June 12th, 2007

Here is a picture of Joyce and I.  We are signing my Montana apprenticeship. The Lord chose a wonderful midwife (and sister in Christ) to get me going in the right direction.  She is so gentle and a gifted teacher.  I am not nearly as nervous as I used to be.  Thankfully, we have become very close friends.  It is so wonderful to share this time with her.  In a way, I wish this time in my life would never end.  I am having so much fun.

Joyce Vogel, CPM  Libby, Montana.  She has a birthing center in Libby, Montana called Family Birth Services.

Babies!! Babies!! April through June

Here are some really cute pictures of our babies born in the months of April through June.  I am so blessed to be a part of each birth.  Each experience teaches me a lot about myself, about babies and helping moms labor.  In August, I will have completed my Doula and Christian Childbirth Educator certification.  I am appreciative of the strictly Christian emphasis of Cascade Christian Childbirth Association, as I am working through the other midwifery material towards my NARM. 

My heart is at home....

Here is a picture of our home.  It is June. The flowers are gorgeous...the grass is green.  I love to sit and relax in our yard with the children on a blanket.  We read, or even just talk.  It usually dissolves into a wrestling match with our 5 year old son, Jayben. 

We have Dorrisa, a registered collie, Daphne, a very special black and white mutt and Matchen, a German Shepherd.  The German Shepherd is mine.  We go for walks together down the road or through the fields.  She looks scary, but has a timid nature and a soft heart.  She was rescued from a kennel and is still a little kennel shy.  She is much better than this past Fall when we got her at 11 months. 

Our barn is empty now, except for a lone, very old horse.  Lucky is very gentle.  The girls can ride her and I am never worried.  She hangs out in one corner of the field next to the fence line of a neighboring draft horse. 

Our garden is mainly a snack for the children.  With a family our size, it takes a lot of corn, beans and green stuff to make a meal.  The children weed a row a day, when it is hot out.  We also have a rototiller to go between the rows to make the weeds more manageable.  The strawberries and raspberries are pretty thick this year.  I look forward to eating berries...if I can get there before the birds and children!

On our way to the Philippines via Texas...

At the airport!  Tom and I got up at 4:00am to meet Julia and Abe at the airport at 4:45.  We checked in, got through inspection with no problems this time.  I braided my hair, banded it and walked right through without setting off the alarms.  They did run my suitcase through twice scratching their heads a bit, as all my medical gear and things were stuffed (literally not an inch to spare) and zipped up, barely.

My backpack is not too heavy and my pillow and box of textbooks are bungee corded to the airline carry-on suitcase with wheels.

I cannot believe that I missed Jamiee’s birth last night.  On the way to Spokane, Joyce called to say that Jamiee was in labor.  Tom and I talked about turning around and going back home.  But the time factor would make getting back to Spokane from Libby, Montana, was really tight.  And I would have been totally exhausted.  So we decided to go on to Spokane.  Tom was also committed to delivering trusses and measuring a job for work by 5:00 that evening. Well, I am overjoyed to say that Elida, Joyce, Martha and Michelle got her through with flying colors!  I am so proud of Jamiee.  I am so grateful to Joyce and Elida! A wonderful baby boy, straight forward birth with minimal bleeding.

Thank you Lord!

Julia and Peggy

The plane ride was uneventful… until we landed in Dallas, TX.  We were surrounded by fire trucks, police cars and aid care.  Apparently they thought we blew a tire on the runway taking off in Denver.  The pilot didn’t tell us until after we landed!!  We did land without a hitch, so they figured out that the tire that was actually lost was from another plane.  We just wondered what happened to the other plane…

Julia and Peggy eating dinner (Sonic’s hamburgers and fries).  Julia and I spent the afternoon, evening hanging out at Peggy’s Birth Center where she works.  I was surprised at how much I appreciated just holding still for a while after our plane trip.  Peggy is driving us to Killeen, TX for our Association of Texas Workshop and Prenatal Exams.  She, Julia and I are all a little concerned about how we are going to do on the tests… It matters a lot to us if we pass!

Family Birth Services in Grand Prairie, TX, is a beautiful center housed in a 100-year-old house.  The midwife that started it 25 years ago still owns it and comes in almost everyday to review charts, pay bills and keep things going.  All of the midwives and students here are single woman, under 35 who have a great working relationship.  It was so fun to spend the afternoon and evening with them.

 I learned to draw blood today!

We just finished Friday’s workshop in Killeen, TX.  Julia, Peggy and I stayed later.  I offered to be our instructor's guinea pig while she practiced with the “harpoon” for drawing blood.  She usually uses the butterfly, ( a smaller kind of needle used to draw blood) but didn’t have any for the class tomorrow. She did fine.  I guess we all get to use the harpoon style.

 Then I got blood, the first try, on a young lady that was having a really hard time getting the needle in on me.  She was pretty timid.  She practiced and practiced on me and went home with a banana to practice on some more.  She’ll try again tomorrow. I am sure she will get it tomorrow.  I had a hoot!  Having my blood drawn was never a big deal to me. Now Julia, Peggy and I are signed off for blood draw for TX.  Julia did a draw on me also.  She did terrific.  Peggy did Julia. Thanks Joyce, for letting me practice on all that placenta.  It really helped! 

We had dinner at the China Star tonight.  It had great food, with lots of variety.  It is really hot and muggy here in Killeen.  Just getting ready for Davao, I guess.  In studying for my exam tomorrow, I feel like my brain might leak.  Hope what ever I need is in there already.

I've arrived in Davao!

After having a nice cold shower, I can think to answer some of your questions better.  It is 10:00 am here and it feels like 6:00pm.  Yikes, how am I going to make it all the way through today!

The customs went great.  No problems at all.  I made my hair into a braid and just got through with no beeps.  Except for in Nagoya, we had to disembark the plane while they cleaned… and then go all the way through customs again.  So, I had to quickly rip my hair pins out of my head and throw them into the canister to go through x-ray.  I have a picture of me in Nagoya, Japan, with my hair all askew.  I look terrible, because I have now been up 24 hours without any sleep.  I did finally take a little nap from Nagoya to Manila.  I felt much better.  I dosed from Manila to Davao too.

We got a taxi to the old domestic airport for 150 pesos.  I guess that is the going rate.  No problem there.  While we were at the old Manila airport, waiting for the plane to Davao, we had just arrived and sat down on the cold cement floor.  About 15 feet in front of us, a huge rat with a dead mouse in its mouth came scurrying by.  Julia and I found it very funny and tried to take its picture.  It did come out again, but I wasn’t quick enough.  The people around us didn’t even bat an eye.  They thought we were pretty funny for laughing at the rat.

Here I am snacking and laughing at that rat!  We had almost 5 hours to kill, time wise, so we went over by the wall by the carts and put a movie in my computer Something To Sing About, and watched it until it was time to get in line.  We waited in line to get a seat on the plane.  They wouldn’t let me take my airline suitcase on the plane, so it had to check it in.  I said that there was a lap top in there so be careful.  What did they do? They put a big sign on it that said “Be careful, lap top inside.”  Oh great, I thought, this is just an advertisement for someone to come steal my suitcase, laptop and all.  Anyway, it all landed in one piece and was fine.  Here are some pictures of Davao as we were coming in for a landing.

Quiet tonight... but not for long!

Tonight is very quite in the birth center.  This is unusual… as they have 200 births scheduled for the next few weeks.  It may have something to do with the typhoon left overs we are having tonight.  Some wind and hard warm rain.  Still muggy, still sticky, but at least not hot.

I think I am adjusting to the time change.  This morning I awoke having a horrible head ache with migraine nausea.  I thought I had to be at work at 6:00am, but had clinic at 8:00am instead, so I went back to bed with 2 Motrin for an hour.  I woke up feeling 100% better and have functioned the rest of the day.  I did 8 prenatals today and found 2 births I might be able to have for continuity among the 40 some ladies lined up for prenatal exams.

The language barrier is not extremely bad.  I can use sign language and I have a cheat sheet with Visayan words that match what I am trying to convey.  My next clinic day will be the new moms having Initial History prenatal exams which will more of a challenge to get the right point across and spelling etc…  One of the other interns, Sue, let me use her prenatal form that she translated into Visayan, so if I can manage not to butcher the pronunciation I will do O.K.

One of the times I went to get a patient (they use this term instead of client or mom) I called out for Liza….. no one stood up.  I was trying to think of any other possible pronunciations for Liza when one of the ladies said  Leeeza…???  Yes!  There she was.

One of my patients was just tiny.  She was very thin, her babies heart tones were consistently low (had been since she began coming for appointments) and has gained only 5 pounds since becoming pregnant. Her tummy is as tight as a drum and the baby seems smallish, but not tiny.  She only measures 24 cm and only has 5 more weeks until due date.  We’ll see if she comes in or goes to the hospital for transport or whatever.

I have enjoyed the food cooked so far.  We had soup much like I fix once in awhile at home.  Broth, small pieces of pork instead of my usual chicken.  Greens, galloiou chucks (kind of like potatoes, only stickier and chewier) galangal, ginger, lemon grass.  This was served with rice.  They had a very salty, stale tasting, dried fish I took a small bite of, but didn’t prefer.  Tonight they had fish cakes (probably from the same fish) that were good, to go with the soup.  Tiny baby bananas were for dessert.

I have been making sure to drink at least 48 oz of liquid, but I think that this is not enough.  I am going to up it some more tomorrow. (Maybe even right now!)

I got to meet Matt and Krys today.  We had an orientation meeting and discussed the various needful points about being here.  How to get along in the culture and how the seniority system works for births, etc … being quiet and keeping my mouth closed will be a good thing to remember.  All these woman, I am sure that offenses happen some times.  It is very different for me to be living so closely with someone other than my family. The Pinoy woman are all very smiley and friendly.  The are very nonconfrontational, and will go out of their way to avoid offending someone. 

Up in the office, I am happy to pay the amount for the copies on the copy machine.  They are charging a little for each personal copy made by the interns and students.  1.5 pesos per page.  I am using this quiet time to go over the Protocols for the birth center, as I can see that not every midwife here has the same idea of what they mean.  I guess I will do my best on that one.

Well, three hours left to go on my shift, and I guess it will be a no show night.

Here are some pictures of the first baby I caught by myself.  It is sink or swim here, to a certain extent.  I enjoy the challenge and pray that I don’t get any bleeding complications right away or a stuck shoulder.  The baby’s head from last night was a little dark, due to shoulder coming slow.  But the mom did not tear at all.  She did loose about 650 cc of blood, but I guess that is not unusual for here.  It sure looked like a whole bowl full to me.  One of the things that we do is collect the blood (with gloves on) in a measuring bowl that holds 500 cc.  The bowl was overflowing.  I scooped and scooped, scraped the placenta off and the clots too. 

Today (not my patient) a mom lost about 1,500 cc of blood and they just about transported, but she stopped bleeding.  They do IV’s here when the patient looses too much blood.  2 moms have had IV’s so far.  I hope that sitting by my moms and keeping the fundus firm right after birth will avoid a huge bleed…. But sometimes it just happens due a piece of placenta still stuck in there or whatever.

 It is much nicer than I imagined.  They keep things very clean, but not overly so. They mop everyday, but it doesn’t reek of a strong soap disinfectant.  We do not wash our hands every 5 minutes, or even between patients for prenatals. But no one gets sick… at least they come back each week looking well enough from a germ standpoint.  Many moms cannot afford even a small amount of protein.

“Home” for the students and interns is a fairly new building.  It is actually very nice.  I am impressed with how nice everything is here.  2 big kitchens, lots of bathrooms, lots of food.  The showers are all lukewarm, to cold, but believe me, I have not wanted a hot shower since I got here. Even this morning early at 4:00am a cool shower was wonderful. I wash my hair with each shower, because the wet hair feels cooler around my shoulders…for awhile until it dries, then I want it up off my neck.

I am wearing the scrub pants and shirt that all the midwives are wearing.  But I am thinking of trying the scrub dress I made tomorrow.  There are also scrub skirts downstairs that I might give a try one day too.  I am not used to wearing pants all day long.

The little geckos scurry around the tops of the walls.  There are lots of them and they are kind of cute.  I am watching one now about my head.  He has been staring at me for the last 2 hours without moving.  They can go really fast if scared.  Like the one in the kitchen this morning when I turned on the light to make my breakfast at 4:00am.  I think he scared me as much as I scared him!  They are grey, only measure about 6 inches long and have big, black, beady eyes.  I haven’t seen too many ants yet.  A few tiny red ones, here and there, but certainly not annoying.  The smallish, thin, wild cats outside give me a start if I go out at night.  They are everywhere, but all stay outside, even if the doors are all open.

My first transport

After assisting / observing a birth this morning and doing the postpartum and baby exam and going over all the paperwork, I went upstairs to work in the prenatal department.  I love this part…

I did 12 prenatals today, finding altogether 5 patients that I can call my continuity births.  I need altogether 25, for Montana and NARM, but I am going to try for just the NARM 3 I need right now.  Joyce and I can get the rest at our leisure over the next couple years.

One mom I was going to choose looked really sweet, but she handed me her lab slip and her HCT (iron count) was only 24.  Yikes… if she lost just 100cc of blood that would be disaster city.  Most moms loose a lot more blood than that here.  Just last night, a mom lost over 1,300 cc and almost transported.  Thankfully she stopped.  There seems to be a fine line between O.K. blood loss and let’s get her out of here to the hospital…  It varies with each patient.  This mom had a high iron count to begin with, so she fared well in the end.  She was up and around this morning and left around lunch time.  The moms here are amazing.  They are strong, give birth, get up, go to the bathroom, and leave just a few hours later. 

We had a great Bible study this evening with the Director his wife and the other midwives, interns and students. There were about 20 of us altogether. The Lord is so alive and real here.  They rely on Him for everything…. Prayer is a very integral part of all that we do here.  We pray with each patient that comes in for each prenatal, for each baby…during the births and when she goes home.  We pray at meals, we pray with each shift change.  It is so wonderful!

I am on shift all night tonight 10:00pm until 6:00am

11:20 pm – I just got back from a transport to the Davao Hospital.  The patient started having hard contractions, one after the other…  in fact, her tummy felt like a rock.  Her baby’s heart beat was over 200!  We monitored her for a while, started an IV and oxygen.  No improvement.  So we loaded up into the little, cute blue ambulance and zoomed down the roads, this corner and that, weaving around people in the streets.  We arrived, got out and went into the emergency room.  All I can say is that it is better than Calcutta!  There were very sick people and their family members almost packed into a large room lined with beds. (About ½ the size of our gym at church)  The beds are about 2 ½ feet wide and about 3 feet apart.  The room is divided into extra emergency; moderate emergency and the you’re ‘gonna wait outside section.  I don’t think anyone goes there who is not an actual real emergency.  Believe me, people don’t go there for an ear ache.

          I will describe what I saw, but I want you to know that I think they are doing a fabulous job with what they have.

          The hospital entrance has no door.  A huge, open, arch way that is about 12 feet wide.  A simple desk sits in the middle and two people, along with the uniformed guard admits in who he pleases and discerns whether you are a real emergency, or moderate. The building is stone and plaster, with the typical concrete, white stone or marble flooring.  I think they keep the place fairly clean, but with so many people, so many different body fluids landing on the floor and being tracked around before it gets mopped, it looks dirty. 

          The 5 of us (2 Pinoy midwives, me, the bana (father) and birth mom, still hooked still to her IV) slipped past patients on gurneys, patients sitting on the floor, patients standing in line, to a small back room, where two exam tables against the wall waited.  One table was full (about 3 feet away, the other patient watched us the whole time, cross-legged on her exam table.)  A large, used, bloody, orange, flattened rubber bowl lay at the end of the table for our patient to scoot her bottom down onto to catch any fluids.  It emptied into a garbage can lined with plastic on the floor.

          The doctor was actually very kind and gentle, unlike many others who are woman OBGYN’s and very mean to the midwives when they bring in patients sometimes.

          He measured her tummy, listened to heart tones, and did an internal exam.  She was only 50% dilated.  They will probably decide to induce her with pitocin, or if the baby is still in distress, do a c-section.  We left her and drove home in the ambulance.

 I am impressed with the kindness that the Pinoy people show each other here in the hospital. Even in the stressful situation at the hospital, no one was going crazy or yelling, or crying out.  It was noisy, but strangely silent too. Worried parents held children, husbands and wives sat or stood next to their loved one and just waited patiently.  Everyone must wait in a long line.

And yet, it wasn’t like the huge long lines in Calcutta, India, that ran outside the hospital for a block or more, where children died as they waited for help.  This hospital was functioning and getting people help. (Albeit with not much privacy… but maybe that doesn’t matter much when you are truly in very real need.)

                   At first, I thought that maybe the Philippines had socialized medicine and that the medical help was free.  But it is not.  At the government hospital (where we went) a normal delivery costs around $4,000.00 and it is set up so that patients cannot leave until they pay in full.  I cannot imagine where they would get money like this, when they cannot even afford protein at meals.  A c-section, like the patient we probably transported today will have, costs around $10,000. 

Second transport tonight...

It was early morning 3:00am.  Our next mom that walked in, was measuring way too small.  She was in active labor, and her baby felt tiny inside her.  We did not feel comfortable doing the birth, so off we went again in the little blue ambulance.  Her mother went with her and her bana followed behind in a TricyCab. (A Tracy Cab is a motorcycle that has a cab on it at least that is the best way to describe it.)  She was disappointed at not being able to birth at the center.  We arrived at the same hospital, but it was much quieter this time.  Families lined the covered street and benches out front of the hospital, sleeping soundly.  The benches are barely big enough to sleep on, and so people were also balancing on the tiered cement walls behind it and on the pavement itself.

We were able to get right through the 3 admission desks and walked to the doctor's desk.  He was sitting in his chair, sleeping soundly, with his head on his arms on the desk, exhausted from the night's foray.  It is early morning now....almost 4:30 am  The mess on the floor was cleaned up from earlier and people were sharing beds, 2 sometimes 3 to a single bed, sleeping.  A child screamed in pain in the emergency section, as they attempted to start an IV in his little arm.  In this hospital, to be admitted, you must have a family member caring for you at all times.  In addition, someone must provide all your meals We timidly said, "Good morning, Doctor...”  No response.  We tried 3 times to carefully wake him...so we just sat down on the bench to wait until the last paperwork cleared the desk up front.  Finally, getting a little desperate, our mom painfully contracting beside us, we whispered a little louder and set the now cleared paper next to his arm on the desk.  He awoke suddenly, and grabbed the papers and tried to focus on them.  Unfortunately, at that moment, we realized that we had forgotten the ultrasound results from last month at the center.... Oooops.  He was very gracious, as he was earlier in the evening, and admitted her.  One of the hard things, is that we won't know whatever happened to our patients after they leave the center and are transported.  I can really see that these doctors work incredibly hard, with not many tools and materials to work with.  The nurses all wear the old fashioned nurse dresses with the small pointed hats and the doctors all seem to wear ordinary polo shirts and slacks.

We came back to the center and everyone, except me crashed asleep. I guess I get to watch the two patients we have for awhile!  I get to go to sleep in a couple hours and sleep part of the day.  I am on again in 8 hours after that.

Another mom came in and we sent her home.  She is a first time mom and in early labor.  She came in this morning also.  I feel bad for her, I know she would just like to get that baby out.

3rd transport...what's going on???

I am feeling a little emotionally weary.  I had another transport this afternoon.  This makes 3 for me....  What in the world???  This mom was fully dilated, but refused to push.  She was exhausted and I think mentally a little slow.  Her guardian was quite a bit older than her.  She was 27 but had the mind of a 10 year old or so.  I spotted her a couple days ago when I was doing prenatals.  I am so glad I got her.  We were very gentle with her, but she was like a wet noodle, wouldn't move around, cried out and moaned through each contraction.  After 2 hours of pushing, we decided to transport.  Her baby was just right there... ordinarily just a few pushes would have eased her out.  But she would give a little push and then stop because it hurt and then moaned the rest of the way through the contraction.

      Anyway, it was off in the ambulance again.  This time we had a female OBGYN.  She was very nice to me. The hospital was very, very busy, wall to wall people.  It took us a few minutes to get through the triage paperwork.  I had to get a little pushy at the desk and elbow my way to get paper through the window.  There is no such thing as organized lines here in this place.  EVERYONE is desperate.  They wouldn't be here, unless they were. At least my height can be used to some advantage. (I am almost a head taller than most of them, even the men)

      I was getting a better understanding of the lack of privacy issue.  Culturally, they are very comfortable with having people close.  It is how they live. In sorrow, in pain, in happiness having others very close is what makes them at ease.  This how they are happy.  Now I understand why it is not a big deal to have just a curtain, or nothing at all between beds.  They are not into the privacy thing.

      Tonight it is raining very hard.  It will be dry again by morning.  It cools things off a little.  It wasn't as hot today or muggy.

      For dinner tonight, I had rice, vegetable stir fry and side dish of chopped pieces of fish in a vinegar, lime broth.  It was really good.  A little bony, but very tasty.

            The native midwives keep asking me what I think of the hospital.  They cannot believe that I am impressed.  Most of the interns that come here are horrified. I can see that at the hospital, they are at least providing care. People are being served and in a semi-timely fashion.  They do not close their doors on patients and no one is waiting ready to die in the parking lot in a line.

       It is amazing to me. No universal sterilization techniques here.  They reuse dirty gloves and other tools. It seems normal here.  Everyone must be used to a heavy germ environment. I know that many of the families have dirt floors at home. I also know that most of the families keep their homes very neat and clean.  They are very clean people, too.  They bathe 2 times a day and their clothes are worn, but spotless.  I have not seen any lice or skin problems here at the clinic. 

      Outside of their homes and yards, it is another story.  It seems that public property is the government's responsibility and they do not feel personally responsible to pick of trash or any other mess.  It is the government's job and it they don't do their job, oh well... So, when driving around, it looks like a garbage dump in some places.  Along the streets, although you see people sweeping picking things up, it still looks littery.  There are some beautiful places too.  Some families have cultivated along their yards.  The native plants, banana trees, huge Rhododendron looking plants with huge white flowers, lots of jungle looking plants with big wide leaves and vines twine up the walls.  Very, very pretty.

      I did get to see a birth today, though. A mom came in just as my shift finished this morning at 6:00 am.  I stayed and assisted and charted.  A nice baby girl. 

      Julia had a birth today.  She was pretty thrilled.  Her mom pushed and pushed.  They pulled and pulled the mom's perineum apart during a contraction trying to get that baby out.  Eventually they did.  Whew! I decided to go home and get some sleep so I missed the birth.  After being up all night, I was getting a little rummy and hungry. 

       Julia is really motivated to get her observes in.  She just marches right in and gets what she needs.  I am feeling a little worried about offending the local midwives and stepping on other people's toes so to speak.  Sigh... I am such a people pleaser. 

      It is hard not to feel like a bit of a failure at this so far... all my moms are being transported!

A morning off and some fun...

Julia and I had the morning off, so we decided to go get the cell phones we three will be needing and some groceries.  We took Carmen with us, one of the supervisors that has graduated from here.  Walking along the road, we took the quick route to Victoria Plaza, the mall.  Small side roads selling everything from single cigarettes to bananas lined the road.  It was busy, and I felt like we were dodging the cars.  In order to cross the road, you just start.  No, you don't wait until all the cars are clear.  (The never are).  for a 4 lane road, you look for a break in the first lane.  Stop.  A break in the second lane (you are now standing in the middle of the road, cars are zooming all around you.  A break in the third lane.  Run for the side of the road.  Phew!  Cars honk, people slow down.  It is amazing that no one gets hit.  The smells are well, interesting. We had a good rain last night, so the deep ditches on the side of the road did not smell like something died in them, like they did yesterday on the way to the hospital.  The air is redolent with light cooking or garbage smoke, car or motorcycle exhaust and a humid earthy smell from the rain. 

We arrived at the mall and had to wait, as they did not open until 10:00 am. (We had spent the last 2 hours singing harmony with the 2 hymnals Carmen has and that was very wonderful while we waited at home.)  Upon entering the mall, most people are searched, patted down style.  I wasn't.  Even with my big old back pack on.  "Good morning, Mam (pronounced mom)" The guards greeted us.

So now we have 3 cell phones ready for action. This is to help Julia and I get those birth observes in for each other.  We will text each other when our mom is fairly close to pushing the baby out. The next stop was the ATM machine.  I am going to need to renew my passport in a few weeks and I wanted to make sure I had the funds early.  I am going to get in line in the morning first thing, so I don't have to wait all day.  It takes several hours to shuffle papers from one person to another, to another, to another.  It is gated, locked building and the guard lets you in and locks the gate behind you.  Shiver.

The ATM machine was empty of money.  So was the next one.  Well, we started back to the mall and went to the grocery store to buy some items.  I got a bottle of fabric softener and some shampoo.  Julia got some Laundry soap, cranberry juice and snack items.  The ATM machine worked now, after a guard gestured me over to try again.  No one is allowed to take bags, packages, or back packs into the grocery store.  All items are checked in at a counter before entry.  We emptied my back pack with the now 3 cell phones, camera, wallet and such into Carmen's tummy pack.  After making our purchases, we claimed our stuff and hailed a Tricy Cab to take us to the open air market.

The market is a unique blend of old stuff and new.  Lots and lots of fruit (the same kinds in each stall with some variation)  Durian looks like a football with spikes.  Jackfruit is a huge oblong fruit; they open up in the stall, peel back the rough, pointed all over, shell and carve out columns of yellowish fruit.  I also saw Ugly fruit.  Rambutan, which I bought a bag full of, look like a red hairy, oblong golf ball.  The tough hairy skin peels back, like the skin of a golf ball too, to expose a clearish white, sweet fruit with a pit in the middle.  It is mild sweet, with a fruity flavor.

Julia bought some mangos and some mangosteens.  The mangosteens are 3 inch round shaped fruit that resembles a persimmon in shape.  It is dark purple and has a green thick stem.  You pull it open to find am smallish, bright red stringy, very bitter, flesh just inside the shell and in the middle is an opaque segmented fruit.  Only the middle segment has a seed.  It is sweet and very good.

After our market purchase, we headed back home to eat a lunch of fruit and some veggie soup that Julia made last night. I took a nap in our air con room and got down to my swing shift and here I am.

My patient is a G4 P2 and is steadily getting stronger contractions.  She wasn't dilated very much when she came in, yet we didn't want to send her away with it being her #4.  She is puttering around and I check her vitals every hour. 

Quick birth... and very sweet little girls...

                  Soon after I came into the birth center this morning, my patient arrived in very active labor.  Many Filipino women, when they are in active labor, look like they are just having a slight cramp.  Let the midwife beware!  I took her back to a bed to check her vitals and see where she was at in labor.  She asked if she could push.  I wasn't sure if she was serious...  She certainly did not look like she was ready to push a baby out.  I did the vitals, not rushing too much, and then sploosh! Her water broke.  OK!  She was serious!

                After 10 minutes of pushing, looking like she was at a garden party, she pushed a head out.  I worked a little at getting the shoulders out, as the baby was good size.  6 lbs is good size here.  Baby was 6.5, a sweet boy, with quite a cone head from getting through the pelvis.  Baby was so cute with lots of back luango (baby " "fur"), and tons of vernix.  He brightened right up, gave a nice lusty yell, saying hello to us.  Mom delivered placenta 10 minutes later and had minimal bleeding.  This was a nice, butter birth, as Joyce and I call them.

They did not smile much, but the 3 little girls that waited outside on the bench for mommy to have her baby were very, very cute.  They were so anxious to see their baby.  I think that maybe they have never been around glass windows very much up close, as they were having a blast playing, tapping, banging, and smooshing their faces against glass.  The dad is a Triceycab driver and the mom is his housekeeper.  Many people are not married, because the paperwork is expensive.  At the birth center, we sometimes don't know if the bana (man or husband) is actually the patient's husband or not.  Anyway, this particular bana was taking really good care of his "housekeeper".  They lived near by, and he went home really quick and brought her some chicken, broth and rice right after the baby was born.  The children seem to love him and he them. 

Today is Sunday.  I have worked all day, but got up early to enjoy a good Bible time and prayer.  I also got to talk to Tom and some of the children today which was really special.  I can see that the Lord is covering them in a special way during this time.  They seem to be coping very well without me... I know that they miss me though.  Mercy and Sheraya have been writing me e-mails faithfully. It was good to hear their voices.  There is a 3 second delay over the lines and it takes some getting used to so you are not talking all on top of each other and saying, what, what??  We'll get the hang of it.

I am still enjoying the food that the Filipino women are cooking.  It tastes extra good to me in the heat.  I guess they must know what works in the humid heat.  They don't seem to mind me eating with them.  I lavish compliments and help with washing dishes occasionally too. (Which is a no-no, sort of, but I can't help myself.  Washing dishes makes me feel less homesick.)  Today for lunch I had a bowl of chicken, lemon broth, with several chunks chicken too.  To put in the soup were several bowls of things. There were greens that tasted sort of like Swiss chard, and then there was a bowl of bitter melon.  The bitter melon tasted like a cucumber that might have been water deprived in my garden at home.  It was tolerable, but definitely an acquired taste.  Actually mixing it in the soup gave it a milder flavor that I didn't mind. I then sprinkled everything with a soy, garlic, onion sauce that really brought the flavors all together.  For a side dish there were sliced bananas in a coconut sauce that were frozen.  I thought it all tasted great!

Someone made banana bread at the house and I think that I have eaten 1/2 of the whole loaf between yesterday, last night and this morning's snack.  I think that I am doing pretty good eating.  I am feeling good and energetic.  I have had a bit of my tummy getting used to the different bacteria's, but mostly just cramps, rumblings and nothing very serious.

Bananas are a big part of their diet here.  They are very small 4 - 5 inches and a little yellower.  They are sweeter and slightly different tasting.  I love them.  I eat many everyday. I will take some pictures of the fruit I was talking about earlier and show you.

I  had one morning in my bed before work, where I was teary and cried a bit, but otherwise, I have been holding up really well and not getting homesick.  I was looking at the pictures of Tom and our family I swiped off Tom's desk at work before I left.  The Lord comforted me and after praying for a while, I got over the hump.  I think I was having a hard time really feeling confident enough to do this.  I know all the head knowledge.  I know where all the supplies are, and I have really gone over the protocols here... It's just that I don't want to make a mistake.  This morning's birth was the first one that I did not have a big adrenaline rush.  I was relaxed and doing well with the whole process. It helps when there are no emergencies!  I guess finally getting into the groove without stressing out is totally normal here and they say that everyone is the same way when they first come.  I guess you just do enough births that it just becomes natural.  I don't think it will ever get boring though.

The clouds are covering in a dark way.  Night falls very fast here.  5:45 dusk.... 6:00 dark.  We are probably in for more rain.  It is the rainy season here... so of course it is going to be wet.

Well, 6 more hours to go on my swing shift, and it could be busy or quiet.  The quiet evenings, I actually get to nap.  Busy nights we are kept hopping from one bed to the other.  I, trying to see as many births as possible for my observes.  I realized this morning that I could almost not really care about the numbers deal.  What I really want is to know how to handle emergencies.  I am getting lots of experience in deciding when to transport.  My mom last night that I left ended up transporting, because the baby's heart beat went down to the 80's and 90's during a contraction and she was only 4 cm along.  Cord compression probably, as I was hearing a lot of cord sound down low, almost so noisy that I couldn't hear the heart beat its self, just cord or placenta.

Rambutans and Mangosteens

Here are some pictures of the Mangosteen and Rambutan fruit.  the Mangosteen is purple and the rambutan is red and hairy.

Today was a busy day.  I worked day shift and now am on for night shift as well.  I did a birth this afternoon and then assisted 4 others.  I guess the rest of tonight would count for tomorrow.

I have the morning off until swing shift.  I am planning on going to go pick up Joyce and Monica at the airport tomorrow at 9:00 am if I am awake and functioning at 8:30 am or so.

After my day shift, and I was off at 2:00,  Carmen and I went to the produce market.  It is really large, with tables and mounds of all kinds of vegetables.  We bought quite a bit of veggies, stuffed them all in our back packs making them pretty heavy, and then took a jeepney home part of the way, and a Tricycab, then a motorcycle!  the rest of the way.  I balanced my heavy back pack on my back, the squash I was carrying in one arm and held onto the cycle seat with the other. The motorcycles certainly don’t travel very fast, with all the people and cars crowding the streets.  The motorcycle was able to weave around the taxis, jeepneys and triceycabs to get us home faster.  We were late in getting dinner made.  We had stir fry and rice. 

I have gotten money out of the ATM machine once so far.  I took out 8,000 peso’s, about 125$ or so.  I will need a bit more around the 24th to get my passport renewed.  I am paying for the internet here for my use, which will be about 75$.  This is actually a bill that is late and needs to be paid at once, or they will shut us off.  Here you have to go directly into the office and pay the bill.  You don’t mail in a bill.

This evening I then took a 3 hour nap in the cool room, and then jumped out of bed 15 minutes before I was on for shift at 10:00pm, scrambled into my scrubs, hurry-hurry brushed my teeth, grabbed my tools, pillow, laptop and books and ran to the clinic.  I made it just in the door as a mom was pushing, so I grabbed some gloves and assisted the birth.    I then assisted at another birth about 30 minutes later and now I can sit down and record it all.  My camera is working really well.  My system for recording births is good, as long as I keep up on it and don’t loose track of which picture goes with which birth/ patient.  Tonight’s births were during a big thunder storm, with torrential rain.  We could hardly hear each other and had to really speak up to get charting done.

I had initial history prenatals today.  I now have 28 prenatals total,   3 primary births where I caught the baby, and 5 observes.  This morning was the first birth that I didn’t have a big adrenaline rush. (Did I already tell you that??)  It is sort of a mile stone I am happy to have gotten to.  Carmen says it takes quite a birth to get her adrenaline going….

In prenatals, we check for anything odd or concerns or problems.  We give tetanus shots; we listen to the baby, measure Fundal height and make sure their iron count is sufficient.  I really like the prenatals, although a lot of the students, midwives, interns do not.  One of the students gave me a language cheat sheet that worked absolutely wonderful today.  It took all the stress out of communicating.  I always ask the same questions over and over again, so I get fairly good at pronouncing the words.  I appreciated the Spanish course I took a little bit of, because Visayan has many Spanish similarities and words.  This makes me fairly understandable.  The only problem I am finding is that when I am speaking Visayan to them, they assume I can speak more than I really can.  So I have one of the midwives come over to translate if there is a problem.

(I just jumped a foot off the couch, as a gecko appeared under my feet)  He has turned white, as the floor is white.  Such big beady eyes looking at me.  Doesn’t he know I could step on him???)

In between births, we can sleep if we want to.  Unless you have a baby and mom to tend.  It will be hard to nap tonight, as there are several moms and babies waiting to be discharged.

Last night a taxi drove up outside in a big hurry and honk-honked his horn.  We ran outside, and a mom was getting out of the cab.  She was in active labor but not pushing.  The taxi drivers hurry to get to the birthing center, however, if it does happen that a baby is born in their taxi, it is considered very good luck.  They are usually very happy and talkative.  There have been babies born in the cab, right outside the birth center entrance and in the doorway or kitchen of the clinic too.

Today is much quieter in the birth center.  Yesterday was Sunday and the neighbors were home all day.  They started in the morning with loud, wild sounding interactive video games with the kids.  Afternoon it was boxing. Evening it was horrific sounding, violet movies. Although I cannot understand the language, the sound effects are all bad enough with screaming, crashes, gun shots, etc... That is much more stressful than a very busy clinic.  I wanted so much to just plug in my headset from my CD player and listen, and even brought it, but the batteries were dead.  I was so glad when my shift was over to get away from the noise.  The neighbor’s house is less than 10 feet away and everyone’s windows are completely open to catch any breezes.  I guess they don’t like the sounds in here when moms are birthing, and we don’t like their noisy sounds and music/TV either.  Thankfully that was the only day that was very bad.  Most times they are pretty quiet, save for cooking noises, children playing and family ruckus.  On Saturday, they broke 2 glass somethings…   Well, privacy is not on their list of priorities here.  The Filipinos that come into the clinic like it just as it is.

Joyce and Monica have arrived!

My bedroom               The kitchen     Laundry with my clothes  and living room

I have lost all real sense of day or night type schedule of sleeping and awake. This is good, as I don't feel sleep deprived at all.  I nap when it is slow down in the birth center.  Like last night, I slept almost all night, after 1:30 am and awoke feeling refreshed and ready to go.  If I'd have worked all night, it would have been a different story.

Joyce and Monica arrived today. They had quite the adventure getting here. Los Angeles was actually the worst. Krys, Julia and I drove to the airport and met them. I gave Joyce a huge hug.  It was solo good to see her. 

I went to the market to get fruit with Carmen.  We went to Agdow market and carried home back packs full of mangos, rambutan, a watermelon, bananas, and pomelo (kind of like a cross between a grapefruit and tastes like a pomegranate.  We rode home in a taxi this time, as our load was too heavy to be adventuresome. (No motorcycles today)

I was looking at some yummy mushrooms in the meat market.  I am craving mushrooms.  Carmen started laughing... those are chopped goat intestines!  Oh well, I think I will pass...

Included some pictures of my room / spot, my house and what it looks like outside. Someone suggested that I go to the beach for some recreation.  I told them, "No thanks" I wouldn't have any real fun without Tom there.

 Today I unpacked the 5 boxes that came.  The Filipino midwives were thrilled with all the stuff.  They promptly unpacked everything and put it away.  They had to rearrange all of their cupboards, but managed to store it all away. Maybe the US girls will enjoyed the Farm, Reminisce and Taste of Home magazines. One of the Pinoy midwives grabbed a magazine and promptly started copying recipes out of it for herself.  They oooed and ahhed over the pictures of everything in the magazines.  It must seem as strange to them, as their land is to us. 

Tonight one of the intern midwives are making cinnamon rolls, fried potatoes, a breakfast for dinner. The cinnamon rolls are homemade and I am looking forward to them.

After last night's crazy thunderstorm and births, it has been quiet today.  I am sort of glad, as I wanted to spend a little bit of time with Joyce.

Busy day today...

7:00 am -  Today started bright and early with a transport to the hospital. Baby’s heart beat was 185- 200  and mom was only 7 or 8 cm.  She had been in labor since 3:00am and was really crying out with each contraction.  This is unusual here.  Most times, the ladies labor very quietly, with minimal facial grimaces even.  After her baby started getting stressed, we gave her some water to drink.  Then we check 5 minutes later and it still was rising.  We started an IV , loaded her up in the little blue ambulance and zoomed to the hospital.  I took Joyce with me to the government hospital and she was floored. ( She had never seen anything like this.)  Blood on the floors, very sick people everywhere.  We left our patient there.  As far as them doing anything about the baby in distress, Krys said that they would probably just continue the labor, in spite of the baby’s heart rate.  I feel so badly just leaving her there.  "Can I take a shower now?"  I remember kind of feeling the same way the first time I went to the hospital.  We both had to settle on washing our hands, as we were still on shift.

8:00 am  I did 7 prenatals. There were about 75 women there today.  They start coming at 6:00 am signing in with the guard.  Women are seen first come, first served basis.  At 7:30 they all file upstairs to a large room and sit on wooden benches.  The Pinoy midwife hangs, with clothes pins, a handwritten paper (poster board size) up on a clothes line strung across the room.  After prayer, the midwives play the guitar and start leading a worship chorus time.  The songs are beautiful and they sing the same ones often, so I am catching the melodies of some.  They words I can hardly fit my tongue around, but that is getting easier too.  The ladies line up to get a blood test for their iron, and are singled out to get gram stains if they have pus or blood in their urine.  Yesterday we did pap smears and vag exams.  Joyce and I got through 7 ladies today… and were called away early, as a mom came in fully dilated.  She was just sort of hanging out without pushing, so I went back and finished my last prenatal. 

                      This particular lady I was doing the prenatal on has a very small baby (measuring 29 cm at 36 weeks and her baby was oblique in position. (sideways, sort of).  She is one of my continuities that I saw last week and after seeing her last week, I fretted and wondered about her.  After seeing her today, I had no doubt that her baby has IUGR or something that is preventing her baby from growing.  This is so sad.  The mom is about one of the sweetest ladies and smiles all the time. I am pretty confident that she will not be able to have her baby here, unless she starts eating some protein and gets that baby a little bigger by about 4 weeks. 

11:00am  I did postpartum exams on 3 moms and 3 new baby checks.  These are moms and the babies that I caught last week.  They come in for a check the day after the birth,  3 days, 1 week, 3 weeks and then a 6 week visit.  These are all free for them. Sometimes they come, and sometimes they do not.

1:00 pm found me cramming a bowl of white rice and pork pieces with veggies,  and pineapple chunks into my mouth, in between helping with a laboring mom, fully dilated and still just hanging out with contractions every 10 minutes.  2 hours later, (Yes, really she hung out fully dilated for 2 hours!) Medula (a student midwife from Switzerland) and I finally caught the baby in mid air, as the mom was standing, hanging onto her bana.  During a push, we were looking at the perineum with the little mirror and suddenly, there was the face looking at us.  Then sploooop, that baby was out into our hands.  We then got the mom sitting onto the short birthing stool, bringing the baby back through her legs at the same time (quite a feat).  Baby was doing terrific, giving lots of good crys and having great color.

2:30 I did another postpartum check and baby exam

I finally sat down at around 3:30 and promptly fell asleep amidst a whole lot of commotion for a 5 minute nap.   One of the midwives came over to tell me a mom was here to see us, and jumping up, I did another postnatal and newborn exam. Things have finally slowed down now.

This afternoon I made some salsa while I was on shift, in the Pinoy midwives kitchen, in the clinic, for the girls at the house.  They had never made homemade salsa and are having enchiladas.  No store salsa to be had in the stores here.

Hey! A gecko just ran by my feet!  They are so cute, but startle me sometimes. A tiny ant keeps running across my computer screen.  I think that it might be trying to chase my lap top cursor!

About those ants.  They are very interesting.  They stay out of view, unless there is a tiny morsel of food on the floor, counter or where ever.  I have not figured out where they all come from in such a hurry.  I dropped a piece of rice on the room in the birth room, while I was stuffing lunch in.  Within 10 minutes, there must have been 50 teeny, tiny ants dragging this rice piece away.  They are itty bitty. One of the midwives dropped some food down the front of her shirt and after awhile started feeling very tickly in front.  She looked down, and saw a marching line of them maneuvering across the inside of her shirt.  They mean business.  Food and survive.  The rats might get it first!  (Not in the shirt, I mean, of course…)  Thankfully they do not bite.

Here is a picture of the ambulance that we take to the hospital.  They do not have stop signs here.  The person who honks the loudest, gets the right of way.  No kidding.  The sirens are abused here, not by our driver, but in general, so although we have siren blaring all the way, no one really gives way.  He weaves expertly through oncoming traffic, nearly bumping or getting bumped or so it seems to us. Sometimes I just close my eyes.  I will never, and I mean ever, complain about my husband's driving again!!!! ( He is so careful as I mentally compare habits here.) Never the less, we always get where we are going and home again and I have not seen a single accident since I have been here.

One of the things that I am really happy about learning how to do, is to suction a baby.  There is so much meconium in the amniotic fluid here.  I have only seen one birth, where there was no mec.  Anyway, I learned to suction mouth first, then down the nose into the stomach.  This gets all the mec flavored water out of the mouth, nose and insides.  They work so hard to avoid infection of mom and baby.  I have not seen any babies or moms sick with a fever or infection, but I guess it happens.

The 5 big boxes arrived that I sent full of supplies.  They were very happy to have the K-Y Jelly, gloves, gauze, cloth tape and lots of other stuff sent from CrossLink International. I would like to continue to send them stuff as needed, if the Lord allows. The midwives spent all evening (I was on swing shift)sorting, rearranging cupboards and finding places to put all the goodies.  I really hope that they will be able to use the stuff. One of the midwives said that the huge pile of boxes of gloves might last them 2 months.

Here is a picture just outside the balcony of my room.

Mornings always start with the gymnasium birds... that is what I call the birds that sound just like tennis shoes squeaking on our churches gym floor. The roosters soon follow, along with the neighbor's housekeeper hosing off the ground in front of his house.  Next come the breakfast hawker's selling balut (duck eggs that are half embryo, still in the shell) and rice and whatever people on the way to work might want to eat. The sun is fully up, the traffic starts up, and at this time and a new day has begun. This is the same 7 days a week. It is then that I am off shift and go find a quiet room (we have a sleeping room with air con) and get the few hours sleep I missed that night.

I am very much enjoying the challenge and have learned an incredible amount in just the week I have been here.  Last night as I was falling to sleep, I thought, how can I possible cram any more information into my brain... and yet today was another day of huge leaps of increase in skills.  Each birth teaches me lots (especially the ones we transport and the borderline emergencies). 

                       I have been diving into the Bible each morning, desperately craving my “instructions” for the day.  I have been so blessed, as the Lord gives me living water and I feel refreshed and confident to meet what He has for me to learn that day.  There is such a difference in my heart when I am just floating along in life spiritually and then the times when I really, really need Him. (Like now.)

                      It seems that we are praying all the time. Pleading with the Lord to bring a baby quickly, for baby to breathe, for a mom to stop hemorrhaging ( stop bleeding),  to heal moms that are sick or whose baby is not well, or for a good birth pregnancy, or for safety and wisdom for the midwives and students.  There is no end of things to pray for here.  Prayer is under our breath constantly, along with out loud with each other and the moms.  I really need my head covered here for the sake of the angels!  What a life! I can say right now that it is good for a visit here, but I will be glad for the experience and to get home.  Home with all 10 children seems incredibly peaceful.

My day off...

I  took Joyce and Monica shopping today.  I am on for dinners all next week and I have to work much of the time that I should be cooking, so I am not sure how to handle all of that.  I have regular 16  - 19 hour days next week.  Thankfully I can sleep (and I do) during the quiet hours.  I have napped with incredible noise all around me.

This was my first day off since I got here. I made an apple / mango pie today, a pumpkin pie and some banana bread.  It was all a hit.  Sue said she could tell there was a mama in the kitchen today!  I did laundry and then went shopping.

Last night I learned so much about placenta management.  The births here are usually no problem.  It’s third stage that is the kicker.  The mom last night was 16 years old.  This was her first baby.  I was catching her baby and doing all the responsibilities.  She did outstanding with the labor and pushing… no tears.  After the birth, there was a huge gush of blood that filled the big pad she was lying on.  The placenta then took a long time in coming.  More blood.  So far about 750 cc.  Finally the supervisor midwife said to get the placenta out.  Pull on the cord.  Now this is totally against what I know to do… but, she put her hand over mine, and started really pulling.  I could feel something shredding inside.  Eventually, it did separate and come out… everything except the bag.  I scooped blood and scooped blood until the container was full.  I examined the placenta and found it complete, so I dumped it into the plastic bag, along with the container of blood.  (This is saved for the family to take home and dispose of).

Next we tried to recover the membrane.  Ultimately, the midwife went back up into the mom’s uterus and tried to tease it out… to no avail.  She pulled out some tissue and said it looked like placenta.  Could I have missed a pulled off cotyledon on my examination of the placenta?  So I offered to get the bloody placenta out of the bag and look at it again, which we did.  Everything was perfectly complete.. except for the missing bag.  She then thought that there might be an accessory lobe or something.  Mom had stopped bleeding at this point, thankfully.  I am so glad that I took that placenta out to look… otherwise I think I would have kicked myself and the blame would have been on me for her bleeding.

Mom’s pulse kept rising 120’s so we ended up transporting her to the government hospital.  It was insane busy.  There was not even a stretcher available to get her out of the ambulance.  I felt so bad for taking this mom in there for a DNC.  Her baby was doing really well and she had stopped bleeding.  But the midwife felt that there might be a chance that she could bleed to death at home, if there was more placenta in there still.

The only thing that I really wished I had done differently was that I let my patient’s IV run out.  So, while I was giving the baby a bath, hepB and tetanus shots and a newborn exam, Carmen and Jonna had to start a new one in the other arm.  This was very painful for my patient, as they have to use huge harpoons for hospital protocol and once you get into a vein, that vein is really stressed.  I will not forget that one again!

The hospital was packed full of people standing in long lines, old people and young people on stretchers.  Some dying, some moaning, some bleeding.  We could barely get through the crowd with the stretcher. (We finally found one outside unused, unwashed, to the side of the building. Who knows who was laying on it, or why it was outside.)  We waited and waited to get through the first line (there are three you have to get through in order to be seen). In one corner of the room a huge open doorway led into the emergency room.  An adult was crying, crying and yelling in pain as they did a procedure on him.  A crowd of about 20 people who were either in line themselves, but mostly family members of the sick, gathered around the doorway watching.  A hospital police man would shoo them away and they would just gather again. In the next corner, we were up near a wall with one stretcher between us and the wall.  An elderly man was all laid out.  He looked really dehydrated.  He had a little container, in which he was retching into periodically (about 1 foot from my backside and yes, I turned my backside to him!)  My patient turned away and covered her mouth from the germs and I felt so bad for her.  I stroked her head and murmured comforting words.  I don’t know if this helped any.  If you can believe this, my patient, all through labor, birth and transport had never looked into my eyes to communicate.  I have never done a birth that I did not communicate with the mom with my eyes.  It was eerie.  Today Sue told me she probably didn't look me in the eye because my veil makes me look like one of the Catholic nuns that are around here a lot.  I guess my cape dress looks Catholic too. So, out of respect, she wouldn't look at me.

Now, as we waited for a while some more, around the next corner, a big narrow room and two long, long lines of people already admitted against each wall, waited to have procedures done to them.  Or, they had them done and were waiting for…?  I know this sounds awful, but even yet, memories of India 16 years ago are still in my mind.  At least these people are being seen and cared for.  In India, people died in line waiting to be seen. Some had to wait days.

 So, with this positive note in my head, after getting her through triage, we were able to wheel her through a maze of people on stretchers, to the OB intake section.  She was admitted, and we next fought to get the baby in with her.  I was for leaving the baby at the center, while she had the DNC.  But the family wanted to bring the baby.   The hospital doctor insisted on examining the baby before giving it to the mom, only she was not around.  I waited 20 minutes, with the baby in my arms, surrounded by all manner of children who were very, very sick.  I covered the baby’s face with the blanket, although it was swelteringly hot in there.  Finally I got to talk to who I thought was the right doctor, only to be told that the doctor I needed to see was not available right now, as she was resuscitating a baby.  We finally left the tiny baby with the grandma, in the hospital, in a long line, waiting for this pediatric doctor, while we drove back home in our little blue ambulance.

It is a holiday week here.  Lots of dancing at night down the road and cheap microphone sounding karaoke (one place is only a few places down) so I am serenaded to sleep each night as someone sings, croons and croaks out their rendition of their popular tunes.  I can’t understand them, so it all sounds the same.  Lots of beat. And they are trying so hard. They love Karaoke!  Actually they call it Vidoeke, as how they do it is they watch a video and sing along with it.  I was watching them do this in the mall today.  It's quite the show.

Speaking of music, I am really blessed here in our house and at the clinic.  The Filipino’s love music.  There is almost no time that someone isn’t playing the guitar and singing worship choruses.  They are in Filipino mostly so I cannot understand, but it sounds like heart felt worship to Our Creator to me.  It is water to my soul. 

I am glad for a day off today.  I feel rested and ready to face the fray again.  Sometimes the clinic is very quiet and there are no laboring moms.  Then there are the days that we have lots going one, mom about to give birth, some coming in to see if they are in active labor, postpartum checks and baby checks.   I love to do clinic upstairs.  Today Joyce found twins.  It is so much fun to meet all the ladies and try to determine how they are doing.  I like to see their eyes light up as they listen to the baby’s heart beat on the Doppler. 

Monica made me pancakes for breakfast this morning.  I am eating really well,

I am gradually getting used to all the outside city noise.  It is constant.  People talking, laughing loudly in the street in Visayan, sirens and the honking, honking of trucks, cars and jeepneys, and bike peddle cabs wheeling by, motor bikes, and of course the loud music of karoke all day and late, late into the evening.  TV’s, CD’s playing thudding beats and radios.  Bicycle riding street vendors make their rounds every few hours, hawking their wares, whether it be rice, balut, boco juice (coconut water).

At day break, first come the gymnasium birds….. well now it is the yelping puppy bird.  Every night and morning.  It is loud and very obnoxious.  Right across the road about 30 feet from my bedroom window.  I found out just a few minutes ago that it is indeed a real puppy.  They don’t let it in at night, so it cries and cries.  Anyway, I am sleeping fairly well in spite of all the commotion.  Home will sound so peaceful.  Tonight, I am watching lightening glitter across the sky.  It doesn’t feel like rain and the birth room is not chock full, so it just must be for good measure.

I start work at 6:00am tomorrow and maybe I’ll get  a birth observe in and learn a whole lot more about handling emergencies. 

Amazing midwives...

 Me sitting on the living room relaxing a little after work.

This morning for me started with a mom in premature labor.  The baby was only 36 weeks and the Philippine protocol allows them to only deliver after 37 weeks.  She was my patient, and was already about  7 -8 cm.  In a real hurry, I got a transport sheet and triage form for the hospital filled out and hustled the mom, her bana and mother into the ambulance, along with a few towels and a pad in case she had the baby on the way there.  The midwives sent me alone for the first time, without a translator.  This is now my 6th transport… at this rate I am going to beat the record for an intern.....that is 11.  The hospital was much quieter this morning and we zipped right through the 3 line process.. It may have something to do with my wild gestulating, pantomiming, complete with catching baby as it drops to the floor. I was relieved that they decided to take me seriously, as I was not looking forward to having her push that baby out in the triage area, as another side show for the other patients and waiting family members of other patients…. With me as one of the main characters!

One of the Pinoy student midwives was on next for a birth.  She worked and worked all morning with a mom who had been in twice already the last week for labor check.  The baby was quite high up, most of the labor, and still only plus one station.  Still, very, very slow to descend through the pelvis.  This mom was most uncooperative.  Sort of like the wet noodle mom I had last week.  She would not do what we asked her too and only pushed half-heartedly. Her bana physically lifted her onto the birth stool on the bed and we finally saw some progress and head.  She had leg cramps and did not want to be active in getting her baby out.

Finally, after  1 ½ hours of pushing, the head slowly came into view, then was all the way out… and then retracted back in a little.  At this time I knew that I was just about to see my first stuck shoulders.  Anna, one of the senior Pinoy midwives took over and tried to push the posterior shoulder in, to let the anterior one slide out.  Nothing. Stuck.  Next I pulled the mom’s knees up to her chin, literally, and the senior midwife put her hands inside the mom, one on the baby’s chest and one on the back and turned the baby inside the mom clockwise, as another midwife was applying downward  traction to the head.  Baby’s head is getting purple and we have very few minutes left.  By this time, we have the mom with her bottom off the edge of the bed.  She is pushing like mad, and we are praying like mad!  Please Jesus!  Another turn clockwise and pulling down on head and neck, along with 1  2  3  push! supra pubic pressure on the outside above the pubic bone,  trying to get the shoulder to bend down and slip out the canal.  Finally a little give... a little more... more tugging and the baby came out….a very big baby (7 1/2 lbs!)

White body,  with purple head, limp and unresponsive. Apgar 2.  We then suctioned the baby’s mouth and nose and stomach, then started resuscitating the baby with the oxygen and stimulation.  After 1 minute, the baby took a little gasp and let out a little cry.  He came to life and started to pink up.  Whew! Thank you Lord!  Baby continued to give weak cries and was starting to react more. 10 minute apgar was 8.   Eventually the baby did nurse.  A couple hours later they transported because baby was showing signs of respiratory distress.  I can certainly guess that might happen, after the rough birth he just went through.  So off to the hospital again. Not me this time though.  I’m going home to get some rest.

            This particular mom was having a hard time being interested in her baby.  She wouldn’t talk to him, or caress him.  Even though the baby was on her tummy, she had her head turned toward the wall and wouldn’t look at her baby for the first ½ hour.  This labor must have been quite the experience for her to have gone through,  She seemed a lot happier when I went down to the clinic a few hours later to take a picture of them, even though her baby and bana were at the hospital. The Filipino people love to have their picture taken and will pose, even just after having had a baby!

It is a national holiday week. This weekend is the final days of it.  People are everywhere…. Sort of like Christmas Eve evening, in Los Angeles, in a department store.  Folks are generally pretty excited about the parade today and all the festivities. Schools compete for the best music and display. The theme has to do with the harvest.  There is a lot of dancing, fairly sensual for my taste, but normal for here.  A lot of people seem to really look up to the dancers. Some of the midwives demonstrated a few of the dance moves that were popular and practiced them while we waited for another labor to come in.  I saw enough to know that it wasn’t something I was going to brave the intense heat, heavy traffic and people everywhere for…even for a cultural “treat”.  A lot of the students at the clinic went though, and had a good time.

Sue Struble, the other Idaho midwife, headed back home today.  I will miss her.  She is has 8 children and is truly a kindred spirit.  

Tonight, right after dinner, Carlie, the two-year old that Laura brought with her, pulled a chair up to the bars on the gate outside to the street and peered outside.  She called Hi to the people that were walking by.  Carlie is a curly white blond and has dimples. She is a real dolly.  Light skin and light hair is considered very beautiful here.  (So are big noses)  The Pinoy people are always enamored with her, everywhere she goes.  So, outside our gate, as we looked out the window, a crowd of 20 people were all gathered around her, talking to her.  She was waving, and saying Hi to everyone!  She was having a great time and so were they.

No videoke tonight, as they are all headed to the festivities down the street.

We decided to parcel out the days to cook, as there is a team of 4.  My days to cook are on Tuesday and Friday.  I get to shop, cook and wash up the dishes.  Thankfully everybody pitches in, for the most part.  Using local ingredients to cook our favorites takes some substituting and thinking.  I have been enjoying all kinds of veggies that are new.  Today, in the clinic kitchen for lunch, we had a soup with big chunks of actual tuna, bones, scales, skin and all in a light broth with what looked like clover leaves taken all apart.  There was a cucumber looking veggie, along with big ‘old chunks of peeled ginger.  It was really good.  We also had rice with a chicken meat crumbled and stir fried along with a bean sort of veggie that tasted a lot like Swiss chard.  This was added to the rice.  Then a salty, clear, amber liquid is spooned over top lightly for additional flavor.  We also had pieces of pineapple.   The pineapple here is mild and very sweet.  If you order a pineapple in the market, unless you specify, they will speedily .peel it right there in a spiral pattern and put it in a plastic bag for you.  I never have them peel it, as with my luck the bag would spring a leak and make me a sticky mess all the way home in the taxi, and I am not sure if they washed their hands first…….probably not.

Speaking of sticky....my skin is always sticky and even after a cold shower (there is no hot water in the house, except the hot/cold water dispenser in the kitchen.  We even wash all dishes in coolish water.  My body is quite used to the weather and only just part of the day, in the afternoon, am I feeling really hot.  I am used to hot, flaming, over-heated cheeks.  Today at lunch with hot soup and rice, I was really pouring.  The Pinoy midwives and cooks had mercy on me and started the fan.  Ahhh...now I can finish eating, without wiping my nose from the hot ginger, my brow that is beading sweat and threatening to drip down my temples and my mouth, as the cheap spoon I am using that is angled funny keeps spilling. The Pinoy midwives are very interested in America and when I am alone, they will question me about different things.  One midwife was dream planning her trip to American and thought that she would go to Manhattan and then to Oregon and then to Pennsylvania to see the chocolate.  I tried to explain how very big the states are and the time it takes to travel from place to place.

I let myself get dehydrated today, so it has taken all afternoon and evening and several big containers of water to even need to use the restroom...ooops.   I’ll do better tomorrow.  No major mistakes today...except for a charting boo-boo last week on the mom with the baby with shoulder dystocia, that I did last week when she came in for false labor.  Now I am getting much better at charting and the whole process.   This helps me be able to relax at births more, and to concentrate on the finer details...like not letting the IV run out.

 I am waking Joyce up at 10:00 pm tonight, before I go to sleep, as she has night shift. A nap in the evening really helps. Last night she had night shift too, but got to sleep a few hours while on.  We finally got our text message cell phone's working.  It was not so hard after all, just needed to find an hour to concentrate and practice.

Beautiful butter births...

My big, little guy and his mommy...

Julia's little peanut and her mommy...

I worked 10 hours today and felt more comfortable with the clinic’s procedure and total primary handler responsibilities. I almost let the IV run out again.  My patient today had a beautiful birth, but a little heavy on the bleeding.  I was sure glad to see that the placenta was good and intact and a strong bag, after the last birth.  In fact, it came right out after the feet of the baby, which means that it detached from the uterus before the baby was born….. Yikes!  I am glad that he came quick and didn’t have a long time in the canal.    This patient of mine had a wonderfully attentive husband.  They were married, and this was their 3rd baby.  He made me think of Tom and how attentive and kind he is during my births.  I don’t think that I ever thanked him enough for being there so completely when our babies were born.  Many husbands are here in body, but not in heart.  They may even want to help, but are at a loss how to comfort or how to assist.  I remember with ShaHannah’s birth how he rubbed my back, literally for hours. It really touches me even now.  Two days ago, one of my patients’ bana (provider?) left her there after the baby was born and I had handed them the bill, for over 5 hours, without telling her where he was.  She couldn’t leave without assistance, so there she sat on the edge of her bed, bags packed, ready to go, for such a long time. He finally did show up with some food for her.  She took a few bites and he ate the rest.  No wonder she was so very, very thin.  We let them leave without paying, as they really did not have even enough money for a baby diaper, let alone a clinic fee.

I pray for each of the babies I deliver.  I don’t know if anyone will ever pray for them again…  I ask the Lord to be with them, to touch them and to somehow bring them into a greater knowledge of who Jesus is and that He loves them very much. 

Perhaps the Lord will answer my prayer and have mercy on a very poor little one, born into the poorest section of Davao City.  Most of them live in very small huts, made of various scrap materials and have a dirt floor.  It always amazes my how clean the people are.  If I was camping in a hut with a dirt floor, I know that I would really struggle with keeping myself from getting smudges on my clothes. Bathing is very important here in this culture with the heat.  Most people bathe twice a day, even if it is over a pan of water with a used rag.  Every rag is precious here.  In the clinic, linens are a premium.   We conserve linens and use pads that are washable and not disposable.  Joyce and I were talking today about how we just take for granted the many gloves we use with each birth and the many blue pads that we throw away.  It almost seems wasteful. Yet, we looked at each other and said, “Would you like to have to wash these incredibly bloody, urine, poopy amniotic soaked pads after each birth?”  No thanks! I’d much rather wad up and toss in a big plastic bag and be done.  The men that come to the clinic and get the lidded garbage pails full of yucky linens every day, arrive in a fairly dirty looking vehicle that as bars around it and is covered on top, and they are all wearing long orange plastic gloves.  I wonder what kind of washing machines they have to make the linens come back all clean.  The linens all reek (eye wateringly so) of bleach when they arrive.  Yet they are clean.

 One of the moms that came yesterday morning was in labor prematurely. She had little leaves all down the front of her dress when I examined her, and I wondered if she had been sleeping in a pile of branches!  They mostly make their living around the Agdow open air market, where I go to get my fruits and veggies.  There are many opportunities for a do-it-yourself type person, as far as selling products, but the competition is fierce.  Everything from used clothes, other items to animals like goats and pigs.  Rows and rows of service people, like the knife sharpener I went to, to get our kitchen knives sharpened.  Or the peanut butter man, who roasts the peanuts and then grinds them into peanut butter.  Mostly folks here put way too much sugar in their peanut butter. (We ask for it without sugar.)  Fruits and veggies are sold along the rows, and peddlers walk along the crowd searching for a buyer so they can make a few pesos.  Interestingly enough, people sell things by the piece.  Like a single cigarette, instead of a whole pack.  A single baby diaper, instead of a pack.  One of about anything.  I read in the Filipino culture book I am studying that the reason for this is that the Pinoy people are so worried about offending anyone, that they feel totally obligated to share with you what ever they have extra of in a package.  If they just have one of something, and it is consumed, they are not obligated.  This may be, but also I can see that most of them cannot afford to buy a whole package of diapers for baby. I bought a package of baby diapers to share with my patients at the grocery store, so that they can at least go home in style from the clinic.  Even in the mall the other day, there are rows of people selling their wares.  I saw a little stand selling homemade potato chips….they looked delicious and almost stopped to buy some, until Joyce and Monica saw her cutting the potatoes thinly, using the floor as her cutting board!

The second birth was Julia’s and it was a very nice birth, no problems at all.  I am so glad for a few of these beautiful butter births between the crazy births. I think that all of the moms I have delivered here, would have been considered high risk back home, for one reason or another.  I am getting pretty thoughtful about risk assessment and what it means to me and my practice.  I tell you, a home birth family I take on, will need to be squeaky clean as far as risk.

Today, Julia’s little baby from her patient, was just around 5 lbs.  We named her Peanut.  Her banti (mother-in-law) kept going out with nervous fits right before the baby was born.  I could tell she was just an emotional wreck.  Apparently, the last baby was born at the clinic also, and had to be transported because of how tiny it was and was in respiratory distress.  I could hear the banti asking Jesus for mercy and help…. She was so scared. The mom gave birth to her baby on her hands and knees, so we were all focusing upside down for a while. The baby was born in the caul (membranes.) I pulled them aside to find a cute little baby girl… I rubbed her down and immediately she pinked up and was beautiful.  The first 10 apgar score baby I have seen here.  The banti kept whispering… Thank you Jesus!  She was echoing all of our hearts right then.  God really does answer their prayers and ours too!! This little baby girl is tiny but strong and doing wonderful.  I was especially happy, as I prayed for this baby girl as I held her for a while, as mom cleaned up.  Little Peanut will learn to love Jesus from her Grandma (banti).  Mother-in-laws are very, very influential in this almost matriarchal culture. 

I am so happy to have the Lord’s special covering during this time.  I can feel His presence around me during the hard times and even when I am not paying attention necessarily to His steadying hand.  I am very much trusting that He will lead me, if He is ordained each day and help me learn what I need to know.  Mornings are usually a special time of devotions (unless I get a text from Joyce to high tail it down to the center for a birth like I did this morning.).  One really wonderful thing that I am learning is that I am very ungrateful for all that I have at home.  If anything else, this time has been a time of eye-opening for me as to how incredibly generous God is to our family.  We have so much.  We give so little.

I will always remember to share with my children stories to impress them about how we need to be very thankful.  The people here are very happy.  They are very thankful for all that they have too.  It truly is a heart issue.

My four minute birth!

Today I was able to get my passport extension. It is a lengthy process that took several hours, even though there wasn’t more than 20 people in the waiting room, and about the same in the back working at different desks.

          First step: Arrive very early, to be first in line. (I was the only one in the room for the first hour and was definitely the FIRST in line.)  Office opens at 8:00.  The immigration office is gated and a guard checks me in and goes through my back pack.

          Second step: fill out paper work asking all kinds of questions.  Most of which I had the answers.  I remembered that Matt had given me his address and phone number and this was what saved my bacon. I did not have my passport with the Philippine stamp photocopied, so I had to l eave the immigration office, go two doors down, and get a copy made. Back through the heavy gate and serious guard who check me over.  Go back to wait in line.  Only to find out that the guy in the photocopy place didn’t give my passport back to me… or was it I didn’t ask for it… anyway.  Run back out the gate, past the guard, to the copy store, red-faced and ask politely for my passport back.  Get back to the guard, have him check my back pack again and get in line. Finally everything is in order.  Now I wait for another half hour after I hand in my paperwork.  Every one is very kind, but slow.

          Third step:  Wait for my name to be called again and to pay a fee…in exact amount.  Only I wasn’t sure how much it was when I came and no one seemed to know how much it was going to be.  Thankfully I had what I needed.  It was 2200 pesos.  

          Fourth step:  Sit and wait another ½ hour for my name to be called again.  This time I sign my name and receive my passport back and my extension.  Phew! Back out the door past the guard, out the gate.  I am really glad to have that done.

I am on today for cooking dinner, so I shopped at the grocery store in the mall near the immigration office.  I learned my lesson about buying meat there last week.  It is all open air and smells strong. The chicken I bought 2 days ago was really spoiled this morning.  Think I’ll stick with beef and buy at the specialty meat shop instead of the grocery store.

I purchased a can of Wilderness Pie Cherry filling and some apples to make an apple / cherry crisp.  And some beef for satay and noodles for a pasta salad.  I also got some oats to make granola or oatmeal and some dragon fruit,  Dragon fruit is hyper magenta in color, but fairly tasteless.  I also bought some cooking oil and mangos.  This I put all in my back pack.  Next I purchased some soft shoes for clinic for myself and a cute pair for ShaHannah. 

          The bakery had some yummy looking rolls, that were freshly baked and some empanadas.  Boy could I tell it was lunch time!  So, now I have a very heavy back pack and a big bag in each hand.  A quick stop at an outdoor stand for a whole rotisserie roasted chicken and I’m off to find a Peddle cab to get me and my treasures home.   A peddle cab is a bicycle with a covered cab for 3.  It looks hard to peddle, but these guys are able to zip right along.  It costs about .05 cents for a ride home.

          The last few days have been slim pickings in the kitchen, as we ran out of food.  Several of us girls have gone shopping now, so we are sitting well.  One goes to the market to buy veggies.  One goes to a different market to buy fruit and someone goes to the grocery store (me.)  This is because we have to either walk or cart everything home by hand and those groceries get heavy.  I nixed the 10 lb bag of potatoes.  Maybe next time.  

          My birth yesterday was very speedy.  My patient walked in the clinic, said she had to push.  She sat down on the bed after washing and proceeded to push the baby out.        If I look hot, I am. This was late afternoon and it was 95 degrees with 80% humidity.

          I had 2 minutes to set up oxygen, suction and get my cart wheeled over.  Mom’s water had broken and there was moderate meconium stain, so I was concerned about baby’s need for resuscitation.  The birth went well and a little baby girl was born.  She was feisty.  We did do suction as soon as her head was out.   Joyce assisted me and Julia charted.  It was great.  The paperwork went good, but it seemed my mind was getting really foggy toward the end and I was really glad to go home before I started making errors.

          My mom did not rip or tear and I did a better job of managing the head as it crowned very quickly and the perineum wasn’t the easiest for me to support. 

          Joyce, Julia and I were invited over to dinner at Heather’s home.  She has 7 children under the age of 10.  Two are adopted from Sierre Leone, in Africa.  They are also the ones taking care of the tiny 9 month old, which was very malnourished.  He has gained since I have been here and gives more eye contact.  Heather is going through the midwifery school here and her husband is homeschooling the kids and helping to manage one of Mercy’s Ministry Outreaches.   For dinner, she made a common meal in Africa called ground nut stew.  It had chicken, tomato sauce, peanut butter and special spices from Sierre Lenoe, Africa.  It is served over white rice.

          I have some pictures of the major modes of transportation that I use here.  I was particularly impressed with two blind men that navigated across this incredibly busy road.  I chickened out and walked an extra block to go over the walkway overpass to get to the other side to the immigration office.

          Transportation is very different here. I am including the different ways I get around. Mostly I use the tricey cabs, which are motorcyles with a cab. But very popular are the miniature vans and jeepneys. The jeepneys are in a competition to see how elaborate they can be. They try to out do each other to attract more business. Most are fairly simple, but there are some outlandish ones. They are usually clean and packed with people. One guy rides shot gun on the back and bangs on the roof of the jeepney when someone wants to get on or off. In one we rode in home from the market, there were 25of us stuffed in like sardines and I began to wonder if we were going to resort to laps. Thankfully some started to get off at their stops and we could breathe again. It is different being so very, very close to someone you have never met. So close that you are bare arm, to bare arm with a stranger. Her clamy arm skin against my clamy arm skin. The air pollution is bad. Many people hold cloths over their mouths and nose when walking or driving. The air is thick with exhaust (and other smells too).

          Here is a picture of the motorcyle like I rode on, behind this guy (with helmet) just for the boy's info. I was hanging on with one hand, sidesaddle, with a squash tucked under the other arm. I don't plan to repeat the performance. One of the girls had the ride of her life yesterday and did know if she was going to get home alive. I guess we need to be wary of the motorcyle drivers that have big truck horns welded onto the front handlebars of their cycles. I much prefer the peddle cabs.

          Many days in the morning, I am work in the clinic from8:00 are to 12:00pm... Here is a picture of my little table and corner where I see many, many woman for prenatals. I see so many different situations. One set of twins, complications of different kinds. Many would be deemed high risk for US midwives to handle. I have cheat sheets of the different Visayan phrases like, "Do you have any problems?” specific questions about woman problems relating to pregnancy, and what to do if they state that they have a particualr problem. The only challenge I have is that when I speak Visayan, they think that I can converse much better than I can and I am over my head in a real hurry. When I am out shopping, when someone asks me if I can say any Visayan, I don't dare say yes, or they might ask me what words I can say... most are not regualr words spoken in public... if you get my drift.

          I am now on my 8th transport to the hospital. My patient this morning at, 3:50 am came in with her water broken and leaking. She was referred to a Dr. last week for high blood pressure at her prenatal. The first thing I did was check her blood pressure and the baby. Her blood pressure was 185 / 125. Baby was fine. We always transport a patient when it is 140 / 90 or above. I felt like I was looking a time bomb! We started an IV immediately and transported her to the hospital. She was praying so hard to Jesus. I know she had a good relationship with Him and I felt so bad abandoning her at the hospital. Yet, there was no way I was going to deliver her baby safely at the clinic.

          Here are a few pictures of clinic in the morning. We sing and pray with the moms who come for prenatals for 1 hour. One of the Pinoy midwives teaches from the Word and one plays the guitar and leadsworship. I enjoy listening to them very much, put have a hard time fitting my tongue around the words. They sometimes sing an American song for our benefit so we can sing along.

          These are the shoes I decorated for in the clinic. I was tired of my thongs, and kept tripping over them at the wrong time. These are much better and provide a little more protection.

          Our quiet evening is turning into a quiet night. That is how it is here. Totally quiet evenings punctuated with crazy ones now and then. I think it has something to do with the barometric pressure and frequent thunderstorms here. Just before a storm rolls in, we are usually slammed busy.

The ministry of gentle touch...

  A cutie! 

Julia got really sick last night. Anyway, it got so bad that she was throwing up and was in a lot of pain. She gritted her teeth and sat very still, just charting the birth. She came home and slept after her shift. The next morning I woke her up at 11:00 am, as we were concerned that she was pretty dehydrated. Because both Joyce and I had to work all afternoon and night, we were trying to get her system going again before we left.

 She was sleeping in the air con, cool room.  I brought her up some hot oatmeal, milk, ice cold mango juice and a banana.  I leaned over the bed to place the plate beside her on the bed and the plate tipped over on top of her.... In shock, Julia just sat there... eyes wide....we couldn't say a word, because Carmen was sleeping soundly just 4 feet away. I gasped in disbelief… Julia started laughing and I was very red faced. She sat up and I rolled the wet sheet up and got it out of the room, scrubbed the mattress and turned it over, and shook off the blanket.

 Thankfully the oatmeal had stayed in the bowl. I refilled the cup with juice and she at breakfast after changing.  She will never forget that "special" breakfast from Sherry!

            My evening was pretty quiet until about 7:00.  It was my turn to handle, and in walked a very pregnant, very tired, 16 year old girl. Her eyes darted around the room, taking in the clinic.  She didn’t want to be here.  She didn’t want to be pregnant.  She didn’t want to give birth.  No bana followed her.

            She used the CR (comfort room) and washed with soap under the cool faucet.  She wandered out of the CR, without a smile. I took her over to a bed and pulled the curtains closed. She nervously told me that her water had broken and a lot had come out. Tears beaded her eyes as the contraction squeezed her tummy.  Gently, I rubbed her tummy and back. I kept smiling gently and kept reassuring her. (She did have an Ante’ or “in-law-sister” that was waiting outside and I had her come in to be with her too.)

            Speaking no English, and I no Visayan, the only way I could communicate reassurance was with my gentle touch and eye communication. The Ante’ was able to translate some. As I checked her, I found her to be about 4 cm and baby still high.  Her water was intact and baby’s head was not applied well to the cervix.  Her blood pressure was borderline high 135/80.  The baby’s heart beat was fine so far.

            As the night went on, her contractions remained steady, but not really getting any stronger.  She started warming up and smiling at me a little each time I came in. I think she started looking forward to my coming in and taking her blood pressure and listening to the baby.  Each time I would gently rub her shoulder and back. She laid her head on my shoulder as I was sitting beside her taking her blood pressure.

            Next morning, it was time for shift change and I was exhausted, so I endorsed her to Carmen and Julia.  The next morning I came over and she was still sitting on her bed in the same spot.  Still 4 cm dilated, baby was in distress off and on all night with heart beat over 200 sometimes, and she had an IV in place.  Her face lit up when I walked in. She tried to tell me she wanted to stay and have her baby here with me.  She was sad ... having to go to the hospital is a very hard situation for them.  No money, and no way to pay.  Her gentle hopeful smile as I left made my heart ache.  She couldn’t stay, and I communicate to explain why I was sending her away.         I left to go make dinner for the evening, because I worked swing.  When I got back she had been transported. 

 Last night, Elizabeth’s patient’s baby died after being transported to the hospital.  They transported due to funny baby heart tones and no progress in labor. Today, they went to see her in the hospital.  The hospital said she was not admitted… so they made their way quietly up to the OB floor.  They did find her bed.. well actually the mother-in-law saw them and came running over to them, but would not speak.  Walking over to the bed, her patient was crying and wouldn’t speak. The neighbor in the bed 2 foot away zipped her hand across her neck, saying death.  A cat walked across the room.  Tears streamed down everyone’s  faces. Baby’s die often here.         

Settling in.... for real..

I finally put my things away on the shelf today.  Ever since coming here, I have stored everything on my bed.  It’s not that I didn’t have access to closet space, it’s just that I wanted to sleep with all my things….security??

Well,  I have gotten tired of kicking off my vitamins and clothes in the middle of the night and waking up the girls, so I broke down and put my stuff on the shelf.  The shelves are all open and I can still see everything.  When I was little, I must have been the type of little girl that needed a blankie.

There is so much information that I am absorbing each day. Even the birth I am doing right now, I am learning so much…like patience.  My patient reminds me of me in labor. I remember how at my first birth, and how long I had to wait until I could start pushing. I am sure it must seem like forever for her. This patient and her husband are born again Christians.  They already knew that I was a Christian, so they asked me if I loved Jesus.  I replied, “Yes!”  Her bana and I prayed for her and her baby and had a great conversation.  He said he was back slidden and needed to come back to Jesus.  We talked about how important it is for him to be following Jesus now that he is going to be raising a child.  It is amazing how childbirth causes moms and dads to seriously consider their own spiritual state all across the world.  Especially if they have tasted of the Lord and know the truth.

It is dark outside now.  The clinic is quiet except for my laboring mom who is softly crying out with each contraction. Well, the clinic is not exactly quiet. Horns honking, cabs, bikes zooming by, children laughing in play, and Pinoy midwives laughing and talking, heavy rain and thunder. And oh yes, the neighbor’s television going full blast.  I am really glad I cannot understand it.  They do not like our noises and complain about the woman and baby sounds.  We do not like their blaring TV and fighting children.  Yesterday one of the children had captured a 6 week old chicken and was playing / torturing it.  I think that one of the most stressful things I have to deal with is their television, that is about 10 feet away, although I cannot see it. Drama is very dramatic here, complete with screams, music that wells and ebbs and crashes, sobbing and laughing hysterically, and guns or traffic accidents.  The more dramatic the better!    

          One thing I really miss is good whole wheat bread.  The only bread available in the store is totally white flour.  Even the “whole wheat” bread is really just carmel colored. The bakery has white everything.  It is Wonderbread city here.  Not the brand name, but the same, if-you-squeeze-it-it will-make-into-a-golf-ball-and-stay-there, type of bread. 

          I made peanut, coconut chicken tonight for dinner and I am not sure whether the girls liked it or not.  I wasn’t there.

A sweet little Angel...

On my afternoon shift and night shift, a quiet little couple came in.  She was in labor and this was her first baby.  She was not coping with the contractions very well… in fact the whole labor she had a hard time.  As the evening wore on, she would cry and even collapse on the floor with each contraction.  I got a coaching work-out!  She complained of a lot of back pain.  I would rub her back and push hard at the pressure points and it seemed to help very little.

          Finally by early morning she was ready to push.  That was not much more fun for her either.  After 1 hour of very strenuous pushing, with her bottom at the edge of the bed, legs up around her neck, she brought a sweet baby girl into the world.  Unfortunately, she tore a 3rd degree tear (almost to the rectum).  I felt badly, as it was partly due to my not supporting her bottom very well as the shoulders came out.  On the other hand, some of the midwives felt she was tearing inside before the baby even came out…

          The special thing about this couple, is that they both had a relationship with Jesus. Not just a “Christian” veneer, but a real live love for Jesus.  During the quiet moments between contractions, the bana told me that he felt he was back slidden and wanted to come back to Jesus.  So we talked about what it means to come back to Jesus and why he should. They spoke a little English, so the communication was easier for me than some.

          This was frosting on the cake for me, as I absolutely love sharing about my Heavenly Father with any of these ladies that will listen.  With this couple we prayed and called out to God many times during labor and thanked the Lord profusely when Angel was born and mom was safe.  Here is a picture of Marivec, her bana and Baby Angel.

  Sleepy baby!

A train wreck

A “train wreck” is what the midwives call being “slammed busy”.  We had 9 moms in labor over the course of 24 hours.  This is a lot for a 6 bed clinic.  We had moms laying out all over the place either in labor, having a baby or postpartum resting.

            On my shift that day, there was a continuity birth ( a student that has followed through with all of a patient’s prenatals and has agreed to come at any hour, for her birth). This mom was measuring small for how for along she was, and the person handling the birth decided to do the birth anyway. As it all ended up, the birth was a tight fit, even though the mom was normal sized.  That seems to happen a lot around here.  We knew that the baby was going to be small and were preparing for infant resuscitation.  Pushing seemed to take forever, and the baby’s heart beat did not have a lot of variability.  Finally, the baby was born and it was very small. (just under 5 lbs.)  It really had a hard time getting going.  We suctioned, rubbed baby down, oxygen and finally it was starting to pink up after 15 minutes.  The baby seemed to be really struggling to get air in. His little tiny nostrils were flaring and his shoulders heaved with effort.  Things did get better for him after a while, but we transported the little one, with his mom to the hospital because of the question of whether he was early or just plain small for dates.  There was some question whether we should have even tried the birth, because the baby was so small.  But I think he will be alright.

            The next birth was a mom who pushed with great effort, after a fairly normal labor pattern.  The head was visible about 3 cm and then kasploosh!  The baby was out, sitting in the intern’s hands.   As the baby was coming out suddenly,  I looked in shock at the mom’s bottom. It had made a new hole in the mom’s bottom!  Not the vagina, but a hole next to it off to the side.  I felt sick to my stomach.  What a mess.  I had NEVER seen anything like it, nor had the midwives here either.  The baby was doing really well, and the mom stable after a while. We had to transport her to be sewn up, as between the new hole to the side and the hamburger mess inside, it was more than we had time or skill for.  The mother’s tissue was brittle, like paper if seems and did not have much give to it.  I went home and slept for 3 hours.  Her little sister kept the baby at the clinic and several of the students and interns that were nursing their own babies kept his little tummy full.

            Even though I had just gotten off working a 16+ hour shift, I asked Joyce to call me back to see the next birth.  I planned to see the birth and then zip up back to the house for the continuation of my rest. Little did I know that I would end up staying another 12 hours.  When I came down to the clinic, Joyce had woken me up from a sound nap.  I couldn’t even remember how to turn my ringing text phone off or how to retrieve a message. All I read on the text was BIRTH.  So I crawled out of the air con room, no veil on, my hair long and up in a barrett, still in my scrubs from the day/night shift before.  (I had just collapsed in the bed for a nap before I showered.)

            Anyway, I walked into the clinic and looked at the busy chaos with some humor.. It had been fairly quiet the last few days and some people were complaining at how boring it was.  Now, as it ended up, they were a little short handed for the amount of patients, so I stayed and charted a birth.  Then the moms just kept coming in.  Labor!  The guard would shout from the door way.  Labor!  He yelled again.  Labor! This was getting ridiculous.  9 labors… I worked hard all night and had a great time.  I did end up transporting to the hospital 3 woman.  They were not my births, but because I don’t mind going to the hospital, I was happy to go. At one point in the evening, I was in the middle room charting for Julia, who has catching, with a labor also on each side of me.  I would chart one, chart the other and go to the other side to view the birth.  There is just a curtain separating each cubicle, so this was entirely possible.  We only have two birth carts, so as soon as a baby was born in the one area I was charting,  we needed suction for the baby about to be born in the next bed.  I quickly cleaned the machine and got it ready for the birth next door.

            I did not actually catch any baby that evening, as I was not officially on shift.  Some of the girls are protective of their births on their shifts.  I can certainly honor that.  If I had a baby that was supposed to my labor and someone who wasn’t even on shift waltzed in and took it, I might be sad too.  As I have seen it, it is always the luck of the draw on whether you get births or not on your shift.  Some shifts you get none, some you might even get two. The paperwork is quite lengthy for each birth and the responsibilities for postpartum care are pretty big too, as moms usually stay a minimum of 6 hours afterwards.

            Two of the births were 3 minutes apart. I was just having a great time, charting for two and observing one at the same time.

            The last one of the evening for me, was actually my patient from the previous night shift.  She came in at 2:00 am in light labor.  She was quiet and labored literally all day and all evening, finally getting to 9 cm by 9:00 pm.  She as very tiny.  About the size of Mercy Grace, and thin.  I wondered how in the world is that baby going to come out…  I did an IE and felt that she was small, yet I had hope that her body would open and her bones spread.

            Carmen worked with her (she was also supposed to be off shift) and Krys came in just to say hi and ended up working with us.  This little girl was crying, sobbing with the contractions.  It must have hurt her very much.  She had been so brave all day and now, after being up all night and all day, she was literally exhausted.  It came time for her to push and she worked and worked and strained and strained.  All positions we could think of and then some new ones!  Her little bottom was so small and although the baby small, it wasn’t tiny.  By 9:00pm, with hair of baby barely visible, the baby’s head was just too small to fit past her tail bone.  It was sort of strange. This mom’s tail bone would not give an inch.  Most times, they break, or at least bend in response to the baby coming through. This baby’s head was not coming down with the normal, chin tucked, presentation, but straight on with both sutures felt.  The baby was small… but mom was too small even for her baby.  So, after an incredible effort, we transported.  This was my third transport that evening and the Dr. at the Davao Hospital threw her hands up in the air! What are you doing here tonight again?!  She was laughingly, joking at me.  It had been a wild night for her too, with 33 births, ours being number 34.  So we got our little mom up on the exam table and they could hardly hear the baby’s heart beat.  It was very slow.  They got her ready for a c-section immediately.

            Carmen and I were very quiet on the way home in the ambulance.  We were both exhausted beyond words. I crawled into bed and realized that I had neglected to get pictures of the births that evening, and by morning, the moms would be gone.  So I crawled out of bed, threw a dress on over my nightgown, and took my camera down to the clinic.  Julia was kind enough to snap pictures for me, as I zombied on the couch for a few minutes.  I then sleep-walked back to my house, found my bed and promptly feel asleep until 7:00 am.

            It is 8:00 am.  I am here at clinic now, doing initial histories until 12:00 pm.  There are a lot of moms here (60).  I went home, ate a bowl of leftover oatmeal, peanut butter and milk for lunch and went for a nap.

            I feel asleep for a nap and woke up with 5 minutes to spare to get back to the clinic for my shift endorsement.  Whew!  I almost overslept.  The clinic is quiet now, except for one mom who had her baby at 1:04 pm, so I think I will continue my nap.  I am on next when a mom comes in.  I am sure that the guard will awaken me with a shout of “LABOR!”  soon.

A perfect birth

By the way, I am in Davao City, Philippines.  I guess I needed to make that more clear at the beginning of my blog, and throughout for those who are jumping in, in the middle.

I arrived 6:00 am, on shift, sleepy and half hoping all would be quiet until I woke up. (wasn’t sure when that was going to be…)  2 scrambled eggs and a piece of apple were not enough to get rid of the groggy feeling in my brain.  I think that the go  go  go  go schedule is catching up with me, after all I am 43!  I did get 6 hours sleep last night, so I am very thankful for that.

No sleeping allowed.  An active labor was endorsed to me.  She was a G 5  P  4.  That means that she was pregnant with her 5th baby and has had 4 live births.  Anyway, I was lazily hazing through her last birth history and saw that she went from 5 cm to crowning in 1 hour, last time.  Yikes… I jumped off the couch and went to see how she was doing.

I took one look at her and proceeded to set up my birth cart and oxygen tank.  She was progressing fast and I decided to just plant my bottom in a chair and to sit and wait.  Her BP was rising, (160 / 90 ) and I was really hoping she would just spit this baby out, as I really, really did not want to transport.  Felt like I was watching a race against her rising blood pressure and the birth.

5 minutes later, BOW (bag of water) was visible… and then baby crowned and then she was out.  Baby looked terrific.  Apgar 9 / 9.  She was just barely 6 pounds and really cute.  Here is a picture.

 Placenta came 10 minutes later.  We did give mom a pitocin injection, because she was anemic and I didn’t want to chance her bleeding and running out of juice with all of those little ones to care for at home.

It is interesting getting to know the woman of Davao, Agdow district.  In this particular family, (as in many others I am working with)  they are not officially married with paperwork. It is very expensive here.  Her bana is a laborer.  Probably one of the cement workers that are building a new retaining wall for the ditch full of water down the street.  It is very hard work in the sun, and it is all done by hand, mixing, carrying and everything.  This particular birth cost the family 450 pesos which is about $5.00. They looked in dismay at the bill.  I felt so badly.  I would love to just pay for the births out of my own pocket that I do here (after all, I am the student and they are the victims….)  but it is not allowed.  It is so obvious that this lady loves her banal very much, in fact is giving her little daughter his last name, and hers, though they are not officially married.  The woman are called on the birth certificates (housekeepers).

          After mom has recovered for about 1 hour, we get the moms up right away to the CR (comfort room).  That is if they have not lost a lot of blood and are dizzy.  The mother then walks to the CR and pees, then squats to clean herself off with COLD water.  The toilets do not flush here either, and as in many 3rd world countries that even have toilets, a big bucket is kept near by with a scooper to “flush” when you are done.  Toilet paper must not be put in the toilet either, but placed in the trash.  All of this effort must be really hard so soon after giving birth, but they want the moms to empty their bladder as soon as possible so that the uterus can contract well.  

          Mom is brought food in by her bana or banti (mother-in-law), or aute’ (sister).  She eats rice and a piece of chicken or vegetables.  There is a sari-sari stand that sells food for bana’s to buy, along with fruit, coke, adult diapers and baby diapers.  As soon as she eats, we give the baby a bath, complete with soap.

          The bath is actually a blessing to these families, as many do not have any way to bathe baby at home.  Most cannot afford diapers and just use pants.  If they do use diapers, they keep them on them until they weigh a ton.  I bought a big bag of baby diapers to share with my moms when they go home.  I just give them a slug of them and they are so grateful, it makes my heart ache.

          Then I do a complete newborn, I give the baby a vitamin K, and Hep B injection.  Then the paperwork begins.  I am still pretty confused about it all, but I am doing better.  Mostly because of all the details and some of the forms are written in Visayan and I don’t read Visayan yet.  So I invariably get something wrong on the birth certificate or something.

          I can relax a little now, as I keep an eye on them until they are ready to go home in about 3 hours. 

Shopping in the Philippines for gifts

It was 3:30 pm.  I had worked many hours straight and had taken a nap, but still felt really tired and groggy.  There are only a couple windows of time I have in my schedule to go gift shopping and this afternoon was one of them. Yet I wasn’t really in the mood.  Still, a window is a window, so out I flew. 

I hailed a jeepney and climbed aboard.  There are six to a side, as this was a miniature version of one.  Crammed like sardines in a can, we bumped along, stopping and starting picking and dropping of riders.  As we weaved in an out of traffic, zooming in front of other Jeepney’s peddle cars, motorcycles and Tricey cabs with a loud honk! Honk! There are no stop lights or stop signs here.  Everyone just moves along, negotiating the traffic in a zip-in-line style of driving that would surely get a ticket in the states!  The honking is not meant to be rude and no one is offended.  It is just the way of getting along, sort of letting them know your turn is next, whether they like it or not.

          We rode several miles toward down town, the buildings were getting bigger and more elegant looking.  The Embassy, the post office, the famous (or not so famous) big Marco Polo Motel are all there.  My stop to get off was just outside the Marco Polo motel on the opposite side of the street.

          The Aldevinco market was where I was headed.  It was just about an hour from closing time, so I wandered in among the shops.  There are many and all are small, even tiny, with glass fronts and doors.  Mostly all the same things are sold, just presented differently and different colors.  There are wrap around skirts, blouses, dresses, Filipino knick –knacks, and all manner of tourist trap items.  I bought my fair share!  One thing that is amazing to me, are the real pearls that are sold for so cheap.  I am going to bring home several different kinds for gifts.  They are just beautiful in different colors and shapes and sizes.

          After I had bought enough to stuff my back pack and a large bag I purchased, I set about crossing the road to find a taxi going the right way toward home.  Several young men stopped me, trying to sell me Seiko watches, leather belts, and such.  They pled with me that they were soooooo  hungry.  I felt bad, but honestly, I didn’t need a Seiko watch or belt with strange buckle attached.

          I got a taxi and headed across town to a restaurant called Boodles.  I sat down with all my packages and back pack and had their special.  For my dinner, I had a piece of chicken, broiled, and a small pile of rice.  A serving of pickled ginger and a Kalimansi (like a lime) were served along side.  I then had a Durian shake.  Durian is sold along the streets.  It is a very prickly looking fruit, rather formidable looking.  People use a machete to get into it.  The Durian has a sweet flavor, but an unusual odor.  If you can get past the odor, I think it actually tastes good, that with a little sugar and milk and ice.  Anything with ice sounds really good, as it is scarce here.

          It was now quite dark.  The streets are very active after dark here, as it is finally cool enough to enjoy life a little.  Music blares, people are coming in and out of the restaurant, there are more people on the streets now than earlier in the day.  I hired a peddle cab, and had a leisurely ride home for a mile.   For a while, a young boy (about 8) raced our peddle cab for fun.

          Back to work for night shift all night 10:00pm to 6:00am… and what a night I had.. but I  will write about that next.

A lesson in Humility...

        The evening started out quiet enough… two laboring moms, both had been at it all day, since early morning.  I am getting fairly good as spotting the shoulder dystocia labors and feel like I have a limit as far as how long I would let a laboring mom go.  There are 3 kinds of dystocia.  One, as the baby enters the pelvis way inside, one in the middle at the ischial spines and outlet dystocia.  Each as it’s signs and potential correction measures.

            Here at the clinic,  if they try the birth stool, if they try hands and knees, if they try a standing squat, and still not progress over 2 hours, then we transport.  I think that I would probably transport earlier, if I felt that there was true dystocia.  

            My laboring mom started getting high blood pressure and she had been laboring all night and all day, and pushing for 2 hours, so we decided to transport for mid-pelvic dsytocia and exhaustion.  It is such as disappointment for these moms to transport to the hospital.  None of them can afford it.  And, the hospital does not let them leave until they pay.  We have one mom who they are not letting her see her baby after c –section and she has been there for two days. Another mom we transported has been there for 5 days and is very ready to leave, but they have no money, so she and the baby must stay, separate beds (baby in nursery).  Her bana must bring her food to eat and the cats prowl the floors for mice at night. ( and day).

            As the lessons of the night progressed, I was totally blind-sighted by the next lesson that I was about to have. 

When we walked in the hospital admittance area, at the admission desk, I saw something as I climbed head first, out of the ambulance with my laboring mom, IV held high, that I couldn’t figure out.  About 20 feet away, I saw what looked like a huge acorn, sitting on a stretcher.  I couldn’t reason why everyone was hovering over this “ball” but I thought maybe someone’s body part was being protected with something brown and round.

          As I walked up closer I still could not register what I was seeing.. until I took an organized, good look.  I was in line right beside the gurney. There, lying quivering, was a baby, about 1 year old.  Her head was about the size of a beach ball.  About 1.5 ft all around.  The huge, tan, “acorn shape” was her head. Her little face was stretched completely out of proportion, as the skin was taut. The skin around her eyes stretched upwards and her eyes were opaque and obviously blind.  They wiggled with each heart beat. Her skin was very thin and blood vessels very prominent.  Her hair sparsely placed and stretched out over her scalp, were separated by individual hairs.  Actually, fairly large vessels were feeing this huge orb.  Her hands and feet were in a curled, spastic position.  It was obvious that this little one had not gotten there over night.  She was born with hydrocephalus and it had gone completely untreated.  Her huge head rested on a little pillow and her body shivered with seizures.  I have no idea how they had kept her alive that long feeding her.  She lay silently, not crying or even grimacing, obviously very used to being this way.

My stomach churned as I stood within 2 feet of her for quite a while.  I prayed, Oh how I prayed, that God would please take her home to be with Him. She did not look human. Her mommy and daddy and grandma, tenderly cared for her. Daddy carefully lifted her head. It took both of his arms to lift her head, another person supported the neck and another person the body.  All of this so they could weigh her.  He stood on the scale first without her, and then the 3 of them picked her up and then he stood with her alone on the scale for a moment and was weighed.  It is obvious that they are not treating her by inserting a shunt. And it looks like they are just waiting for her to die.  Are they just waiting so see how much fluid can collect in one little baby's head?!?

            My heart was (and is) just so touched.  I do not usually have these experiences (in fact I cannot every remember anything like this happening to me.) But, at that moment, as I was looking at her with such pity, the Lord spoke to my heart, letting me see my own soul in comparison to this baby.  I knew in an instant, that this baby, in all of her swollenness and paralysis, is how I look to God.  My head swollen with pride, completely unable to help Him, I could see the tragedy of it all.  In my state of swollenness of mind, I am so dependent on Him and yet so full of myself.  To be of use to Him, to be functioning as His servant, I must be drained of myself and the pride that just keeps accumulating. Have you ever had the Lord reveal your true nature to you?  Ouch!  I hope that the Lord can speak to me in a quieter voice next time... 

               So, in a state of spiritual shock and being really tired, I cannot sleep and I am the only one awake here out of the 5 of us.  It is now 4:00am.  There is a laboring mom who is getting pretty close. I'd hate to handle a birth all by myself... actually the patient isn't even mine tonight but Jenn is so tired, and I offered to labor sit for an hour or two.  I'll wake her up as soon as mom wants to push.

      This is another sweet Christian couple.  Her Bible is by her side and she is saying scripture with each contraction.  Her bana is trying so hard to help her by rubbing her back and meeting her needs.  She is working through them very well.  Quietly, as they do.  She wanted to push sooner than I expected, so I set up all the equipment.  We sat with her, as she made tentative pushes for about ½ hour after having her get on her hands and knees for a few more contractions, then on the birthing stool, and working through getting the last few centimeters up over the baby’s head. Some wandered back to the couches to sleep. We were still working through, (painful and long lasting contractions) when 6:00 am arrived.  Time for shift change.  I considered staying, but I just longed to go hide my head under a pillow somewhere. I elected to go home to the air con room and slept for 5 hours.  It is so strange to wake up in the middle of the day and try to figure out where you are, and what it up.

            I slept soundly, but awoke with the picture of the baby burning a hole in my first conscious thought.  Oh Lord, I groaned… it this really me?  Gently He laid my thoughts to rest as He reminded be that pride is a choice, once we see it, and that I could lay it all his feet and truly be of use to Him, if I wanted to be.  I can choose to change.

        And now, a few days later, I am still feeling the effects of my “vision” of what I am like if I am full of pride.  It helps me remember to put others first. 

A cutie

My anniversary surprise from Tom!

I was busy studying away and labor watching my mom, when Matt McNeil came into the clinic.  He carried a beautiful bouquet of flowers.  With a happy smile, he said, "These are for you."  "What???" I said, "Who from and why???"  He said, "You'll just have to come over and read the card!"  After opening the card, tears stung my eyes... it was from Tom.  Dear Sherry, it read, Will you Marry me?  Happy Anniversary! Love, Tom.

I cannot believe in all of this craziness, in all his business taking care of things, thousands of miles away, that he remembered.  It is not our wedding anniversary, but the anniversary of the day that he asked me to marry him.  He has faithfully remembered this date every year for over 26 years now.  I am floored!  The bouquet smells like home.  Roses remind me of home.  There are no roses growing here.  I wonder where in the world he came up with them. Tom, you are such as sweet heart!!!  I LOVE being married to you!  16 more days until I am home!

Starting IV's on each other

Today was pin cushion day.  I was victim for Joyce twice (she got the line started on me twice!) and Beth once.  I am sorry to say that I did not get it first try.  I tried Julia and she was in a lot pain, so I stopped.  I tried on Carmen, but am still not successful.  Part of the reason was that I was a little distracted because my laboring mom down in the clinic below, was in the the middle of very active labor and I knew that she was getting pretty close, so I skipped out a tad bit earlier than I would have otherwise.  

We all sat around laughing and joking and looking a little faint.  We were all eye-ballling each other's veins to see who had easy veins to try on.  I went first, of the students, and had Joyce do it twice, successfully on me.  I happened to know that she is the more experienced of all of us students, as she drew blood at the hospital all winter! 

She did a great job and here are some precious photos of me trying!  I will try again another day when I am not so distracted with a labor.  Good thing I came down stairs when I did, too!

My lunch today

Today has been pretty quiet.  I did do 3 postnatals on moms and 3 newborn exams.  These are always fun to do.  The moms hardly look the same, now that they are not in labor.  Sometimes I don't even recognize them.  There is one mom that I really wish would come back in.  She had a baby boy and he was pretty small.  He was lethargic at his last prenatal and in my gut, I wish I had made a bigger deal about having him seen at the Hospital clinic.  Something wasn't right.  Anyway, I may never know.  This is so hard to let go of...This never knowing what happens to these moms we transport to the hospital. 

Mostly today I slept and slept down in the clinic.  I would wake up, study for a while and then fall back to sleep.  I have never slept so much in my life.... I've never been up so many  hours in a row either though and I think my body was saying THANK YOU for taking a rest.  Thank the Lord for a quiet interlude. 

I thought I would share with you a picture of a typical lunch of mine here at the clinic. This was today's.   The fish was actually very tasty with a coconut, ginger, kalimansi , (like a lime) broth and noodles.  I wasn't sure what kind of meat were in the noodles were, but it did taste good.  The cook here likes to make squash bread (kind of like pumpkin bread).  It is very similar to the pumpkin raisin bread I might make with left over squash or pumpkin at Thanksgiving. Those are not typical bananas you are seeing.  They taste very different.  I think that they are tiny plantains.  They are kind of starchy tasting, and only a little sweet.

We drink water here almost exclusively, unless we go across the street for a coke.  I don't refer the cokes here, as they are EXTRA sweet.  One of the girls that had been here for 4 weeks left today.  Last night she had a good bye party for herself and ordered Pizza from Pizza Hut!  Yes Pizza Hut.  They do have some differences though.  The crust is definitely different.  Maybe it was the flour.  Maybe it was the fact that they used more oil in cooking the crust.  They also had different toppings.  The spaghetti was different with noodles AND rice.  The sauce was more of a sweet and sour taste than Italian.

The McDonalds in the mall serves rice as a side, along with the French fries and chicken.  The hamburgers are not beef... they are textured soy protein.  I haven't had the nerve to try one yet.

Mostly we have plenty to eat, if someone goes shopping.  I am going to morrow and will bring home some new and interesting fruits to try.  So far my luck has been better with the recommended ones.  The ones I brought home last week were rather a taste disappointment. 

The Filipinos are not much on raw green salads.  The only salad that they served so far at the clinic kitchen was a seaweed variety that was salty, crunchy and was definitely an acquired taste. There is lettuce to be bought at the outdoor market and grocery store, but I think that they use it more of a vegetable to add to soups that green stuff.  I bought a bottle of BBQ sauce for hamburgers last week and the lady at the check out stand stood for a moment looking quizzically at the Cattleman's BBQ Sauce bottle and then asked me... what do you use this for???

Badjoe Indians...crazy birth and homesickness

Last night Joyce, Julia and I were invited over for dinner at Mordecai and Toinette’s house for dinner.  They moved to Davao City many years ago from South Africa to do mission work.  They are still supported by their home church there.

          Mordecai was an architect draftsman and Toinette was a school teacher.  Soon after coming here, Mordecai was trained as a missionary medical person and Toinette became a midwife.  They felt called to the mission field and were led here to Davao City to work among the Badjoe Indians. The Badjoe Indians are the lowest tribe here, being boat people.  Yes, they live their entire lives in boats or basket houses held way up in the air on stilts.  They are very poor and are a unique group of people of about 300 families.  They come to shore to shop and to sell pearls.  They are not really very honest (although there surely are some that are).  They claim to have found the pearls in the sea and strung them, but in reality, they go to the mall, buy a string and then sell them at absorbent prices.  We had some at the door of the clinic today.  The mall sells pearls for 300 peso for very good quality.  They try to sell them at 1,000.  Many foreigners will buy them just to say they bought pearls from the Sea Gypsies.

          They have been very closed to all medical help or Christian teaching until Mordecai became their friend.   Birth for them is something to be feared.  They are very concerned about the mother bleeding to death.  After the baby is born, they leave it off to the side and try to keep the mom from bleeding too much.  The floor is made of reeds with cracks and the blood is pushed down into the water.  It is hard to know how much a mom lost that way!  Anyway, the birth process is quite amazing.  The birth mom is covered head to toe with blankets.  The birth granny goes under the blankets to help with the birth.  The mother of the birth mom actually bites her daughter’s ears and pulls her hair, while she is trying to push, in an effort to get her to get all riled up to push harder.  They had invited Toinette (midwife)  to the birth in case the mom bled too much, maybe she could help. After the fact???

          For dinner, as Mordecai and Toinette were telling us all about their ministry to the Badjoe Indians, they served us a real South African meal.  We had cornmeal mush, with a tomato, onion sauce with special spice and skewered BBQ pork.  It was really good.  She got out her precious American cups (like we would maybe treasure something from another country) and made African Roobios tea and served a box lemon cake she had made.  It was very touching to be a part of their lives for the evening.  They have a son with autism and we talked about curriculum and speech / language therapy for quite a while. 

          Today in the clinic, I assisted with 2 births that were very nice.  I also did speculum, vag exams on woman who had STD’s and infections of different sorts.  Some of the women were very young (14, 15) and had pretty bad infections from their sex partners.  So many of them did not even know how many other woman their current partner had been with.  Several of the girls were very nervous and I spent most of the time trying to get them to open their legs willingly.  I need both hands for the exam…

Thankfully they had a lamp I strapped onto my head and that freed up my hands some what.  I cannot imagine what these girls are going through in life.  And now they are pregnant.

          It is now 12 days until I am home.  I am truly homesick.  On my days off, it is the worst, as I have time to think too much about what I am missing at home.  My family has been faithfully writing me and that helps a whole lot.  I spend a lot of my time on the computer conversing with Tom, writing my Xanga blog, studying for ATM test when I get back and writing the kids and friends.  I am also thankful for the diversion of my CD player with hymns and songs I enjoy.  My computer doubles as a private movie theater as I can get lost for an hour or two watching Mother Theresa, the Christy series and some other sweet movies the kids thought I should take.

          I am so thankful that I made it through this weekend.  I slept and slept. Tears of homesickness and frustration (I am sure Tom was worried) shed and past, I think we’re through the worst of it.  But now I am now going into a tough week as far as my schedule and am going to need every ounce of strength I have left to make it.  Exhausted physically and mentally, my brain is on overload from all the details of what I have learned.  Oh, I hope I can remember it all when I need it! 

As far as coming home,  I so much want to get off the plane looking like a beautiful wife and mommy, coming home at last, joyful and ready for action, but instead I’m afraid I am going to look like something the cat drug in from the woods…. Yikes. 

          Joyce left today to come home.  Julia leaves Thursday, Lisa and Beth leave on the next Monday and then I leave on the 13th.  The 12 new students all arrive this Friday.  Jordan Geyman (Dr. Troy Geyman’s daughter) arrives on Friday and it will be good to see her.  We are sharing a room for the time I am here.

          I went shopping today for the rest of the gifts I am bringing home and some things for Sue Struble, a midwife that was here when I first came.  She wished so badly that she had gotten pearls for all of her daughters and it was a whole lot more cheaper for me to get them for her, than for her to come back and get them!

          Today, it was dusk by the time I was making my way home from the mall, about 1 mile away.  I used a peddle cab driver, as the roads were packed with taxi’s and cars.  Joyce was about to leave for the airport and I really needed to get home quickly to say goodbye. He was about 15.  He was very nice (too nice) and sang American love songs to me all the way (way off key).  When I got home, and after I paid him, he hung around the gate, still singing, peering in the gate and saying that he was in love with me!!??!!  ‘crazy kid!   I think he wanted money.   Carmen went and told him to go away and that I was the mother of 11 children (or something to that effect) anyway he left….   Now I am a little nervous about going out in the dark to the clinic, but thankfully the clinic guard is right near and within ear shot.

          My shift starts at 6:00 am tomorrow.  I was late to work this morning due to a misunderstanding about where I was supposed to be.  Ate’ Susan had asked me to do the exams today last Friday and my schedule says that I was on day shift for clinic also.  Assuming that Ate’ Susan took my name off clinic and put it on for the exams at 8:00, I took my time getting up and eating breakfast.  As I was talking to Tom on the phone, Carmen came up the stairs getting off night shift and she whispered… “Where were you? You are on this morning!?”  I honestly did not know that I was supposed to be two places at once, but I was… oooops…

          Please pray for the baby born yesterday, with an Apgar of 2.  It was the worse case of shoulder dystocia that the clinic had ever seen here.  It was actually my client I had worked with all night, with a very slow labor. I went home in exhaustion a couple hours before birth.  She finally got the head out and there it stuck.  They tried about everything.  They cut in several different directional episiotomies, they were trying all the tricks and still this baby was very stuck.  5 mintues later, the baby finally was worked out.  Jonna was standing on the bed, doing supra pubic pressure and actually broke the bed with her force down.  (In the middle of it all!) The birth mom had her knees up around her ears pushing and pushing.  It turns out that the baby had his hands locked behind his back and they could not bring them forward without breaking them.  There was blood, amniotic fluid and stuff everywhere.  About 2 minutes into this thing, one of the girls rang the emergency bell that sounds upstairs where all the senior midwives stay.  It rang quick once and they thought…  it was just an accident.  Then the girl hauled on it and then they jumped up (many were not quite dressed yet and dressing flying down the stairs.  Aute’ Susan was trying to put the wrong garment on her head…)  they arrived and worked and worked, finally getting the rest of the body out.

          The baby lay there limp and white, not breathing.  The heart was beating, though, so we did eventually get the baby to breathe with much resuscitation.  The baby didn’t really pink up. We transported the baby immediately as the baby was breathing in little gasps, little gasps, pulling in his chest so hard in an effort to get oxygen and really struggling.  The mom seems fairly uncomprehending about the whole thing, or else she doesn’t care.  She is still smiling and she went home this afternoon, her baby still in the hospital.

          Amidst the poverty and differences, I see a real sense of pride and modesty that is lacking in America.  To be covered during birth is very important. In spite of huge poverty…they very much want to repay kindness with kindness and just a tiny gesture and word of encouragement goes a huge mile.  I just love to compliment the moms if they are doing a good job.  They just beam with happiness and work even harder.  Most moms do not have diapers and so I bought a big pack of Pampers to give each of them a few out of, so they can go home in style.

          Little Peanut came in today with his mommy and he looks great.  (He was my baby that was just under 4 lbs a few days ago.)  Friday he came in and his temp was 102.00  I was horrified and ran to get Aute Anna, my supervisor on shift.  She looked at the baby awhile and said, “I think that he is just hot from being outside.  Unwrap him and cool him off.”

  I did and sponged him off as well and sure enough he cooled right down.  I guess a little one that small does not regulate their temperature on their own very well… Feeling a little foolish, I guess I will remember that lesson now.  It was a scorcher outside and I had scheduled them for 3:00 pm to travel in the hot sun. I made their future appointment for 5:00 pm.

Almost taxi birth...

Here is a picture of me eating a tropical ice “Sunday” with fruit.  It was called halo halo. This was my lunch and included shaved ice on the bottom of the bowl , with a creamy liquid poured over it.  Chunks of tropical fruit such as avocado’s bananas, mango’s and others, are put on top of the ice.  This is then served with a scoop of purple and white ice cream of undistinguishable flavor, and a squirt of additional fake cream…  It did taste good, although sweeter than what I am used to right now.  I haven’t had hardly any sugar at all here.  This picture is taken in the food pavilion in the mall.  Eating out is very common and cheap.  The restaurants serve food that is very different from ours and have signs advertising names of dishes like squid balls, raw fish of many kinds, all manner of vegetables and sauce, whole little pigs and chickens,  turning slowly over hot coals, and even hotdogs, encased in a waffle, on a stick. Rice is served everywhere, even in the “American” style restaurants serving pizza, chicken and spaghetti….even McDo’s (McDonald’s) serves rice!

 This morning, right away, I started with an “almost Taxi” birth.  She arrived in a taxi, but barely made it to the bed.  As soon as I had her feet up and she was lying down, she started to push.  No time for vitals here.  Couldn’t even find heart tones…. baby was too low and on his way out. 

          I had just finished assisting Julia with a birth, and then ushered in a new laboring mom that was barely started contractions (her water broke). As I was starting the vitals on her (Blood pressure, temp. baby heart tones…. Etc..),  I heard “Cher!” (that is what they call me here).  “Laboring mom and she is pushing NOW!”

This mom was 24, and it was her 3rd baby.  She was totally calm, but was obviously uncomfortable sitting in the chair on the baby’s head.  As Aute’ Susan quickly, quickly, wheeled her through the back door, and over to the bed made up in the corner, I grabbed a birth cart and the oxygen tank and yanked the curtains closed around the cubicle and yanked on my gloves. 

                   We got her up on the bed, I got the big pad under her bottom, and there was the baby’s head visible.  I have really been working on head control in fast births, because after Julia’s experience with the explosion of the baby’s head out, making its own hole, I can see that head control is very, very important.  I really held this head back hard, trying to get her perineum a chance to stretch and the shoulders not to blast through and make a rip.  Her water broke, just as the head was crowning.  There was moderately thick meconium, so I knew that they were going to want to do deep suctioning with the machine on the baby as soon as he was born. Thankfully, she did not tear.   As the baby was born, he gave a good yell and pooped a bunch more on the way out. Now my bed was a mess, but I was glad to see that he was lying there safe and sound.  

          While the little fellow made no mistake about wanting to get out quickly, mama’s placenta took a little over a ½ hour.  I was just thinking about getting some action going by getting her up into a squat on the bed, but then it came with some gentle traction. Only moderate bleeding this time.  Everything looked great. I did give her a shot of pitocin, to control bleeding, since the placenta was so long in coming… (not my idea).

          This mom was so strong.  She wanted me to let her go home about 2 hours after the birth.  All moms must stay 6 hours and this is very hard for some.  Her bana came and laid down on the bed with the baby and took a nap, while she watched over them both for several hours in a hard chair by the bed.  Earlier I could tell that she was definitely the one in charge here with the family.  She gave him all kind of grief for the baby soap not being in the bag, and this and that, that I couldn’t understand. But the expression on his face was enough to say that he’d messed up.  But, obviously she cares well for her family and gives of herself a hole bunch… letting him and baby sleep while she took the chair.

The baby was a little boy and they named him Aierl.  Here is a picture of him.

          Julia’s little girl that I assisted, was named Ashly Mae. Here is a picture of her, too.

          Just before lunch, a woman came in that had delivered here about 6 weeks ago.  She had a breast infection about a month ago and we had sent her to the doctor for antibiotics.  It didn’t work. The wrong antibiotic for the wrong bacteria.  Now she has huge gaping hole 3 inches across and 1 ½ deep, a crater, in her breast, where the infection has eaten away and made its way out.  Milk and green pus leaks out of the hole and it looked very, very painful.  The mom had not gone back to the doctor for different antibiotics, assuming that it was her fault that they were not helping.  Doctors are like “God” here and they can intimidate a young mom from ever seeking further help by being rough or insulting. The breast is ruined and she will need surgery before gangrene sets in, or even tetanus.  Tetanus is very rampant here, as is leprosy and gangrene.  Thankfully, here at the clinic, tetanus must be current by 28 weeks, and I have given more than my share of tetanus injections these last few weeks!

 Staph infections are very common, as it is on the skin at all times anyway, but it grows better here in the constant humid warmth.  That is why I don’t dare break the skin on one of my mosquito bites.  I carry itch medicine with me where ever I go, so that I do not scratch.  An intern here last year got a septic infection from scratching a mosquito bite through the skin, and had to spend a week in the hospital (the nice one downtown, not the government one where I take moms) on IV antibiotics.  That would not be a way I would like to spend my time here!

          So, infections are very common in this environment.  That is also why they do not allow us to do many internal exams.  Back at home, we check for dilation and check for an anterior lip and a check for this and that.  Here you usually only get one chance to do an internal exam and that is on admission.  With it, we have to determine if there is going to be enough room for the mom’s bones to move, so the baby can come down, to see what the baby’s head is doing on it’s way out,( if it is cocked to the side), or if the baby is breech or otherwise odd presentation, if she is dilated and effaced, if the water is broken, if the tissue is healthy, and if there is going to be any problems with the decent of the baby at the vaginal opening, with the muscles and tissue at the very end.  It is a lot to try to take in on a 2 minute or less exam.  But they are really trying to minimize the chances for infection.  Even so, they give out antibiotics with all suturing and for any other reason.  They are really going through the amoxicillin and cephalahexin that I brought. 

          For lunch today, the cook in the clinic made a really good chicken curry, served with white rice.  She had grated the coconut by hand and squeezed out the milk and cream and discarded the grated coconut meat.  Then she braised the chicken pieces and added them to simmer in the coconut milk curry sauce.  It is amazing to me that they do not try to cut the chicken in recognizable pieces.  It is common just to chop the chicken in bite size chunks, bones and all and then just cook it that way.  Everyone is always picking bones out of the side of their mouth, but that is what they do all the time with the fish they have for every meal anyway, so it looks normal.  They did have fish again today and it wasn’t too salty this time. They often serve a dried fish and eat it with most meals. It is way too salty for me.  I don’t mind the fishy taste, but the salt bites my tongue.  This particular fish had been dried and then steamed and wasn’t too bad.  It reminded me of trout, although didn’t look anything like one.

          The curry today had potatoes, carrots, the coconut milk, ginger and lemon grass.  I really do enjoy the curries and they never make them too spicy. Yesterday’s soup had plantains (look like banana’s but don’t really taste like them) and was thicker from the addition.  Another amazing thing to me is the common practice of not refrigerating food.  The cook will make a big lunch (enough for dinner too) and it will sit on the stove (with the stove off) for hours, sometimes all night and the next day, until the new food is being cooked.  No one gets food poisoning.  I just do not understand.  I am very careful to smell the pot before I take, after Julia’s blind trust, and soured pork veggies the other day!  I suppose, if one heats it up really well, that the spoil bacteria that would make me sick would be gone.

          The clinic cook is a real sweet heart.  She loves to please everyone and makes treats to share.  She also does all the kitchen cleaning and mopping, along with making shopping lists and organizing meals.  Yesterday she made little spring rolls for dinner and some of us found out about it, including me… and we snitched some from the basket as they were piping hot and so delicious.  I think she was a little frustrated, as when I went back in for a drink of water from the cooler, there was a sign on the bowl with exclamation mark “This is for dinner only!”  She gave me a big smile this morning when I walked in to work, so I guess she doesn’t stay mad very long.

          There are other ladies that work as people who clean, ladies who do the laundry (not the bloody stuff) and keep things tidy.  Sweeping, yes there is constant sweeping going on…. with shorter, wispy, wide brooms, made of a soft, fibrous plant.   It is a common practice here to have household help.  In fact, nationally, household help makes up for 40 percent of the jobs in the nation.  Even the fairly poor have household help.  Women that live with their bana’s, that are not married, are officially called housekeepers on their child’s birth certificate.

          I am sitting here, with my fan blowing on me constantly and I am still sweating bunches.  My skin is always sticky, my clothes are always damp from my sweat, and I cannot tell you how much I am looking forward to that air conditioned plane on the way home.  For that will be the end of my stickiness.

          I am off for the evening and just woke up from a nap.  I am surviving by sleeping and eating when I am not working. The idea of traveling to see the famous beautiful beach doesn’t even appeal to me.  Not without Tom anyway….

2 births, a baby bath and a Muslim family...

Today I reported for clinic at 6:00 am, very groggy and sort of hoping that I could have a chance to wake up a few hours before any labors came in.  My wish was granted… for a little while.

          I went in to assist another midwife that had taken this mom over in endorsements, from another midwife who was heading to bed.  This particular mom was in a lot of pain.  She cried out and moaned all night, since she had been admitted in the wee hours of the morning.  I think that the fear…tension…pain cycle is so true.  Blatant examples this are seen here all the time. I wish so much that I spoke the language so I could work with some of the moms, helping them to understand that what their bodies are doing is natural and it’s  O.K.

          This mom finally was fully dilated and started pushing, sort of… She cried out with each push and was having a hard time focusing down below.  She would throw her head back and lift her bottom off the bed and scoot, trying to get away from the pain.  She pushed for 1 hour, and then 45 minutes… then her baby started getting worn out.  Heart tones started taking a nose dive after contractions… late decels meaning that her baby was not getting enough oxygen.  We put oxygen on the mom and listened for a few more minutes.  Carmen started an IV.  I called out the heart tones every 6 minutes as I counted them with the doppler.  90…..100….80….70…80……70….65…..70….  Yikes normal is 110 – 160.

We could see the baby’s head, but we were a long way from getting that baby out.  We decided to transport, because the birth would be safer in the hospital where they had better resuscitation equipment… (well not really, but the rules say we needed to transport).  It was better that way anyway, because I don’t like dead babies and we just could not tell whether this one was stuck or not, as it was coming so slowly through the pelvis.

          They flew off in the little blue ambulance after getting her loaded up out of the wheel chair.  She delivered after being in the hospital not very long… The baby is safe.

          My second birth of the day was right after 2:00pm endorsements.  The midwife on shift had gotten her settled and thought that she might go pretty quickly.  She handed me the file and said like… quick! I mean right now!…So I jumped up and grabbed a birth cart, oxygen and yanked on gloves… (sound familiar). And she was pushing.  3 pushes and the baby was out.  I again worked really hard at getting the baby’s head to stretch the perineum slowly, but the baby came so fast…  number 5 for her.  That he just sort of slid out onto the bed.

          A little boy.  He seemed very healthy and pinked up right away. This family is Muslim and just the birth mother-in-law was there to help her.  At least the dad was not there this time to whisper in his baby’s ear before his little one hears anything else, “Allah is God, and there is no other…” The Muslim dads all do that…

          The mom speaks almost no English and really doesn’t talk much at all.  It is so strange not to be in communication with the birth moms I am helping.  It makes the situation seem kind of “not real”, but they are very real…. There is lots of blood with this one to prove it.  This mom bled about 600 cc which is not too bad.  Still, my heart was with her as she kept throwing big clots and trickle bled, even though I was really squeezing the uterus firm every couple minutes. I gave her some pitocin.  Finally, about a half hour, she slowed way down and she is fine now. 

I, with baby in one arm and her clean clothes in the other, we slowly made our way to the bathroom.. It amazes me that she is not dizzy.  She even balanced on one foot to get dressed in the soaking wet bathroom.

          The bathroom has big white, tile flooring and a huge bucket with a scooper that is used for flushing the toilet and washing off.  We slosh the toilet off, too with it.

          After getting her settled back in bed and resting, I did the baby exam.  I heat the big tea kettle on the gas stove and get the green plastic baby bath out the back door, where it is hanging from the last use.  I fill the baby bath with a little hot water from the now steaming kettle and some cooler water from the sink facet.  I touch the water with my elbow… Yes, I hate scalding babies…. My hands are pretty numb to heat after all the years of mothering and washing.  I adore very hot baths…. (Ahhh a hot bath… I have not had one in a very, very, long time.)  But babies do not.

          I carefully carry in the warm water bath and place it on the bed beside the mom.  I then ask for the bar of soap that they generally have brought.  I unwrap the baby and lower them in the water, carefully swishing them off, getting rid of the blood and mec. Most of them holler and are not happy with me. If I hold one arm pinned to their body as I wash, sometimes I can get a quiet one.  I soap the head, wash it off and rinse off the rest of them and turning them on their backs as I am taking them out of the tub, do a quick exam for any anomalies.  We do find some occasionally.

          After the bath is done, I wrap up baby and whisper in his ear that he probably won’t like this next part, and I am terribly sorry, but it is the rules… and I will try to be as quick as possible. Next I run out to the fridge and get the vitamin K shot and draw up the HepB syringe.  Then I get a cotton ball with alcohol saturated and steel myself for the most unpleasant task of this whole thing.  We have to record which leg we inject what, and what time and the date, after we footprint them with ink on the newborn exam form.  They don’t like being messed with on their feet… but the 2 needle pricks are worse.  After my dastardly deed is done, I wrap them up and give them back to mama to nurse.  Sigh… sorry little one….

          The paperwork in the clinic is just a reflection of this paperwork-happy-country itself.  There are literally reams of paper work and everyone seems to think it makes things more official.  So, the birth certificate paperwork is 5 pages long and sometimes 6 if the family is Muslim.  The birth record form itself is 5 pages, each having a special purpose and part of labor.  They document EVERYTHING here.  Papers to get into the clinic, a paper to get out (to show the guard).  Paper that proves you are married or a tax schedule that shows you are a household with your housekeeper.  Anyway… you get the idea.

          Tonight the Pinoy midwives are all singing in the kitchen with much gusto and laughing.  They are singing Filippino Christian praise songs and using a small congo drum, spoons on the counter, a guitar and their voices.  I wish I could tape it and put it on the web so you could hear it.

          My birth mom just wandered by to the CR  (comfort room) again, so I am going to see if she needs anything.  Her husband (yes the Muslims are all married). He left to go get something down the road.  They just told me that they wanted to change their baby’s name…. so I’ve gotta go!

3 births, and a wild woman...

When it is about to rain, in pour the labors.  It was no exception to that rule this evening.  We had 3 at once.  It seems that there really is something to the falling Barometer deal.

The first one was a mom who had been laboring here all afternoon.  Her name is Beautilyn and she did a wonderful job at pushing her baby out.  At 4:57 pm she had a baby boy.  Only thing is that she bled and kept on bleeding off and on.  At one point, her banti helped her change her diaper (pad) and then told the guard that she was bleeding… but didn’t bother to tell the midwives… so we do not know HOW MUCH she bled.  She was looking pale and weak, so we started an IV and did a manual removal of clots and found a membrane piece and maybe a small piece of cotyledon from the placenta.  She stopped bleeding after that.

          The next mom, Calle Deosyl, came in at 8 cm and pushed a baby out 9 minutes after the above mom did.  I was able to assist both of the births by actually receiving baby and helping evaluate apgar score, cutting the cord and charting.  Calle gave birth at 5:06 pm to a baby girl.  She also bled a huge amount after placenta came out and we started an IV on her right away. EBL 800.  She stopped after the major gush with the placenta.  It just was a WHOLE lot at once.

          The third mom, Ma. Cindy Traabucon was a G3 P3 and came in during the hemorrhage management of the two above and was 8 – 9 cm.  She gave birth at 6:49 pm. EBL only 75cc, thankfully.  I assisted by charting and doing most of the immediate postpartum checks.  Her estimated due date was 9/18/07 and her baby boy looked really frosted with vernix when he came out.  There was moderate to heavy fresh meconium in the water, so this baby was deep suctioned immediately upon coming out.  Deep suctioning means that they put a thin tube down the baby’s throat and nose to get the fluid out of the esophagus and stomach and nasal passages. This may or may not help, but is hospital protocol.  They also use the bulb syringe routinely because it is hospital protocol.  So even if the baby is not gurgling, we use the bulb syringe. I use it sort of as a token suck in the mouth then nose and then put it down.  Babies do fine without it, for the most part.

          Earlier this afternoon, we had an 18 year old mom in labor with her first baby, that we worked with all morning in labor and then for about an hour and ½ with pushing.  This was the first “wild” woman episode I have seen here.  She was flailing around on the bed, screaming in pain.  She grabbed her bana and shook him.  She hauled on his neck, his waist and anyone else that got near.  Bruises all around for anyone within reach, I am sure. She kept crying out in pain while pushing and was literally sobbing and begging for help. She would lift her bottom up from the bed and try to crawl away from the pain, literally. We had her try various positions and tried to comfort her.  The Pinoy midwives were a little annoyed with her for acting out like this.  Their culture dictates that a woman labors quietly and makes no noise… not even with pushing.  She desperately needed a mommy.  And although her mom was there, she wasn’t much help, but just looked on horrified and kept trying to get her to be quiet. Although it is fine here to make noise while in labor and pushing here at the clinic,  many times the bana or banti will try to shsush the birth mom from making any nose louder than a talking voice.  This mom was yelling so loud, we were afraid that the neighbors would complain.  Thankfully the clinic was almost empty at the time, except for a few woman and their babies waiting for their postnatal and newborn check ups and the last of the woman just leaving from their prenatals upstairs.  This mom eventually did get down to work to push very well for quite a while, but the baby’s head just would not come under the pubic bone, no matter what position we tried. Then the baby started getting tired and having late decels of 70….80…. and 90, so we transported.  I could hear her yelling outside and even in the ambulance as they drove away.  The way the ambulance driver gunned it out of here,  I think he was in a hurry too, for the sake of his ears.

          So that was the gist of my shift today along with 12 prenatals in the clinic this morning.  One breech baby, one mom who thought she was 17 weeks along, but no baby to be seen. And several moms with very low iron and one with a raging UTI or vaginal infection of some kind.  It seems that all of these moms are high risk, with the exception of a few souls that try hard to eat well.  Actually eating enough vegetables is not hard here, it is the everyday protein issue.  But eggs are fairly cheap and can be bought individually.  An egg a day and a plate of greens would go a huge way in making a healthy baby and mom.  But instead, their diet of white, processed bread products, lots and lots of white rice and minimal protein creates unhealthy placentas and babies that are not very vigorous.  There are no whole grain bread products for sale here and most families do not have any way to bake anything.  Oats, and cornmeal are available in the grocery store in the mall.  It is expensive for them and I can tell that mostly the white foreigners buy it because it doesn’t move very fast.  I really have to watch the shelf date.  Grainola and hot cereal are available here and I have literally lived on it for breakfast while I am here.  This hopefully counteracts the white rice I eat everyday. 

Tour of Mercy Maternity Clinic

I thought that maybe since the clinic was quiet except for my one postpartum mom, I’d share some pictures of the clinic.  They have a beautiful way of keeping things very simple.  I have learned that simple is better… after all, babies come out without scads of equipment.  The essentials like oxygen for mom or baby is always available.  The birth carts are very uncomplicated.  Big, clean, birth pad, some blue towels, a baby blanket, some gloves, some sterile gauze for looking for tears, a cord camp, scissors, gloves, bulb syringe, and Pitocin.  That’s it.

Simple birth uncomplicated the process of birth in my mind.  Being here has done several things for me.  It has given me more knowledge and confidence.  It has helped me with skills that I might not get to practice in the states.  On the other hand, it has really made me see how much more I need to understand and just how many different ways there are to approach problems in labor and birth.  (Each supervisor has a different approach to the same problem. Thing makes learning really interesting.)

Emergency management of hemorrhage, a baby with stuck shoulders or even true shoulder dystocia and a baby who is slow to respond and get going… these are regular occurrences here.  It almost seems common to me now, but I have to remember that when I get home, I will see it much less… But I will know what to do!….

I really like how calm and ready for action the midwives here are.  They seem to know what is going to work and when to transport.  They have their perimeters, imposed by the hospital rules… and yet they do have some leeway if they think a mom can pull it off.  Because of the high risk, under nourished, moms, we do transport a lot.  High blood pressure, SROM over 12 hours, with no labor progress,  babies not getting around the pubic bone (pushing for over 2 hours) or contracted pelvis and severe hemorrhage after placenta is out (1,500cc to 2,000cc ) are the most often reasons for transport.  Also babies that are not breathing well or moms unable to cooperate with instructions are some other reasons.

This is the clinic entrance.  60 to 80 woman line up here 5 days a week to have their prenatals.

Here is the basic clinic.  There are 6 single, wooden, beds in this room and then 2 beds out in the big area. Every bed is separated by curtains.  Each cubicle has a single bed with a 2 inch plastic mattress, with a sheet and a flat pillow with case.  A single sheet is for covering mom.  A piece of  heavy plastic covers the middle of the bed and is washed by the bana after the birth before they can go home.  the room also includes a black 3 tired stand, and a white plastic chair.  There are two birth carts, 2 oxygen tanks with tubing for mom and one for baby..That's it. There are fans everywhere, as it gets blazing hot in here!  I don't know how many births I have done with sweat dripping off my nose.

Here is the midwife's area that we hang out in, between births.  I sleep here, eat here and have in depth conversations about everything with my fellow midwives on shift.  Rose and Anna are using my lap top getting their e-mail and I snapped a picture of them.

Here is the winner of the mellow baby award.  Most little ones yell when I bathe them.  This little guy seemed to like it.  His daddy was giving him his bath.  He was not a happy camper, though a few minutes later when I gave him his injections.  He recovered quickly though. They named him Lorenzo Mari Talo

For now I will think about how to put them all in a logical order with text

Escape to Paradise Island...

Yesterday, I was totally exhausted, mentally and physically.  On the spur of the moment,  I decided to go to Paradise Island for the night.  I am so glad I did!  I slept for almost 12 hours straight in my simple but safe room with two single beds. It was so quiet.  No guy riding a bike by shouting at 4:30 am to sell Mya Buko, (deep fried, ½ embryo eggs) the rice peddler or fighting cats or anything!  After I arrived, I walked on the beach for a couple hours.  I tried to get a sun burn, but I just got browner.

 I am doing much better.  I have a happy outlook on life again and I feel alive… like I can do this.  It took some courage on my part to leave the house.  But all went well on this trip, and I did take a taxi for most of it.  I just sat in the sand, numb, feeling the waves and sand… picking up a few shells, crying a bit… and went to sleep at 7:00pm.

  I awoke at 6:46 am.  I took my time getting a nice warm shower… not HOT!  Or COLD! I ate a nice quiet breakfast of steamed fish and ginger.  I also had strawberry crepes, but they forgot the strawberries and just used jam…

  I left the island at 9:45 am and went to the big, big mall.  There I found some more material for dresses and some great Tea Rose perfume that I have been looking for, for years, and a nice new jean jacket… for me.

I got here at the clinic for work at 12:00 pm, got into my scrubs.  At 1:37 pm,  I just delivered my 13th baby and now I need 4 more for my 17 total.  In addition, I have assisted in some way, with way over 50 births, including the 12 transports.  I think I learned more during the transports!

It is now 3 days until I fly out of Davao City to Manila and head out across the ocean towards home.  On my Thursday, I am spending the night in Manila and my plane leaves at 8:15 in the morning for Portland, OR.  I am so much looking forward to being home.  Words cannot express what my stay here has done for my ability...  my thoughts about catching babies and about myself and my limitations.  And yet I am so very, very anxious to be home and settle into being wife / mommy again.  Nothing like a little time away to help me reflect and decide what I want to do differently for the better! 

Much of my afternoons lately are spent doing postpartum exams and newborn exams.  I am the last intern to leave and so I get all of the postpartum and newborn exams everyone left behind.  So that is good... but sometimes I have them lined up pretty deep waiting for me.

The clinic was pretty busy... yet I am so tired (always am) Yawn....so I decide to take a quick nap on the bed below, just taking a "short nap" before some of my mom's were due in for postpartums.  1 hour later, I awoke with a start to find 4 pairs of dancing, laughing eyes holding babies looking at me.  All my postnatal moms had decided to show up at once and there I was snoozing away for over 20 minutes with them sitting within 3 feet of me, quietly waiting for Punta midwife to wake up!  I am sure I had sleeping lines on my face and probably had my mouth hanging open or drool or something.  They are always so polite...

I only have 3 more shifts left, and I need 3 more births for the 17 complete handles required for my Association of Texas Midwifery school I am going through.  3 more additional will be at home with Joyce, as they need to be continuity births from 15 weeks on until birth and then 6 weeks afterward.  I have way over the 40 I need for Montana. And way over the amount of prenatals and postnatals and newborn exams for everyboby, which I am very thankful for.  So, whether I get the 3 in the next few days, is not a terrible big deal to me, as Joyce and I have more births this year yet too.

Last night I had night shift.  I was pretty tired and so I went to sleep on the bed above... see my pillow!  This is where I hang out a lot when things are slow.  Suddenly the guard calls”Labor!"  Up I jumped!  A mom had just come in the gate, after getting out of a Taxi, by the road and could hardly walk.  Her bana was trying to support her as she walked.  I had my clinic shoes on, so I didn't go out and help support, but somehow she made it to the doorway.  We then hustled her over to a bed... ( I am still walking in my sleep).  Sure enough, she wanted to push.  The baby's head was visible. Once again, I yanked on gloves, wheeled the birth cart over, and someone else got oxygen and pitocin.  We did get heart tones and they were very low.  I stimulated the baby's head and urged her to push harder.  But not too fast... we don't want to rip.  8 minutes later, from the time she entered the door to the center, she was born.  As the baby's head was crowning, the cord appeared on top, so I looped it over the head to the side, out of the way. So it turned out that she had a nuchal cord that was between her head and the canal and had slowed the oxygen down getting to her. She was very dusky and slow to start.... I always hate that...( I was awake now!)    Anyway, after a few resuscitation breaths with oxygen and blow by for awhile, she perked up good enough.  She was also a big baby.  It was big baby night..

The baby before that same evening, had really stuck shoulders.  It was the typical slow to progress labor that these bigger babies that are having a hard time descending into the pelvis have.  It took her forever to get from 4 - 7 and then another forever to get to 7 - 10.  The head was asynclintic too, sort of chin tucked way down and off to the side.  The head came out dark blue and then retracted in a bit against the perineum.  Uh oh... We tired briefly to get baby out and realized that the shoulder was pinned under the pubic bone.  Elizabeth held onto the baby's head, as I quickly brought mom's knees way up to her chest and had someone hold them there.  Mom stopped pushing, then I did supra pubic pressure, while Elizabeth pulled down.  Then the shoulder slipped under the pubic bone and swoosh, she was out.  Non-responsive. White with very blue head, I stimulated the baby and we grabbed resuscitation equipment and gave baby a few good breaths.  Finally with a little cry she started to pink up and respond.  Thank you Lord!  She was only stuck for about 2 minutes, but it always seems forever while we are trying to get a baby out like that and breathing on her own.  Time almost stands still.  We used blow by oxygen for about 1/2 hour. Baby had chest retractions and nasal flaring for a while.  But perked up after nursing and thankfully we didn't have to transport. She was actually a stong baby and withstood all this in good stride.

I think that I will write a book called  "The Birth of a Midwife"  but maybe someone already has... Anyway, that is how I feel.  I affectionately call my stay at Mercy Maternity,  Midwife Bootcamp.  It fits.  I am exhausted and being pushed harder than I ever have been in some ways.  I have grown in confidence.  I can go home now and feel a bit more prepared to be of good use to Joyce.  I am expecting to have a bit of a hard time with jet -lag and so your prayers will be much appreciated as I integrate back into home life and a heavy schedule.

The surprise of my life...

It was early morning.  I had just woken up and lazily lying on my mattress on the floor (I like it there). I yawned and stretched.  There was a knock on the door and Krys poked her head in the door and said very concerned, “  You have a patient downstairs that is really upset and she needs to talk with you right now…”

          “Oh dear… is it Phoebe?” (the young mom with the tiny baby ‘Peanut” )  I have been concerned about them.

          “Yes, I think that’s who it might be…” 

          Lots of questions ran through my mind all at once…So I jumped up in bed, really worried.  Is the baby sick?  Why can’t Krys handle it, she speaks much better Cubano than I do…  Maybe Phoebe is in trouble.  Why does she want only me?  None of it made sense.

          Getting to sleep at 1:30 am last night, because of a birth, I was really rummy and not thinking very well.  I wriggled into an already worn dress; put my hair into an alligator clip, deciding to put it up while I talked with Phoebe.  I grabbed my bag of tools, my computer (to check if Tom had sent an e-mail and my back pack.)  I raced down the stairs, out the door and over to the clinic.  Walking through the clinic door, the curtains were closed around the nearest cubicle.  (Not a big deal, since in the AM interns that are not working are sleeping.)  I walked around the corner, and looked at one of the students who had a camera pointed at me.  I stopped in confusion.  What?  Everyone was silent. (This seems all slow motion to me)  I looked to the left, onto the bed expecting to find Phoebe….. And there was Tom sitting with his feet up on the bed, smiling from ear to ear.

          My mouth hung open for a very long time.  I was shocked.  I couldn’t speak.  I just stood there staring.  It was as if time stood still.  My mind was in a fuzzy state anyway.  Then my legs somehow managed to start moving again… to the other side of the bed.  I was in his arms……  I was shaking like a leaf….  He kissed me soundly and we hugged again and again.  I was still in disbelief…… Here are pictures of all of this   I look incredibly silly with my mouth hanging open, my hair in the alligator clip and dressed a wrinkled old dress!

          I was totally useless for about 1 hour.  I couldn’t think where my key was to get into the house.  I was going up to change my clothes and put my hair into some kind of order….  When I couldn’t get into the house, I turned around and went back into the clinic kitchen, where Tom was waiting and I decided to do my hair there.  I got my hair up into my bun and then spent 5 minutes rummaging around in my back pack looking for my hair pins. (all ready in).  I must have seemed to Tom like I now had ½ a brain.  All I could do was stare at him and mumble glib answers to his questions.

          It is now 24 hours since we have been together and after a good night’s sleep, I am doing better.  Mentally adjusting to having him here, instead of all of my dreaming about how I would look getting off the plane, what I would say when I returned, all went out the window.  The Lord knew all of this was going to happen, and so did Tom, my family, my church family and even Matt and Krys here.  They did a fantastic job keeping clam about Tom coming to get me.  I have truly NEVER been so surprised in all of my life… 

          So, now it is Wednesday morning.  We had breakfast in the Insular Waterfront hotel where we spent the night, and are heading off to Paradise Island for our last night here.  This is the same place, where I cried tears of longing, just not even a week ago, for  wanting to share this beautiful place with Tom.  I cannot believe how good God is to me… This is truly an incredible conclusion to this midwife drama… called the Birth of a Midwife….  Thank you everyone who worked hard to make Tom’s coming possible.

          We leave tomorrow evening to start our journey home.  Flying out of Davao and to Manila at 9:45 at night.  We sleep in Manila and then fly out toward Japan at 8:15 am.  We then fly from Japan to Portland, then Portland to home… I am so very glad Tom is here to do all the thinking about timing and all.  I am really not too bright right now.

          So, we will be home the afternoon of the 14th.  I cannot wait now to hug my children.

Tom waiting behind the closed curtain....

Sherry in total, absolute shock!

In his arms at last!!!

2 Wonderful days with Tom and good byes...

We were able to spend 1 night at Paradise Island and toured the island, via a jeep.  It was a very rough ride, but interesting.  I think that now we have a really good idea of what this part of the Philippines might be like, in the city and way out in the country.

Here are some pictures of us on our tour...  there are so many pictures I have taken that I wish I could share.

One of the stops they took us to was a big cave that over 1 million bats call home.  This bat colony really smells.  In fact, it was very nauseating.  I remember this smell from my childhood and recall a barn that really reeked like this.  Now I know what the smell was!

Here is Davao City just before sunset.  It was really raining, so the sunset was not very spectacular, but I know that they can be here.  This is an overlook called Jackson's ridge.  They have a restaurant and places to sit and see the view.

Here is an Assembly of God church.  They have many outreach churches of all faiths.  Mostly the more common denominations, along with a fancy Jehovah's Witness building and a Mormon building.

Tom is front of a bakery that we stopped and bought some bread and cookies for our lunch.  Paradise Island had packed us a lunch to take that consisted of plain rice, garlic broccoli, a pineapple and a mango cut up. 

We took a hike to some waterfalls for a picnic lunch.  We had to cross several "bridges" to get to our cascading waterfalls and eating place.  Here is Tom just coming off one of the bridges.  He is carrying lunch.

Here is our picnic spot.  We stayed and shared lunch with our guide named Drdr. 

Our trip home.

We were able to get tickets out of Davao several hours earlier than planned.  This got us to Manila at a decent hour to get some sleep.  We slept in a Christian hotel, and they had a unique set up for dinner.  Open cooking, they had seafood and vegetables.  You chose the piece of seafood you wanted, they cooked it.  I had a couple shrimp and some adobo greens and rice with a watermelon shake.  Tom had a couple prawns, some fish and rice, along with a mango shake.  All of this for under $20.00. 

We ordered breakfast up to our room, as the kitchen  for free breakfasts opened at 6:00 am and we had to leave at 5:45.  We ordered scrambled eggs, sausage and toast and hot chocolate.  We got scrambled eggs, hot dogs, toast and coffee.  Anyway, we ate what we could and then left in time to get to the airport.

With 2 huge suitcases, 4 smaller suit cases, my back pack and Tom's study materials, we had quite a load.  I really don't know how I would have managed coming home by myself.  Tom had taken one look at my rickity box held together with duct tape and promptly went out and got some luggage.  We spent about $20.00 on 2 luggage sets at Davao's biggest mall, that really suited us well.  The gifts we got for everyone, fit in just right.

Our flights home we uneventful, except for in Davao, they almost took my sea shells.  The guard was very compassionate and looked left, looked right and stuffed them back into my suitcase and stuck a "fragile" sticker on the outside of the case.  He said to tell the guards that they are "finished product".  We did not encounter any trouble in Manila.

The long ride home was loooooong.  One flight I sat in the seat for 8 hours without getting up once.  The meals were airplane meals, but tasted good.  3 movies later, we landed gracefully in Portland, Oregon.

In Portland, we almost missed our flight to Spokane, because our flight from Japan to Portland was very late.  We had 1/2 hour to get through customs with all of our luggage, get through security again, get a boarding pass and get from one end of the airport to the other. 

We arrived home safely to Spokane. The Poole family brought our car for us to the airport, so we could get straight home.  3 hours later, we were home.

The children were very excited when we arrived.  Balloons and welcome flowers greeted us.  They could not wait to look at their gifts.  After several hours of oooos and ahhhh's we collapsed in a heap to sleep (after being awake for over 24 hours.)