Sunday, March 30, 2008

Full Circle.

After working over 21 hours on Friday, a restful weekend was welcomed. The rain has slowed and the sun has returned ferociously. Sunday afternoon, after spending the day in the sea, marveling at starfish and delighting in homemade coconut ice cream, I was excited to get back to the maternity ward.
I walked in a bit past 4:00pm, took a look at the board, checked out some charts and was approached by a mama who wanted to sit-sit (push). We went into the delivery room and 6 minutes later she had a small boy. This was her 6th pikinini and I’m not sure she even broke a sweat delivering him. There was quite a bit of meconium in her amniotic fluid and the baby came out a bit floppy (or as they call it here-flat). I wiped the young one’s face, talked to him a bit and within seconds I could see (or feel?) his spirit arrive in his body. He opened his eyes, quivered his bottom lip and let out a wail. He was just fine.
I spent the next 2 and a half hours admitting 5 more laboring women, four of which were in premature labor. These four got a combination of nifedipine (a tocolytic used to stop the uterine contractions) and dexamethasone (a steroid injected aimed at helping mature the fetal lungs). For laboring women, the protocol at this hospital is to assess them about every 4 hours, offering a bed to those in early labor (less than 4 cm dilated) and encouraging those in active labor (more than 4 cm) to ‘walk about’. The laboring mother, I’ll call her Eve from here on out, was only about 3 cm, so she was given a bed in the antenatal room. She was a quiet, young woman, only 23 years old, having her second pikinini. She whispered almost everything, and was timid in her responses and way of walking. She looked down at her feet when she spoke. I admitted her, checking the baby and her vitals. The CTG (cardiotocogram, or electronic fetal monitoring strip) looked good. As I reviewed her chart, I noticed that she was a victim of domestic violence and was still married to her abuser. Perhaps her timidity was more than just a cultural manifestation?
An hour later I heard a woman’s cry just outside the labor ward. One of the midwives and I went out to quickly assess the scene, as we both thought there was a woman having her baby just outside the entrance. We stepped out the door to find a procession of women…grieving. Their son/brother/husband/father had passed only minutes before. Just 35 years old, died from lung cancer secondary to liver cancer. Their cries permeated the ward and the night sky seemed to lose a bit of its luster. Death. The other side of life. Inevitable, really. Almost always excruciatingly difficult for the ones left behind.
Eve approached me at around 9:20 saying she felt she had to push. It had been just under 3 hours since she was last checked. We went into the delivery room to assess her cervix. Fully dilated. Immediately she began to push and the midwife present drew up the syntocin, an injected medication routinely given after the birth of the baby to help decrease the incident of post partum hemorrhage and speed the delivery of the placenta. The baby came quickly, just 7 minutes later. It was flat. I wiped the baby’s face, clearing meconium stained fluid from her eyes and lips. I rubbed her chest and dried her off. No response. I felt for her heart rate at the junction of the umbilical cord and her belly. Nothing. Per hospital protocol, the cord was clamped, cut, and the baby was taken to the warmer where oxygen administration was initiated. Keeping my eye on the mother, for she still needed to deliver her placenta, I approached the baby girl. One minute Apgar of 0; no heart rate, no respiratory effort, no muscle tone, pale in color, and no response to any stimulus. After a bit of oxygen, I started chest compressions and called for another nurse, who arrived shortly with a pulse oximeter (a device used to monitor oxygen saturation of the blood). She immediately calls the pediatrician. I continued resuscitative efforts for the next 6 minutes (which seemed like an eternity) until the doctor arrived, upon which she took over my role and I went back to the mother as her placenta was just beginning to detach and needed to be delivered. I prayed to the Creator to be present for this young one, for her mother, for her family. After 15 minutes of resuscitating, the pediatrician called me over. She opened the baby’s eyes with her fingers and shined her light in. No response. The pupils were dilated, fixed. She called the time of death: 9:40 pm. Apgar scores at 5, 10, and 15 minutes, 0, 0, and 0.
She walked over and informed the mother. I took the placenta in to the workroom, attempting to hide my tears from the room. The doctor approached me and smiled. This stuff happens, she said. She felt fairly certain that the small girl had died in utero. A fresh stillborn. With absolutely no response to any form of stimulus, lungs full of fluid, an absent heartbeat, and her clinical experience, she diagnosed the loss. There was nothing we could have done, she said. She asked me if this was the first one I’d seen. Yes, I replied through silent tears burning my eyes and stinging my cheeks. It gets easier, she assures. (Really? I thought…and doubted). After a few moments of stolen, sobbing filled solitude, I went back to the delivery room to speak to the mother. I gave her my sincerest apologies and asked her if she wanted to see her daughter. She shook her head no and immediately said yes. Yes, I do. I brought the small one over to her mother and helped her uncover the face of her daughter. Beautiful little girl, slightly blue in color now. Her mother touched the face and chest of her daughter and closed her eyes. The father and aunt came into the room, both having been informed by the doctor. They surrounded the mother and her baby girl, and I stepped out of the room, once she let go of my hand. For the next 5 (or 20?) minutes I sat in the dark in the break room, trying to make sense of what had just happened. Nothing came. No reason, no rationalization. Nothing.
I was reminded of the times I’ve counseled people through their own grieving process. Death is another phase of life. A different door that opens while an all too familiar one closes. A completion of the circle. While I truly believe those words intellectually, my emotional body was having a quite difficult time resonating with them. In this moment, they were complete bullshit. I could speak them, but was not yet ready to own them. My head spun.
I went back into check on Eve. She was alone with her daughter, cradling her in her arms, and they both appeared to be sleeping. I didn’t wake her, I just witnessed. Trying to hold space for her and her daughter. I prayed for the spirit of her daughter that never seemed to reach her physical body; for her strength as she grieved the loss of a child; for compassion for the husband/father; for the family and for the community. She woke, offered a weak smile and said, “I’m so sorry for my baby”. I’m sorry too.I wheeled Eve back to her bed and told her to try to get some rest. I then went back to the delivery room to get the small one. I picked her up, taking her into the pediatric workroom, managing to make it through the halls without audibly sobbing. My silence was brief. I lost it. Entirely. So there I was, weighing a lifeless infant, wrapping her in her warm blanket and cradling her. Both of us covered in my tears.
Please, keep her in your thoughts.

Friday, March 28, 2008

One smol Sunita blong Vanuatu!

Yesterday was a very special occasion…the first baby named after one of us! Apparently it is a phenomenon that mothers, or sometimes the midwives, name the babies after visiting midwives and students that they like very much. There are a few Tracy’s, Molly’s, and Tara’s running around Vanuatu, and just recently a nurse named her granddaughter after a midwife from New Zealand that she befriended during her stay here.

Just this past week three of the midwives told me that they liked the name ‘Sunita’ and were threatening to name someone after me…now there is another smol Sunita running around Vanuatu! Well, not running yet, as she is barely 24 hours old…and it suits her because she was a very naughty little girl and decided to be born with both of her arms across her chest. Her mother had to push for an hour, which by Vanuatu standards of pushing is a VERY long time. It was extremely hard work for her, she was pushing so hard and the baby was coming very slowly. The mother asked us to cut the baby out a number of times and we had to calmly, and sometimes sternly, coach her to push and assure her that she had plenty of power.

Little Sunita was her second baby, but her first child was born by Cesarean section after prolonged labor and fetal distress, so effectively this was the first time she had to birth her baby vaginally. Here in Vanuatu they do not automatically sign someone up for a Cesarean section if they have had a previous one; they allow a trial of labor on well-healed scar. This type of birth is commonly referred to as VBAC: Vaginal Birth After Cesarean. This made the “prolonged” pushing stage trickier to manage because I wanted to coach her to push effectively and also be mindful of this being a VBAC, which is a much bigger issue in the States both politically and in practice. However, here in Vanuatu, we have already seen many successful VBAC’s and it definitely adds flavor to my brewing thoughts about the lack of availability and support for VBAC in the States…but we’ll save politics for another time.

What was also lovely about this birth was that I was able to use my French! There are a number of French speakers here in Vanuatu, and one of their three television channels is in French. This mother is a teacher at French-immersion school and spoke fluently. Although I am not a fluent speaker and am out of practice, words came flying out of my mouth and it felt good to finally be able to truly communicate with a mother here. Even though we try with Bislama, our skills are limited and it is rather unintelligible to women who are not from Port Vila or Efate because there are many different languages in Vanuatu. I think that the fact that I was able to speak with her in French made her feel slightly more at ease and take on the task of pushing so hard for one hour. It also reminded me how important it is to have at least one support person who is on her side (whether from her language group, religion, race, or family) to support a woman through the incredible work of birth. Even within the same country, hospitals and medical institutions are a different culture and the people in them speak a different language; a doula or someone who can function as an ‘interpreter’ to straddle that cultural gap can be invaluable.
To end the evening, I had to write my own name on the baby’s birth certificate, which was a very strange and also proud feeling. For those of you who have slightly more unusual names, it’s not often you encounter someone else with the same name, let alone write it as someone else’s! And it doesn’t hurt that the ‘someone else’ was a very cute baby! Now I am off to do a lot of nothing on my stunning day off…working on my excellent tan, Vitamin D levels, and floating skills. Seeing as how the three of us have split up in to different shifts, you are likely to be treated to more variations on the same day. Enjoy!! Love, Guess who

Thursday, March 27, 2008

Finding the rhythm. . .

We are settling in nicely. Yesterday was a gorgeous day off with brilliant blue skies and a hot, hot sun. Our Seattle-pale skin is browning nicely (Sunita obviously in the lead, Kat coming in second as my meager celtic melanocytes struggle to keep up. We visited the Mele-Maat cascades – an amazing set of waterfalls with a number of shallow pools for swimming. You are able to swim right under the waterfall, letting the cold, pounding water temporarily relieve the heat of the day. Quite amazing – we have a lot of waterfalls in our collective experience and all agreed that this one was one of the best. We are working 4 days on, 1 day off. Kat and I took the am shift today – starting at 4am and staying til around 3pm, Sunita is at work now on the 3-11 shift. We are kicking it into high birth gear – planning to work long hours for the next ten days and then maybe take a few days off to adventure around to the surrounding islands (there is a live volcano that is calling my name). Averaging about 3-4 births per shift, more on a busy day.

Today started out with the observation of a vacuum assisted delivery – a first time mom with a “prolonged” pushing stage. Most women, even first timers, push their babies out in short order here – the 3 plus hour sessions we host in the states are completely unheard of. This woman was making slow progress after 1 hour and the OB was called in. The vacuum was used and baby came out with quite a cone head. Kat and I agreed that with some creative positioning and patience, the baby would most likely have gotten out on it’s own. However, the heart rate was starting to show signs of stress and the culture here doesn’t really go for pushing in any other position besides on the bed on their backs. For an instrumental delivery, it was fairly uncomplicated and a good learning experience.

Next up was a first time mom who went from 5 cm to complete in less than 2 hours and then proceeded to push her baby out in 15 minutes. That is a pretty normal timeline for the women here. Delivery was quite smooth, but there was a relatively complex (at least for a novice like me) 2nd degree (into the vaginal muscle, but not extending into the anal sphincter) tear. I have to give myself a little bit of pat on the back for a job well done. With the guidance of Kat and a senior midwife, it looked pretty darn good. (We have been studying our Ann Frye suture book religiously and are feeling like our techniques are really starting to come together – no pun intended).

To end the day, a sixth time mom showed up and had her baby in the admissions room. Normally a woman shows up in labor, we get her chart from the antenatal care department, take her vital signs, get a history of her labor (when did contraction start, is the bag of water intact, any bloody show – all done in Bislama mind you), do a CTG (electronic tracing of fetal heartbeat and contraction pattern), followed by a vaginal exam to asses dilation. Five minutes into the CTG, we heard the telltale signs of second stage. Kat lifted the woman’s dress to do the cervical exam and saw a crowning head. I managed to run to the delivery room to grab our tray of instruments: surgical gown, sterile gloves, cord clamp, gauze, towel for baby, suture tools and kidney pan to catch the placenta. Kat slid on a pair of gloves and barely caught the baby.

My greatest lesson so far, and one of the best gifts of this experience, is the reminder that birth works. The cervix dilates, the mother pushes, the baby is born. These women don’t have childbirth education, don’t take prenatal vitamins, certainly haven’t written a birth plan, many have had little, if any, prenatal care. And yet their babies come out. Always without pain relief unless undergoing instrumental delivery, 99% breastfeeding easily within the first hour. Why does it seem so (relatively) easy here and become so much more complex at home? I can’t really say – maybe it is because these women know that their only option is to push their babies out – there isn’t an anaesthiologist waiting down the hall to make the pain go away; maybe it is because they have seen their mothers, aunties and sisters push out babies and breastfeed them – an experience most US women lack; maybe they posses some physiologic/genetic difference that makes these women bad-ass birthing machines. I’ll let you all know once I figure it out.


Monday, March 24, 2008

A day in the life...

After a lovely weekend off, some actual sunshine that toasted our skin nicely, we headed back to work this week. Now that we are more comfortable with the pace and procedures of the maternity ward, we are trying our hand at working in the evenings and nights, when they are less staffed and more babies generally like to be born. (Don’t worry families! We come and go safely…)

For those of you may be wondering what this hospital even looks like, how it is set up, or who we work with, here’s a little taste…. Unlike the US, most of the babies here are born with midwives. These midwives are trained in natural childbirth (they don’t use or need epidurals except for Cesarean sections), hemorrhage management, IV’s, neonatal resuscitation, episiotomies, and suturing, as we are in the States. In fact, until about 10 years ago, some of these midwives were also performing occasional vacuum extractions! Several of these midwives also have some experience catching babies at homes in the rural areas of Efate (the island we are on) or other islands of Vanuatu. We also work alongside RN’s and nurses aides, specializing in obstetric care, who help the ward and the nursery run smoothly, administer medications to moms and babies, and assist with births.

There are two antenatal beds for mothers who come into the ward in labor where we listen to the baby, assess contractions, and perform a vaginal exam to determine whether a mother is in early labor or ready to stay. Mothers often come in with their mothers and sisters, and occasionally a partner or husband. They must bring all of their own stuff: clothes, water, food, baby diapers and clothes, soap, powder, pillows, and mats for their family members to sleep on beside their beds. There are four beds for mothers to stay in when they are in labor, which we also use for mothers who are recovering from Cesareans. Sometimes all of these beds are full and mommas are up and about strolling the hall! The general ward has another 20 or so beds of moms and babies in various stages of postpartum recovery (most stay about 2 days).

The actual delivery room has 4 beds partitioned by curtains and made up very simply with a sheet, a macintosh (plastic or rubber landing pad that the mother lays on), and a pillow. Sometimes, like our busy day on Friday, they are all full of mothers having their babies at the same time! In the times we are not delivering babies, we are admitting or discharging mothers, performing baby exams, cleaning delivery rooms, making mid bundles (our birth kits of instruments, gown, and gauze), folding gauze, making cotton balls, making up or cleaning up beds, and basically doing any possible task that needs to get done no matter how big or small.

Our team here is incredibly lovely and welcoming, interested in teaching, and very laid back. They have all inspired us to walk just a bit slower, talk a bit more softly and slowly, and approach even emergent situations with a calm, assured presence while doing everything that is necessary to secure the safety of the mother and baby. I am pleased to watch and learn their approach to these situations; if I were a newborn baby I think I would rather have someone talking softly to me, inviting me here, and explaining why there is a tube in my throat rather than people talking about me and hurriedly shoving things in my mouth. Don’t mistake the calm for inattentive; these midwives have seen babies die or struggle. There is simply more space in their life and practice for the possibility of babies not making it, and as a result, they know when a baby is truly in trouble instead of approaching the entire process with fear.

There is definitely no shortage of learning here, and I am sure the remainder of our time here will provide many good stories! Till then, Sunita

Friday, March 21, 2008

Pretty place...and the seaside outside our hotel

The market where we buy our goodies....prices are written on the fruits and veggies...100vt is $1
Our gear...

The view from our balcony at Kaiviti....

Return of the cankles...

You know how babies have such chubby legs that their calves blend into their ankles? Those are cankles. And we have them, again.

Why, you may ask, do you have cankles, again? Well, we were on our feet today for 10 straight hours catching non-stop babies in low-budget imitation Crocs (rubber garden footwear that are apparently very fashionable here in Vanuatu).

Perhaps it’s the thrill of Good Friday and Easter weekend, the full moon and beginning of Spring, or something was in the water today in Port Vila, but Vila Central Hospital was hopping with birth hormones! Today we started with a full house after our busy day yesterday, and momma after momma walked in the doors in very active labor. The nurses went about their business discharging many of the mommas who were either ready to go or ready enough, so that we could make room for the incoming mommas.

The first momma to start off our morning came in visibly working hard, which is actually quite different than most women here. They tend to labor quietly and take many events of labor in stride. Apparently our first momma, who was also a first-time mother, was in transition and she was completely dilated and pushing within half an hour of walking in the door, and had her beautiful baby half an hour later into Caitlin’s skillful hands. Our second momma to walk in the door, literally minutes later, was also a first-time mother and flew through transition to having her baby about an hour later without a tear. Our third momma, who had been there since earlier in the morning, was having her fourth baby through thick meconium and had a very stoic laboring style. It also happened to her birthday, and she was very happy to have had Kat as her fantastic midwife!

The fourth momma was also having her fourth baby, minutes after walking in the door, and Caitlin did a fantastic job single-handedly managing the birth. Simultaneously, I was managing a birth of a second-time momma who walked in the door and stated that her baby was coming. The baby was born literally 12 minutes later! Clearly the day was filled with many laboring mothers, beautiful babies, and a great amount of faith in the birthing process. Additionally, there were many opportunities to hone our skills in perineal support (with some new tricks), cord reduction (unwrapping the cord from around the baby’s neck), and suturing.

Our sixth momma was actually someone who we sent home two days ago because she was in very early labor. She came in today at 8cm, but unfortunately her baby was having severe decelerations to nearly 50 beats per minute (normal fetal heart rate is 110-160 bpm). The doctor on-call broke her water (ruptured the amniotic sac) and discovered very thick meconium, and made an immediate decision to perform a Cesarean section. I was called in to help with the baby who was born with an Apgar of 1 (some heart beat but below 100, not breathing, limp, pale, and no grimace). It took at least 10 minutes of resuscitation to stimulate a normal heart rate and have the baby breathe on her own, which feels like 2 hours when you are eye to eye with a small creature that is barely alive. Once she was breathing on her own, with difficulty, I brought her to the warmer, placed her in the head box with oxygen, and sat with her as she decided to join us. She was later moved to the nursery and given antibiotics, and her mother came soon after to the ward to recover from her surgery.

One of our last adventures, literally as we were preparing to walk out the door, was with our very first momma who decided to take a shower and passed out. We helped her to bed and realized she was losing a great deal of blood. As a team, we carried her to a wheelchair, brought her to the labor room and proceeded to express several handfuls of clots from her uterus, with the help of one of the midwives. I placed an IV and she rested with several bags of fluids under observation. Our day ended with giving babies baths and bringing them to their mommas to cuddle. No giggles this time…..just cute little cankles to match our less cute ones.

Thursday, March 20, 2008

One dozen babies blong Vanuatu...

It’s nearly a full moon, which may explain why the maternity ward was in full swing today. 12 babies from midnight til six pm – a tie between six c-sections and six vaginal births. Four of the sections were planned (one previous c-section with an L-shaped scar on her uterus due to a complicated delivery of twins, one with 2 prior c-sections and a mitral valve replacement, two others for reasons unknown), one emergent section happened during the night (not sure of the indication) and one during our shift for a G8/P7 (G= number of pregnancies, P = number of births) mama who dilated to 7 cm, at contractions stopped, then there was meconium (baby poop in the amniotic fluid), and there were decelerations in the baby’s heartbeat. All babies and mamas were looking good, but it made for a lot of post-operative follow-up and many, many baby baths. The policy at the hospital is for every baby to receive Vitamin K and Hepatitis B injections, as well as a bath before being given back to mama. For Sunita’s first baby bath, she had 12 people watching her and laughing…and making commentary about her not having any pikininis (babies) of her own.

On the more normal side of things, three babies were born in the early morning, two just as we arrived around 7 am. Then after a relatively mellow morning and a successful trip to the market (we bought a 12-pound stalk of plantains for approximately one dollar), things got pretty wild. Our first mama was a G4/P3 woman who had a nice, uneventful birth – notable mostly for the fact that it was the first papa who joined us in the delivery room. Next, we had a first time mom with an entire labor in less than 4 hours; she surprised us by starting to push while we were busy cleaning up after the last birth! This baby needed a little encouragement to breathe, but was doing fine by five minutes.

Our last delivery was a little more complex. The baby was in a posterior position and was descending slowly – the midwife used her “special technique” to turn the baby into a better position. All I can say about this technique is that it involves inserting an entire hand into the vagina and manually repositioning the baby’s head, not something I have ever seen in the States, but it seemed to work and the baby began to progress. Once the head was out, Kat felt a tight cord around the baby’s neck. Under the midwife’s advice, Caitlin clamped and cut the cord on the perineum, and the baby delivered. Oh my, was that a pale, floppy baby! Another one of the midwife’s techniques involves holding babies upside down by the ankles – again, not something I am familiar with, but once again, seemed to work. It was quite a sight- a very, very pale baby hanging and gently swinging by its ankles. Baby began to breathe by about 1 minute, but remained pale and with poor tone for at least ten. Finally, he started to cry and pink up and, like 99.9% of the babies here, was on the breast and feeding vigorously within the hour.

It must be noted that this would be a busy day by most maternity ward standards, but now imagine a ward staffed with one midwife, two nurses and one nursing aide. They do all the deliveries, do pre and post op for the c-sections, take care of the 6 babies in incubators as well as the 5 other neonates undergoing continued treatment for other medical conditions, and the twenty-some post-partum beds. All this and they seem to end everyday laughing. Lukum yu! (See you)

We ended our day with a bus ride home, a quick dip in the pool, takeout pizza (yep, they have pizza here – hooray!) and a cold Tusker (Vanuatu’s local brew). After our 12 hour day, we are ready to climb into bed and dream about more babies to come.

Wednesday, March 19, 2008

Mifala save Bislama smol be mi traem tumas. (We know a bit of Bislama but I am trying hard)

Olsem wamen long u tufela? (how are all of you?)

Today was mellow day in the ward. Only 3 laboring women, none of which had their babes while we were on shift. We spent the morning following up with post-partum mamas and cleaning up the maternity ward. Apparently we are quite a sight as we help with the daily tasks of running the ward. The patients are surprised to see us working so diligently, as they rarely see foreigners making beds and collecting laundry.
For lunch we walked down to the market for our daily repast of fish and rice. And, today we found chiles!! …Sunita was very pleased. After grabbing a couple paw paws and passion fruits, we got caught in a torrential downpour on our way back to the hospital. Despite hopping in a bus halfway back, we were soaked entirely.
Arriving back in the maternity ward with our dripping clothes, we dried out in the tea room, spending good quality time with the sisters learning and practicing Bislama. There, we surprised them with our small Bislama knowledge by telling them “mi fillup tumas” (“I am already full”) and “lukum titi basket blong Kat” (look at kat’s bra!…because her shirt was soaked through)…a joke made by Caitlin that was well recieved by the sisters. Learning Bislama is quite entertaining, moderately difficult, but quite entertaining. We have been choosing a phrase or two each day and practicing our small Bislama any chance we get. Caitlin’s enthusiasm is contagious, with each phrase she smiles as if it is the most awesome thing she could ever say.
Tata. Lukum u.(Bye. See you later)
ps. I had a the wet shirt on all day.

Tuesday, March 18, 2008

What a difference a day makes!

Today was a busy day in the Port Villa Central Hospital Maternity Ward. 4 babies born in the morning before we arrived at 7, and then 2 more before 10:30. Sunita was assisting Sister Leitangi (the head midwife) with one delivery, when the G6P5 (sixth time mom for the non-midwives), who had been laboring in the same room (separated by a curtain) started to push. Kat jumped in and delivered the baby (a six minute pushing stage) who had such a tight cord that it needed to be cut on the perineum. Caitlin took care of the baby, who needed a little resuscitation to come around (some stimulation, a few PPV breaths and a little time in the “headbox” – a hard plastic box that goes around the babies head and allows for the administration of supplemental oxygen). Both moms and babies were happily breastfeeding within the hour and we were all so happy to have been a part of the group effort.

We seem to be catching on quickly – when not doing deliveries we help to assess the moms in labor, do the newborn exams, help with postpartum discharge, follow midwives around, practice our Bislama and work on the mounds of paperwork that goes along with midwifery everywhere. We must be doing something right – Sister Leitangi got a phone call from one of the OBs requesting she send one of her medical students to help with a procedure. She firmly denied this request stating “midwifery student blong me.” We agree and are totally happy sticking with the midwives.

Jetlag-wise we are doing pretty well. Vanuatu is 18 hours ahead of Seattle. Still getting really sleepy by about 8:00 at night – but this could be due to the fact that we are walking a few miles back and forth to the hospital and the market, working ten-hour days in the heat and humidity and coming home to Sunita’s hard core yoga sessions. Haven’t yet got to the beach or the kava bar – but we have big plans for the weekend. . . .
Ps – We are taking awesome pictures, but they take forever to load. Planning to hit up an faster internet cafĂ© this weekend and we will post a bunch.

Love to all!!!!

Monday, March 17, 2008

First Day!!

Today was our first day at the hospital! We went in the morning after rounds and stayed for the day shift. We will be doing the day shift (7-3) for the first week to get familiar with the procedures, then most likely move to the nights shifts (either 3-11 or 11-7), since most of the babies are born at night. 103 babies have been born in March so far, over 200 were born in February. Today was pretty mellow – 3 women in labor, none delivered by the time we left, we will most likely meet their babies in the morning. Sister Leitangi (the head midwife) showed us around and introduced us to all the other midwives, nurses and nurses aides. Everyone is very nice and helpful – we brought in brownies that we made, as well as some donated amnihooks (for all the non-baby catching folks – this is an instrument for breaking a women’s bag of waters during labor). Both were quite well received.

We amused everyone with our primitive attempts to speak Bislama. The phrase of the day was “Tangkyu tu mas” which means thank you – tomorrow we are working on “Oslem wanem” (how are you) and “Kae kae ya i numbawan” (the food is excellent).
We are amusing ourselves with the fanny packs and crocs we are wearing to the hospital – very fashion forward! Our tans are not going so well as it as been pouring rain – but we are keeping the faith that the sun will shine soon. Our biggest adventure so far has been going to the local market to eat lunch and buy fresh fruits and vegetables – an amazing array of papaya, banana, coconut, green beans, ginger, green onion, pineapple, peanuts, manioc/cassava greens, avocado, plantain, peppers and a number of unidentifiable specimens. We are trying to eat like the locals – focusing on rice and fish and produce. Pretty tasty overall.
We will keep you all updated as things get more exciting. . .

Saturday, March 15, 2008

Safe but weary...

Hello! We have arrived in Vanuatu safe and sound, after a very long but uneventful trip. We are now enjoying some tea on Sunday afternoon, as we are 18 hours ahead of PST. It is a beautiful, humid, incredibly dense tropical island. Today's events are simply to clean up, settle in, and hit the sack early for our first day of work tomorrow.

Monday, March 10, 2008

Sunday, March 9, 2008

As we get ready to embark on our adventures in Vanuatu, we are incredibly thankful for all of the wonderful support we receive from our program, donors, family, and friends to have the opportunity to do what we do. Thanks!