - Newsletter

My latest newsletter: Labor of Love December 2010. Enjoy and Merry Christmas!

Sudanese Christmas.

Summer is upon us with a vengeance. With highs in the 90’s, I find any excuse to hide in the shade and siesta all afternoon. Doesn’t the weather care that it’s December and things should be cold, icy and white? Apparently not.

In fact, it’s pretty hard to believe it’s even Christmas. It feels like Vegas mid-June with gusty breezes that dry our laundry in seconds! Under its intense heat, everything withers and wilts -even my Christmas spirit.

I tried lifting those spirits by playing Christmas music. But it didn’t help. Brown grass, sweltering heat and tank-tops. That is my life right now. Not to mention, a thin layer of fine yellow dust coats EVERYTHING. I wake up to my face caked in yellow dust. It’s in my teeth. I cannot escape it.

And I am dry. Very dry. My lips. My skin. My eyes. My hair. One wrong move and I might chip off and flake away. And with these winds, who knows where I might end up! Uganda perhaps?

Christmas as I know it has been transformed. Gone are the cut out snow flakes. Gone are the thoughts of hot cocoa and wool mittens! Honestly, how do you sing, “Dashing through the SNOW, on a one horse open sleigh....” here without laughing? It’s totally ridiculous.

Even the traditional Christmas Carols start taking on whole new meanings. When I sing, “Away in a manger, no crib for a bed...”, I imagine a mud tukul surrounded by cows and goats. It, too, is covered in a thin layer of fine yellow dust and so is baby Jesus! Ha!

Christmas. Christmas in Sudan. *Sigh*

I do have to say there is one HUGE benefit in spending Christmas here. I am not ‘shopping’ or ‘running around’ or ‘holiday stressing’. I’m stress free. I feel no obligation to shop and not even a hint of stress. It’s pretty nice.

No. It’s REALLY nice.

So, if I can be so bold. I pray that you all are having a Sudanese Christmas -- stress free and hot! (minus the layer of yellow dust!)

G6! G7! G8!

Akur with her new boy.

Three ladies have come to deliver in the last three days. The first one was a G6 (“gravida 6” meaning she’s pregnant for the 6th time). The second was a G7 and the last a G8. They are all prenatal regulars and I’m so glad they came in.

The first one, Akur, came just 30 mins after my plane landed. She delivered an hour or so later on her knees but tried to fundal pressure her placenta out. I kept insisting she not do it and she kept insisting she should.

(Fundal pressure for those who don’t know is the pushing on the top of the uterus to expel the contents. It’s painful and dangerous as it can cause hemorrhage and/or uterine prolapse. Risky.)

She explained she needed to ‘bleed a lot because the blood is causing all this pain. It must come out.’ I told her that the blood was keeping her alive and she should not do anything to her fundus (top of her uterus) and certainly NOT do fundal pressure in the squatting position as there is a risk of uterine prolapse.

We debated the benefits of not dying or hemorrhaging for awhile. Once it got a little testy but eventually we were able to come to an agreement. She wouldn’t do fundal pressure but I would do CCT (controlled cord traction) to help pull the placenta out. It worked like a charm and she was breastfeeding in no time. We were able to laugh about it later--Thankfully.

Once she was finished, Gai came in. She was expecting her 7th child. She has quick deliveries so I asked her to come in early labor. She did. I wasn’t sure how fast she’d go, so I got her settled in for the night. She quietly sat outside in a chair and watched the ‘goings-on’ at the clinic. (We were hustling around getting an anemic girl transfused - or at least trying to. Read her story here.)

Gai and her newborn Son and young son behind her.

I checked on her regularly but I couldn’t even tell she was in labor. She didn’t writhe in pain. She didn’t contort a face. She didn’t even breathe heavily. She just sat there calmly and watched the circus act.

She called me a while later saying the contractions were more painful, so I did a vaginal exam. She was already 9 cm dilated. So, we set up the delivery room and waited. Her contractions were short, so I encouraged nipple stimulation and they picked up like a charm. Within 30 minutes she was ready to push.

I asked her at one point during transition if she needed anything. She responded, “I don’t need anything because I’m going to die!” We all had to chuckle. She was far from dying. In fact, I was still having a hard time believing she was 9 cm along. She was the essence of serenity.

Not long after, she held her precious boy in her arms and we all giggled at how cute he was.

Then yesterday, I was called to another birth. Her name was Adhieu. She is beautiful and startlingly tall. The top of my head barely reaches her shoulders. But she didn’t labor standing up. In fact, she spent almost all of her time on her knees. She would walk off in the distance and kneel alone. She didn’t want to be disturbed.

This was her 8th child and she knew what worked for her. She was so quiet and calm. The only tell-tale sign she was in pain was the sweat beads on her upper lip and the occasional “very painful” murmured to anyone close enough to hear. She would look me straight in the eye and whisper it over and over, “Very painful. Arem Apei. Very painful.” I would nod and she would labor on.

She progressed quickly and an hour or so later, she came to find me saying it was time. My translator, Dongau, was a bit nervous since it was his first birth. But she didn’t notice. She just knelt on the floor and leaned against her friend. Two pushes and a little girl was born! She was almost born in the caul (meaning the membranes were still intact). But I ruptured them at the last moment.

After the placenta was born, the Sister-Wife came in and kept patting me on the back. She was SO excited for this little girl. She told me over and over again how happy she was and praised God with both hands raised in thanks. Her enthusiasm was contagious. She kept saying she would tell their husband how good of a midwife I was and that he would be very happy.

Adhieu and her oldest and youngest daughters.

I had to laugh. Even now, thinking about her, I can’t help but smile. She must have pat me on the back for over 30 minutes non-stop. I told her that when she tells her husband about me, make sure she tells him how strong and brave Adhieu had been during the birth. Make sure he knows how wonderful a wife he has. She just smiled a big toothy smile and nodded enthusiastically. She would!

So, there you have it. Three simple yet remarkable births. Two boys and a girl. They feel a bit like early Christmas presents.

Thank you for continuing to lift up these women in prayer. Thank you for praying for me. Thank you! 


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.

Woman's Retreat!

IDAT's 1st Annual woman's retreat was last week. We went to Nakuru and stayed in a beautiful bed and breakfast. A lovely woman of God, Dina, came all the way from California to bless us with a study on relationship building. It was much needed and wonderful in so many ways.

The retreat was on a dairy farm which also holds a knitting project to help families effected by HIV. They had horses, dogs and cows (of course! ha!) and most of all.... they had beautiful gardens where we could wander at leisure.

One day we took off for Nakuru National Wildlife Preserve where we were able to enjoy gazels, water buffalo, warthogs, zebras and white rhinos. We drove close to the giraffes and even tracked down a lion but we couldn't get a good look at him. He hid lazily on top of a rock shaded by trees. All I really saw was an ear twitch.

All in all, it was unforgettable.

2nd Degree Missionary...

During lunch I found a bug baked into my bread. I quietly dug it out and threw it away.... then finished eating my sandwich. Big deal. A bug. It wasn’t alive or anything. It wasn’t hissing at me or trying to bore into my skin. I thought nothing of it.

But later, I told my roomie, Rachael, about it and she laughed. She said I was now officially a second degree missionary! Never having heard this term before, I asked her to explain.

She said that during her first missions trip to Africa, the director told her there are three kinds of missionaries.

~ A 1st degree missionary: Sees a bug in her food, gets grossed out, refuses to eat it... or at least the food it was touching.

~ A 2nd degree missionary: Sees a bug in her food, picks it out and eats on! You must eat to survive.

~ A 3rd degree missionary: Sees a bug in her food, decides it must be food. Eats it and smiles.

What kind of missionary are you?

Frankly, between us.... I’m not sure I want to be a third degree missionary... unless we are talking about deep fried crickets.... or chocolate covered ants.... or pan fried termites....  Yum!

The 11 fingered beautiful dancer!

Yesterday morning, I was called to a birth again. (This is the 5th birth in five days! Woohoo! The women are coming to the clinic to deliver! I couldn’t be happier.)

Nyalou was expecting her 4th child and was going strong when I arrived. She was 8 cm dilated so I asked if she’d like to walk around the clinic to ‘labor down’. She had her trusty friend by her side (who obviously thought it was cold enough to merit wearing a down-feather snow jacket!) and together they walked the clinic grounds.

About an hour or so later, her water broke but she still didn’t have an urge to push. She didn’t seem to know how. She huffed and puffed for a while and then stopped trying and asked me to do fundal pressure. Both her friend and I just laughed at the idea. We encouraged her to keep trying and reminded her that fundal pressure hurt a lot! (In fact, thinking back, I wonder if she has ever pushed out a baby on her own.)

About 45 minutes later a HUGE baby was born. He weighed 4 kgs exactly. I gave him a quick “once over” and handed him off to his family. The placenta was causing some trouble and I needed to handle an unexpected hemorrhage.

But once the dust settled, I was able to turn my attention back to him. I asked his mom what he’d be called but she deferred to her husband. A few minutes later a very proud and elderly man walked into the room.

He was smiling ear to ear, chest puffed out and standing extra tall. Joy danced across his face and  made him look shiny. He just watched me chart and smiled. I found it strange that he would stare at me charting and not this new boy, so I asked him if he had a question.

He just grinned wider and said, “Oh, I do not have a question. I am here because I am told you need a name for this boy.” His English sounded stilted and proper. He was obviously very educated. I couldn’t help but smile at the business like manner of his words and his oh-so-official sounding voice. This must be the father I thought.

-- “Great,” I said, “What will be his name?”
--”Machiek. It is spelled M-a-c-h-i-e-k.” When he said it, the room stirred a bit with conversation but I couldn’t understand why.
-- So I asked, “What is the English meaning of ‘Machiek’?”
-- “It means the man with 11 hands!”
-- “Really? Eleven hands? Does your boy have 11 hands?” I asked, more than a bit confused.

He pointed to his fingers and said again, “Yes. He has 11 hands, go see.” His English was good but not good enough to make the distinction between hands and fingers.

I jumped up to inspect this 11 ‘handed’ boy and lo and behold there was finger number eleven, dangling from the pinky on his left hand!

I laughed and asked them, “Do you like it? Because if not, I can make it fall off.”
-- “Oh no, don’t do that. It’s good luck.” They all nodded in satisfied agreement. The finger would stay.

I smiled and nodded approvingly. Personally, I’d hate to have a floppy appendage but I guess it’s not so bad if you’re Dinka.

I snapped off a few pictures and returned to my charting. But he interrupted me and said, “There is another name for this boy.”

-- “Really? What is it?”
-- “Madheng. M-a-d-h-e-n-g.”
-- “Excellent. And what does ‘Madheng’ mean?”

He smiled again and moved his body back and forth in a wave-like dancing motion. “It means one who dances beautifully.”

So meet my new friend, the “Eleven fingered beautiful dancer.”

I wonder if I could get away with a name like this in the States.                   Unlikely.