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Midwifery Apprenticeship in Davao City, Philippines

The following is a blog written during my internship at a Christian charity birthing clinic in Davao City, Philippines. Many names have been changed for privacy.


THURSDAY, JULY 14

I arrived safely this morning in Davao. The trip in went very well, I think. The flight from LA to Seoul was about 12.5 hours, and that is a haul, but overall 36 hours of flying was filled with God's mercy. The part of the trip I was most worried about was the overnight stay in the Manila airport. After getting my luggage (which arrived with me safely!) and going through customs, I sat around next to the guard station from midnight until about 2:30am, and there were maybe 3-4 other passengers that stayed there too. There were maybe 6-8 guards, at least 2 of whom were armed, so I felt pretty safe, but it was creepy. I easily found an ATM and at first wasn't sure how much to take out. I thought, 100 pesos sounded like a lot, I'll just get 100. LOL! Think pesos = pennies. Divide pesos by 2, and then move the decimal point. A 100 peso bill is the equivalent of about 56 cents! So once I figured that out, I just went and got 10,000 pesos (about $100). That should last me awhile.

At about 2:30am, one of the guards came to tell me the last taxi was leaving, and I had better get on it to the domestic airport for the Philippine Air Lines flight to Davao. I argued a bit with the taxi driver about cost. He said it was 115 pesos, or 8 American dollars. I let him know that no way was I going to give him $8 if it was 115 pesos. He handled my bags, and didn't have change (or so he said), so I ended up giving him 200 pesos. That's about $1.20 for the 5-minute cab ride to the domestic airport. Better than $8!

Once I got to the domestic airport, I realized I should have gone there right when I arrived. It was loaded with at least 100-200 people all sitting around waiting. At 2:30am!! I got checked in at the domestic counter, found the gate where my plane to Davao would take off and found a chair. All this time I had been praising God for my trip so far, and asking him to surround me with His angels to keep me safe until I was securely in the birth center. A nice man sitting next to me said hello, and we struck up a conversation. (Everyone, and I do mean everyone I met spoke English.) He asked me about my destination, and I mentioned I was going to be working at a birth center in Davao. He lifted his eyebrows and said, "M_____ Clinic?" I said yes! He stuck out his hand and said, "My name is Tom. Pastor Tom. [The directors of the birth center] attend my church." I got teary-eyed as I shook his hand and told him my name. I had prayed for an angel to protect me, and that angel had arrived. I sat with Tom for the next two hours, he showed me the portfolio of pictures of his church, described their campus ministry, youth ministry, and leadership ministry. We traded business cards, and I gave him a card of the new church plant in Leavenworth. He had been in Manila for the last month on a leadership training for a church plant there. He told me where to go, stuck with me all the way until we boarded the plane. It was obvious this was a man of God, on fire for Jesus Christ. Then it turns out that on an Airbus that holds 300 people, he sat right in front of me! IS GOD GREAT, OR WHAT?? Elaine from the birth center met me at the airport and drove me to the clinic. I have been able to take a shower, which I desperately needed, change clothes, and relax a bit.

The clinic here is about what you would expect for a "lying-in clinic" in an economically poor nation. This is no luxury place, ladies. Plain tile floors, bunk beds with foam mattresses, only cold water (I took a shower when I got here, and trust me--I did not miss the hot water!). So far everyone I have met is very nice. This is going to challenge me on *so* many levels, but Christ has been right with me so far, and I know He will carry me these five weeks. The birth center is filled (at least 20, I think) with ladies right now for either prenatals or postpartum checkups. There are no women here in labor right now, but she said even last night they had all 6 beds in the primary birthing rooms in labor. The "birth rooms" are cots with rubber-coated mattresses, and a curtain hung from metal pipes from the ceiling. Sometimes they have more than 6 in labor, and the overflow goes into the postpartum checkup room, where there are 3 more beds. I sat with them earlier this morning, and just sort of eavesdropped on a PPM (postpartum visit), and saw the midwife pray with her at the end. Another young mother came in, 19yo, primip, 36 weeks. She had been having prenatal care here, and today found out she is pregnant with twins, but one has died.


my bathroom


my room; there are 2 bunk beds on the left (not shown), mine was bottom bunk.


L: View outside my room; notice the goats. R: backside of center, my room is upper left.


Birthing room “kitchen” with sink, autoclave, stove for heating water; supply closet, newborn bathtub, etc.


Birthing rooms, separated by curtains.

They are letting me 'decompress' today, and I will start in with a full orientation tomorrow (Friday). A good night's sleep will do me good, I am sure. FYI, there is a 13 hour time difference. I am writing this at 10:30am Thursday, where it is 9:30pm Wednesday in Leavenworth.

PRAYER REQUESTS:
Praise for safe arrival
Praise for easy travel
Praise for my luggage arriving with me
Praise for Pastor Tom and his fellowship in my time of need
Request for jet lag to be over quickly, so I can jump in and get to work.
Prayer for Anna's remaining twin to be delivered safely.

Anita <><


FRIDAY, JULY 15

I slept pretty well last night, after staying up 48 hours on only 3-4 hours of sleep, sleeping from 7pm until 5:30am. I woke up with a jet lag headache, but am better after taking some tylenol.

Pillows are scarce here. I am very thankful for the small pillow that my kids bought me for my birthday that I brought with me. It was supposed to be what I used on the plane, but it is what I slept on last night! They provided a pillow that was in the birth rooms, but it is very, very stained and dirty. I set it aside, if I get desperate, I suppose I may use it, but for now am using the small pillow I brought with me, with a pillowcase over it. They ask you to bring your own sheets, and I did not realize when I packed the sheets that I had two fitted sheets. I am just using the other fitted sheet like a top sheet, and it worked fine. There are big fans everywhere here, so sleeping wasn't too uncomfortable. Sweaty, but tolerable.

This place is infested with ants. Teeny ones, they are everywhere. One of the local midwives brought some fruit from a tree that is in her yard. I can't remember what it was called, but it looked like those balls the kids play with that are rubbery with stretchy, tentacly things. Once you get the rind off, it was about the shape of a date, with a pit in the middle. Very sweet and juicy. When she brought them, she just set them on a postpartum bed (the beds also used for labor if they get full) and ants crawled all over it. She just brushed them off. I'm in a third world country, folks. But the ants crawling everywhere don't seem to bother anyone, so I'm getting used to it. Fortunately they are not in the bedrooms.

Power outlets here are just like American outlets, but they have no third ground prong. Fortunately there is a big power strip next to the birthing rooms that I can plug into. Laboring women are walking by me, I can hear laboring women, a newborn is crying that was born while typing that last sentence. :) There were three babies born last night, one just now, and there is another still in labor here. They stay about 6 hours postpartum before going home. They take a lot of women, accepting up to 250 per month. So the dry spell they had yesterday with no babies born all day was unusual. But I appreciated it, just sitting around, taking everything in, while feeling fuzzy-headed from lack of sleep. But they made up for the dry day last night. A baby that was born a few minutes ago just left with oxygen to the hospital. I did not hear why. The birth center has its own ambulance that the midwives drive.

Last night I went for a walk with Mary, one of the U.S. interns, and bought an internet card with 12 hours of use for 100 pesos (56 cents). The phone card was 22 minutes for 500 pesos (about $2.50). I was able to call my family a few minutes ago, the connection was much better than I expected, with no delay. It was good to hear the kids. The internet card signs me on at 118kbps. That's better than at home.

My first full shift is not until Sunday. I will spend the day with the birthing team, then Monday in the clinic, then Tuesday on the night shift, with Wednesday off. The day after a night shift, you do not work. :)

Anita <><


SATURDAY, JULY 16

Adada came to the birth center yesterday afternoon. She comes every two weeks and gives pedicures to all the midwives. I am not on the schedule yet, so had a pedicure today for 50 pesos. I got confused about the exchange rate, it is multiplied by 2, not divided, then move the decimal point. So a 50 peso pedicure is about a dollar. :) I have lovely pink toes now.

I fell asleep again last night to the chirping of a gecko in my room. Then awakened this morning by the bleating of the goats in the vacant lot that is outside my window. I feel so sorry for them--a bunch of goats. Four of them, to be precise. They are tied up all day and all night long. I assume someone at some point comes and milks them, but haven't seen who takes them away.

The woman whose twin died had the other baby yesterday. They had to transfer her to the hospital, so she had the babies there. Fortunately it was a vaginal birth. Apparently it was a cord accident, as they were identical in the same sac, sharing a placenta. The midwife here who had been caring for them, Linda, was very sad and felt badly that she had not caught the second baby. But at this point, I doubt there was anything that could have been done, even if she had known it was twins. The hospitals here are like big gymnasiums, with folding tables for exam rooms. No curtains, no doors, just a big empty warehouse. The staff are rude, mean even, and the infection and mortality rate is very high. Hence women come here to have their babies. At least the people are nicer, and it is free. Some things cost, like if you have an IV, have to be sutured, receive oxygen, etc. But if you added up every intervention they are able to do here, it would come to a whopping $12, and an extra 50 pesos if you aren't married (don't know why). But for these people, that is a lot.

I am very dizzy this morning. I have had this problem in the past, and attribute it to changing hormones (I am 39, and peri-menopausal). The jet lag probably doesn't help. I am getting a lot of headaches, and going through a lot of the tylenol I brought with me. Fortunately there is a shopping mall that is about a 10-minute walk from the birth center, and I can just get more if I needed it. I walked there last night with Carol. She has been here 12 days, and is here for another 2 weeks, and says she is already very ready to go home. Anyway, we walked together to the mall. You have to walk single file, because there are no sidewalks, and the "shoulder" of the road is very muddy. Traffic here is a trip. There are no stop signs, no street signs, no stop lights, no speed limit. It is a miracle they don't all run over each other. Motorcycles and bicycles weave in and out of traffic, there are no lanes either. Jeepneys abound. A jeepney is a small air taxi. Think a motorcycle with a sidecar, but the sidecar is on the back. It holds 2, maybe 3 people. If you get lost here, all you have to do is ask for a taxi (which are everywhere) and tell them to take you to the maternity clinic. Everyone knows where this place is. (An ant is crawling across my computer screen right now.) The place where we went to is called Victoria Department Store, but it is really more like a Walmart. I am happy to report I now have a pillow! Praise God for pillows! I was able to pick up some crackers, peanut butter, snacks, etc., as well, and a pair of sandals. You are not allowed to wear your street shoes inside the birth center, so when you walk in there is a basket of sandals and flip-flops. The midwives usually have their own, and let the patients (I can't get over not calling them clients) have the ones in the basket, and they were very uncomfortable, so I bought my own pair. Sort of like fake plastic Birkenstocks. :) I am definitely one spoiled little white girl.

I never expected this to really be like homebirth back in the U.S., and for the most part they are relatively non-interventive. There are no pain meds, no forceps, very rare episiotomy (most of these women are rail thin, and the babies average 6 pounds). For the Filipino midwives, this is nothing more than a job, a way to feed your family. For the missionary midwives, they are not here to treat women lovingly and bring babies into the world gently, they are solely here to keep the women and babies from dying. But with 250 births in the average month, they don't have much time to be warm and fuzzy.

My feet and lower legs are very swollen. I am guessing it is from all the sitting of the travel. I am not the only one who has had that problem, several others reported they had the same issue when they came over. Hopefully it will go away in about a week. I look positvely pre-eclamptic. It is better today than yesterday though.

My first full shift in the birth center is tomorrow. They had given me several days to get over the jet lag, and clear up the fuzzy headedness. The shifts are from 8 to 8, same with the night shift.

PRAYER REQUESTS
Praise for a pillow
For the dizziness to go away
For my first shift tomorrow
For the swelling in my ankles
For the headaches and jet lag

THANK YOU for your prayers! I know I am being covered in prayer, and am so thankful to God for you! It may be Monday before I can get back to the computer, I will probably be very tired when my shift is over and will want to go right to bed.

Anita <><


SUNDAY, JULY 17

I just finished my first full shift at the birth center. I tripled my birth experience in 12 hours. True to my form, all boys. (I have four of my own at home!) This was a very busy day, but it was awesome, and my brain is toast, but I need to get this down before it gets fuzzy. The midwives here were AWESOME with me, a first-timer. When someone would start pushing, I would hear my name called, "Anita!" to come watch. Or I would hear, "Get Anita, the head is showing" or "I need someone to chart, where is Anita?" I am so exhausted, both mentally and physically, but grinning from ear to ear. I assisted at all of these, charting, handing over instruments, getting heart tones, BP, etc. I did many, many postpartum checks (checking her temp, bp, fundal height, blood loss). I am in tears from the joy of being a part of this.

Baby #1: Utong!
This baby arrived before my shift was even supposed to start. I had woken up very early, so puttered around for awhile, then went ahead and got into my scrubs and went down to the birth center. Ten minutes later, a woman came walking in. She said one word, "Utong!" while holding her puerta (vagina). I had no idea what utong meant, but suddenly midwives were scrambling, grabbing gloves, a birth kit, and flung closed the curtain. Linda was grabbing gloves, and I asked if I could come in and watch. She said, "Sure." I was not three steps behind her, and when I walked in, Linda already had her hand on the head. Turns out "utong" means pushing. Apparently, she'd been holding her legs closed while she was in the taxi because she needed to push, and didn't want to give birth in the cab. I watched her as she waited for her bana (husband) to pick her up later in the afternoon. She stared off into space while her baby sat on the bed. She didn't seem much interested. When I would do a postpartum check and ask her if she had tutoy (two toys, get it?), she would nod and pick up the baby and nurse him. I am looking forward to seeing her postpartum tomorrow to see if that baby is being fed. Some of these moms just aren't interested, and some just don't understand the concept of feeding every 2-3 hours. Carol told me of a mom she had asked if she fed her baby today, and she said yes. Once. I charted this birth (short chart!).

Baby #2: Shoulder Dystocia
Very soon after utong mom was stable, Mary, one of my roommates, was handling another mom. Mary was finishing up her night shift, but had been with this mom all night, so wanted to finish it and do the catch, since she was close. When this baby's head was out and body did not quickly follow, aggressive head flexion began. Then digging in for the posterior shoulder, then Mary got up and Andrea (a Filipino midwife permanently on staff) jumped in with her hands inside her puerta almost up to the wrists. Andrea then instructed Mary to do suprapubic pressure, shouting-- "1-2-3" and SHOVE. They probably did that four times. I was charting, and when all was said and done, the time from head to delivery was two minutes. Seven pounds, 11 ounces. Mary says that is a big baby. Most are 5 or 6 pounds, the biggest she's seen was 8#2oz. Most of these moms never even reach 40cm fundal height at term. I charted this birth and did heart tones, plus several ppm checks.

Baby #3: Paraurethral tear
All these moms tear. Their nutrition is just so poor. They have no money for fresh fruit and vegetables, high protein intake and milk and eggs every day. This poor mom had a perineal tear, a labial tear, and a bleeder into the clitoris. Gina was the primary, and this was her first catch. After the birth, mom began to bleed and bleed and bleed. Never seen so much blood. Andrea jumped in and grabbed a hemostat from a sterile pack and went clamping anything in sight, with no lidocaine. Laura, another senior midwife, came with a syringe of lidocaine as mom writhed, and Andrea then began to inject her with it and then kept clamping. She had vicryl, and I kid you not, she began biting flesh and stitching. I commented, "I don't know how you can see what you're doing." There was just so much blood flowing from her. Andrea answered, "By faith." She took about 3 stitches into this mom's clitoris until she found the bleeder. I charted this birth, held the flashlight for the suturing, handed instruments as Andrea called for them.


Gina

Baby #4: Help me!
Filipino mothers are *very* quiet laborers. You don't have to do a VE (here they say IE, internal exam) to know when they are 10. They are silent up until transition, and then when they have to push, you KNOW it. But this mom writhed, groaned, moaned, cried out for help, for hours. I was next door with another mom who had shown up at 8-9cm, but then got stuck with a swollen anterior lip for about 3 hours, then pushed for 3 hours. I was midwifing the midwife for that mom, and this woman who had been moaning and groaning all day suddenly cried out, "Help me Lord!" I peeked through the curtains, and her eyes locked onto mine. I came up next to her, her bantay (her companion, usually her mother, sometimes her bana [husband]) was on one side and the midwife was on the other. She looked right at me and said, "Help me!" I held out my hand and asked her if I could pray for her. She said, "Oh yes!" I prayed out loud for strength from Jesus Christ, our Rock and our Shelter, and when I was done, she kept saying over and over, "Thank you for praying!" She was still saying it hours later. :) I will not forget her. I charted, took FHT, and did the newborn exam with vit K inject for this birth.

Baby #5: Proud Grandma
This mom had come in right at the beginning of my shift, but I was busy with other births, and ultimately Andrea had sent her home. She was 3cm with mild cx. She came back in around noon, saying cx were stronger and closer, and she was now 5-6cm. This was a nice, ordinary birth, after the shoulder dystocia and paraurethral bleeder. She had come with her bana and her mother, and I definitely noticed how these people don't ooh and ahh over their babies the way Americans do. So when the grandmother was helping me do the bath, holding the blankets for me, I was commenting on how gwapo (handsome) her grandson was, she smiled broadly and launched into Visayan I could not understand. I just smile. But it was obvious she was a very proud grandma. I charted this birth, did a pit inject, did the newborn exam, vit K inject, (as an ant crawled across the bed), and the newborn bath. These Filipino babies are C-U-T-E!!

Baby #6: No reflexes
This mom came in around noon and was a "continuity" of Linda's. Linda has been here for 10 weeks, with another 2 weeks to go, and has been trying to get all her NARM numbers. To accomplish that, you have to have done at least 3 births where you did at least 4 prenatals, birth, newborn exam, and at least one postpartum. To help you obtain these, they label the chart with your name and "continuity of care" on it, so that even if you are not on the shift, you will be called to do the catch. Linda had just gotten off the night shift, but they called her back on due to this being one of her continuities. Mom came in at 8-9cm around noon, and we thought this one was going to be quick and easy. Mom ended up with an anterior lip that she, Laura, and Andrea worked on for several hours. Mom finally got where she was 10cm, and was pushing, and she pushed for over three hours. FHT were good throughout labor, but at the very end, near crowning, FHT went to 170. At least that is what Andrea said and what I charted, but when I was counting as she did the doppler, I got 200. FHT were again tachy for the next several cx. They did PPV (positive pressure ventilation, aka bagged him) and lots of external stim, but although he was pink, his Apgar was 5 and 5. Baby has never cried, not even for the vit K inject or the bath. Baby has no red reflex, no doll's eye reflex, is apparently blind, very weak to non-existent Moro (I would have said non-existent, but Andrea said it was there), very slow Babinski and Plantar, weak to no suck. As I was going off shift, they were preparing to transport. I believe this baby most definitely has central nervous system damage and may be permanently disabled. That is very bad for these people. I charted and handed instruments for this birth, and gave backrubs to the midwife.

Saturday, July 16, 8pm:
I feel very safe at the birth center. I have not gone anywhere by myself. Some of the other students have said it took them a week to feel confident to go walking to Victoria (like a Walmart, about a 10-minute walk) or to the mall alone, but I don't know that I will ever feel comfortable. Not that I feel my safety is in danger, but I could easily get way lost here. And it is creepy, I think mainly because everyone honks at you, and all the taxis slow down and try to offer you a ride. The little kids always say "Hey Joe!" or "What's your name?" Not because they really want to know, but they see a white person and it is the only English they know. :) I walked yesterday with Linda, the student midwife who had the mom with twins, and we walked quite a distance to a mall that was a bit further away, and much larger (five floors!). I went just for the exercise, to see if it would help the swelling in my feet (which is better today, PTL). You do have to keep a watch on your bag. I have not had any problem, but I keep my hand on it all the time. Don't wave around that you have money, don't leave your wallet lying around, etc., because shoplifting and petty thievery is common. Trying to purchase something at Victoria is a lengthy, multi-tasking event. One person rings you up, move down the assembly line, another checks your receipt, matches it with the items you have purchased and marks the receipt, another person then checks the receipt and items again and bags it. It is bagged and then sealed with a seal-a-meal kind of thing, then your receipt is stapled to the outside. As you leave the store, there are guards at every store, and they then check your receipt again, make sure your bag is still sealed, then you can leave. Whew! But overall, I do not feel the kind of fear from terrorism, just the general crowdedness and culture shock. The main concerns with terrorism are in much more remote areas of Mindinao and in Manila.

I just did an approval for someone new on this list, and she stated she was heading to Africa as a missionary midwife. There is a midwife here named Toinette (like Antoinette, without the "an"), and she is from Namibia in South Africa. She is a hoot! She has a great sense of humor. She and her husband Mordegai are permanent missionaries here, and Mordegai is the primary doctor who does the mountain healthcare outreaches. Toins ("twans"--her nickname here) is pregnant and due in September, planning a homebirth here in Davao with the center midwives.

Before my first shift, I spent the evening going over the NARM application booklet. I want to be able to record all the births I do here to hopefully become a CPM. The requirements are *SO* strict, and the instructions so convoluted, my head was spinning. I had looked it over before, but last night I think I am just overwhelmed and tired, because it seems like I may not get to count every birth I do here for one reason or another. As the tears fell from feeling so overwhelmed and nervous about my first shift, I picked up God's perfect Word, and began to read in Isaiah. I prayed, and God spoke to me that being here isn't about numbers of births, or about the North American Registry of Midwives, or about becoming a Certified Professional Midwife. It is about me being used as His instrument, it is about showing the love of Christ to these destitute families. It is about gaining the experience to take what I create here back home with me, to share with the women in the Kansas City area. It is about pleasing the Lord and serving and worshipping Him alone. Not serving or worshipping NARM. If I never become a CPM, I know that what I do here and the memories I make here will be what God desires of me, if I do it for Him and His glory.

PRAYER REQUESTS
Praise to the Lord Almighty for an incredible first shift
Prayer for the baby with no reflexes
Prayer for Linda, as she is very distraught
Praise for all the midwives here being so wonderful

Anita <><


MONDAY, JULY 18

Today was my clinic shift. They will take 40 new moms today, apparently "new patient day" is Mondays. I did prenatal exams for four hours. Not the homebirthy one-hour type prenatals. I was working with Julie, a CPM from the U.S. who has been here several years. I can be a good student, I take direction well, just tell me what to do and I'll do it. But Julie speaks fluent Visayan (aka Cebuano), so she did 2 prenatals, all in Visayan, then asked me if I wanted to do the next one. Well, I can take FHT, I can do vitals, etc., but their procedure, and what questions they want asked, where to put what information on their form in what spot, I was clueless and became overwhelmed. I feel like I stumbled along, at one point near tears. This is TOUGH. I am tripping over myself, feeling timid and totally without self-confidence, I am tired all the time, overwhelmed with the newness, the culture shock, the jet lag, no family, and...well, let's just say while yesterday flew by, by 10am I was checking the clock, begging for a margarita and a nap. I can tell clinic is going to be the worst. I feel like this was my third day postpartum with the hormone crash. Ahhh...and my period is due Thursday. Maybe that is why I'm teary and overwhelmed.


Intake day; 40 new moms lined up for their initial visit; guard is on the left.

Food here isn't too bad. You can drink the water, and they have a jug dispenser that gives you chilled or heated water. It is easy for me to make coffee with my French press that my husband bought me for my birthday right before I left. You would think you wouldn't want coffee with no aircon (what they call air conditioning) in a country on the equator, but I suppose it is just habit for me. Ging-Ging is the Filipino cook, and she is pretty good. We had adobo the other day, sort of like soy and ginger-marinated chicken and pork. I really try to limit my intake of pork, but you'll be surprised what you're willing to eat when you're really hungry. Either I was *very* hungry, or it was absolutely delicious. Rice goes with everything, including spaghetti and tacos.


Nora, the lavadera who does the residents’ laundry.

After clinic was over (thank you God, for getting me through without a complete breakdown), I wanted to go back to Victoria to get a notebook and a couple of pens for recording all the prenatals and births I attend. I am recording them here in this blog, but I don't get to my computer during shift, and it is good to be able to record what I'm doing right when I'm doing it. The six births I attended yesterday blurred together, so I got a notebook to take into the birth center with me. I say "take into the birth center", I am living in the birth center, but upstairs in the student apartments. The actual birth *center* is on the first floor. Anyway, I also got an adapter for my laptop. The AC plug for it works with either 110 or 220, but it has a grounding plug, and all the outlets here are not grounded, so there's only 2 prong holes. So while we were at the mall, I went to a hardware store (like having a Home Depot in the Mall of America!) and got a 3-prong to 2-prong adapter. I'm happy that I can now plug in my laptop in my room, instead of always having to go down to the prenatal room on the second floor where the computer is to plug in. I still have to go online in the prenatal room, but at least I can be sitting here on my bed typing this email with a fan blowing on me in just my bra, before going down to the prenatal room to send it. :) Did I mention I was a spoiled white girl?

While I was out with Linda and Carol at the mall, we took a cab to a restaurant called Swiss Deli. It was strange, walking off the street in the middle of a poverty-stricken, urban, "downtown" kind of area, into an aircon, wine-list and cloth napkin (oops, don't call them napkins, that's a maxi pad here), I mean cloth tissue restaurant. ("Excuse me, may I have an extra Kotex?") I had seafood linquine and clam sauce with shrimp, calamari, and scallops, with kalimansi juice to drink for 230 pesos (double it, move the decimal point, about $5). Kalimansi is like a very small lime, about the size of a quarter. They add sugar, and it is something like lemonade. It was very tart and very sweet. Sitting there for lunch with these other two missionary-minded midwives, after such a taxing morning at clinic, was SO refreshing. We laughed, talked about decapitating a baby's head in a dystocia, clamping a paraurethral bleeder, and how delicious the tiramiso was.

No one is going to walk you through this adventure. At times I feel like a 2yo who can't find her way to the potty. To take a cab home from the mall today (they stayed, I came back to the center [gasp! I was alone!]), I had to have one of the other students literally draw me a map, just in case the taxi driver didn't know the way, then she walked me through the mall to the taxi stand. I told her I felt so stupid, here I was wanting to take the responsibility for the life and death of a mother and child, and I can't find a cab on my own. It isn't the "safety" issue here that is unsettling, it is the feeling of being so absolutely lost. I feel like I'm on another planet altogether.

I am slowly figuring out how to record the things I do here in my NARM book. The mistake I made was not taking notes on what I was doing from the get-go. Do not walk in here without a notebook and at least a couple of good ball-point pens, if you are working on your numbers for NARM. I had to go back and dig up the files from the six births I did yesterday, chart exactly what skills I performed, vitals on the birth, and now track down each preceptor I did each one with, and get them to sign off on it. To dig up all the files on the women I did initial history and prentals with, I had to find the log book for ALL the women who came in here today (65 women), then go through each name in the filing cabinet to find their file (I had no memory of what their names were), see if the primary was Julie and myself and then chart the skills I performed and the vitals. The filing cabinet is in the stairwell where there is no air circulation, no fans going, and I am digging through roughly 1500 charts with sweat literally dripping off of my face. All because I did not have a notebook or a pen when I started work.

I have tomorrow off, because I will be on the night shift, so don't go in until 7:45pm. Linda and Carol asked me if I wanted to go to the movies tonight, but I don't want to be out that late at night. They didn't want to go until the 9:30pm show. Fantastic 4 is at the mall, and some Jackie Chan movie billed as "the most expensive action movie this year." LOL! Maybe in a couple of weeks I'll be ready to zone out in front of a movie for a couple of hours, but not at night. I have been told not to miss going to the movies here. I'm told it is an interactive experience. :) Filipinos hoot, clap and send text messages on their cell phones all through the movie. They whistle and cat call during love scenes, stand up and shout in the action scenes. Sounds like Rocky Horror Picture Show in the U.S. Cell phones are everywhere, but no one calls anyone. It is all in text messaging.

Love to all of you, I pray for you! Thank you for praying for me!

PRAYER REQUESTS
Praise for all the wonderful people praying for me!
Praise for getting through clinic this morning
Praise for a nice lunch out with the fellowship of Christian midwife sisters
Request for tomorrow's night shift to go well

Anita <><


TUESDAY, JULY 19

Thank you all SO MUCH for your encouragement. Your posts are so special to me, I read every one of them. I am sorry I do not have more opportunity to answer every one of them individually. They make me cry, but I love them! :) You just have no idea how much it helps me to know I am being prayed for. I cannot imagine being here without the covering of God's people in prayer.

I am having a hard morning. I am hoping it is just PMS hitting me hard, but I have been crying, it seems, since I woke up this morning. I tried three times to get ahold of my family, but I couldn't get them, and that just made it worse. I did eventually get to speak with them, PTL. Then I went online, and got your replies, encouraging me, and I cried harder, but I was so thankful. THANK YOU THANK YOU. Filipinos seem to just repeat a word for emphasis. I'll repeat it again, THANK YOU THANK YOU for your prayers and encouragement. It means A LOT A LOT to me. And I am so happy to hear you all are enjoying reading my emails. Part of me wonders why, I'm just sitting here sharing my boring days and adventures. I wish I had more birth stories to share. I am on night shift tonight, so maybe tomorrow I will have more. :)

I need to run to Victoria again today. I forgot my tweezers, and my eyebrows are looking pretty ragged. I wake up every morning with a headache, and am out of the tylenol I brought as well. Fortunately today it went away without taking anything, except two doses of Rescue Remedy! I should have brought a new bottle of it, if this continues I'm soon going to easily run out, and I'm not sure they carry Rescue Remedy at Victoria! But it seems like I have to go to Victoria every day for *something.* It is a pain, it is like having to go to Walmart everyday, because you realize there's something you just *have* to have. And so far I have a lot of down time. I figure after this night shift, I'll need some sleep tomorrow, and maybe I'll get used to it. There's a lot of midwifery books around here, I know I should be studying for my AAMI (Ancient Art Midwifery Institute) stuff, but so far have not found the motivation.

Someone emailed me asking about my training and previous experience. For those of you who do not know me personally, I started down this path to midwifery in late 1996, when I found out midwives still existed and people still did *that* at home. I had a cesarean in '93 (standard American birth, CPD and FTP) and a VBAC in the hospital in '95, that was only marginally better than my cesarean, with AROM induction, pit, epidural, episiotomy, huge tear, enema, you name it. So when I heard the words home and birth in the same sentence, we ran toward homebirth and never looked back. I had a precipitous homebirth in '98 with the midwife attending via cell phone, and planned another homebirth in '00 for my last child, but transported and had a c/s after a 17-hour second stage. We aren't planning any more children, although I think I could have had 12 of them. :)

In 2000, I enrolled in Ancient Art Midwifery Institute. Apprenticeship in the Kansas City area has been difficult difficult to obtain. :) So I continued to pray, and researched trips like this. I prayed for the Lord to work it out, and when He thought I was ready He would make a way. In the meantime, I have been studying through AAMI, and am now about 75-80% complete and should graduate next year. I hope to take the NARM exam fall of '06, but it all depends on numbers. There's that evil word again, "numbers." I know the Lord doesn't care about numbers, He cares about my heart, and that is what I am relying on right now--His shaping of my heart. A pot cannot be shaped without a lot of pressure. Silver cannot be refined without going through fire--several times over. Boy, it's hot here. :)

I have been blessed to attend two births in the KC area as a primary midwife, and a third I was supposed to be there, but she delivered while I was en route. They knew I had no experience, only academic training and neonatal resuscitation certification. So when I came, my experience was very limited. But I am not the only one who shows up without much experience. That is relatively typical here for the interns. A new intern just showed up yesterday, who will be here for three months, so at least I am not the newbie anymore. :) She has never attended a birth, just desires to become a midwife. She has less academic training than I do.

It is nearing lunch time, and at some point this afternoon I need to take a shower and a nap to prepare for my night shift. I love you and appreciate you all!

PRAYER REQUESTS
Praise that I was able to reach my family
Praise that I am sleeping well
Request for the headaches to go away soon
Praise that the swelling in my feet is slowly getting better
Request that I won't have any more breakdowns like today
Request for a busy night shift

Anita <><


WEDNESDAY, JULY 20

Well, I just came off the night shift. I slept all night. :/ Not a single mom was in the birth center. But, there was a baby! A mom was being transported just as I was coming on last night, and the baby could not go because it was a possible infection. Mom had a rapid heart rate, fever, and abdominal pain, and had had a cough when she went into labor. She had been there almost 24 hours, and they usually leave after just 6 hours postpartum, but she was not doing well. So they transported her. So I got to babysit a newborn all night. Boy, it is has been awhile since I had a newborn! And bottlefeeding him--I felt so awkward. I breastfed all four of my boys, and I don't think I gave a bottle to them except my first, 12 years ago! But it was sweet, sleeping with him and cuddling all night. I just slept on a birth bed, right near the door, so I would hear anyone coming in. I was disappointed we didn't have anyone come in because Andrea and Inneke ("in-uh-kuh", a Canadian resident here, she only works part time) had decided I would get "first on" and get my first catch. :/ God is in control! Maybe next time!

I liked "working" with Inneke. Well, sleeping, and cheeky-cheeky (chatting). She was a full-time midwife here, but her love was with the babies. She started an orphanage and home for street children, but still occasionally pulls a shift here at the center. She invited me to have a shift at her orphanage. They do shifts from 6am-6pm, so maybe on a day when I am on night shift, I can do that and then go to work at the center. She said I would be feeding the newborns, playing with the toddlers, rocking children to sleep. Sounds right up my alley. :) The youngest they have there is one month old, the oldest is 14. They try to phase them out by the time they are 13 or 14, because they become sexually active and then the younger children aren't safe with them around.

We have had two fans in our room die in the last two days. Now there is only one that hangs on the wall, and I am on the bottom bunk, so it never really reaches my bed. God has turned up the heat on that refining fire. :)

I am feeling better this morning, despite my disappointment in the shift last night, and the burned-out fans in my room. My period started overnight, so that should get me feeling better soon. It is very light though. One of the other girls who has been here almost 3 months says she has menstruated only once the entire time she has been here. Her body has not ovulated from the stress. I am hoping I can be so lucky and not go through this again while I'm here. :)

I have the day off, and since I was able to get a few hours sleep last night, won't be sleeping all day, so I am going to try to get some studying done. I need to keep myself from getting bored, that is when I get too lonely.

PRAYER REQUESTS
To find a replacement fan
For the children in the orphanage
That I would be able to have a shift at the orphanage
Praise that the PMS will be over soon
Praise for the special night with the newborn
Praise that I am feeling better today (thank you for your prayers!)
Request that I not have anymore breakdowns like I had yesterday

Anita <><


THURSDAY, JULY 21

(None; I know I sent a blog every day, so this one may have disappeared into cyberspace.)


FRIDAY, JULY 22

It is 10:52pm here, and I just got off the day shift. I was supposed to get off at 8, but had been with a mom in labor who had come in at midnight last night, and labored all day. About 5pm, she was 8cm, but baby was asynclitic. We did some things with hands & knees, mom wiggling her hips, hip squeeze, pancake maneuver. Eventually she had a bulging bag of water, and an urge to push. When her water broke around 8pm, it was green and particulate. They prepared the suction machine, baby was finally born at 10:06. They suctioned him on the perineum (yes, another boy!) and he is fine. Her bana (husband) was amazing. At one point, she was pushing on a birth stool on the floor, and she stood up with her bana behind her, and he grabbed her under the arms and she went into a supported squat, but then she lifted her feet off the floor and pulled her legs up, and her bana was literally holding her full weight as she pushed in a full squat, but at eye level. It was absolutely an awesome, powerful birth, and I am so glad I went ahead and stayed on shift to see it. I did not catch. It was the only birth today. At one point, my cell phone rang in my pocket. I knew it was my husband, and was so embarrassed that it was ringing. I just picked it up, said "I'll call you back, I'm at a birth" and hung up on him! LOL! (I called him back, he said he understood.) Another great thing at this birth was that at 5pm, they were preparing to give her an IV and transport her, because she had been laboring so long. They did one last IE (internal exam, what I would call a VE) and she had gone from about 5cm at noon to now 8cm. So they put a halt on the IV and decided to go ahead and let her continue. I am so glad they did, it was just an incredible birth. You would never know it when these women are at 8cm. They are just so quiet! Amor (the mom) was so beautiful, so powerful, with sweat pouring off her, she was just so exhausted, but she was beautiful. I stayed afterwards for about 30 minutes, and then let the primary midwife do the newborn exam, etc., so I'll have to let you all know the particulars, weight, etc., tomorrow. I am exhausted. I charted in the beginning, doing vitals, checking heart tones, but at 8pm the new shift came on, and Narita, the new intern, began charting, and I stayed and mostly provided doula support from them on. She squeezed my thumb until it was purple. :)

Well yesterday afternoon, after taking a nap, I didn't study. I ended up doing karaoke with Sonya and Jonna, two Filipino midwives! We were singing Air Supply songs at the top of our lungs. ROFL! Karaoke is like sitting around playing Nintendo back in the U.S. It is the national pasttime here. It was hilarious, singing Lionel Ritchie songs and doing Barbra Streisand duets with Sonya. Yes, *with* a microphone turned WAY up, and all the windows open. What a hoot.


Sonya


L-R: Jonna, Aliza, Mira

I said the food had been pretty good. I should have said the food was pretty good *so far.* :) The last couple of nights dinner has been nearly inedible for this American woman. I just ate a lot of rice. :) Praise God for Jif and Hershey's. Last night's dinner was like homemade Reese's. :)

I am going to try to see if I can go over to Inneke's orphanage tomorrow for a few hours.

PRAYER REQUESTS
Praise for Amor and the birth today
Request for a good night shift tomorrow night
Praise that I got to talk to my husband again tonight

Anita <><


SATURDAY, JULY 23

I believe the Filipinas are conditioned to remain quiet. In the birth I attended last night, mom even covered her mouth to remain quiet. I tried to assure her that she could just let it go, that she was safe here, that she could make all the noise she wanted. Body language is also a big part of the culture here. Things are communicated in other ways than words. For example, the standard greeting here is not Hi or Hello, but a smile and lifting your eyebrows. To get someone's attention, you do not cry out their name, you whisper "psssst." It is just part of the culture, so even from across a crowded room, people may turn to look if someone says "pssst," no matter how quietly. When you ask directions from someone, they do not point--that is rude. They won't even say, "take the second left." They look in the direction and then purse their lips and "point" with their lips. It has taken me some getting used to. The first time I asked someone at Victoria where to find something, she sort of nodded her head in that direction and moved her mouth to the right, but never said a word. I wondered what I had done that she hadn't answered my question. :)

I just got back from the House of Living Stones orphanage. Boy, that will change your life. I was only there for 2 hours, and it was heartbreaking to leave. I split my time between the infants and the toddlers. One preschooler almost immediately came over and climbed on my lap when I first sat down. I fed one 7mo baby, and cuddled and talked with, and changed two infants, one about 6 weeks, the other maybe 2-3 weeks old. But my favorite was Alfie. One of the caretakers told me that Alfie was mentally retarded. He spent a good deal of his time while down on the floor, banging his head against the couch, or the floor. But he would walk over to me and hold out his hands, and when I picked him up, he would cling and wouldn't let go! He had the cutest smile, played "I've got your nose!" with me, and kept saying "baby" over and over again. I'm guessing that's the only word he knew. Alfie was maybe 2 years old. He would just cling to me and lay his head on my shoulder. The house where they live is not horrible. Of course by American standards, it might be considered nearly unlivable, but I have seen the squatter's part of town, where houses are made of discarded pieces of cardboard, tin, wood, that are maybe 12'x12' square, with 8 people living inside. So by that standard, this was a very nice, big house. There are maybe 20 orphans living there now, from the newborns to the oldest, a boy of 11 or 12. They are desperate for attention, the older boys pick on the toddlers, and the girls were quite aloof. They didn't even come near me or speak to me, and if I engaged them in conversation or a lift of the eyebrows, they would look away and leave. But one little girl, maybe 4, was a sweetheart, and loved standing in front of the mirror, brushing her hair, smiling at me in the mirror. I imagine she was pretending to be a princess in a far-off land of make-believe, where she was loved and beautiful and adored. It was difficult to leave, and I could only stay a couple of hours because I am on the night shift tonight, and after cuddling and singing with the newborns, when I set them down and prepared to leave, they began to cry and cry. I left holding back the tears. I wanted to take all of them home, give them warm beds, a good meal, and rock and sing and read God's Word to them.


Newborn room at the orphanage; another set of cribs is on the right (not pictured).


Alfie, and some other children from the orphanage:


I am headed to take a nap before going on shift tonight.

PRAYER REQUESTS
For the mercy of God to all the orphans of the world
For a busy shift tonight
Praise that my headaches and swollen feet are completely gone

Anita <><

[Added later: Got invited to dinner at the director’s house, hosted by the Americano midwives: Elaine, Stacy, and Julie.]


L-R: Elaine, Narita, Linda, Stacy, Mary, Carol, Julie.


SUNDAY, JULY 24

I am so disappointed! Another whole shift without a single mom in labor even! Please pray for the next couple of days to be busy. I am bored. They said it is highly unusual for it to be this slow. I pray it picks up, I really want to get to catch. This was the second night shift where they said I could be "first on" and get to catch, and no one came in. One woman came in about 5:20am, she said her water was leaking and she was having cx every 5 minutes. I did a sterile IE and found her a fingertip dilated, maybe 50% effaced, so they sent her home. She was back again in labor when we left the center around 1pm to do some shopping.

After I got done with my night shift, I came up to my bed and took a nice long nap. Sleeping downstairs on the birth beds is very uncomfortable, and I awoke at the slightest sound, so kept waking up about every 20 minutes. Then Carol came in and said that she and Mary were going to the El Davinco, a touristy open market not far from here. So the three of us took a cab and I got lots of souvenirs for friends and family. I spent nearly $100, but when you count that I bought at least one thing for 11 people, you realize just how cheap things are here. And every store we walked by, the clerk would beg us to come in and shop in her place. "Come inside! Come inside! Is cool inside!" We took a taxi out there, but took a jeepney back. A jeepney is cheaper than a taxi, 6 pesos each, where a cab was 40 pesos for all three of us. A jeepney is like a small bus, that holds maybe 8-10 people. The jeepney dropped us off at Victoria, which was a short walk back to the center, but I finally caved in to a big mac and a coke at the Victoria mall. It was delicious.


Jeepney

Sorry I don't have anything more to share. I work days tomorrow and Tuesday, please pray that I will actually get to do what I came here for!

Anita <><


MONDAY, JULY 25

I CAUGHT!
I CAUGHT I CAUGHT I CAUGHT! I am beaming. Thank you for your prayers for a good shift, God is so Good!

Birth #1: Funkytown
Birth #1 was one of Laura's continuity's, and I just observed, because I had been labor sitting all day, and she was nearing transition and getting vocal when Laura's mom showed up fully dilated and already pushing when she came in, so with one ear to the mom I was labor sitting, I observed Laura's birth. This was a mom who had had a homebirth 3 years ago, a stillbirth after she had fallen in the C.R. ("comfort room", what they call the bathroom) and hemorrhaged. They took her to the hospital that time and she ended up getting 6 units (!!) of blood. They said she almost died. So this time they were watching her very closely for any hemorrhaging. But mom did great, with very little blood loss. A baby boy (of course!) was born at 3:36pm, while "Funkytown" was blaring on someone's stereo outside. ("Won't you take me to--Funkytown!") It was a very nice birth.

Birth #2: My first catch here!
Mary Jean, G5P3, came in at 8:55am, having already labored at home since noon yesterday. I did an IE and found her 5cm with waters intact, about 80% effaced. She was already asking if she could push, but even with her birth experience, we still had to explain to her that she needed to wait for her body to tell her when it was time. She labored quietly with her 14yo daughter as her doula. :) About noon she asked again for an IE, and I found her to be 7cm and 100% effaced, with a bit of a swollen anterior lip. We got her into hands & knees to put some pressure on the anterior cervix to see if that would help it dilate. She was still asking if she could push. Around 3:30pm, she started showing signs of pushing at the peaks, so I did another IE and found her 9+cm, with that anterior lip. I held it back for a couple of cx, and then it just disappeared beneath my fingers, slipping behind the head as she pushed. With waters intact, the head was born over an intact perineum. She had obviously had several previously unsutured tears, because she had a very short (maybe 1/2") perineum. I was so afraid she was going to tear into the rectum, but she did fine. Water broke just as the body was delivering, water filled with green mec, baby with more terminal mec at delivery. Six pounds, four ounces, born at 4:21pm. Great, thick cord, with a placenta with TWO quarter-sized succenturiate lobes about 2" off the edge of the placenta, both with vessels across the membranes. I have a photo, hopefully you will be able to see it. I just won't be able to upload photos until I get home. I took a photo of the family, with papa and doula-daughter and big brother. :) Her other son was not there. I was so excited to actually get to handle a birth from intake to birth. I did her postpartum until my shift was over at 8pm, they had to stay the full 6 hours, so someone else actually discharged her. I will do her postpartum visits starting tomorrow morning. They will come in at day 1, day 3, day 7, day 21, and six weeks. I won't be around for her six week visit, I'll already be home, but hopefully I'll get to do her postpartum visits. She has a history of skipping prenatals, her last prenatal was June 23, and she had not been back since. I totalled their bill before endorsements (shift change, when you share about the births/labors still at the center), and it was 143 pesos. Their birth cost about $3.00. :) It truly made me feel like I was part of something special.


Mary Jean


Mary Jean’s inunlan (placenta) with 2 succenturiate lobes.

Afterwards, I would have just taken a shower and gone to bed, but I was high on birth (I just LOVE this job), so accepted an invitation to walk to Blugre' (like a Filipino Starbucks) for an iced decaf mochaccino. :) I went with Linda, Mary, and Carol. As we were walking back, I decided to get a souvenir for myself of a Blugre' travel coffee mug, so Mary and Carol went on ahead (Linda stayed behind to read) and told me to just catch up. I wasn't in there very long paying for my mug, but when I came out, I didn't see them. I'm a pretty fast walker, so I tried to walk fast to catch up to them, because I wasn't really certain of which streets we had walked to get there. They were nowhere in sight. I was a little spooked, because I was alone, it was 9:30 at night, and I wasn't sure how to get back. I prayed for the protection of Jesus Christ, and His help to find my way. God is faithful, because I'm sitting here on my bed writing this to you. Praise God. That'll teach me to go out at night. That is the last time I'll be going for coffee with the girls after a shift. Turns out they decided to walk back to the center a different way than the way we came, that is why I couldn't find them. I'm a tad miffed, not only at them for the foolishness of leaving me hanging, but also at myself for being so stupid as to go out at night, and alone. Up to this point, I had always said no when they asked me if I wanted to go for coffee, or to a movie or something at night, because I just was not comfortable. They can tell me all they want what a safe city this is, but when there are signs about petty thievery and the rampant shoplifting, I know I'm not exactly dealing with a culture of high moral value. I'm not going out at night again. Thank You Jesus, I got the message. Loud and clear.

PRAYER REQUESTS
Praise for my first catch here
Praise for a healthy baby and healthy birth
Praise for a great shift (thank you for your prayers!)
Please pray for another good shift tomorrow (I am on all day)
Praise for getting me home safely tonight
Please pray that I will be gracious towards my roommates, and they to me

Anita <><


TUESDAY, JULY 26

Baby #1: It's a girl!
I actually attended the birth of a girl this time! And I got to catch again! God is so good. The whole day the center had been empty. Then Dailenda came in at 3:35pm, with her waters ruptured and her labia already opening during contractions. Her BP upon admittance was 180/100, and a couple of minutes later they took it again and it was 200/120. They prepared an IV, but she began pushing almost immediately and a baby girl was born at 3:42pm, before they could get an IV in. Makes birth look easy! It was awesome. I was almost shocked to find a girl beneath those blankets. They gave her Calciblock (what is that?) under her tongue, and her BP was within normal limits in about 15 minutes postpartum. And if the woman yesterday had a short perineum, this woman had NO perineum. Even with the hypertension, she hardly bled *at all*. She was a 41yo G5, and had obviously had several babies with unstitched tears. I swear, her vagina ended and her rectum began. Baby's apgars were 8/9 and she weighed 6#14oz. She has a very strange cry--a very high-pitched squeal. The last couple of days here have gone slowly, but it was nice to be able to have two catches with an otherwise empty birth center, because I knew I had lots of assistants and people to translate and answer questions for me. While most of these people speak at least a little English, some of the poorer moms who come in don't have high school, so have no English. I have been feeling disappointed that the center isn't busier, but I kept telling myself that God is in control. I will be at the births He wants me to be at. Thank you all so much for your prayers, keep them coming. I know the Lord is with me here, and I am so thankful that I am adjusting and getting more settled, and I know it is because God is faithful and just, and is providing me every day with just what I need.


Dailenda

The vast majority of the Philippines is Roman Catholic. This was a special treat for me, when I was filling out the birth certificate for Dailenda, she listed her religion as born-again Christian. I said, "Hallelujah! I am born-again also!"

PRAYER REQUESTS
Praise for a beautiful birth today
Praise that this momma was saved by the blood of Jesus
Prayer for my family while I am away
Prayer for continued good attitude and trust in Christ

Anita <><


WEDNESDAY, JULY 27

I am on tonight, so I have the day to myself. I want to go to Guisano Mall, like Victoria Plaza, but a lot bigger. Before I left, I made copies of my entire NARM book, and took the book with me, but decided to leave the copies at home. I am regretting that, because there are copies in there that I could really use. So my super dh is scanning and emailing them to me, and I need to go to the internet cafe at Guisano to print it off. They have a printer here for the Center's computer, but it is exclusively used to print birth certificates, and I can't use it. I understand that, if they let all the students and midwives use it, they wouldn't have paper or ink to print birth certificates! So I need to do that, and I have a list of things that I'd like to get at Victoria as well (Guisano has 2 Victorias--it's huge). I'll be going by myself and taking a taxi (it is much further than just the Victoria that is close to the Center). Please pray for safe travel, that I am able to find what I need, and get home safely in time to take a nap before my night shift.

The bathrooms here have a shower (at least most of them, some just have a faucet with a bucket and a pail for bathing); but for some reason the shower floor is perfectly level (okay, not perfectly) with the rest of the bathroom floor, so when you take a shower, water runs all over the bathroom floor. Because our bathroom floor is *not* perfectly level, the water then runs behind the toilet and puddles all along one wall, where we hang up our dop kits, hang bras from the hooks, towels, clothes, etc. So I keep dropping towels, clothes, etc., into this puddle of water. And of course because we are dirty when we shower, the puddle is a *dirty* puddle, and then it dries and we have somewhat of a muddy, stained, filthy....whatever....on the bathroom floor. Then when you walk out of the bathroom to the slick tile floor of the bedroom, your feet are wet and you go WOOOOH across the floor as you slide from wet feet. :) We've placed one of the hand towels I brought on the floor outside the bathroom to use as a sort of rug to dry our feet so we don't go skating across the room, but of course because we are standing eternally in dirty water, that towel gets disgusting quite quickly from three sweaty women taking two showers a day. To make a long story short, I am going to buy a squeegee and a bathroom rug at Victoria today. :)

Last week, my watch quit working. Not good for a midwife, so as soon as I could, I went to Victoria to have the battery checked, because I knew I had just put a new battery in it. She checked the battery and said it was fine, and when she put it back in, it started working again. Then a few days ago, I dropped my watch in the bathroom (into the muddy, stained, whatever puddle) and the back popped off. I was able to get the back put back on, but the next shift I worked, I realized my second-hand had come loose and was now floating around inside, and the crystal was cracked. Again, not good for a midwife to be without a second-hand, but fortunately every birth cubicle has a clock above the bed with a second hand, but I am finding I do wish I had my watch. It is difficult to search for heart tones and then realize I have to move to see the clock, then I lose the heart tones...you get the idea. So in addition to the squeegee and bathroom rug, I need to have my watch repaired (hopefully). If I can't get it repaired, I am just going to buy a cheap timex or something. I also need some post-it notes to stick notes in my NARM book.

When I was studying the culture here before leaving, I had read that upwards of 10% of the population has hepatitis. That was one of the reasons I chose to go ahead and get the series of 3 shots that took me 6 months to complete. I found out the other day that if they test positive for hepatitis, they cannot birth at the center. And if they don't have their lab work done to confirm they don't have hepatitis, they cannot birth at the center. So you can skip the hepatitis shot too.

Julie, one of the Americano midwives who lives here, is going on outreach today. I was going to go with her, but Linda and Mary were already going, and she will only take two. She usually goes every two weeks, so I am hoping to go next time. The August schedule isn't up yet, there was a tentative August schedule, but it isn't final yet, so I'm not sure when I'll be working. That is one for which I am glad I got the typhoid shot. If I do that, I am definitely going to need it. I won't be drinking the water or eating there, so I'm not sure how important it is, but I'm glad I've got it anyway. I suppose I'm being a bit fearful about it, but I've seen pictures of this place. It is built right on the ocean, all the houses are made of bamboo and are on bamboo stilts to keep them up out of the water during high tide. There are bamboo bridges that go from house to house, with 4-6 pieces of 4" round bamboo lashed together. They have no running water, they use the floor of the house as a toilet, and the pee and excrement just falls to the sandy ground below. They say the toilet flushes twice a day--when the tide comes in. But about a year ago, the government built a stone tide wall to prevention erosion of the beach that these houses are built on. Now the toilet barely flushes. Part of me doesn't want to go, because I know how hard it will be on this "spoiled white girl." But the other part of me doesn't want to miss it. The chance to truly see how the other half lives. The "least of these."

Early next week I will have to go to Immigration to get my visa renewed. The tourist visa I got only lasts 3 weeks, so I need to pay 2000 pesos to renew it. They will have to keep my passport, and it takes a week before I will get it back. I feel a bit funny about leaving my passport with them, and not having it for a week. President Aquino is under investigation for possible voter fraud, and even just 2 months ago, some of her extended "royal family" was trying to flee the country, so some flights out of Manila were cancelled. It affected Mary when she was traveling here, her flight from LA to Manila was cancelled when the plane never left Manila because President Aquino's brother was trying to leave on it. The peaceful coup that brought down Ferdinand Marcos and brought Aquino to power is at work again, and this country feels on the verge of a major uprising. Possible impeachment, "people power" (the peaceful coup), and the political corruption that is rampant here is in the news every day. So I could pay an extra 500 pesos ($10) to have them do it right there, and then I wouldn't have to leave my passport. But I'm wondering if I should save the money and just leave them my passport. I'd appreciate prayers for that, and if you have a peace about leaving my passport and saving the $10, please let me know one way or the other.

PRAYER REQUESTS
That I will be able to go to the outreach in 2 weeks
Safety while I am out today
A good night shift
Prayer for my visa renewal

Anita <><


THURSDAY, JULY 28

Yesterday I ended up just walking to Victoria instead of going to Guisano. What I needed to print out wasn't in my email box yet, so I just went to Victoria. I was able to get my watch fixed, PTL, for 40 pesos. :) Try that in the States. While I was there, I took the opportunity to have lunch. This time I ate at Jollibee. Jollibee is the Philippines answer to McDonald's, although there are Golden Arches everywhere. Jollibee is just like a McDonald's, but on a much grander scale. It seats about 200 people, and is more like quick-service (the way the old Wendy's used to be) than fast food. There are guys who deliver your food, bus your table, get you extra ketchup, etc., and they RUN through the place, getting it to you as fast as they can. They RUN to deliver your food, RUN to bus your table, RUN to get you something. And all of them are male. The females all worked behind the counter. I got a "champ value meal" which would probably be the equivalent of a quarter pounder. They also serve fried chicken, but instead of mashed potatoes and gravy, it comes with rice, of course. They had spaghetti, pork chops, some oriental beef dish, and then hamburgers and french fries. The big mac I had the other day was delicious, just like back home. But this hamburger was different. Remember when you were in elementary school, and they served hamburgers? More like textured vegetable protein with beef flavor. I didn't finish it. But the french fries were good. So if you like TVP hamburgers like when you were in grade school, stop by the Jollibee. If not, you can skip it. After about 2 hours and I was done with all I needed to do, I got a Jollibee ice cream cone. Like a Dairy Queen chocolate-dipped cone, with rice krispies sprinkled on top. I did say rice went with everything here. :)

I've got a computer bug. Literally. There are ants in my laptop. I have been very careful if I have a snack or something in my room, because if the ants find one little crumb, pretty soon they're inviting all six million of their cousins. But what I neglected to consider was if there was any residue on my fingers as I sit on my bed and type. I went to pick up my computer last night, and found it crawling with ants. I killed them as I saw them, which was tough as they scurried in and out of my keyboard, like Whack-a-Mole on qwerty, then cleaned off the chair where my computer had been sitting. They are gone now, but last night I was literally laughing out loud that my computer had a bug. You have to laugh, or the ant infestion will drive you crazy. Either that, or I am going a bit stir-crazy. I just thought it was uproarious.

Around here they have balut vendors. (Hope I'm spelling that right.) He is like the ice cream man, driving by with the music playing from his bicycle with the side car. Instead of ice cream or hot dogs, he sells balut. You do know what balut is, don't you?

I just got done with my night shift. I am exhausted and overwhelmed, and just took my last dose of Rescue Remedy. It was a relatively quiet night, but the morning was altogether different. About 1:30am, a woman came in in labor who had had one prenatal in Rose, where she had a hematocrit of 26, no other lab work such as blood typing or UA, and she hadn't been back since. Jonna, a pinoy midwife, was with me, and checked her eyes and found her pale through and through, with almost no venous return in her fingernails either. Jonna refused to admit her, and they transported her to DMC (Davao Medical Center). (“Pinoy” is slang for Filipino, sort of like saying “white” instead of caucasian.)

About 3:00am, a continuity of Aliza's came in. (A continuity, for the new members of this list, is someone who has had continuous care from a single midwife, instead of just getting whichever midwife was on duty.) Her name was Jill, a G1P0, and she was Aliza's cousin. She was still laboring, but getting vocal when I did endorsements and checked out.

I was able to sleep for about the next 3 hours or so, and at 6:20am, it hit the fan. It was like someone said, "Birth Center's open now" and three women came in, back-to-back, all fully dilated and pushing. I caught the first one, a G1P0 named Eme, whose water had broken just outside the center as she walked in, and she began to squat and push in the hallway. Jonna helped me get her to a bed, I grabbed some gloves, and Jonna asked me to do an IE (internal exam, what they call a vaginal exam here). I got up to grab some KY to do the IE, and before I could get back to her cubicle, Jonna was saying, "Head visible!". I tossed the KY, gloved up and grabbed a flour sack towel to support her perineum. I think it took 3 pushes and what appeared to me to be a serious tear that I could feel "pop" beneath my hand, and her beautiful boy was born at 6:26am. Then she began this trickle bleed. About this time, I hear another labor come in, vocalizing, and I knew she was close too, just by her sounds. Julie handled her because I was still with Eme, doing aggressive fundal massage with Jonna leading me to do it harder (I think I felt her backbone). She had lost maybe 300-400cc at this point. Jonna then took over with the massage because apparently I wasn't doing it hard enough, and as Eme writhed, I heard Julie calling for suction from the other room to Gina, local nursing student who was assisting. Julie repeated it, "SUCTION!", then I heard a huge crash and the sound of glass breaking, and Julie said, "OH CRAP!" I peeked behind the curtain and saw that the jar of water that goes with the suction machine had fallen off the cart and broken glass and water was everywhere. I grabbed the other cart just outside the room, struggled to get it plugged in while walking across broken glass in flip-flops, while Julie continued to shout SUCTION and I handed her the tube. That was when I saw this baby just *covered* in thick black meconium, all over his body, his face, all over the bed. By this time, baby was already screaming, so I'm not sure why she even bothered (current research indicates deep suction may not be worth it). I went back to Eme, and she was better, so Jonna got the broom and swept up broken glass while I took vitals on Eme. With the glass cleaned up, Jonna did the stitching on Eme while I watched. Her uterus would get soft, but firm up nicely with a little (okay, a lot) of massage. Eventually an hour postpartum after suturing was over, Jonna directed me to give her 10cc of pit. She was still putting out about 10-20cc clots every five minutes during aggressive fundal massage (the worst thing about their procedures here), so Jonna asked me if her placenta was complete. I told her I had examined it, and it looked whole to me, but Jonna grabbed a set of sterile gloves and then said she was going to do a manual exploration for placental fragments. The swelling and suturing made it very tight, but Jonna kept digging in. She found nothing but some small clots. Eme had a strange uterus though. At least not like the ones I've been mashing on for almost 2 weeks now. Usually I found the uterus at the umbilicus, at least a finger or two above or below. But Eme’s was small, and already almost down to her pubic bone. I swear, sometimes when I'm doing the postpartum fundal massage (which you are required to do every 5 minutes for at least half an hour), I feel like her uterus is going to invert and just plop out on the bed. Yes, I guard it at the pubic bone, but I *hate* having to do that. This was the first birth I have ever attended where I became nauseous. Total blood loss about 600cc.


Eme

Another woman had come in, I think while Jonna was suturing Eme, and I have no idea who handled that one. Maybe Aliza. She also came in fully dilated and pushing, the third one birth in less than 40 minutes. I was helping clean up Eme and finishing her chart, because it was 7:45, and I needed to do endorsements. I would have/should have stayed and done Eme's newborn exam and bath, and helped her get cleaned up, but I was cooked. (Again, for some new members here, endorsements are basically just shift-change, where you "endorse" your patient over to a new midwife, telling her all about the birth/labor and important info.)

As I prepared to leave, Laura came in with the August schedule. Mary and I had spoken with Mordegai last night about going on an overnight outreach with him August 8-9 to the mountain village. It is a 2-hour drive and then a 90-minute walk down a mountain to where Mordegai does medical and dental visits (he pulled 7,000 teeth in 2004). So I was curious to see if I would be able to go with Mordegai or at least do some switching, maybe even a 24-hour back-to-back shift, so that I could go. I really wanted to do this one, and was willing to forego the bamboo village with Julie to do this 2-day outreach. Apparently Mary wanted to go with Narita. I had told myself that I knew it was definitely possible that I would not be able to do this, but I told God that I trusted Him, that if He wanted me there, it would work out. So when Laura told me I was not going to be able to go because she had already had to finagle (sp?) the schedule so Narita and Mary could go, and the only way I could was to put the schedule back the way it originally was, with Narita on and me off. I was disappointed, but was truly okay with it, because I know that God is sovereign. Narita was sitting next to me, and she said that since she was going to be here for 3 months, and I was only here until the 17th, that she would just work those days so that I could go, and she would do it in September. Since Narita has now been gracious to forego the outreach with Mary and pull 3 days shifts in a row so that I could go, I thanked Narita deeply, and Mary walked out of the birth room. I saw Mary again as I came into our room and she was leaving to do clinic, and she didn't even make eye contact or say hello, even though I greeted her. I will obviously need to talk with her, iron things out, but confrontation is not my strong suit. I could really use prayer at handling it maturely and with grace. I still have to live with her for three more weeks, and spend 2 days out in the middle of nowhere with her, so I need her as a friend. Please pray that there are no hard feelings. Maybe I am being over-sensitive, and I pray that is all it is. I am a sensitive person, take things personally that I probably shouldn't, and am easily intimidated by people like her. So I really am asking for prayer for that relationship, and that I might even be able to witness to Mary, who is not a Christian.

I am exhausted, physically and emotionally, so am headed for a nap. I hope to check my email as I am sending this, and the form I need I pray is there. After my nap I will go to Guisano to print it out. My next shift is tomorrow, where I do clinic and then a half-day shift for Toinette, the pregnant midwife from South Africa. ............ Carol just came in while I was finishing this and asked me if I wanted to go to Victoria with her. I told her I needed to go to Guisano to print something off the internet at the web cafe, and she said I could do that at Victoria. So I grabbed my bilum (been using it as my purse, it is a hand-woven straw bag from Papua New Guinea that I got when my SIL was in PNG in 2000) and went with her. The NARM form I needed was in my email box, thanks to my dear husband, who is still protecting me and caring for me from 7,000 miles away, and I printed 3 copies and was done. I did see in my email that the overwhelming response to my request for wisdom on whether to leave my passport at immigration to renew my visa was a resounding "no way." Thank you all for the offers to provide the $10, but I am doing okay on money for now and should be able to do this on Monday after my clinic shift.

PRAYER REQUESTS
For my relationship with Mary
For the mountain outreach Aug. 8-9
Praise for Eme being okay
Praise that my watch was repaired very cheaply
Praise that I have had another catch (that makes 3 catches and 7 observes)
Praise that the NARM form I needed is here
For my visa renewal to go smoothly

SCHEDULE:
Friday 7/29: Clinic/half Day shift
Sat 7/30: Night
Sun 7/31: off
Mon. 8/1: Clinic
Tues. 8/2: Day
Wed. 8/3: Night
Thu. 8/4: off
Fri. 8/5: Day
Sat. 8/6: Night
Sun. 8/7: off
Mon. 8/8: Mountain outreach
Tue. 8/9: Mountain outreach/Night
Wed. 8/10: off
Thu. 8/11: Day
Fri. 8/12: Day
Sat. 8/13: Night
Sun. 8/14: off
Mon. 8/15: Day
Tue. 8/16: Night
Wed. 8/17: depart Davao for Kansas City, 6:25pm

We have had several new members join recently. For new members:
Clinic days start with devotions at 7:45am, singing/worshipping with the moms, then prenatal visits
Day shift begins at 7:45am-8pm
Night shift begins 7:45pm-8am, the following day you have off to sleep

Anita <><


FRIDAY, JULY 29

I had this big, long blog typed out, saved and ready to send in Outlook Express, and then my computer crashed and it disappeared into thin air. This is the second time this has happened to me here, so I’m going to try to reconstruct my post from the last 24 hours, and this time I will be saving my blog in MS Word, and just copying/pasting into an email so this doesn’t happen again.

DRAWN TO OBEY
By Hannah Whitehall Smith
“…for it is God who works in you to will and to act according to his good purpose.”

“God’s promise is that He will work in us to will as well as to do of His good pleasure. This means, of course that He will take possession of our will and work it for us; and that His suggestions will come to us, not so much commands from the outside as desires springing up within. They will originate in our will; we shall feel as though we desired to do so and so; not as though we must. And this makes it a service of perfect liberty; for it is always easy to do what we desire to do, let the accompanying circumstances be as difficult as they may. Every mother knows that she could secure perfect and easy obedience in her child if she could only get into that child’s will and work it for him, making him want himself to do the things she willed he should. And this is what our Father in the new dispensation, does for his children; He “writes his laws on our hearts and on our minds,” so that our affection and our understanding embrace them, and we are drawn to obey instead of being driven to it.”

I was in clinic this morning, and after doing devotional and singing with the moms (which I LOVE), I had picked a cubicle and made the bed with a sheet, pillowcase, and cover sheet, etc., and then had some time before the first mom came in. I found a book on the shelf beneath the bed, “A Gentle Spirit: Devotional Selections for Today’s Christian Woman” and opened it to today’s date. In it was the above devotional. Before coming here, I was questioned by family about why I was making this trip. “Why are you leaving your children for so long? What about your family/husband? Don’t you know you are not ‘keeping your home’ as scripture says you should? Don’t you know the foolishness of the danger you are putting yourself in?” I prayed that I was in the will of God, and this trip was for Him alone. At one point, we almost changed plans and shifted this trip from the Philippines to Casa, in El Paso, Texas. But it is not Christian-based, I could not pray with the moms, or worship, or share the gospel. I told my husband, “If I can only do El Paso, I’d rather not go. It changes it in my heart somehow.” So we stuck with our plans for the Philippines, and I am so glad we did. I have been reading a borrowed book, “Captivating” by John & Stasi Eldredge. It has been like ripping off a band-aid, one hair at a time, exposing a gaping wound in my soul. So reading this devotional seemed so Providential, that God was sending me a love letter, to let me know I was doing His good pleasure.


Singing with the girls before clinic.


View from the prenatal room on the second floor; all the banas waiting.

I spoke with Mary last night. I asked her if she was upset that I was going on outreach with her instead of Narita. She smiled and said no, that she knew I really wanted to go. I told her I just wanted to make sure we were okay, and she said yes. I still have lingering doubts about her authenticity, there is just something in her countenance that seems “off.” I pray I am merely being oversensitive, and there is nothing to it.

I did two postpartum visits in clinic this morning, one for Dailenda, whose baby I caught 7/26, and Eme, whose baby I caught yesterday morning. Dailenda’s baby looked positively yellow. I thought she looked a little yellow when I saw her yesterday, but it is so hard to tell, because Filipino skin is a tanned-yellowish anyway, and I couldn’t see the whites of baby’s eyes to see if they were yellow (she had them clenched shut tight). But she looked even more yellow to me today, so I asked Festa, a pinoy midwife, to check if baby was yellow. She looked at baby and said she was definitely yellow, and to tutoy more (“two toys”—get it?) so the jaundice would go away. I watched as Dailenda nursed the baby, and helped her with latch as she was complaining that her nipples were sore. I showed her how to get baby to nurse tummy-to-tummy, and to get more of the breast in baby’s mouth. The baby also looked like she might have been sucking in her bottom lip a little bit, so I showed Dailenda how to pull it down a bit.

I then did six prenatals. :) One was for a woman at 37 weeks whose fundal height in the previous visits had been 16, 17, 18, 16, and now 25. These women are so small, their fundal height never does reach 40cm, but if it does it is either twins or she is seriously overdue! I tried to palpate for baby’s position, but all I could feel were miscellaneous parts. I checked her chart, and the previous visits no one else was able to feel position either. FHT was 150. It was obvious this baby was IUGR. She had been referred for an ultrasound, but apparently did not have the money for it, so kept putting it off. I got Festa to come and translate for me, so I could explain that she really needed that US, that her baby was in trouble, and that if she did not have the ultrasound, she could not deliver at the center because her baby would be too small. She would have to deliver at DMC (Davao Medical Center). I could hear the concern in Festa’s voice, even in Cebuano I knew what she was telling this mom was devastating for her to hear. The mom cried, and I held her and prayed with her in English. I’m not sure she fully understood me, but I cried too as I prayed.

The next mom was 33 weeks, and had been breech at 28 weeks and begged me for a referral so she could get her second ultrasound. She had had one at 6 weeks, with pictures, that she had done at the upscale doctor’s office, and wanted another one. I told her that her baby could still turn, we talked about knee/chest, etc., and that she probably didn’t need an ultrasound right now. I silently thought, “why don’t you give the money to the woman before you who really needed the ultrasound?”

After clinic, I went to the birth room to relieve Toinette. Toins is the South African pregnant midwife, and she is only doing half-shifts now. She is due in about a month.

It is now 9:43pm, and after having to retype this, I am ready for bed. I just finished the split shift in the birth room. There were no births tonight, but two women did come in. The first came in about 4:30pm, a G4P3 who had birthed her last 2 here at the center, both within 40 minutes of arriving. So I expected her to get active and vocal relatively quickly, but I endorsed her when I left at 7:45, she was still laboring. Her name is Anita. :) I learned that Anita is a popular Filipino name.

Another girl came in about 5:00pm, a G2P1. Her contractions were still 20 minutes apart, but her bana (her husband) wanted her to come in and have the baby checked. I listened to her story unfold in broken English, and was touched deeply by this 18 year old girl’s maturity that outdid her years. Her first baby was born at home with a hilot. Despite the fact that most of this country is Roman Catholic, some of the tribal beliefs that are inherent in the culture are still there, and a hilot is evidence of that. A hilot is a healer. Sort of like a shaman, but with no medical training and not a midwife. She said that the hilot never checked heart tones, or dilation, I’m not even sure what the hilot did. But she pushed for 5 hours on what I took to be an asynclitic head. The baby never cried. She struggled to breathe, so they took her to the hospital after a few hours. Going to the hospital is like going to the bus station. No rooms, no curtains, 40 babies in the nursery to 2 nurses, and the doctor comes by once a day. They intubated the baby, but with only 2 nurses, there was no one to squeeze the bag, so the responsibility fell upon the father. He bagged his own baby for hours. Eventually I got that they did take the baby back home, but she began seizing and was in convulsions and died at 3 days old. My only guess was that there was some hypoxic event in the birth that inadequate medical care could not overcome. The baby eventually died from anoxia. She said she was “sigi” (Cebuano for “OK”), but the depth of her eyes penetrated me. I prayed with her, and she eventually went back home to await stronger labor, but I asked Stacy if I could make her a continuity. Her story so touched my heart that I wanted to be there for her in this birth. It feels strange to now be “on call”, but if she comes back in tonight in labor, they will come awaken me, even though I am not on a shift. I am asking for prayer for her (her name is Juvy) and her baby, a healthy birth, and healing in this time.

PRAYER REQUESTS
For a good relationship with Mary
For Juvy and her baby
For Dailenda’s baby with jaundice
Praise for God’s healing hand

Anita <><


SATURDAY, JULY 30

Juvy did not have her baby last night. She came in again today, but she was not in labor. Festa had suggested that she come back today to have Evening Primrose Oil (EPO) inserted to help soften her cervix. So I did an IE and inserted 2 EPO capsules. Her cervix is only 1-2cm, and only 50% effaced, and baby is very high. If she does not have her baby by Wednesday, she will have to deliver at DMC because she will be 42 weeks. Please pray that the EPO helps, and she goes into labor tonight while I am on night shift.

I don’t have much to report today, I have been sitting here working on a midwifery assignment on the pelvis all day. :) Haven’t done anything special, or gone anywhere, just doing some studying, so this is a very short blog today.

PRAYER REQUESTS
For Juvy to have her baby soon
For a good night shift


SUNDAY, JULY 31

Juvy had her baby today—without me. I was on night shift last night, and it was Linda’s last night here, so she was first on. She handled a beautiful birth with a G1, 18yo girl and her bana, and it was just a nice, quiet, beautiful birth. I had a headache that had been getting worse through the night, and after Linda’s handle about 1:30am, I laid down to try to get some sleep, but my headache kept getting worse. By 5am, I was in a full-blown migraine. Light sensitivity, nausea, the works. And oddly enough, I began spotting again, even though my period was over early last week. Is it being around all the progesterone/laboring women? About 6am another mom came in, this was her third time here. She had been sent home twice before in very early labor. Julie asked me if I was up for a handle, or Mary, who was also on shift, and I just told her to let Mary handle it, I had a migraine. I felt like I was going to throw up if I opened my mouth. Since it was near time for end of shift, Julie told me to just go up and go to bed. I did not argue. Sure enough, right after I had laid down, Julie came up to tell me Juvy had just arrived in labor. I had put my name on her to handle her birth, because of her story, as I was telling a couple of days ago. But there was no way I could handle it. I apologized to Julie from my bed, with a washcloth over my eyes, and she said not to worry about it. Turned out she had a beautiful birth, so I am praising God for her.

I slept until well after 1pm, then Carol came in. Today was also her last day, and she was packing up. She was concerned about me, midwifed me and asked me if she could go get me some lunch. It is Sunday here, so there is no meal service, and I had not eaten in about 20 hours. Food has not been as good as it was the first week or so (or I’ve gotten pickier), and I have eaten predominantly rice for about 3 days. I needed a good meal, so we took a taxi to Picadillo, an Italian restaurant at Guisano. It was very nice, I had a good meal of fettucine and a Coke. Real, in the red can, Coke. I think that was the best part of the meal. We came back and Carol had to leave for the airport, and I went back to bed. My headache was much better, but I was still exhausted. I slept from 4pm until after 7pm. I heated up the rest of my fettucine left from lunch and for the first time since I’ve been here, planted myself like a couch potato in front of the TV. There is a television over on the other side of the midwives’ apartments, and I have seen it on with the other midwives watching, it is where I did karaoke the other day. :) I had been sitting there for an hour and a half, watching NCIS and then Without a Trace. It is getting late, so I decided to come in and do my blog and head to bed again. That migraine really knocked me flat. I still have a bit of a shadow headache, but I think I just really needed a good meal and some rest.

Yesterday, the Anita who came in in labor but did not deliver before I left shift, did eventually deliver. She had stayed her 6 hours and was ready to go home, but they did not have the 147 pesos to pay for the supplies. The midwifery care here is free, but all they pay for are any supplies that are used. This is a breakdown of the charges. Remember, pesos = pennies. Just double it, and move the decimal point, e.g. P15 = $0.30

Betadine P15
Calciblock P15 (for high blood pressure)
Cephalexin P07 (antibiotic, given if a manual exploration is done)
Cord clamp P15
IV Canula P65
IV Fluid/liter P50
IV Macroset P30
Lidocaine P40
Methergine tab P02
Methergine amp P50
Oxytocin P50
Sterile gloves/pair P12
Suction Catheter P20
Syringe P06
Vitamin K P15
Exam gloves P20 (always charged at least 1 set)
Laundry P50 (always charged)
Birth certificate P30

Anita’s birth was 147 pesos, and they didn’t have the money. So her husband kept leaving and coming back again, trying to borrow or do whatever he could to come up with the equivalent of three American dollars. It broke my heart. I wanted to just give them the 147 pesos, I easily had it, but there is a rule, you can’t do that. He eventually left and was gone nearly all day. He returned 7 hours later with the money. He had gone to work for a day to make the money, while his wife and baby stayed here. I contrast that with going to Picadillo, where I paid 300 pesos for fettuccine and a coke without blinking an eye. You have no idea how blessed we are as Americans. But that is all these people know, is poverty. They do not think it is bad, or sad, or heartbreaking, because they’ve never known anything else, or never knew that it could be any different. I think about my 2000 square foot home on 2.3 acres of land, my minivan, central air conditioning—everything that makes home, home. And I whine that my refrigerator doesn’t have water and ice in the door, I whine about the dandelions in the yard, and my minivan doesn’t have a cd player built in.

And I am humbled beyond words. I am a stingy, selfish, ungrateful, whiny woman, who has until this day, really no concept of really, truly how blessed I am. This life is such an incredible gift from God! I don’t walk across bamboo poles over a salt-water sewer to get to my neighbor’s house, I walk across a paved street, waving to the neighbor as he mows his 3 acres with his 54 inch John Deere lawn tractor. I get mail delivered right to my mailbox everyday but Sunday, and these people don’t even have addresses except maybe the cross street nearby. And it strikes me how every American should do a mission trip at least once in their lives, to a third-world country. It will bring you to your knees in humility.

I have clinic tomorrow with initial intake. That was what I did that first Monday I was here, and it overwhelmed me. I pray this one will be easier. Afterwards, I need to go to Victoria to get a copy of my passport (I already had one in my suitcase, but need another one) and another set of passport photos to go to immigration and get my visa renewed. I am probably headed to bed again, hopefully I’ll be able to sleep, after being in bed all day.

PRAYER REQUESTS
Praise for Juvy’s safe birth
Praise for this incredibly blessed life we live
Pray for safety while I am out tomorrow
Pray for my visa renewal to go smoothly
Pray for an easily clinic shift


MONDAY, AUGUST 1

I was to go to immigration today with a set of ID photos, a copy of my passport, and pay 2200 pesos to renew my visa, which expires Wednesday. I was unable to get money from the ATM to accomplish any of that, and only have 200 pesos (about $4.00) right now. I tried 3 different ATM's, and none of them would process my transaction. I am still trying to solve this problem, but please be in immediate prayer to regain access to my account, so that I can get this accomplished today. I pray someone is awake to get this. :) I am on days tomorrow, so will not be able to get my visa done until Wednesday (the day it expires) if I cannot solve this problem in the next couple of hours. Thank you!

This day has been a fiasco. There are some spiritual things going on here, I am now certain of it, but I am resting in Christ, as the battle is His. I covet your prayers over me for these next 2 weeks. I never was able to get money from my ATM card. The first ATM I went to was out of service. The second one, I had to stand in line for about 15 minutes to use it. ATM’s are very popular here. People don’t use credit cards. When that ATM didn’t work, I walked all the way back across Victoria to find the web café where I could check my bank account. I was able to get online and see that yes, there was money still in it, everything looked fine. I went to yet a third ATM and it still refused to process my transaction.

I gave up, and went back to the center and I went into the birth room and spoke with Laura to seek some wisdom on how to approach this. We started talking, and for the first time, took a good look at my passport. The 21-day tourist visa expires on Wednesday! I was thinking 3 weeks would be NEXT week, (yes, time is going fast here, PTL) and now instead of 9 days to accomplish this, I now only had 2. That made the issue of not being able to get the required money even worse. I work all day tomorrow, and if I don’t get the visa renewed Wednesday, I will be deported.

I have a separate account, with money in it just for this trip. That ATM card is not working. I visited the website again from here at the center, that is when I sent the Urgent Prayer Request. It appears my account has been flagged for possible fraud, because someone is accessing it from the Philippines, of all places. ;) At 7pm my time, I will be able to call and see if I can get that fixed. In the meantime, I got the ATM card from my regular home account and walked back to Victoria. So I have just shorted my husband about $80. I am sure he would appreciate the prayers to meet the financial need, until I can transfer that $80 from my trip account into our home account. That ATM card finally worked, and I got 4,000 pesos.

After making two trips to Victoria and finally getting money, I went and got the required passport photos taken, the required copies of my passport, and ran to immigration, which was fortunately right across the street from Victoria. By this time, it is 4:10pm, and I didn’t even know if they would still be open. There was a guard at the gate, but he wouldn’t let me in because I was wearing shorts. Of all the times to give in to the heat and wear shorts, it was the day I should have been wearing a dress! I rarely wear shorts in public anymore, and it was so hot today, and I knew I would be walking around outside a lot, so caved in to shorts. It was only then that I remembered Carol telling me to make sure and dress nicely, because they don’t allow shorts! I had completely forgotten! I asked the guard what time they closed, and he told me 4:45pm. Okay, I’ve got about 35 minutes to make the 18 minute walk back to the center, change clothes, and make the walk back to immigration. Wait, nevermind, I’ll just take a taxi back to immigration. So I raced back to the center as fast as I could, made it in 12 minutes, changed clothes so fast, I didn’t realize until I was halfway down the three huge flights of stairs that I had my dress on wrong-side out! LOL! I jumped into the prenatal room on the second floor and slipped into the bathroom to turn it right-side out, and then ran downstairs and out to the main street and thankfully immediately was able to hail a cab. I told him I needed to get to immigration “pas-pas” (fast) and was now headed back to Victoria for the third time in as many hours. I pulled in to the Bureau of Immigration at 4:32, but the guard wouldn’t let me in!! I had just paid 28 pesos for a useless cab ride. I begged him, said “salamat salamat!” (please please), showed him my watch, told him it was only 4:30! He shook his head and locked the gate and said “closed!” Okaaaaay. Bummer.

I walked across the street (this time taking the time to use the pedestrian bridge, instead of taking my life in my hands to cross the street), passed the beggars and people selling pirated DVD’s, and back into Victoria where I had a McFlurry for dinner. So much for losing weight while I’m here.

Now I am covered in at least three layers of dust and dirt, sweaty, exhausted, frazzled, and worn down. I’m okay with it, I really am, it is my fault really, for not paying more attention to the calendar, and for not preparing my online bank that I would be here so this kind of thing wouldn’t happen. On top of my wildly fluctuating hormones, plus a migraine, I now have a full-blown urinary tract infection. I had suspected I was getting one before I even left the states, so I loaded up on cranberry capsules and was feeling better, so skipped going to the doctor. With all the busyness here, dehydration, not eating well, I am not drinking enough, it only stands to reason it would come back. I have cranberry with me, and I did a prenatal on a girl today that I diagnosed as having a UTI, and Toin suggested I tell her to drink boco juice with kalamansi, that it works very well. So maybe tonight, after I come down from the fiasco of the afternoon, I will again head back to Victoria for the fourth time to find kalmansi and boco, whatever the heck that is.

I am on days tomorrow, so will go back Wednesday 8am to immigration to again try to renew my visa. I covet the prayers of God’s people.

Chris Anne, you are so sweet. I think it shows such a strength of character to be able to admit your faults. ;) I told Mary you were a midwife on my blog list, and she said that yes, she has heard of you. Mary is from Minneapolis, and she said to tell you she used to work with Joy. She said she almost went to your birth, but that you lived 2 hours from her and she didn’t think she’d make it.

I am having trouble with my internet service. It takes me at least 30 minutes to even be able to get online at all lately, and sometimes it logs on at only 13kbps, and I can’t even pick up my email that slow. So it is taking me a while to be able to get these sent. I am asking for that to be bathed in prayer, as it is such a relief for me to be able to share my trials with you all, and to know I am being covered in prayer from you all. It really is very, very special to me, and gives me strength from Christ, when I know He is hearing my name. I know it is only through the Power of Christ through your prayers that this trip has gone as smooth as it has. I covet your prayers for the remaining 17 days. :)

I was in a very busy clinic shift today. There was only 4 of us, at times only 3, and we did 42 new patients. I did 10 prenatals. We were done at just past noon, and Toin commented that they used to do prenatals until 4pm. Whew.

PRAYER REQUESTS
Prayer for the internet to be reliable
Prayer for my visa to be renewed
Prayer for good health
Prayer to fix the problem with my ATM card


TUESDAY, AUGUST 2

Monday, August 1, 7:53pm
I walked back to Victoria in the rain tonight. I’ve learned that in the Philippines, walking in the rain is bad, they think you will die if you walk without an umbrella. They’ve torn up the road between here and Victoria now, digging some sort of drainage trench. A four foot deep trench, and all the dirt from it is now piled up on the left side of the road. So now we have to literally walk in the middle of traffic. It rained all day today, and it has become a muddy mess. But there aren’t any bulldozers doing this work, it is just a bunch of men with ordinary garden shovels. And they’ve dug a four foot deep trench, five feet wide, and 40 feet long. I chose to take a tricy-cab (motorcycle with sidecar and roof; like tricycle, but cab instead of “cle”) back for 5 pesos, as it was dark and I was alone, and I just don’t like walking around here at night alone. I feel much better now that I have had a nice cold shower and scrubbed the muck off.


Tricy-cab

I found out what boco is. I was able to buy it at Victoria. Actually it is spelled buko and it is simply coconut water. Break open a fresh coconut, and drink it. Anyone who knows me intimately knows I HATE coconut. But, I’ve been eating fish soup for several weeks now, so surely I can choke down eight ounces of coconut water three times a day for 3 days in a row. I have a liter of water next to my bed, and am going to drink it all before I go to bed tonight. Please pray tomorrow brings healing, a good day shift, and a blessed day. I need another love letter from the Lord.

Tuesday, August 2, 5:58pm
I am in a rare quiet moment today during the day shift. I am off in 2 hours, and definitely ready for it. It has been a busy day. There were only three of us on today, so it made it challenging.

When I walked into the birth room this morning, there were NINE women on the board. Some laboring, some already delivered, but it was obvious it had been a very busy night. Some of those nine were near discharge, so ultimately we were only actually endorsed a total of six, if I recall, several of whom were discharged at some point in the day. I was endorsed with Mercy, a 20yo G1P0 in labor at 7cm, but her baby was still ROP, so transition came slowly. I would dart in and out of her cubicle while I was helping Julie and Mira with their other births. About 9am, with every bed taken, including one of the postpartum beds, in walked six moms for postpartum check-ups. At that point, there were 13 moms needing care, including 3 in active labor, for 3 midwives. The break in the slowness has come.

#1
Marcell, 17yo G1P0, had a baby girl at 10:32am, with Julie attending. I was hearing her get active, but I was with Mercy, and asked Julie to let me know if she gets close, I wanted to be able to be there. I basically walked in as the head was crowning. I stuck around for about another 5 minutes, charted the apgars, before I had to run back to check Mercy’s labor.

#2
I caught Mercy’s baby girl at 11:37am., ROA, 6#11oz., with a first degree tear that we did not suture. There was lots of mec, but we never saw her water break, so we weren’t even sure if it was intact or not. But as the head became visible, I could see the baby’s hair, which was green. :) So with Julie assisting, we used the suction machine with baby on the perineum. I was really hoping she wouldn’t tear, and tried to get her to breathe through crowning, but she said afterwards it hurt so bad, she just wanted to push hard so it would be over. I was dying for a crockpot of warm water with some vitamin E oil in it to help her stretch, but I settled for simply using a flour sack towel to provide perineal support and counterpressure to maintain head flexion. Filipino babies have dark lanugo, and she asked after her baby was born if her baby had feathers because she ate balut while she was pregnant.


Mercy

#3
Mira was with a woman named Jenevie who was close to delivery while I was still with Mercy doing postpartum stuff. While Julie was with another mom who was close to delivery, I stepped in to help Mira chart. I again walked in with head visible, and mom pushed just another five minutes or so, and delivered a baby girl at 12:59pm. I went back with Mercy.

#4
A few minutes later, Mira was with Jenevie, I was with Mercy, and I heard Mira call out if Julie was okay. I could hear Julie’s mom, Joselyn, getting close, and knew at that point she was alone, so I left Mercy for a moment and went to ask Julie if she needed a charter. I was halfway across the room to her cubicle when I heard the SPLASH. I walked in and Julie was wet all along her left side, standing up charting that Joselyn’s water had just broken. I took heart tones while Julie went to wash the amniotic fluid (fortunately clear) off her arm. Mom pushed for just 15 minutes or so, and Julie caught a baby boy at 1:21pm with lots and lots of vernix. She was, by LMP, 4 weeks early, but they were convinced that her fundal height and baby’s size that she was at least 37w, so they went ahead and let her deliver here. Baby weighed 5#4oz.

Mercy had finally gotten up to go to the C.R., so I started her newborn bath and exam. I was right in the middle of the exam when Mira came in to tell me a G6 mom had just come in and I was up for the next catch. Knowing what these high gravida moms are capable of, I wasn’t even sure if I could take the 15 minutes to finish the baby bath and exam before she delivered! I zipped through the exam, explained to her what lanugo was, and that no, it was not because she ate balut, and zipped out quickly to attend to the G6 mom.

Nida, 33yo G6P5 mom, 42 weeks today. They had given her EPO earlier in the day, and her last baby was delivered literally seconds after she came in—right inside the door. I expected her baby to fall out of her, but she continued to labor into the early evening, nearing the time for my shift to be over. It was almost 7:00pm.

#5
Another mom came in that Mira handled, a G1P0 fully dilated with water ruptured, pushing. I went with Mira to chart while Nida quietly labored. About that same moment, Nida decides to get active and I hear her pushing during a contraction while I’m trying to sneak one more observe into the day. With a G6 moaning and pushing, I know a baby can’t be far behind, so I left Mira, grabbed a birth cart, gloved up, and prepared to catch a baby. That was at 6:45pm. I sat with her while I heard Mira’s mom Annabella pushing. I SO wanted to go next door, at least peek my head around the curtain to watch, but I knew I couldn’t leave Nida alone. I can hear Mira and Julie telling her how much head was showing, and Nida had slowed down and apparently was not about to deliver, so I snuck next door and stuck my head in just at crowning. I stayed for the 1min apgar, then ran back to my mom. Nida did not have another pushing contraction, at least not up until I endorsed her at 7:45pm. I was bummed, I had labor sat her all afternoon, thought she was going to have her baby, then I ended up leaving her. I debated whether to do an IE, because if she was 9cm, I’d stay and do the catch. If she was 5-6cm, I’d endorse her. But that’s a selfish reason to do an IE, and I was already tired from the busy day, so I just endorsed her. But I was delighted to endorse her to Narita, the intern who arrived just after I did. This will be her first catch ever.

It was such a busy day, I didn’t even eat lunch until about 3:30pm. As for drinking lots of water today, I don’t think I took a sip until almost one o’clock. The UTI is getting much better already, hopefully I caught it soon enough that it won’t get any worse. But I’m trying to make up for not getting much water in today. I am headed to have some peanut butter and crackers for dinner (wasn’t up to fish and rice again), and guzzle my last cup of buko before I make an early night of it. I need to get up first thing and go to immigration, which opens at 8am.

PRAYER REQUESTS
For Nida’s birth to go well for Narita
For a smooth renewal of my visa
Praise for an exhaustive, but fun birth shift
Praise that the UTI is better
Prayer for complete healing

Addition: I just got an email from my dh that my youngest son Jacob was taken to the ER because of some sort of allergic reaction. My dh had told me about it when we talked on the phone the other day, and I talked with my kids last night and they were telling me about it. Apparently it got bad enough that they took him to the ER. They gave him a shot, I am presuming prednisone or epinephrine, and now my 7yo appears to have it, so it must be some kind of poison ivy thing. I am crying that my 5yo baby was in the hospital and I wasn't there to comfort him. Please pray for my son? That he is feeling better soon, and that my 7yo doesn't get it badly too? Or anyone else in the family for that matter. Thank you all SO much, that I can send these requests to you, and know that God is hearing my prayers en masse. It means SO much to me, you just don't know.


WEDNESDAY, AUGUST 3

I am praising Jesus for His faithfulness this morning. I went first thing to immigration, dressed in the nicest skirt and blouse I brought, and it went very smoothly, and only took about 15 minutes. I received my passport back within 10 minutes, and the total was P2020. I am so relieved to have that done.

When I returned to the center, I had a baby checkup waiting for me. Mercy, the mom I caught for yesterday morning had shown up at 8am for her postpartum visit, and had been waiting nearly an hour for me. I felt badly that I had completely forgotten about her. I had immigration-on-the-brain, and completely neglected her. But getting these moms to even come on the day they are asked to, at the time they are asked to, is a feat in itself.

I spoke with my dh this morning, and my son Jacob is doing better with the rash. My dh said he was very brave and didn’t even whimper with the shot he got. Please continue to pray for healing.

This is getting tougher. Just being away from home, from everything and everyone I know. For those of you on this list considering this trip, do not take this lightly. It will push you to the outer limits of your limits. The other interns here, especially Narita and Linda who both have no children, all seem so much tougher than me. Even Mary, who has 2 children, seems unshaken, and she’s here longer than me. I can at least rest in the truth that in my weakness, Christ is made strong. Thank you Jesus, for making me weak.

It was fish yet again today for lunch. The fish they serve is only about 6-8” long, from nose to tail. I think they do gut it, but it is a small, skinny fish, that you have to pick through fins and scales and bones to get to the flesh. It is a lot of work for about a tablespoon of fish. They love it and eat it all the time.

Remember the Anita who came in in labor on Friday? I labor sat with her for a while that day, and was looking forward to catching her baby, but endorsed her because she had not delivered yet. Mary eventually caught her baby later that night. I just learned today that her baby died Monday. I am stunned. There were no outward signs, baby was born healthy, no murmur, lungs clear, no mec, heart rate was good, etc., nothing that would indicate a problem. She had a postpartum checkup Sunday where again baby was found in good health, pink, breastfeeding, nothing out of the ordinary. Then Monday apparently the baby began to have trouble breathing, so they took him to DMC where he died 15 minutes later for no apparent cause. Mary and I were both stunned. That is the second baby to die since I have been here, the first being the twin that died of twin-to-twin transfusion syndrome, originally diagnosed as a cord accident. They did 106 births here at the center in July; that makes a nearly 2% neonatal mortality rate. And that is here at the center with trained, caring midwives from relatively healthy moms. Not the cold, substandard care at DMC with higher risk patients.

The one thing I have noticed about the midwives here is that they give great weight to a woman’s hematocrit. You’re doing good to get a mom with a crit of 33, but they often are less than 30. A woman with a crit of 45 they think is doing great, but I’m much more concerned about her having a contracted blood volume, with a crit that high.

I was just checking my stats, and I have now attended 20 births, including 6 total catches. Just here in the Philippines is 16 births attended, including 4 catches, 41 prenatal exams, 3 newborn exams, and 10 postpartum exams. I leave 2 weeks from today, so it is possible that count may be doubled before I leave. I just realized that I’ve already done my last clinic shift, the rest are birth shifts, so I won’t get anymore prenatals, the rest will be birth-related. Considering that when I came here I had 2 catches and had seen 3 births, I’d say I’ve come a long way.

I have been invited to dinner tonight at Mordegai and Toinette’s house, with Mary and Narita. I am looking forward to it. Mordegai and Toin both have a great sense of humor. I always laugh when I am with Toin.

I just got back from Victoria, where I had to reload my cell phone with minutes, get some soap and other things. I also went into the grocery store and bought another jar of peanut butter (they only come really small) and three Fuji apples. Apples here are prized fruit. They are sold one at a time, sort of the way you would find a Harry & David pear—wrapped in styrofoam webbing and then saran wrap. They were P19 each, and very delicious. I am finding that I crave fruit and salad. I love salad, crisp with green leaf lettuce and lots of ranch dressing. :) They’re not big on salad here, unless it is iceberg lettuce or seaweed salad. Which, incidentally, is not too bad if you like eating salt. It is ocean seaweed, blanched, then some seasonings added. The taste itself isn’t bad, just very, very salty.

I need to take a nap before my night shift, then a shower and prepare to go to dinner. Hope you are all well!

PRAYER REQUESTS
For Anita’s family to find comfort in Jesus
Praise for the renewal of my visa going smoothly
Healing for my son’s rash


THURSDAY, AUGUST 4

Wow, the outpouring of support that you all are giving me is so special! It warms my heart, and helps me SO much. Thank you thank you!! You are all amazing women!

It is 8:30am, and I just came off the night shift. It was a nice shift, just one birth, my own catch, and one other mom that I labor sat and endorsed. There was one other labor that wasn’t mine, so it was a relatively busy shift. I finally did a shift with the director of the center. She is a midwife, but she doesn’t catch here. She said she will if they get really busy, but her job is to train midwives, so she lets the interns and students do all the catching and she assists. I thought that was very nice. If the other labor I had would have given birth, I’d have had two catches in one night. :) But I think that would have been too much, especially how my one catch went.

Annabel, 22yo G2P1, 42 weeks today, walked in smiling quietly about 2:45am. She said she had been leaking water, (seems like they all do that, I’m wondering if it’s nutrition related) since July 29. She was having contractions, but by outward appearances, she was most probably in very early labor. Having her water broken for 7 days was way outside their protocol for BOW rupture, so I did a sterile IE to find out if there was a bag or not. I could not find her cervix at all, and felt so badly that a supervisor was going to have to do yet another IE on her, because with my inexperience I couldn’t find her cervix! Then I realized I couldn’t feel her cervix because she was 9cm, with an anterior lip (because they all labor lying down!) from about 10 to 12, with sutures at 4 & 6 just beneath an intact bag of water. You should have seen her face when I told her she was 9! You should have seen MY face, when I realized she was 9! She was so quiet, smiling in between contractions, sitting up, her bana rubbing her back because she was complaining of lower back pain. I felt baby LOA, but it was possible baby was LOP for awhile (indicative of sutures at 4 & 6?). She appeared to be doing little pushes during a contraction, so when The director asked her in Cebuano if she was pushing, she commented that she was afraid of pooping. This was her second baby here at the center, and the first time, she pooped a lot while pushing, and she was afraid of pooping again. I think without that fear she may have delivered within minutes of arriving, but she held back on pushing. I assured her as best I could, even just by tone of voice and a soft touch of my hand and smile on my face that it was sigi, it was fine if she pooped, that was normal, and I didn’t mind. :) Just a few contractions later, we got her up on the new birth chair that Sonya made (somewhat like a birth stool, but taller) and she finally got serious about pushing. But she still never made a sound, and continued to smile in between pushing. When she did push, she was right, she pooped a lot just like last time, I took care of it, and within maybe 2 contractions head was crowning. It took awhile for the head to come out fully, and after seeing all these small babies here, this one looked positively obese! Big, puffy cheeks. Sitting on the birth chair made it very hard for me to see or feel or support her perineum, but the head delivered very slowly, sucking back in a bit if she wasn’t pushing, tight against her perineum. The director urged me to get the shoulders delivered, and it took, by my estimation, quite a bit of head flexion and I went in to put some pressure on the anterior shoulder. Baby was born within 2 minutes of head out, but it is hard to estimate because the head was only out to about the nose/mouth for a whole contraction, so it was maybe longer. I did a one-minute Apgar, which was 8, then looked down and blood was covering the floor, including all over my right big toe. I’ve heard midwives talk about the “faucet hemorrhage” but somehow always thought they were exaggerating. No, they’re not. The bowl below the birth chair sounded like someone was pouring water into it. A steady, flowing stream of blood from her that sounded just like when you plug up the bathroom sink and then turn the water on kind of low. I was encouraged to do strong cord traction and get the placenta out NOW. I’ve studied so much about third stage, and seen so many times, “don’t pull on the cord!” that I was fearful of it. I pulled gently, then The director guarded the uterus and pushed hard and told me sternly to “PULL—HARD!” This time I was in a tug of war I had to win, and gave it good, hard, steady traction and the placenta came out, and bleeding slowed, PTL. Estimated blood loss at birth was 1,100cc (more than twice what would be called a hemorrhage). They have kidney basins at birth to pick up the blood as it clots and put into it, to measure. They hold up to 600cc. I filled it almost twice. I would have given her pit immediately, but The director thought she was OK now. As I mashed on her uterus every five minutes (I’m going to be so glad when I’m back on my own and don’t have to abuse women that way), she continued with a trickle bleed, as much as another 200cc. I eventually did get permission to give her pit about 20 minutes postpartum, and with a soft uterus and more bleeding, an hour postpartum gave her 250mcg of methergine po, along with prayer and asking in the name of Jesus for her to stop bleeding. I looked at her seriously and said, “dili dugo! (no blood!) You must stop dugo.” She knew what stop meant, lifted her eyebrows with a seriousness that I knew she understood. Her BP was down to 90/40, with a bounding pulse of 100. Every time I checked her, she would ask me, “blood?” She then told me in broken English that she forgot to drink her galay juice this week. I understood that she thought that was why she hemorrhaged. Galay juice is the water left over when kamato leaves (sweet potato) are boiled. It is very high in iron, and what they recommend to moms. Her latest crit from June was 34. She did eventually quit bleeding and bounced back, and when I left her she was sitting up on a chair at bedside. Amazingly, she never got dizzy. I never did let her go to the C.R. (comfort room, what Filipinos call the bathroom), so she peed in a bedpan. A baby girl, weighed 8#3oz. Her first baby was a mere 5 pounds, so this one was a shocker. This one was the American economic equivalent of a 12 pound baby. :) After her newborn exam and bath, I endorsed her and checked out at 8am. She will most likely stay here all day. I’ve heard other midwives talk about how they think the birth stool causes more bleeding, and I silently wondered if this new birth chair was the cause, or what? It was only the second birth using it, but the first one was only 150cc EBL. I’d really like some peer review for that one.


Sonya’s birth chair


Annabel

I came upstairs and laid down to take a nap, but of course my mom from 7/28 showed up for her postpartum visit almost 2 hours late. Filipinos have a whole different defintion of fashionably late. The later you show up, the more important you are. So they are never on time. :)

PRAYER REQUESTS
Praise that I am healthy now
Praise that Annabel’s bleeding stopped


FRIDAY, AUGUST 5

I talked with my dh tonight, was feeling stressed, and needed to connect. I hope to talk with my kids tomorrow morning. He reported that both my sons who got the poison-ivy or whatever are both doing well, my youngest who got the prednisone shot looks almost normal now. :) It always feels so good just to hear my husband’s and kids’ voices.

It was a nice, and interesting, shift, again with only 3 of us. It started with being endorsed a postpartum mom who had a nice birth with very minimal bleeding (150cc), but right after the night shift had left for the day, when she got up to use the CR, her mama called out that she was dizzy. I hollered out to Rose and Festa for help, then went running in there with Rose on my heels. Of course no one is prepared in an emergency like this, I was barefoot, no one had on gloves, and I was catching her as she was going over sideways while on the toilet. (Please God, I pray these women are not carrying blood-borne diseases.) I held her up and then Rose and I picked her up off the toilet and laid her on the floor. Rose is about the size of the average 12yo, and weighs 90 pounds soaking wet, and we are picking this woman up. She was completely unconscious, and we let her lay there for a few moments, then got her covered and protected from blood, and then Rose and I carried her to a bed. I got the top half. ;) Rose started an IV, and she eventually got to feeling better, but stayed all day.

I did one observe and one catch, both within an hour of one another. Both moms were endorsed this morning, one to me (Marilyn) and the other to Festa. Festa’s finally delivered at 3:55pm, with yet another 1000cc hemorrhage. This time, from several bleeders in a second degree tear. Festa and I both were praying over her while Festa was putting pressure on the bleeding, and I gave her two shots of pit, within 10 minutes of each other. Festa and I were both praying in the name of Jesus for her to stop bleeding. Praise God, she did eventually stop bleeding, without anymore pit or even clamping. God is so awesome! It took us nearly a half an hour postpartum to get her stable, and Festa was going to suture.

I went to check on Marilyn (popular name here), my laboring mom, who I now had not seen in over an hour, and she was obviously getting very close. I took one look at her, sat on the edge of the bed and took heart tones and her pulse, and she was at that moment moaning loudly with tiny pushes. These women don’t moan loudly unless they’re either complete or darn close. Her mama was her bantay (companion), and her mom at one point put her hand on her daughter’s chin and pushed it to close her mouth. I told her it was okay, she could make all the noise she wanted, it would probably help if she just let it go. I grabbed a cart and called to Rose, because this mom was having a lot of bleeding in labor. Heart tones were fine throughout, and Rose and I quietly talked about a friable cervix. I caught a 5#4oz. baby girl with slight IUGR, over an intact perineum (yeah!), only 50cc EBL! (estimated blood loss). I’ve seen photos of IUGR babies (intrauterine growth retardation), and she looked just like that. Big head, obviously full term, with skinny limbs and sagging skin. Not quite as bad as the baby I saw last week that Mary caught—that was really bad. But she had been losing weight in utero, and her mama said that “she didn’t eat much” this pregnancy. When I did the newborn exam, I showed her the sagging skin, and told her it was because she didn’t eat enough. I told her that next time, she needed to eat more!


Marilyn

Many of the policies and procedures here I don’t learn about until I’ve done it wrong. They truly do just thrust you into a birth team, and you start attending births and then catching, with absolutely no training on their protocol. I saw 6 births before I started catching. So I’m still learning their procedures. You are supposed to check on a mom every 5 minutes postpartum for 30 minutes, then 15 minutes until she pees, or 2 hours, whichever comes first, as long as she is stable and all vitals are within normal limits. Then you can just check back in 4 hours. So after 2 hours, I left her for about 45 minutes while I charted and did endorsements. They all had a cow when they realized I had not checked on her in 45 minutes. I apparently misunderstood their protocol, and she is supposed to be checked every 15 minutes until she pees, period. But one gal says after 2 hours you can check every 30 minutes. It is frustrating, because I want to do well, but it seems like every catch I do, there is something I mess up on with their procedures. 12 more days.

I am going on outreach on Monday and Tuesday, and I am already in prayer about it. I pray it goes well, that I can handle the hike (90 minutes down the mountain, 2 hour hike back up the mountain) and that I can handle the sickness and living conditions for an overnight stay. Jesus, give me Your strength for what I will experience there. I am going with Mary, and our relationship has improved a lot, praise God. He has been so faithful! When we return Tuesday, Mary and I then immediately have to pull the night shift. I pray that we return early enough Tuesday for a shower and a nap, or for a very quiet night shift that night!

I feel almost selfish when I put these prayer requests here, I know you all are praying for me, and I have seen so many times how God has come through for me in the things I have asked for prayer about. So I keep listing them, knowing that this trip is going so well only through God’s grace and mercy, and that He is hearing my name called out by those who love the Lord and are called according to His purpose. You all have been such a blessing to me, if there is anything I can pray about for you while I am here, please email me and let me know. I want you to see God working as I have! I tell God how much I appreciate how He has sent you to me, and given me such a great group of people to be used as His instrument of encouragement and exhortation. Know that you all are in my heart and in my prayers.

PRAYER REQUESTS
Praise that my sons are better
Praise that Jesus stopped Festa’s patient’s bleeding
Pray for health for Marilyn’s baby
Praise for telephones, to be able to talk with my family!
Praise for my relationship with Mary
Pray for the mountain outreach next week


SATURDAY, AUGUST 6

I can’t believe I forgot to mention that the catch I did yesterday, the baby had a tight nuchal cord that I could not loosen, so I held baby’s face to mom’s thigh and he sort of somersaulted out. So cool to be able to perform something you’ve only read about in books.

Today I went to Paradise Island. It is an island just off the coast of Davao City. A ferry takes you there, and it has a hotel, a beach, and is a public park. I was able to borrow a snorkel and mask from Laura, one of the American midwives, and do some snorkeling today. Unfortunately, it was low tide while I was there. I basically walked out to where you otherwise would be in chest deep water. But I was able to get out far enough to see some neat stuff underwater. I was alone, which was weird, and I think I would have enjoyed myself much more if I had been with someone, but no one here wanted to go. I didn’t want to miss going snorkeling. :) So now I can say I have snorkeled in Hawaii, and in the Philippines.

Only 11 more days. It is amazing that I have already been here 26 days. Makes 11 more sound like a breeze!

There is a pinoy resident midwife here named Gina. She is a VERY sweet 21yo girl, a born-again (here, you are either Roman Catholic, or a “born-again”) and she always has the sweetest smile, lovely disposition, sends me text messages on my cell phone to let me know that she is praying for me, sweet reminders of God’s love, that Jesus loves me, and she just has been such a blessing to me. She calls me “ate” (ott-ay), which is the familiar form of “respected elder.” There are some others who call me “Ate Ani” or “An.” Gina is asking for prayers, as she takes her Philippine midwifery board exam soon, and she is asking for provision to be able to take the exam, and that she would pass it.

Mary has decided not to go on the outreach Monday. She is working hard towards completing her numbers for NARM, and still needs 16 more initial prenatals, which they only do on Mondays here. So she is going to do initial histories/intakes in clinic instead. In Mary’s place, Inneke is going to send one of her interns, Liz, with Mordegai and I.

I need to take a shower to wash of the sand, and then take a nap in preparation for the night shift. Love to all!

PRAYER REQUESTS
Continued prayer for the outreach Monday & Tuesday
Prayer for Gina’s board exam
Praise for an interesting afternoon snorkeling


SUNDAY, AUGUST 7

An internship here is a short-term apprenticeship. Usually 4-12 weeks, but I’ve heard of other students coming for as little as three weeks. For me, I have now been here 3+ weeks, and I feel like I am just within the last few days getting settled into a groove where I feel like I am finally playing midwife. It was a slow adjustment for me. I think less than 4 weeks and by the time you were really into it, you would be leaving. A student here is more long-term, usually at least one year, upwards of 2-3 years. An intern might show up here like me, with lots of book knowledge but no birth experience (I attended 3 births before I came here). But a student comes for all of it: academic and practical experience. The students usually have little to no academic knowledge and perhaps have no birth experience whatsoever. The students are introduced into a birth team and clinic doing prenatals at a slower pace. Interns show up, they give you time to get over jet lag, and then boom! you are attending births. I attended 6 births here and then started catching, so they thrust you into it very quickly. I tripled my birth experience at my first shift. :) Keep praying, and be still and listen for God’s voice. I prayed about this trip for probably two years before actually doing it. With all that said, they have 9 new students coming (long-term, minimum one year) and may not going to be taking as many interns as they used to.

Last night’s shift was nice. I didn’t sleep much, because a mom was endorsed to me after having been there already all day. April, a 17yo G1P0, labored quietly outside with her mama for most of the day, and into the evening. She would periodically come in for me to check heart tones. About 11:00pm, she began to get serious and was pushing a little at the peak of contractions. Aliza and Jonna were sleeping, so I woke up Aliza and did an IE. She had been 3cm at about noon, and she was now 9+ with an anterior lip. She pushed for about an hour, and Jonna went and got the birth chair. That birth chair is like a new toy that everyone wants to play with, but I don’t like it at all. I feel like my supporting her perineum is almost worthless because I can’t see anything and can’t really get my hand in to give her good support. Sonya, who made it, is one of the tallest pinoys, so these tiny women who come in are too short for it, and their feet don’t touch the ground and they are dangling. As she pushed and I was trying to reach to give perineal support, she peed all over my arm. She was making progress, and after the head was out, I felt around to check for a cord, and on the posterior side, felt something that made me think, “What is that?!?” and then realized it was a nuchal hand! She birthed with the hand there, 7#4oz. baby boy, with a small skin split, so maybe I did get some perineal support in there. Immediately after the body was out, she dumped about 700cc of amniotic fluid that splashed all over my feet and legs. Baby was born with a moderate caput on the right side, so Jonna gave him a vitamin K shot immediately postpartum. I usually do that a couple of hours later as part of the newborn exam, but Jonna felt it merited it immediately. No hemorrhage this time, thank You Jesus. I did her newborn exam and paperwork, and discharged her at 6:30am.


April

At 7:20am, a G3P2 mom came in in active labor. It would have been Jonna’s turn to catch, but she gave it to me. I sat with her and Aliza told me to do an IE, and I found no cervix at all, bulging bag of water, baby at 0 station, ROT. I would have liked to have stayed, but with baby ROT I didn’t know how long she might push, and after I had only gotten an hour of sleep, I knew I needed to sleep and prepare for my outreach tomorrow, so Aliza encouraged me to endorse her. I endorsed her at 7:45 to Mary, and then came up for a much-needed shower to wash off the pee and amniotic fluid. :) I had forgotten my pillow down there, so went back down to get it in the birth room, and saw Mary with the patient I had endorsed, with baby’s head out and they were suctioning on the perineum. She delivered at 8:11am. I was so bummed I lost that catch, but I would have had to stay for at least 2 hours to do the newborn exam and paperwork. God is sovereign, and I obviously wasn’t supposed to be there, and Mary was.

I went to Victoria today after a restless nap of maybe an hour where I just couldn’t sleep. I got some Gatorade for the outreach, had some lunch, and got some cash. I am finding that my ATM card works unpredictably at best, and again had to use money from the home account. That card seems to work just fine, but my other one is hit or miss.

This will be my last post until Wednesday, August 10. I should get back from outreach Tuesday late afternoon, then have just enough time (prayerfully) for a shower and a nap before my night shift.

PRAYER REQUESTS
Prayer for a good outreach experience
Prayer for strength for the hike
Prayer for safety
Praise for the opportunity


WEDNESDAY, AUGUST 10

This is very long….

I am now 7 days from heading home, five birth shifts left, and I am SO ready to go home. My body and my brain are adventured out, but I am so full of gratitude and praise for being able to fit in this mountain outreach experience. It was awesome. Beauty everywhere. Lush, tropical green mountains stretching as far as the eye could see. A river way down in the valley that you could not see, but you could hear. The people there in Opian village were so sweet, the children are so endearing, it was everything I could have hoped for and more. It was the experience of a lifetime.

Sunday night before I left, Mary was on birth shift, and as I packed up, she said I needed to come down to the birth center with my camera to see the most fascinating placenta ever. This was the kind of placenta that you just don’t see. It was oval in shape, with a central insertion of the cord. But the cord was not centrally inserted in the placenta, it was centrally inserted in the AMNIOTIC SAC. No less than 6 vessels coursing through the bag, two as big around as my pinkie finger. Big, fat, purple veins all through the sac. This was actually Narita’s catch, and she said that when she did an IE while mom was pushing, she said she felt something that felt like a swollen lip of cervix, straight across the baby’s head. She said she was easily able to push it up behind baby’s head. Her water broke, and the birth proceeded completely normally, baby was healthy, apgars 8/9. But when the placenta came out, Narita realized that it was not a swollen lip of cervix she had felt, but a blood vessel. Complete velamentous insertion with a total vasa previa. The fact that this baby is even alive is a miracle. You could clearly see the hole where the sac broke and the baby came through. It is right in the center of a triangle of blood vessels. Truly amazing. I love placentas, I think they are fascinating, and this one was really cool.


Velamentous insertion with vasa previa

Mary let me borrow her backpack, which was smaller and lighter than mine, and I packed it up and went to bed early, with my alarm set for 4:15am. I was to meet Mordegai and the others at House of Jubilee (another of Inneke’s orphanages). The ones from HOJ that came were Liz, O’Shawnna, Lydia (our leader), and Jonathan. Jonathan showed up at the center to pick me up on a motor-cab (just a motorcycle that gives rides) and the driver, Jonathan and I got on the motorcycle and drove over to HOJ. Malcolm was there to go with us too, he is from London, and is here staying with Mordegai and Toinette, training in medical missions with Mordegai. I actually met him last week when I went to dinner with Mordegai and Toin. He also met us as HOJ. Mordegai had loaded up his motorcycle with medical supplies, generator, DVD player and projector (they were planning on showing the Jesus film), along with his own backpack, so instead of any of us riding with him, he just met us at the top of the mountain and the rest of us took a bus to the village where we were to meet him. The bus was just like you might see in ordinary mass transit in a large city, seated about 50, and there must have been 70 people on the bus. Many standing, it was very, very crowded. We actually started the bus trip at 5:40am, at the bus depot, and took the bus almost to the end of the line. I don’t remember the name of the village at the top of the mountain, but we arrived before Mordegai, so sat at the sari-sari store (sorry-sorry, like a very small outdoor convenience store) and had coffee and waited for Mordegai. He arrived about 30 minutes later with Beth, a pinoy who came on the trip to cook for us. Two men then arrived with horses, and Mordegai unloaded his motorcycle onto the horses. I was so praising God, because we did not have to carry our backpacks. They put them on the horses. So all I carried down the mountain was a bottle of water and my camera.


Village at the top of the mountain, where we met Mordegai.


Top to bottom: Lydia, Liz. O’Shawnna


Mordegai (front right) arrives on his motorcycle; Malcolm is directly behind Mordegai.


Some of the families/children of the village. Notice the pig on the right.
Behind the girl is the trail we took. Notice all the trash alongside the trail.


The top of the mountain; the horses carried our packs.
On right, L-R: Lydia, Liz, O’Shawnna starting down the mountain.

The trail we walked down was basically a horse trail. Steep, sometimes very steep, sometimes nearly flat, very muddy, rocky, with some spots as narrow as 24” next to a complete drop-off. It was mostly jungle, sometimes so overgrown you had to push past the greenery. Manure everywhere that was nearly impossible to avoid, so you basically have to watch very carefully where you put your feet, and try to avoid the really fresh stuff. :) At times the trail would open up, and you could suddenly see the mountains. Just fantastic, it is so hard to describe. Jungle-covered mountains, mist and clouds in the air. Both days were overcast, so praise God it was not too hot, just very humid. The trip down was not long at all, only about 35-40 minutes, and was relatively easy, despite the treacherous terrain. I praised God that I remembered insect repellant, as I was now in an area of malaria and denghe fever.


O’Shawnna in the jungle; Lydia (left) and O’Shawnna.

I think the last part of the trip was probably the steepest, and we arrived at Opian (aka Upian). Mordegai owns a house there. It was on the other side of the village, so we walked all the way through the village to Mordegai’s house. It was made of bamboo and wood, but was very large compared to the other 10x10’ homes. The frame was made of wood, but the walls and the floor were bamboo. Part of the roof was corrugated tin, but the kitchen was covered with a worn, torn blue tarp. It had an upstairs, where the five of us girls slept, that you climbed a ladder to get to. It was also bamboo flooring, with very old, worn linoleum placed on top. I silently wondered how tough that must have been for the horse to bring down the trail. :) There were roosters, chickens and their baby chicks, horses grazing, all over in the village. Corn (they call it barley) and coffee beans spread out across a concrete basketball court (yes, full-size even) for drying. Bamboo huts, some with tin roofs, some with straw, laundry hanging out to dry. A community water source from an underground spring pouring year-round from a bamboo pole in the middle of the village. Rubber hoses were strewn around, splitting the water so some homes had a source of running water at least from a hose outside. I praised God that the water was drinkable, and cool.


Nearing Opian. The village is on the lower right.


Me, right next to a drop-off of about 30 feet.


Mordegai and Liz almost to Opian.


Liz, entering Opian.


Mordegai’s house. Malcom (left) and Jonathan. Kitchen on the right (covered by tarp).


Mordegai’s back yard.


Mordegai in the kitchen.


The bathroom.


Community water supply. An older girl is bathing her little brother; a man gets a drink; a woman does her laundry by smashing it against a board with another piece of wood.

We unpacked our gear and medical supplies, and Mordegai began setting up the clinic in the community shelter house, in the center of the village. It looked sort of like what you might find at a park, with tables and logs for chairs. As soon as people saw us arrive, they had already begun to congregate at the shelter, and by the time we were set up, there must have been 50 men, women and children all lined up waiting for a check-up. It was sort of a blur for awhile, listening to people’s lungs, checking for swollen glands, checking blood pressure, and looking at ears through an otoscope. Lots of pneumonia, at least two cases of malaria, tons of ear infections. One boy, maybe 7yo, with both ear drums burst, who could not walk. Dried blood and pus was pooled in both ears.


The shelter house where we held clinic. People were already gathering.

I examined an old woman who had crackles in her lungs and a bad cough, and as I examined her, she also said she had a backache. I smiled, thinking it was probably because she was so old! She was what you might call “old school” Filipino. I guessed she was born well before World War II, before the Americanization of this country, and quite possibly had never been up the mountain. She had beaded necklaces around her neck and bracelets around her wrist, and her ears were pierced with holes at least 1” around. She was smiling, was such a sweet old lady. I asked her how old she was and she said she didn’t know. :)


This woman didn’t know how old she was.

Antibiotics were handed out like candy, acetaminophen (generic tylenol) and ibuprofen as well. The acetaminophen that is available in the Philippines is of very, very poor quality. Mordegai crushed one to dissolve in water to give to an 18mo with malaria with a very high fever. We did not take her temperature, it really wasn’t necessary, you could feel her and tell her fever was very high. I would have guessed at least 104. The problem with the generic acetaminophen is that it is, well, made in the Philippines. It would not dissolve in water. That was when Mordegai explained to me that it is cut with flour. What is intended to be a 250mg pill is probably more like 50mg, because the rest is flour. It literally looked like lumps of flour in the tablespoon of water. He threw it on the ground, grumbling and angry, that that one was all flour. He took one of the brand-name Paracetamol and crushed it, and it immediately dissolved in water, with no lumps the way the other one did, and gave it to the little girl, who screamed and spit it out. I think only about half of the antibiotic and half of the acetaminophen actually got into her.

Brand-name acetaminophen, Paracetamol, in the Philippines is about 6 pesos each. That’s expensive when you are handing out hundreds at every medical mission, so he buys the generic because it is very, very cheap. Mordegai said he won’t buy any more of the generic here, that he was waiting on an order from Singapore of 10,000 brand-name Paracetamol, costing only about 37 centavos each (100 centavos = 1 peso).


Mordegai pulling teeth. Malcolm, consulting “Where There Is No Doctor”

All the pregnant women and those with newborn babies gathered in one spot, and the family next to Mordegai’s gave me their house to do prenatals and baby checkups. I was the only midwife on this trip. I must have seen 20 women, and I was in heaven. It was so wonderful. Fortunately one of the first prenatals I did was on a woman who was educated, so she knew a fair amount of English. She stayed and helped me translate with the other women. I didn’t have a gestational wheel with me, so just used Naegele’s rule to come up with an estimate of a mom’s current gestation.

There was a shelf along the wall of the room of the bamboo hut I was in, and the moms would lie down on this 12” wide shelf while I palpated bellies and listened to heart tones. I only had my stethoscope, but was able to hear most of the babies as long as they were about 22 weeks GA or older. They don’t really have calendars, so sometimes if I asked her about her LMP, she might say “January.” So what I was doing was really just guessing, and then using the rule of fingerbreadths above or below the umbilicus to determine due dates. If I could find her fundus at the level of her belly button, that was about 22 weeks. For every fingerbreadth above the umbilicus, that is about another 2 weeks. So I could judge by that how big her baby was, and if it matched up fairly well with the LMP estimate. One mom I calculated she was about 16 weeks, but when she laid down, I felt her fundus at 2 fingerbreadths above the umbilicus, which would have made her more like 26 weeks. I asked her more in depth about her last period, and she said it was only 2 days long. I asked her about the month before that, and she said it was normal, 4 days long. So I guessed that the 2-day period was more likely an implantation bleed, and she was probably more like 20 weeks. I could not hear heart tones, but when I was checking her, I felt some very obvious kicks, so she definitely was further along than 16 weeks. But these moms never measure big. They always measure small, as a rule. So even if she was only 20 weeks, she was still measuring 26cm. I asked her about movement and she pointed to each of the four quandrants of her belly. I then asked her, “Tumbal?” (Twins?) Her eyes got huge! I asked the woman to translate for me, and proceeded to ask her if she or anyone in her family had any history of twins. She was a G8P7, and had never had twins and no one in her family had twins. They have no midwife or even a trained hilot in the village, no birth certificates are filed, so these women all birth unassisted. My experience is still limited, and her LMP dates could have been way off, but it was entirely possible she was expecting tumbal.

I did a newborn exam on a couple of babies, both about 4 weeks old. One baby was totally unresponsive, had no reflexes, and even with just the daylight streaming in the window onto his brown Filipino skin, I could tell this was a very jaundiced baby. His eyes were open just a slit, with strabismus, no palmar grasp, no babinski, floppy arms. If I were at home, I would have told her to immediately go to the emergency room. But that was not going to happen here. They can’t climb the mountain with a newborn, even with a horse, then take a bus to the hospital. They have no money, and the hospital won’t take you if you can’t pay. It isn’t like in the states, where laws say they have to treat you. I looked at her sternly while the other woman translated and told her to get her baby outside in the sun and to breastfeed him as much as possible. She told me he slept a lot, and didn’t nurse much. The baby wouldn’t nurse because he was so tired because he was so jaundiced. He was so jaundiced because wasn’t nursing enough. I worked with her for about 20 minutes to get him latched on to suck, asked in the name of Jesus for the baby to nurse, and when he did all of the other moms in the room were letting out visible signs of relief, I was saying hallelujah, and praising Jesus. He nursed for about 2 minutes before falling off the breast and back to sleep. I told her that even if he would not nurse, she should at least try to express milk into his open mouth, then stimulate beneath his chin for the swallow reflex. I am very concerned for that baby.

One mom, 38 weeks pregnant, had a blood pressure of 170/110. OMG, what am I supposed to do? I told her she needed to be in the hospital. About all I could tell her was to lie on her left side, drink 3-4 litres of tubig every day, eat iodized salt (goiter is common here) and eat sardines every day (canned fish is their primary source of protein). A single can of fish a week is doing good for these people, and I’m asking her to have it every day. I pray to the Lord that she does not go into eclamptic shock when she delivers.

They were all pale, with almost no pink to their fingernails or eyes. Mordegai gave me some ferrous sulfate, which I gave out until the box was empty. I was prescribing galay juice (the water from boiled sweet potato leaves) with kalamansi (like lime) all over the place, and praying without ceasing for these women and babies to live. Forget praying for fat, healthy babies, I just wanted them to live. My eyes are teary now as I write this, because there was just so little I could do for them. I wanted to right then, uproot my family, come live here in Mordegai’s bamboo house and grow my own red raspberry plants, nettles, yellow dock, shepherd’s purse. I wanted to give my heart to them, catch their babies, heal their aches with feverfew and dandelion. A piece of my heart will forever remain here in Opian.

As it began to get dark, Liz, O’Shawnna and I began to attract a large crowd of children. They love it when you take their picture, especially the digital ones where they can immediately see the picture. We just spontaneously started running around the basketball court, hopping, skipping with them. Their smiles were broad and their laughter was infectious. We played Pato Pato Gonsa with them for probably near an hour until it was too dark to see running around the circle. Can you guess what Pato Pato Gonsa is?

After dark, Mordegai brought out his DVD player. They tacked a white sheet up along one side of the shelter, and he set up a small projector with a generator. He had done this at other outreaches, but never before in Opian. This was the first moving picture some of these people have ever seen. He showed videos of his homeland in Namibia, the desert and safari animals, his family eating sheep’s head until there was nothing but skull left. Then he showed the Jesus film. I was very tired, and by that time I knew that my UTI was back, so I returned to the others at Mordegai’s house with a flashlight. The buko juice I took last week had not completely cured the urinary tract infection obviously, and this was an inopportune time. This time it was full-blown, with searing pain, severe bladder contractions, infection, with only a concrete floor with a hole and a very small bowl over it. It wasn’t bad, I think they even must have had a septic tank down there, but God knows how they got a septic tank down the mountain. You flushed by pouring water into it. Rice sacks and plastic tarp was around it for a modicum of privacy, but the prospect of basically spending all night in that outhouse was daunting at best. Jonathan had taken his machete and gotten several coconuts that day, so Beth had a bucket filled with buko juice. I drank a big glass of it (was much better than what I bought at Victoria last week) and Liz mentioned that maybe I could ask Mordegai for some cotrimazole, that he had some in his supplies. It seemed so selfish for me to ask, but Mordegai was very gracious and gave me a full 10-day supply of it. He said he had hundreds of them, so it was no problem. I climbed the ladder to try to lay down, and Lydia had set up a very large mosquito net for us to sleep under. Liz and O’Shawnna were also there preparing for bed, and I asked if they would lay hands on me and pray with me, because at that point I was in pain, near tears, and was not feeling well at all. We prayed together under that mosquito net for probably 15 minutes, praying for healing, for God to be glorified through the showing of the Jesus film (in Cebuano, of course) and through my illness, for sleep to come, and safety and strength. God provided me such relief that by the time we finished praying, the pain and contractions were already almost gone. With all the weird bleeding I had been doing in the weeks previous, I had packed a couple of maxi pads in my backpack just in case, and actually wore one that night, hoping that it would protect me with the bladder contractions and leaking.


Jonathan (left) and another man cutting open coconut.

We slept directly on the bamboo floor, and God richly blessed me when Beth appeared with a straw mat and even a small pillow for me! I had packed one of my sheets, so laid that on top of the straw mat, and I had a washcloth that I laid on the pillow. Even sleeping on the bamboo floor, I was able to sleep through the night without even getting up to use the C.R., praise His Almighty Name! I was concerned that I wouldn’t sleep at all, but I did sleep fairly well, except for the time that two cats were fighting just outside the front door. It was loud wailing from two cats, and Mordegai and Jonathan were up in the middle of the night hitting them with pillows and whatever they could find to scatter them. In the morning it was comic relief, hearing about the cat fight they broke up. I wondered how cats got down this mountain. There were dogs too, scrawny, skeleton-thin, mangy dogs, with sweet wagging tails and a happy gait, and eight full teats of milk.

Tuesday morning around dawn, I awoke to the sound of Beth singing praise hymns softly in the kitchen, preparing breakfast. It lulled me back to sleep, and I slept until almost 7:30, which seemed a miracle to me. My back and shoulders were achy, but I was so in awe of God for giving me a relatively good night’s sleep, with a pillow even! I praised Him for pillows, mosquito nets, maxi pads, and clotrimazole. :)


A man going hunting. Notice the gun and the machete and the baby in a sling.


The kids climbing the basketball goal.


A family in Opian; the baby is playing with a machete.

[Note added: in the morning before we started out, the corn and coffee was out to dry. It began to rain, and there was a mad dash to pick up the corn and the coffee before it got wet. If it got wet, it would germinate and sprout, and then it could not be ground up. I helped quickly load corn into sacks.]

We started back with clinic again about 9am, but there were not as many people as Monday. Monday we saw about 100 people, but Tuesday was only about 30. I only did a couple more prenatals, one on a very scared young girl, maybe 16yo, in her first pregnancy. She was far too early in pregnancy to hear heart tones, so I just told her about drinking water, using iodized salt to taste, and eating sardines, and how to make galay juice. We were done by about noon, so went back to Mordegai’s and had lunch before packing up to head back up the mountain. During lunch Beth announced that we were only going to have one horse for the trip back up, so we were all going to have to carry our own backpacks. I knew that would make the trip that much tougher, so asked God again for strength. Just moments before we were preparing to leave, God again proved Himself powerful and faithful beyond what I could think or imagine, when a second horse appeared, baby colt right at her side, saddled and ready to carry our backpacks. So at the last moment, we ended up not having to carry them after all, and all I carried was my bottle of gatorade.

We left about 1:45pm. The trip down the mountain was only 35-40 minutes, but the trip up took over an hour. I trailed near the end the entire walk up, my chest heaving and heart pounding. I cannot even fathom the intensity of that hike with even a small backpack on my back, and the blessing of that second horse got bigger and bigger. I tried to keep up with Mordegai in the beginning, but within 5 minutes I was already nearly breathless. Lydia and Beth stayed with me, they were also desiring to walk slow, and Mordegai was encouraging and told me to take my time, we had all afternoon before it would get dark. I praised Jesus for every step, that He was the one lifting and planting each foot, and gave Him the glory for every breath. When I caught site of the tin roof of that first house in the village at the top of the mountain, I nearly cried I was so happy. I had made it! Without fainting or vomiting, or anything! LOL! Mordegai, Jonathan, Liz, and O’Shawnna were already sitting in the sari-sari store drinking cold 7-up. We rested and drank cold 7-up, and helped Mordegai pack his motorcycle back up, which he had left right there in the village. Then we put our backpacks on and walked along the highway about ½ mile to where the bus would pick us up to take us back to Davao. We waited about 30 minutes, and again a very crowded bus picked up us dirty, smelly, exhausted travellers. I got carsick on the bus ride back, all the stopping and starting, and had a headache by that point.

We hired out a jeepney to take us all back to our respective homes, and I just had to walk from the main road to the center. I took my shoes off and put them in the laundry area in the alley outside the kitchen, because I knew they were most likely smelly from manure on them. I walked up the three flights of stairs to my room, and oh my, that was killer on my thighs, which were really aching! It was a little after 5pm, and I had about 2.5 hours before my shift. What an answer to prayer! I took a nice, long, cold shower and flopped down on my bed. I laid there for maybe 40 minutes, unable to sleep, and Mary came in with a newborn baby, whose mom had been transported due to high blood pressure postpartum. We talked about my trip, cuddled with the baby, I pacified him with my finger, and then Mary took him back down for a bottle of Nestle formula. Everything is Nestle here. I never did nap.

I sent out a quick email to let my family and you all know I was back safe and sound, and then went to my night shift. I had prayed that it would be a quiet shift, and since there were four of us on duty and there was only one woman in labor, Elaine told me to just go up to my room and get some sleep, and they would come wake me if it got busy. What a blessing! I hung around in the birth room long enough to show off some of the pictures I had taken, and then came up and ate something and went straight to bed for a good night’s sleep. It never did get busy, so I slept all night. I was so grateful. God is so good!


Elaine

PRAYER REQUESTS
Praise for all the blessings on the outreach
Praise for safety and strength
Pray for the jaundiced baby
Pray for the mom with toxemia
Praise for Beth and Lydia and all the others on the trip
Praise for a quiet night shift, and good sleep
Pray for healing for my UTI and aching muscles

P.S.: Pato means duck. :)


THURSDAY, AUGUST 11

It was a slow day in the birthing room, with just one birth. I was endorsed Evelyn, a 30yo G3P2, when I arrived on shift at 7:45am, and she was one of those that you never really know exactly where she is in her labor. Julie endorsed her to me, having done an IE at 6:45am, where she was 6cm, but already wanting to push. Julie tried to get her not to, left her sitting on the birth chair, and that is where she was when I went in to check on her at 8 o’clock. She was pushing with every contraction, and in between contractions, and I was really concerned about her possibly swelling her cervix if she was pushing and wasn’t complete. I tried to talk to her and get her to breathe in between contractions, but when I left her cubicle, she would go right back to pushing. I tried to keep an eye on her, there was only one other postpartum mom in the birth center, so it wasn’t busy. I had just checked on her at 8:50, when Stacy hollered at me to come. It was 9:00, and I could see head visible! I gloved up right quick and a 6#4oz. baby boy was born at 9:02am on the birth chair, 650cc EBL. She really caught me by surprise! Mira gave her pit as she had a constant trickle bleed. (I hate that birth chair.) She didn’t have much of a tear, and I have been pretty blessed with moms delivering either intact or without any suturing needed. Many thanks to Amber, a doula friend back home, for teaching me about perineal support. The rest of the day was very quiet, and I discharged Evelyn at 3pm.


Evelyn

PRAYER REQUESTS Praise for a nice catch today Prayer for another day shift tomorrow


FRIDAY, AUGUST 12

This will be short--the plug to my laptop has died, and I can't charge the battery on my computer now, so I am using the center's computer. I don't want to be online long, as it is the only phone line the center has.

It was another slow birth shift today, with one birth--another catch for me. I went down to the birth room a little early, before my shift started, about 7:30am. I wasn't even in my scrubs yet when Emelita walked in, vocal and active, and Jonna asked me if I wanted to handle it. I quickly ran in and changed into scrubs, and I checked her in and took vitals, etc. She was walking around, didn't want to sit, and at one point grabbed the pole that holds up the curtains, and was hanging from it as she was pushing! I got a birth cart, and at 8:20am she birthed a baby boy, 7#10oz. with a small 1st degree tear. I think out of the 9 catches I have done here so far, only one has needed suturing.


Emelita

Again the rest of the birth shift was with no more births. There was one labor for Laura, but they sent her home. She had been laboring for the last 24 hours of so, and was still only 4-5cm. We were getting very discouraged for her, but she came back in about 5:30pm, with her water broken, and she was now fully dilated, at 0 station! It was encouraging news. Laura endorsed her to Jonna.

My dh and children are with my MIL in Branson this weekend, going to Fantastic Caverns, Silver Dollar City, etc. I spoke with then tonight, and my 7yo rode his first roller coaster. :)

I am going to Victoria to make some copies of forms I need notarized for NARM, and to see if I can get my computer cord fixed, so I can go back to using my laptop.

PRAYER REQUESTS
Prayer that I can get my computer cord fixed
Praise for another nice birth today
Prayer for my family, they are traveling this weekend
Praise that my laptop lasted this long without problems
Praise that I only have 5 more days left


SATURDAY, AUGUST 13

I am very happy to report that my laptop cord has been repaired, for 450 pesos. The Filipinos don’t show much emotion, so I am sure they must have thought I was nuts, shouting “Hallelujah!” in the middle of the computer store. Once again I have seen God come through for me, in something as simple as repairing some wires. Either I am just more keenly aware of it here, or He’s been doing that A LOT lately!

I spent my morning pulling about 35 charts to take to Victoria and have copied. I now have copies of the charts of every mom I worked on, either prenatally, postpartum, or catch. Now the only ones I will need copies of are any more catches I do in these next 3 birth shifts. I returned quickly with the charts (in case someone in labor showed up and I had their chart!) ate lunch (adobo and rice—pork with soy sauce, vinegar & garlic) and then went back to Victoria to find a money changer. A money changer isn’t really a bank, but just a place that changes dollars into pesos. The one I went to was in the back of a jewelry store. :) I’m not sure if all they do is American dollars, or if they also do maybe yen, but all I’ve seen changed is American. I got $40 changed for 2200 pesos, (55 pesos = 1 dollar) and then walked across the street from Victoria, sort of down from immigration, to the computer store. It was similar to a Radio Shack, and one of the guys was able to strip the wires on my laptop cord and repair it. I am going to need to be very careful with it.

I need to get the preceptor pages from my NARM book signed by each of the midwives I did births/prenatals with, and give it to Sonya to be notarized. That is going to cost me 2000 pesos, P200 for each page notarized. I will also need P650 for an exit tax to leave the country, 150 in Davao and 500 in Manila. After those expenses, that leaves me 650 pesos (about $13.00) for the next 4 days. I only have another $10 American dollars, for my layover in Atlanta. Please pray there are no more unexpected costs incurred.

PRAYER REQUESTS
Praise for my computer repair
Praise for getting money changed
Prayer for no more unexpected costs


SUNDAY, AUGUST 14

It is 4pm, and I had to go right to bed after night shift was over this morning. I think I got 5 minutes of sleep last night, literally. A large thunderstorm moved through Davao yesterday evening, and midwives know what happens when the barometric pressure drops—you get babies!

When I went on shift, the board where all the patients names are written was already full, with 6-7 patients, either laboring or having delivered. I was endorsed with Jennifer, a 25yo G2P1. She had come in around 6pm, and was already looking like she was in active labor. She delivered at 8:25pm with a nuchal cord and a nuchal hand. The cord was loose enough that I was able to slip it over baby’s head (unlike the one last week I had to leave around the neck and somersault) and baby’s right hand was actually by the neck in back, at the nape of the neck. I reached in to split baby’s arm and move it around to front, then the arm delivered spontaneously with rest of baby following. Apgars 7/8. This couple was so sweet. About an hour postpartum, her bana (husband, or live-in boyfriend, both are called bana) went out for something for her to eat. When he returned, she handed me a bag with a small box of milk (all milk is boxed here) and a package of ube dice. Ube dice are similar to fig newtons, but larger and square. It is filled with either fig or ube, and in this case it was ube, a fruit similar to blueberries. She said she knew I had a long night ahead of me and I needed some energy. I nearly cried. These people have nothing in the way of money. Every peso is scrimped and saved and carefully spent. And the ube and milk probably cost them 30 pesos! Their bill was 130 pesos when they left the center! So you know this was a big gift to me. I was SO touched by their kindness and generosity, I was near tears. That small gesture so touched my heart, it will be a very sweet memory.


Jennifer

When I came on shift, Julie was caring for a continuity (a woman for whom a specific midwife has given full continuity of care), and she delivered at 12:54am, a 17yo G2P1, and it was a very nice birth.

There is a guard on duty 24 hours a day here, and the steel door to the entrance to the center is locked after dark. Boding, the night guard, will open the door if someone comes in in labor, find their chart for us, and then peek his head inside the birth room door, shouting “Labor!” Every time I would get settled to lay my head down and rest for maybe 30 minutes, I would hear, “Labor!” Five women came in in labor last night, and at one point 8 of 9 available beds were full. Three laboring women were assigned to me. Imagine caring for three women in labor at the same time! One 19yo G1P0, came in in labor, but we had to transport, because her fundal height was only 28, and she had been very, very small throughout her pregnancy, and she stated she was very sure of her LMP. Filipino women are so small, and the babies they grow are small, that it would be unusual for them to actually reach 40cm. But they at least reach 36-37cm at full term, so this was obviously a problem. She had been referred for an ultrasound at least a month ago to verify dates, and at every prenatal visit, she would be reminded she needed an ultrasound. But she didn’t have the money for it, so never got one. I am guessing her baby was IUGR, that doesn’t seem to be all that rare here, I’ve now seen three. In addition, her hematocrit was 28, so Boding drove while I went with her in the back of the center’s ambulance (just a multicab, like a truck with seats and a tarp roof, but no medical supplies of any kind). The Davao Medical Center is only about a 5 minute drive, and I had never been there. Because it was so busy, neither Julie nor Mira, who I was on shift with, could go with me. Boding dropped us off at the door, and I walked in with her. I had no clue where to go, so asked someone behind a desk. She never even responded to me, just rolled her eyes and looked up at another man who was standing there, and I simply told him I had a transfer from the center. This was about 11:15pm, and the place was a beehive of activity. People everywhere, it seemed like chaos. The man I spoke to asked me how far dilated she was, and I told him only 3cm, she had anemia and SGA. He waved his hand and told me to leave her “over there.” I felt awful! I hated that feeling of the proverbial “dumping your client at the emergency room door” but had no idea what else to do. Julie told me later that that was fine, there is an OB department where I could have taken her, but she would be fine, and not to worry about it.

The third labor I was assigned, a 19yo G1P0, came in about 2am. The pinoy buntis (pregnant women) are so stoic in labor that it is hard to tell from external signs how far they are in their labor. She seemed so active, moaning, writhing in pain, that it seemed compared to the others that she was in transition and probably close. I kept an ear out for her while I continued to do some postpartum stuff with other patients, including my mom who had delivered at 8:25pm, and checked in on her periodically. At about 5am, she was really moaning, scratching and digging at her groin and vulva, saying, “Help me!” That is very unusual for these women. I silently wondered about sexual abuse, which unfortunately is not all that unusual. At 6:15am, I did an IE and found her fully effaced, 6-7cm, cervix still posterior with sutures unpalatable, baby maybe 0 station. She said she wanted to push around 7:15am, by that point nearly screaming even in between contractions, and writhing around the bed to the point where the sheets were coming off. I had tried many, many times throughout the night to get her off that bed, standing up, leaning over the bed, walk around, anything, but culturally they are trained to just lie in bed, flat on their backs. I eventually endorsed her at 7:45am, and I was told that around 9am she was actively pushing.

After shift, I grabbed a quick breakfast of fried eggs (breakfast is not provided for here, but fortunately there are always eggs, and I try to grab protein where I can) and came up to sleep. I slept for over 6 hours.

I have been invited to Stacy & Laura’s house (mother/daughter, they are both midwives here) for dinner tonight. I am looking forward to it. My next-to-last shift is tomorrow, then Tuesday night is my last shift. I can hardly wait.


Jerry & Laura L-R: Kendra, Laura, Jerry, me, Narita, Stacy

PRAYER REQUESTS
Praise for another catch
Praise for an additional beautiful birth
Praise that I only have 3 days left.


MONDAY, AUGUST 15

It was a nice birth shift today. There were two endorsements, both postpartum, and I was up first for a catch. We discharged the two postpartums, and the center was empty. Laura and I talked, Andrea cleaned, and I worked on my computer for several boring hours. Laura and I joked that what I needed was a mom to show up 8cm, labor for a short while, then a very nice birth, with enough time to do the newborn exam and get mom up to the C.R. before endorsements at 7:45pm. We both laughed, saying, “OK, God, we’ve put our order in! It’s up to you now!” :)

But no one came in until 3:30pm. Amylene, a 20yo G1P0, came in in what appeared to be very active labor, but it was hard to tell because she was a G1, and had only been having contractions for 3 hours when she came to the center. As I was checking her vitals and asking her about when her cx began, I heard a commotion outside and heard Andrea go running outside. She came walking back in, and I didn’t hear what Laura asked her, but I heard Andrea say, “it’s okay, baby is on her lap, she is fine.” Turns out a G7 mom coming in to the center in labor had the baby in their car about 10 minutes before arriving. :) Placenta was even already out. They cut the cord and brought the baby inside, covered in thick vernix, bright-eyed and alert and healthy. Andrea offered mom a wheelchair, which she refused, she just walked into the C.R., cleaned up, and walked to a birth room bed. :)

I kept my ears open, listening for Amylene, now and then hearing her moan a bit louder. Around 4:15, Andrea told me to go ahead and do an IE and see where she was. If she was only 2-3cm, I was going to just send her home and let her labor at home. I went to do the IE and barely got my fingers in before feeling a bulging bag of water, baby at +2, fully dilated. I went out of the cubicle to get the birth cart, and told Laura, “I should have done the IE when she came in, she probably would have been 8cm!” Laura and Andrea came in as she began to push, and almost immediately we could see BOW (bag of water). It was one strong bag, and as BOW crowned, I asked Andrea if I could go ahead and break it. I knew if it popped, we’d all be soaked. I took the coco towel and just twisted the bag beneath my fingers and it popped and we could immediately see head. She pushed for all of nine minutes and at 4:26pm birthed a 6#10oz. boy with a nuchal cord over an intact perineum. The cord was tight and I couldn’t loop it over his head, and wanted to do the same somersault thing I had done last week, but Andrea kept telling me, “move the cord!” I tried to tell her as quietly and gently as I could that it was too tight and she kept repeating her order. “It’s too tight, I can’t!” I was putting gentle pressure on the occiput to bring baby’s face against mom’s thigh as I waited for the rest of the baby when Andrea reached in to loop the cord over, but couldn’t because it was too tight. It then became a hand-over-hand delivery, as Andrea pulled baby out. I was a little disappointed I didn’t get to somersault the baby out, there were no stuck shoulders or anything, but it was a fine catch. She was up to the CR in about 2 hours, and I was just finishing up the newborn exam and paperwork at 7:45pm, just in time for endorsements. :) Way to go, God! I am just shaking my head in amazement at how such a light-hearted, half-joking prayer sent up still gets heard. I thought to myself, “I was just joking, Lord! I didn’t think You’d actually provide it!” LOL! Oh ye of little faith…


Amylene

I had tomorrow off, as I am on night shift tomorrow, but Laura wanted to go to a conference, so I took her clinic shift for her.

I am alone in my room now. Mary left today at 6pm to go back home. Our relationship vastly improved these last couple of weeks, thank you so much for your prayers. It feels kind of lonely, all by myself in my room with 2 empty beds. I am now less than 48 hours from heading home. Tomorrow will probably be my last post here in the Philippines.

PRAYER REQUESTS
Praise for such a great birth today
Praise for God’s faithfulness to all prayers
Prayer for safe travel for Mary


TUESDAY, AUGUST 16

I woke up this morning and went ahead and did the first postpartum visit for the family that I handled yesterday afternoon. They decided to stay all night instead of head home at 10:30 at night. I then filled in for Laura in the clinic, and did 11 prenatals. While I was in the clinic, I finally got to meet the director of this place. He was very nice, and we had a good conversation. He said they are looking for more students, young women perhaps looking to find how God wants them to serve in the mission field. He is going to send me a DVD of what they provide at the school, to perhaps help spread the word about what they are doing there. I shared with him the time I spent in Upian, and how memorable that was, and that God would need to do a bit more work on my heart before I was really ready to jump into that (I like air conditioning!). He laughed, and said God had worked on his heart too. Years ago, he had to make the decision between going to Asia for the Lord, or becoming a professional downhill skier. Wow, guess we know which one he chose.

TOTALS HERE:
25 births
11 catches
52 prenatal exams
10 newborn exams
25 postpartum visits

My time here has been SO memorable. It is an experience that, now as I reflect back on it, doesn’t seem like it really happened to me. Adventures like this don’t happen to me, they happen to other people, and I just dream about stuff like this. I am so grateful to all the people here, the midwives, the laundress, the cook, even sweet CheChe, who swept and mopped around here. Everyone was patient and tolerant of all my mistakes, my screwed up birth certificates, my lack of language skills. The moms I was able to serve were so sweet, the babies so cute. It was an incredible time. I think I witnessed more to some of the other interns than I did with the moms, but all the prayers I said with them will perhaps plant a seed that will grow into a saving faith.

I highly recommend this place, and if you ever get a chance, definitely make the trip. It was long, and very difficult to be away from my family for this long, I know hard for them too. But it does seem to have gone relatively quickly, and without too many crying jags. :) The midwives here won’t always practice the way you will, and if you can take what you like and leave the rest, I know it will be as incredible an experience for you as it was for me.

I have one last night shift tonight, and I am hoping for one more catch. :) I then may try to get some sleep tomorrow before finishing up my packing and heading to the airport. I cannot tell you how excited I was today to be packing. Below is my itinerary:

PAL #814, departs Davao City Wednesday, August 17, 6:25pm, arrives Manila 8:05pm
Korean Air #624 departs Manila Thursday, August 18, 12:40am, arrives Incheon 5:20am
Korean Air #35 departs Incheon 10:10am, arrives Atlanta, 9:35am
Delta #385 departs Atlanta 11:54am, arrives Kansas City 1:10pm

Once again I am in the Manila airport late at night for several hours, but fortunately this time it is not in the dead of night. :) I again covet your prayers for safe, expedient travel. I will email you all when I have arrived safely, and hopefully in the next week be able to get pictures up at the yahoogroups site for you all to see. I am also working on putting this entire blog, including pictures, into a PDF format document, almost like a small book. My next aspiration will to be to create a scrapbook.

Lastly, a very special thank you to all of you have stuck around to read these messages, for praying for me and encouraging me. I know the hand of God has been upon this trip, and I have seen His angels going before me and beside me. It is the power of God through the prayers of His people that has brought me safely thus far. I am so grateful to all of you, and am sending you each a big {{{{hug}}}} for being there for me. THANK YOU!!!! And as my pastor says, “See you there, or in the air!”

PRAYER REQUESTS
Prayer for safe travel back home
Praise for such an incredible experience
Praise for God’s protection this whole time


WEDNESDAY, AUGUST 17

(This was written before I left Davao.)

The day I left Davao was full of lasts. My last catch, my last cold shower, my last trip to Victoria. I began the night shift Tuesday night with Stacy telling me that if I preferred to sleep instead of one more catch, I was welcome to go up to my room and go to bed, as there were four midwives on shift. I couldn’t decide between making Wednesday come faster, or one more catch, so I simply delayed my decision until God made it for me.

I settled down to try to sleep in the birth room about 10pm, but couldn’t fall asleep. I G1P0 came in at 11 o’clock, but it was evident she was in very latent labor. I did an IE and found her 1-2cm, 50% effaced, bag intact and head high. I sent her home and finally fell asleep around midnight. I awoke at 3am, tired but suddenly wide awake. I yearned for home, asking God to make the next five hours of my shift go quickly. I laid there and had a long conversation with God about how I wasn’t sure I could do another catch, I had had my fill, my brain was exhausted. I cried out to God that the only way I really wanted another catch was if she walked in fully dilated and pushing, almost like the catch I did Monday. I told the Lord I didn’t know if I could physically or emotionally handle anything else. I didn’t fall back asleep, but about 45 minutes later, I sat up, startled at a sudden commotion. I heard lots of activity, grabbed my chinelas (sandals) and saw a woman being carried in by the guard and her bana. I heard Stacy call my name, and I simply said, “Yes” and grabbed a pair of gloves. They laid Anamie, a 22yo G2P1, down on the bed as I gloved up and reached to switch on the light. I looked beneath her duster, and her panties were still on, so I asked her to take them off. She smiled and removed them, and I was thinking, “Oh well, she’s smiling, she can’t be too close.” She opened her legs and I saw about a quarter-sized portion of baby’s head. I said out loud, “Head visible!” and asked Emily (Inneke’s intern) to grab me a birth cart. I barely got a pad beneath her rear as head crowned. I quickly sat on the end of the bed, and by the time I had my hands on the head, it was rotating and baby was out at 3:43am, one minute after her arrival. Beautiful, healthy, 6#10oz. girl, with only a very small tear, not even first degree. I nearly began to sob, and it took everything I had not to break down at how absolutely incredible and awesome this God we serve is. My last two catches were so selfishly ordered up from God, and it was like He said, “Do you want fries with that?” I am absolutely struck dumb at how clearly and plainly God has answered my prayers since I have been here. Every single doubt, even the tiniest bit, about whether or not my being here was in the will of God has been totally erased. There is no way He would have been so gracious, so kind, so protective and caring of me while I was here if it wasn’t exactly where He wanted me.


Anamie and her bana, with me.


L-R: Rose and Inneke; Emily

And true to God’s faithfulness, Anamie was up to the C.R. and had the newborn bath and exam and all the paperwork done by 7:45am, just in time for endorsements. I came up and slept until about noon, then took my last cold shower before my last walk to Victoria. I needed to make a copy of Anamie’s chart, and the last postpartum I did on Jennifer from Saturday night. I then had my last cup of coffee from Basti’s, another Starbucks-type place, and came back and finished my packing. Stacy met me downstairs at 4:30pm, and we loaded up for the airport.

(The remainder written today, Saturday, August 20.)

My flights were uneventful, although all of them were a tad late. My flight from Seoul to Atlanta was very late. It arrived 90 minutes late, and I had 45 minutes to catch my flight to Kansas City, and still had to claim my bag, get it through customs, recheck my bag, go through immigration, get my boarding pass, and race to the gate, which could not have been further away. I raced through all this, sending up many, many praises to God that my bag was off the plane quickly, and others let me cut in line at customs. I noted that my bag was way more beat up than when I checked it in Manila, noting that even the handle was gone. Probaby because it was so overloaded! The seriousness of that missing handle did not occur to me until I went to recheck my bag, and they hollered at me that it had no tag! My bag made it from Manila to Atlanta, and who knows where the handle, and hence the tag, had come off. It must have come off either on its way into the plane to Atlanta, or on its way off that plane, to have successfully arrived at the baggage claim for my plane. I got my boarding pass, and in a mother’s scolding tone, told me to go straight to the gate, do not stop anywhere! Fortunately Atlanta has some speed trains, sort of like riding the subway, that stopped at each terminal. I arrived at my gate, and the plane had been delayed for 7 minutes, so I ended up arriving about 10 minutes before departure. Thank God for delayed planes!

I started crying when the plane left the runway in Atlanta, and was tearing up again when the plane landed in KC. I was so fidgety, so antsy to get off that plane. When I saw my kids, with my son holding up a sign welcoming me home, I could hardly walk nor see from the tears as I raced to hug my family. My husband had a dozen red roses for me, and I literally sobbed as I hugged them. I have never been so happy to see anyone in my life, and will probably never be so happy again until I see Jesus.

I am working on some “Final Thoughts” focused toward those who are considering this same internship, and working on a PDF file with this blog and pictures. I will also be working on uploading the pictures over the next week. They will most likely not be full-size, as it would max out the available space at yahoo. Please note, I am considering “changing names to protect the innocent” in that PDF file. Two days before I left, I heard of another intern who had been publishing a blog similar to this one, however it was on a public forum, and she was saying some very unkind, even viscous things about the other midwives. I don’t think I’ve said anything unkind about a specific midwife, maybe some practice dislikes, but I think it would be a good idea to change their names, you never know how that PDF file may be passed around, and I don’t want to limit who might be blessed by it. I will let you all know when the pics and PDF file are uploaded to the files section of this list, and you can download it.

One final thank you to all of you for every prayer, every encouraging word that you all gave me. I truly cannot thank you enough for your prayers. You all have been God’s instrument of peace to me. Keep praising God, keep worshipping His name. For it is through the blood of Jesus Christ, through the death and resurrection of God’s only Son, you have been saved.

Some final tips for those considering this trip:

Bring your own equipment, i.e., BP cuff, stethoscope, fetoscope, doppler, etc. It is not necessary, they have equipment, however if you would prefer to have your experience on equipment you would be using in your ordinary practice, I recommend it. I brought mine, and I am glad I did. I also recommend bringing your own digital thermometer (better yet, bring 5 and leave them there, thermometers seemed to be in short supply).

Bring a comfortable pair of plastic flip-flops that can be washed. All street shoes are prohibited in the birth center, and these flip-flops will be for the center only.

If you would like to attempt a mountain outreach, bring a pair of sandals and a good pair of walking shoes and comfy socks. You will need a lightweight backpack, and if you're picky about sleep arrangements, one of those thin, light camping mats to sleep on and/or an inflatable pillow make it more comfy.

Electricity is 220V, so check your equipment such as your laptop. The AC plug on my laptop was compatible with 220, however outlets there only have 2 prongs, there is no round ground plug. Bring an adapter that will go from 3 to 2 prongs if necessary, and a 110 to 220 converter if you are bringing equipment that is not compatible with 220.

If you are a coffee snob, pack your own. I brought a French press, but you can buy a coffee pot at Victoria (like Walmart) easily.

Bring your own pillow. You'll want it on the plane anyway, and you can carry it on.

You will need a good water bottle with a good, leak-proof lid.

If you would like to use the births here towards your CPM, contact NARM well in advance and order the Application Packet ($50 from NARM). Make one full copy of the entire book, plus at least 2 copies of Form 111, 30 copies of Form 114 (need one original and two copies for each senior midwife, to be notarized), 10 copies of Form 202, 30 copies of Form 204 (same as 114). Bring a notebook/journal and a handful of good pens and keep track of everything you do. Plan on paying up to $50 for notarizing and copying files/forms.

Have the senior midwife you are working with that shift sign off on your NARM book each shift. Don't get behind. Write down in your notebook the full name, EDD and DOB of every woman you care for, either in prenatals, births, or postpartum checkups. Keep track of the names of the women whose charts you need copies of. Wait to copy charts until the very end of your trip, the best place for copies is a place called PhilCopy, in Victoria. Post-it notes helped me as well as paper clips.

Before you go, ask for at least 2-3 clinic shifts to be on Mondays, but I don't suggest it be your first clinic shift. That is when they do initial prenatal visits, and NARM requires 20 of them. These are the hardest to get. Also on your first couple of clinic shifts, if you want the 3 continuities that NARM requires, take at least 6-8 women and write "Refer to [your name]" on the file as a continuity. Make sure they are due well before you leave, but with enough time to do the required 4 prenatal visits, birth, and one postpartum. This requires a stay of at least 5-6 weeks, more 8 is better. Some of the continuities you take will either not deliver before you leave or possibly transport, so mark at least 6-8 women's charts as your continuities to make sure you can accomplish at least 3 of them. If you would like to have your NARM book completely full, plan at least a 3 month visit.

If you are renewing/applying for a passport before you leave, just get an extra set of 2 passport photos for the renewal of your visa. Also bring at least 2 copies of your passport for immigration.

Make sure you have more than one source to obtain money. I had 2 ATM cards, and one of them would not always work. Don't exchange money in the U.S. You will get a better exchange rate at the airport in Manila or through an ATM than with a bank.

Pack cool, modest clothes. Shorts should be long, capris are better, spaghetti straps are out. Pack your own twin-size sheets and towels.

I was very glad I had my laptop. If you can bring one. The center computer has access to the internet, but you must buy a pre-paid internet card (available at Victoria Mall, up to 20 hours of use for 100 pesos). The center computer is often occupied, so having your own computer helps. You can buy an international phone card to call home, they cost about $10 for 20 minutes. It is cheaper if your family gets an international card online such as mozcom, and they call you. You can get cards online that are as little as 8-12 cents per minute. I would call my family, and then tell them to turn around and call me back.

I bought a used cell phone while I was there, which gave me easy access to talking to my family in private, in my room, plus access to being text'd by other midwives. If you are planning on taking continuities, I highly recommend a cell phone where they can text you if you have a continuity client come in in labor. With the phone, sim card, and pre-paid calling card, it cost me about $100.

It is always appreciated if you bring a donation for the birth center with you. They are in need of gloves, digital thermometers, baby blankets, gestational wheels, they could use a new doppler, meds such as lidocaine, cephalexin; for mountain outreach, they could use tylenol, children's tylenol, other meds such as antibiotics including children's antibiotics (the kind that mixes with water), and a good, professional otoscope with a good selection of different sized ear pieces, especially pediatric and infant sizes.

Erase all expectations of what it will be like, and you will be much better off. Be kind to the midwives, even if you see things that you disagree with. Take what you like and leave the rest, and give honor and respect to the women who work there under some really tough conditions.

Last but not least, don't forget your bible, and get your head in it every single day.

To contact me: shiphranita @ yahoo.com 1