Thursday, November 11, 2010

Last day in Vanuatu

Oh it is so sad to leave. Today was our last day at Vila Central Hospital in the maternity ward. The midwives were sad to see us leave and so grateful for our help. They presented Susanne and I with little gifts. We brought a big chocolate cake, biscuits, soda and chips. Not the healthiest of snacks, but they loved it.

Susanne and I each delivered a couple babies today. No suturing though. My first baby was very tachycardic (190-200 beats per minute). We started an IV with normal saline, but it did not help. As soon as she was fully, she pushed so strong she got a nose bleed. I have never seen that before. But baby came out (in moderately thick meconium stained water) and was fine. No problems. Later, she could not pee so we put in a urinary catheter. Out came 750ml of urine! So much. Then I pushed 3 large clots out of her uterus.

Tonight we have gathered a bunch of locals and non-locals to go out dancing. Yay. Then at 7am tomorrow we leave for NZ. Hopefully tonight we won't be out too late :)
Now off to town to pick up a bag of powdered kava to bring a friend in NZ, a quick swim in the pool, kava, dinner and dancing.
Peace and love (and kava!),

**Elias, I never got the CDs but I do have a note for you from MW Sam.

Wednesday, November 10, 2010

Over 100 births total...

Hiya! Again, sorry about not writing in so long. Total births my whole midwifery career: 107!! Tomorrow is our last day in Vanuatu, I am a bit sad to leave but also looking forward to our next adventure in New Zealand.

I forget where I left off last time, so sorry if anything is repeated. A baby was born was a huge tumor on its lip, which it kept trying to suck. The peds docs did surgery and it looks amazing. That baby will not even have an outside visible scar.

Last Friday there was a 5.1 scale earthquake here. Susanne and I were reading by the pool, and the ground was shaking. She thought I was pushing her chair, haha, but no. I did not hear of any casualties or damage done by it. The funniest part was the reception lady was in the toilet when it was happening and she thought the plumbing was acting up. On a totally separate note, the brand of toilet paper at our hotel is "ABM." I find that quite funny.

Today a baby was born acynclitic (head was a bit crooked coming out). The momma pushed for a very long time, eventually the midwife in charge cut an episiotomy, and baby came out with the longest/most crooked head ever. Both momma and baby were fine. I helped suture the episiotomy.

Lots of other NSVDs (normal spontaneous vaginal deliveries) at the hospital.

Outside of the hospital, we have been having lots of fun! We went to Blue Lagoon, a lovely little lagoon where the water is a mixture of sea water and fresh spring water. There are several rope swings, where first you climb up on a tree and swing into the water. It was great fun, but I have some sweet bruises on my inner thighs from gripping. Ouch. I took a picture :)

We also went to White Sands Beach and swam in the ocean...the proper ocean, not a harbour or lagoon. The water was so warm and nice, and the sand was white and soft. We got a lot of sun that day. Still working on our killer tans :)

Yesterday we went on an island tour to Lelepa island. We caught a small ferry boat there, did a mini medicinal herb walk with a local guide, snorkeled in the sea, had a yummy BBQ lunch, saw a big cave (where they used to take lepers to live out their final days). Then we fed some fish chicken bones (from our BBQ) and bread, while in the water snorkeling. They were right up in our faces, I even touched some. The snorkeling was unbelievable, saw some huge and brightly colored fish and lots of cool coral. Then a boat ride in the choppy ocean where we all got soaking wet, finishing at a little village where I bought my mum a gift :) Overall, a great day.

Tonight we are going out with the lovely NZ midwife Christine for a Korean dinner. Should be good. Tomorrow we are bringing cake and biscuits to the maternity ward for a final goodbye party. And we brought the midwives each a shirt "Support Your Local Midwife". They will love them. Then tomorrow night BIG partying, lots of dancing, maybe a few cocktails.

Our time here has been amazing, life changing and so rewarding. I learned LOADS, had so much fun and feel like a more confident and competent midwife.

Not sure if I will blog again, maybe a quickie from NZ. Thanks for reading and following and leaving comments (if you did).
Be well! Peace and love,

Wednesday, November 3, 2010

Ups and Downs

Hi again, been so busy lately have not had much time to write...and no access to internet either. Today my friend Jeremi let me borrow his computer, cheers mate!

It has been a whorlwind of emotions for me, both in and out of the hospital. Last Saturday (30th of October), I helped deliver a VBAC (vaginal birth after cesearean, she had previously had a prolapsed cord). The woman was making noises like a hose whinnying (it made me smile, but not in a sadistic way). As she was pushing and I could start seeing the head, a steady trickle of blood started to escape. It was more than I wanted to see, and I could not see any tears. At first I thought, "Shit, maybe the placenta abrupted a bit." I listened to the fetal heart tones and they were fine. As the head crowned and came out, more blood came. The baby came out, and with it more blood. She was given an injection of Syntocin and the placenta quickly delivered. Still more blood. I rubbed her uterus which was very firm, so the blood was not uterine. I checked for tears, using gauze to try and wipe away the blood, but it could not be wiped away fast enough. So, I inserted a finger and felt for tears. On the left side of the vaginal floor my finger sunk DEEP into a tear, and I could feel the blood pulse out with her heart beat. Shit. I had the midwife in charge call the OB (who thankfully was in the hospital) and I packed the vagina with gauze to try and put pressure on the bleeding vessel. The blood was soaking through the gauze and pooling on the sheets,. It clotted and was an inch thick. I was worried, though I remained calm and spoke clearly to the woman and told her what was going on. She was a sweetie. The OB finally came in, had a look, and decided to wheel her off to the surgical theatre to deal with it. Over an hour later she was wheeled back in, with a third degree tear and a lot of blood loss. In just the time I was with her, I estimate at least 800ml blood loss, which is a lot for Vanuatu. I can't even imagine how much more she lost in the theatre. This was the first time I was VERY grateful to be delivering babies in a hospital setting.

I was a little shaken from this, but the next birth totally redeemed my love for midwifery. A G2P2 momma pushed for only a couple minutes, out came a lovely baby, no tears and no blood loss. Such a contrast to the previous birth.

The next day Susanne delivered a baby with gastroschistisis (spelling??), its insides were born on the outside. I wasn't there, but apparently everyone but her stood there in shock and didn't know what to do. The intestines were covered with saline covered gauze. The baby is still alive, and if it makes it until Sunday some doctors are coming from Figi to do surgery. But, it is looking very pale and vomiting meconium and probably will not make it.

Follow up: the baby who was brought in dead from the mum who killled it...the mum was taken to jail. THe sad thing is, what she really needs is some mental health help, which she will not get here. She probably came from an abusive family or was a rape victim, but she will not get the help she needs.

The baby who was born breech and needed resuscitation died. It was seizing and had brain damage. Sad.

Two days ago I delivered two babies. The first one was a lovely birth, and I sutured a first degree tear. The second baby was born with club feet. It will likely be given some sort of therapy, but perhaps not for over a year when a volunteer medical team comes from NZ. Maybe they will do boots or braces.

It has pretty much turned into the tropical rainy season here. Sunshine in the mornings (which we are avidly soaking up) followed by torrential rains in the afternoons. And, I freakin lost the umbrella, darn.

Only one and a half weeks left here in Vanuatu. I am up to 34 births now, and only need 4 more to reach 100 total.
Be well,

Wednesday, October 27, 2010

30 babies and counting...

Hi, sorry it has been a while since I have written. I have been super busy and have had no time for internet. And thanks for all the kind words from my last post.

So much has happened. I have know helped 30 babies come into the world. I only need 8 more births here to reach a total of 100 ever. So good. We still have two more weeks here, so this is totally possible.

Last week I saw my first breech. I was horrified at the management of it. The midwives called in the OB (who is a resident and simply sucks) and the main OB in charge. I was always told for breeches that hands off is the best way to deliver. The resident was ALL HANDS ON, and was fussing all over with the baby and vagina. It was a frank breech (butt came out first). The OB in charge told her to deliver the legs and bend the knees. She couldn't figure out which way to bend the knees, so she hyperextended them! I was grimacing the whole time. Then she delivered the arms, and let the baby hang from the vagina (which is fine). When the momma went to finally deliver the head, the head popped out and a HUGE gush of amniotic fluid came out and went all over. With the fluid, the placenta was delivered and the umbilical cord broke. We have no idea how long the placenta had been detached. Baby was immediately taken away for ventilation (with bag and mask), chest compressions and epinephrine was injected into the umbilical vein. Baby's apgar scores at 1 minute, 5 minutes and 10 minutes were all zero. So bad. Baby did eventually breathe a little, but has been in the nursery ("NICU" kinda). It was seizing the next couple days and had an oxygen saturation of only 60%! It will not make it.

A couple days ago, the first baby Samantha was born. The grandpa insisted the baby be named after me, he was so cute. He alse MADE ME wash the baby ("swim the baby") and dress it. Baby Samantha loved the bath, she was so cute. Glad my namesake wasn't an ungly one :) Allison has had like 15 little babies named after her, but just the one for me. They can't even say my name 100% correct, haha.

Today saw another kind of brutal birth. A first time momma, with a long pushing stage. After an hour of pushing (which is already forever long here!), I decided to put an IV in and give her some normal saline. I thought a little hydration would do her good and maybe perk her up a bit. It did help. She pushed for another 45 minutes. As baby was just about to crown, a Chinese doctor came in (the Chinese doctors here are not well liked by the Vanuatu people, and she speaks almost no English or Bislama). She stood on a step stool and put all of her weight on the woman's belly to push the baby out. It did work to help get the head out, but it was brutal. Then, the head was out and I checked for a cord, there was one, but it was loose so I left it. I was applying some downward pressure to get the anterior should out and the Chinese doctor said I needed to push harder. I was doing it fine. When I didn't do what she demanded, she pushed me out of the way and ripped down on the baby's head. Honestly, I am surprised the baby does not have a brachial plexus injury, ohhh so bad. She was manhandling the baby and the woman ended up with the biggest, messiest tear ever. It was only a second degree tear (goes into the muscle layer), but it extended from the top of her left labia minora, into the vagina (where the deep part of the tear was) and down the perineum. I have never sutured something that big, but honestly I did a good job. Love the subcuticular stitch!

Other than that, life is good. I finished my scuba certification and plan to do an advanced course. Been swimming almost daily in the ocean, so freaking great. In fact, I am going to go swim right now. Peace and love,

Sunday, October 24, 2010

Horrible and scary story, read at own discretion...

Hi again. So, lots has happened. Hmm, where to start.
Yesterday at the hospital was a crazy night. First, we had a woman who was 5cm dilated and was having huge late decels (the baby's heart rate decelerated after the peak of contractions=bad). It got as low as 50 beats per minute and was lasting over a minute, regularly. She was dilating quickly, and ended up having a vaginal birth and baby was fine (though small at 1.9 kg). The baby's eyes did do a weird shaking thing, which I have never seen.

Second mum I helped deliver, G3P3 (3 pregnancies, 3 births), no tears, no problem.

Then, a mom and her family came into the hospital. The baby had been born "in the bush"and was wrapped up in a blanket and was handed to the midwife. I was busy making cotton balls, but I wanted to know what was going on, so I went into the labor ward. The mum needed suturing, so I helped Susanne draw up Lignocaine (like Lidocaine) and she sutured the second degree tear. Susanne said this may be a police case, the baby was dead. After helping suture, I watched the OB (who was specially called in) examine the baby. The baby's face was covered in blood, and the body was covered in dirt and leaves. Blood was coming out of its mouth. There were small bruises and lacerations on the baby's nostrils and on the neck (where the carotid arteries are). This is what the mum told the midwife: she said her baby was only 6 months along (which it was not, it was definitely full term and a good sized baby) and she was out in the bush collecting oranges. She said she jumped up with a stick to get an orange, and when she landed back on the ground her baby "fell out" and hit its head on a rock. She said it died there (there were no marks on the skull and no broken bones, though the x-ray report has not come back yet). She delivered the placenta, left it and the baby there, took a bath in the ocean, and then went home to take a nap (leaving the baby alone, dead, in the bush). Later, her mum asked her what happened and she said her baby fell out and she left it in the bush. Her mum made her come into the hospital. So, a police report was filed. I could not get the picture of the dead baby out of my mind for the rest of the night. It was sad. The mum was kept at the maternity ward over night, and lots of security guards were around. I don't know what is happening now, but I will keep you posted when I find out.

Susanne (who says HI!), caught the next baby, a G2P2, no problem. The next woman, I helped deliver (G2P2). I got to suture her two second degree tears (they were deep, between the vaginal floor and labia minora, a tricky spot to suture, but good experience).

Other than that, not much else new. Oh, we have been swimming out in the harbor (Molly, we go past the helicopter pads to the rock in the ocean). It is super sweet, and a good swim. Sorry if this blog is choppy, I am a little intoxicated :)
Peace and love (and Southern Comfort with Coca Cola),

Wednesday, October 20, 2010

20 babies and counting...

Hi again. Still love it here.
Last night was kind of a blood bath at the hospital. Both Susanne and I left covered in blood, amniotic fluid and sweat. But it was a good night, between the two of us we helped 4 babies be born. The first baby was the woman's fourth, easy easy.

The second and third (Susanne and I each had one) had similar labors. Both had an induction of labor with a 1/4 tablet of cytotec inserted into the cervix. Hours later both had labor augmentation with a drip of syntocin (same at pitocin or oxytocin). Then both took forever to fully dilate and ended up delivering the babies the same minute (8:10pm). During the whole labor we thought my woman's baby was OP (occiput posterior) due to the funny shape of her belly. There was a lump high up near her fundus and then a dip and another lump low down. The midwife in charge said that was classic for OP, but I had never seen a belly like that before. Eventually, I put in a urinary catheter hoping to speed things up a bit, nearly 400ml of urine came out (a lot!!) and the lump at the bottom was noticably smaller. So I wonder if it was just a distended bladder we were seeing for a long time. Poor momma. Baby was born with a nuchal hand and a nuchal cord, but she only had a very minor perineal tear. I sutured it up, perhaps my best work yet. I really and getting better at suturing. It is amazing what a little practice can do! Ha.

Susanne's momma had a retained placenta. 35 minutes postpartum the placenta was still inside, and this was with active management (giving 10 units syntocin with delivery of the baby). The midwife in charge called the OB to come and he did a manual removal. I don't know the whole story, as I was busy with my woman, but I saw him deliver it in chunks. She lost a lot of blood, and that was a mess to clean up. Blood everywhere.

The fourth baby was the quickest ever. I admitted the woman, checked her cervix (6 cm, BBOW, -1 station, 80% effaced) and listened to baby. Took some vitals and AROMed her (artificial rupture of membranes). She was told to go on a "walkabout" and when I saw her next she was lying on the bed with the baby crowning. I barely had time to put gloves on to support hte perineum and the head was out. Head and shoulder came out no prob, but when I had to PULL the baby out once it got to the umbilicus. That baby was huge! 4.3 kg (umm...over 9 pounds). A fat, happy baby. And a small small tear which I let Susanne suture.

Hmm...what else is new. Soaked up the sun some more yesterday on Erakor island. Ohh! Today we leave for an overnight trip to the island of Tanna where there is a live volcano. I am so excited! My whole life seeing a live volcano has been on my to-do list. Yay. I hope it doesn't rain, which could affect visibility. I even had a slight nightmare last night that we couldn't make it there (they wanted to see our birth certificates and we didn't have one and then my mum's car broke down and we never saw it). But, hopefully that will not be an issue.

So that is all for now. Elias, yes please post the comments I don't know how. Hope all is well!!
Peace and love (and delicious sweet potato hashbrowns...)

Tuesday, October 19, 2010

Anterior lips..

still loving life in Vanuatu. Two of the last three babies I have helped deliver, the mommas had huge anterior lips (a bit of swollen cervix in the front under the pubic bone), like nothing I have felt before in the states. I just had to keep rubbing it down and holding pressure on it. I'm sure it hurts like hell, to have me in there messing and pressing, but I need to when it gets swollen. Each of these mommas were trying to push before they were fully dilated. So with a lot of pressure, I shoved the last of the cervix up under the pubic bone and the babies descended instantly and came out with 3 minutes. They are amazing pushers here.

The second baby I helped with last night was born with a nuchal arm (her arm was up by her face) and a nuchal cord (cord wrapped around the neck). Both proved to be no problem at all, and she did not even tear! Quite a feat.

Yesterday Susanne and I did two scuba dives. We saw the remains of a crashed plane, which was cool, though I asked the scuba pro and he said it had been placed there for divers to look at. There was even a fake skeleton in a baseball hat in the pilots seat with a beer can in his hand. Monday we will do our last dive for our certification, I'm excited. I am such a water baby, and diving is awesome. Looks like I will be doing the advanced course by myself though.

Today we are off again to sun and swim on Erakor island, yay. Hopefully we will stop at a little local bakery on the way and pick up something sweet :) By the way, we have mastered sweet potato hashbrowns. So good!

Ok one more random thing. Yesterday I cut a few really hot chili peppers, and washed my fingers so many times, but my finger tips were still burning. It just so happened to by my right hand which I use for checking the cervix. So, last night when I was feeling dilation and my hand was inside the womans cervix it burned like hell. No fun at all.
Talk later.

Sunday, October 17, 2010

15 babies and counting...

Hiya! Last night we delivered two babies, and one again today. I am up to 15 now in less than two weeks of work. Getting some great experience and hands-on skills. I love it! They love having us here to help, too. In Vanuatu the nursing students must do 20 deliveries before they are on their own out in the rural communities. So, we have been helping them learn skills like vaginal exams, Leopold's maneuvers, perineal support and suturing. They appreciate it so much.

On Friday night, Susanne and I went out dancing with some ex-patriot friends we met here. We met a group of plastic surgeons from NZ/Australia who are here doing a kind of mission trip. They invited us to watch some surgeries, so today we donned surgical garb and watched them repair a cleft lip. It was so interesting and they did beautiful work! The two surgeons are so kind and explained everything and we had a good chat about midwifery/maternity care. Then they gave us a curry lunch and chocolate biscuits. Yum.

Tonight we are getting a ferry to Iririki island for the Monday night tourist special (free snacks, sangria and prizes). I'm hoping to win a sunset cruise :) Yesterday Susanne and I took a free ferry to Erakor island where we lounged in the sun on the beach all morning. It was paradise. The one thing they don't do well here is lemonade (just a flavourless sugary soda). I was a little disappointed.

Not much else new. Tomorrow we are doing two scuba dives, I can't wait. I love it! I am hoping to get my advanced certification after I finish the open water certification. Whoop whoop.
Hope all is well with you!
Peace and love,

Friday, October 15, 2010

The babies keep coming...

again I must say Vanuatu is GREAT! I love it here. Not only am I getting a super tan (yes!), the island life is awesome and the birthing experience is great. I worked the night shift Thursday night/Friday morning from 11pm-7am. I caught 3 babies and had some crazy experiences. The first baby came out fine, no issues whatsoever, no tears.

The second baby had some meconium staining in the water, and a tight nuchal cord. I didn't want to cut the cord on the perineum knowing it may already have a hard time breathing. The head came out, and no tear. THen I went to summersault the body out to keep the cord intact. I was supporting the perineum also, but somehow she ended up with a 3rd degree tear. I could see the shiny white rectal capsule and did not feel comfortable suturing that myself. I asked the midwife to help, and she had never seen that before either. She ended up suturing it, but I feel if I had to I would have done it the same way. The woman was so calm and patient and did not bleed much.

The third baby came out fine, no tears. The umbilical cord was super thin and weak. After I saw a little separation bleeding (meaning the placenta is ready to come out), I was tractioning the cord (not even very hard, I have done it way harder on other women before with no issue). All the sudden, the cord broke off, there was not ever a snapping feeling. It broke off right at the base of the placenta. I was like "Shit!" but didn't say it outloud. Some of the amniotic membranes were dangling out, so they were able to be grabbed gently with forceps and the placenta gently worked out. It was scary for a few minutes there though. After that, all was well.

Yesterday I did a half day horseback ride. It was the best ever! I went with a woman from my resort, and we rode in the jungle, over some plantation areas and in the ocean. We took the saddles off the horses and just wore our bikinis and literally rode in the ocean. Not just the horses feet, they were practically swimming. The water was over the horses back, so I had to hold onto the mane to stay on. It was the best ever, and the horses didn't seem to mind at all! Today my adductors are a bit sore, but well worth it! And the horses don't know how to nicely canter, they full out gallop. I haven't run that fast on a horse since I was 15. Awesome.

Today Susanne and I are working at the hospital from 3pm-11pm. This is our first afternoon shift. Hopefully there will be some action. Hope all is well out there.
Peace and love,

Wednesday, October 13, 2010

more babies...

so Susanne and I "worked" the night shift last night from 11pm-7am. We got there at 11pm and there were two first time mommas who were in early labor. We made about a million cotton balls (all the cotton balls and gauze are hand made here) and then the midwife in charge told us to go home and sleep and she would call our mobile if the mommas were ready to push.

At 3:30am we got a call and ran over to the hospital (a 4 minute walk from our hotel). As soon as we walked into the labor ward a baby was crowning. This was the first baby I have seen born in the cul (the membrane sack has not broken and is covering the face and head). It took a moment with an amniohook to get it off the little baby's face, but he came out happy and no tears.

Moments later another momma (a new one who came into the hospital ready to push) was on the bed and pushing. She came out occiput transverse, but fit just fine. There was a minor perineal tear which I sutured. Yay. Then we got to leave the hospital again (1.5 hours later) and go back to sleep. I felt like a surgeon being called in to do a procedure and then leaving.

Our buggy ride on the island was wicked fun! It was a total mud mess and it rained the whole time, but it was so fun. I drove most of the way, through jungle and on a black sand beach.

Today Susanne and I did our first scuba dives. We did a practice dive in a pool to learn the tricks, then a reef dive. Amazing!! We saw all sorts of lovely coral and millions of fish. We have two more dives lined up for next week. Tonight we will work the late night shift again, so hopefully there will be more babies.

All is well here. Lots of fun stuff coming up, but will post more about that later.
Peace and Love,

Monday, October 11, 2010

7 babies and counting...

Hello! While this is a slow time at the hospital, we still have been catching babies. I have helped 7 come into the world, all without any real difficulties. It is amazing how quickly women labor and push here. I have only sutured once so far, which was good practice, but I have been supervising some nursing students in training as they suture. So I help them decide where to place the needle, what needs to be reconnected to what, ect. They don't really learn the subcuticular stitch, so any tear of the perineum gets a continuous stitch with a big knot. It doesn't look the best, and it is probably uncomfortable as hell, but it gets the job done. They pretty much suture all tears (even small first degrees) as the risk of infection here is high.

I have been helping do a lot of newborn exams (which ONLY includes head and chest circumference, length and weight). Also, all babies at birth get a vitamin K shot, hepatitis B vaccination and BCG subdermal (for TB). I feel bad poking the little cuties so much. I have seen a couple infected cord bases, which smell terrible and the babies are put on antibiotics.

Oh holy goddess, yesterday a woman in labor vomitted up a 6 inch long round worm! It was so gross. Of course I got a picture of me holding it (with gloves)! It was still alive and squirming around. The midwife in charge said that is not too common, and she has only ever seen one other worm (a tapeworm which was pooped out).

We were supposed to do our first scuba dive today, but it has been monsoon raining and we decided to postpone. Tonight we will go to a Kava bar with some ex-pats and then have a BBQ at the resort we are staying at. Sounds good to me. Hope all is well with everyone who reads this, if anyone does :)
Peace and love,

Saturday, October 9, 2010

I love Vanuatu!

Hello! Wow, this is my first blog ever. Kind of exciting. Susanne and I made it safely to Port Vila, Vanuatu on the 6th of October. We had a night layover in Auckland, with a free hostel booking. We walked all over Auckland and had a good time.

Vanuatu is amazing. The people are SO friendly, everyone says hello and waves at us. There are more white people here than I expected, a lot of ex pats and tourists.

Our first night here we went out to an outdoor bar with a kiwi guy we met on the plane. We tasted the only local beer, Tusker, a lager. Not to be confused with Tusker from Kenya. After a few beers we were all feeling great and decided to go to a nightclub, haha. It was kind of ridiculous. They played music like U2 and John Mayer, who are good, but kind of hard to dance to and definitely not nightclub music.

We have been going to the local farmers market, which is open 24 hours. There are so many beautiful fruits/veg/eggs/chickens there. We have tried several new and interesting vegetables that I have never seen before. Yum.

We have worked the past 3 days at Vila Central Hospital in the maternity ward. All of the sisters (midwives), nurses and staff are so nice. It has been pretty slow in terms of births, and I have only helped 3 babies come into the world so far. I did get some suturing practice, which was great. The women here are naturals at birthing. Their labors are short, and their 2nd stage (pushing) is super short. They make very little noise and pretty much only give birth on their backs.

The first baby I helped with was OP (occiput posterior) so it came out face up. Babies don't fit as well through the pelvis this way, so the mama had a lot of back pain. They call this presentation FTP (face to pubes) here, which is cute.

I am learning the local language, Bislama. It is a lot like English, and pretty easy to understand. My favorite little saying: pullem good wind (take deep breaths), sit sit (literally shit shit, which is synonymous with pushing).

Ok I could go on forever, but this is long enough for tonight. Now I am going to enjoy my dinner of lentils and sauteed vegetables. Yum.
Peace and love,

Saturday, September 25, 2010

My First Week in Port Vila

Sorry for the delay in updates. I’m enjoying the amazing hospitality so much here in Vanuatu that I haven’t had a chance to get online. Volunteering at the hospital here has been an incredible experience and I am learning new things every day. I thought I would give everyone a highlight of my most memorable experiences over my first week. I've also included a few photos. The first is a picture of Hideaway Island from the ferry. The second is me at Mele Cascades. To the left is a picture of the labor room here at the hospital.

The first that comes to mind is a really sweet twenty-year-old primip (first time mom) that labored for a little over seventeen hours before she was fully dilated. Back in the US we wouldn’t think much of this, but here it isn’t common for it to take that long. Due to the amount of time it was taking her to dilate, she was put on syntocin to augment labor. She had the classic back labor throughout indicating a baby that was occiput posterior. By vaginal exam it was also clear by palpating the baby’s fontanelles that we had a malpositioned baby. Throughout her labor she would ask me “how much longer?” and I kept answering by shrugging my shoulders and saying “if only I had all of the answers.” For a first time mom who was going through agonizing back labor on a syntocin drip without any pain relief, she was an amazing trooper. I was in awe of her determination. When it came time for me to go home for the day and she was at 8 centimeters, I decided I would wait to leave until she delivered. Four hours later she was “fully” and ready to push. While I was managing her labor, another mother who was in preterm labor at 32 weeks was delivering on the other side of the labor room. The doctor on call had been paged to her delivery so once she and her baby were stabilized she came over to see if she could help my mother. My momma had been pushing a little over one hour and had made progress, but it was decided that assisting her with vacuum extraction was indicated. This is the first time I had seen a vacuum extraction so was excited to gain the experience. Before the vacuum was used the baby was at 0 station and with only two pushes the baby was delivered. We had been using intermittent monitoring of the baby throughout labor with no indication of distress and were surprised with thick meconium on delivery. Smol baby girl “Allison” required deep suction and a few minutes of resuscitation before fully coming into her body. This became the first little baby named after me and I feel deeply honored. Allison’s mom was truly incredible in her strength and determination. Afterwards she thanked me for believing in her and apologized for complaining too much and I told her that she should be very proud of herself and that I felt she didn’t complain much at all. She looked at me and said “really?” It is hard for me to express my amazement and sorrow at how much pain these women endure and are expected to not show it.

During my first week at the maternity ward I assisted thirteen women in welcoming their little ones into the world. For many of these births I was accompanied by nursing students here in Vanuatu. Many will graduate as RNs in a few months and will then return to their respective Islands here in Vanuatu. As a part of their training, they are to perform twenty deliveries. Due to the shortage of medical personnel here in Vanuatu RNs perform many of the same functions as doctors and midwives in their local villages. During my stay here I have been given the honor and responsibility to help train these students in the art of normal delivery. They are incredibly excited to learn and are catching on quickly. It has also been a great opportunity for me as well, because as they say you only truly know it yourself when you can teach it to others. I have made it my mission to reduce the number of umbilical cords that are cut on the perineum to reduce the number of resuscitations required. So far I have somersaulted four babies out with nuchal cords that were too tight to reduce. I’ve worked hard to explain the process to the nursing students and they are very appreciative indicating that they have seen the difference and lack of need of resuscitation that is common with cutting the umbilical cord on the perineum. I’m hoping that they will be able to practice the skill while I am here so that they feel comfortable somersaulting a baby out with a nuchal cord. Many will be in very remote areas with very little medical equipment or assistance in the event a baby is experiencing respiratory distress during transition.

After my first six days at the hospital I decided to take two days off and explore Vanuatu. Due to the resort being full with a wedding party, I was given the opportunity to spend a week at the house of the resort owners out on Mele Beach. Their house is really close to Mele Cascades and Hideaway Island, two very popular tourist destinations. I took my first day to explore both and really enjoyed the beauty of Mele Cascades’ waterfalls and cascading pools and the colorful fish all along the coral reefs off of the shore at Hideaway Island. I wish I had a waterproof camera to share the beautiful sea life with all of you. My second day off was spent preparing for my second week by going grocery shopping and relaxing on the porch out and walking along the beach at Mele Beach. While I was at the open air market in downtown Vanuatu, I was stopped by one of the family members of a momma I assisted and presented with a papaya as a thank you. My heart was filled with such love and warmth. The NiVanuatu (native people of Vanuatu) are an incredibly giving people.

Thursday, September 16, 2010

Greetings from Vanuatu

To my family and friends, I have arrived safely in Vanuatu after a little over thirty hours of travel and have spent two wonderful days in the Maternity Ward here. The people of Vanuatu are incredibly welcoming and have made me feel at home from the start. I plan to take some photos soon and post them to let you witness the beauty of Vanuatu -- both the people with their warm smiles and the lush vegetation and spectacular views. Here is a brief summary of my first day:

Day 1: Wednesday, Sept. 15th 2010
I arrived a few minutes before 7 for the morning rounds. This is the time when the charge nurse gives her report from overnight to the new nurse coming on duty. I learned that they had quite the busy night at seven births and that we currently had five women in labor. It turned out to be quite an exciting first day. A midwife from New Zealand was able to give me a quick tour of the ward and location of supplies. Then we were off... As we were finishing up our tour a mother in active labor presented at the front desk so we began the process of checking her in. I set her up on a twenty minute CTG strip, took her vitals, and checked her cervix. She was a primip (first time mom) and 8 centimeters dilated. Things appeared to be proceeding quickly so we brought her back to the birthing rooms. Within an hour and half she had a small anterior lip, but not quite complete or fully as they like to call it here. The mom desperately wanted to push, but we instructed her to pulum gud wind (take deep breaths) and not sit sit (push) with the next few contractions. She was soon complete and then pushed for a little over 35 minutes which they consider a long time here. Moms here are incredible pushers and generally push for less than 10 minutes. I think the mother expected to not push for so long and kept asking when the baby would come.

As I was managing this momma's delivery, the other three beds in the birthing suite became occupied as three momma's began pushing. I quickly finished up with my momma and went to see if I could be of assistance in the other births. The next baby to be born had a nuchal cord that was not able to be reduced. They aren't familiar with somersaulting the baby out, so instead the nurse clamped and cut the cord on the perineum. This little baby boy then required ten minutes of PPV (positive pressure ventilation) before he took his first breath. I can't help but wonder if he would have had a smoother transition if his cord had remained intact during the delivery. As I was assisting with this delivery, two more babies were received into loving hands.

My final catch of the day occurred right before I was getting ready to go back to the hotel for the day. It was a mom I had been following her progress all day and she was fully and wanem sit sit (wanting to push). She was a first time mom and proceeded to push her baby out in seven minutes with only a minor first degree laceration. Mothers here are amazing to watch. They push very effectively and are quite stoic in the process.

I had a great first day at Port Vila Hospital. I met many lovely midwives, nurses, and nursing students. I also had quite the crash course in getting familiarized with the Maternity Ward -- where supplies are located, proper hospital procedure, and very basic bislama. I look forward to the next few days and becoming more and more acquainted. Stay tuned for more updates on my experiences here.

Thanks for reading,

Special Thank You To Jim Key and Tim Dempsey from Orion Medical Supply

The Thursday before I left on my trip to Vanuatu I received a wonderful donation from Orion Medical Supply for the Maternity Ward at Port Vila Hospital. Jim Key, who is an incredible guy and very supportive of local Seattle midwives, was able to put together a sizable donation of chux pads, sterile and nonsterile gloves, sterile lubrication, and hand sanitizer. Having spent two days at the hospital I can tell you that these supplies are in great need and extremely appreciated. I can't thank Jim Key enough for all of his help. Special thank you as well to his Manager, Tim Dempsey, for his assistance in the donation. If you practice in the medical field in the Pacific Northwest, Orion Medical Supply is a great company with which to do business.

Thursday, March 11, 2010

Tips for those planning trips

Elias here. There are a few folks planning their trips for next year, and I've been holding onto this tip post, but I figure now is the time to share it! Hopefully Hillary will add her own tips to people planning to go.


ITA Software has some of the best searching capabilities, including their monthly or beta "Matrix 2" feature that lets you find the cheapest days to fly, if you're flexible, which we usually are. Some of the flight combinations are complicated and it's helpful to book using a travel agent, but travel agents can't book some of the airlines (like the discount Australian airlines or Air Vanuatu). I found my flights on ITA and brought them to a travel agent at STA in the University District (hi Dave!) and he managed to get me an even cheaper itinerary. It cost $50 to book the itinerary with him, which was definitely worth it, though I had to book some of my flights on my own. He also booked my tours in Australia, and I was pretty happy with that service (I emailed him from Vanuatu asking him to book me).

For internal Vanuatu flights, Air Vanuatu offers a baby doc discount, and you can search for flights on their web site. You can book those flights pretty close to when you want to leave and can walk into their office downtown. Tanna and Santo are popular internal destinations.

Where to stay:

Many baby docs stay at Coconut Palms. Booking through or FlightCentre is cheaper than booking directly (though you don't always get breakfast included). They don't advertise it, but they have a baby doc lounge with a kitchen, fridge, and free internet access. This is important because only the most expensive Coconut Palms rooms have cooking facilities. Some even have shared bathroom facilities. You can get a discount for staying an extended period of time, and some have gotten discounts for being medical students. The manager is extremely sociable and often looks after the baby docs. There's a pool, a pool table, restaurant, bar, and laundry (250 vatu to wash).

If you're not coming alone, or you don't need the social aspect of Coconut Palms, Tradewinds is closer to the hospital (marginally), can be cheaper, and even the studio apartment has en suite bathroom and full kitchen. We're paying 4500 vatu per night over the course of our extended stay ($45/night for 2 of us). This is a much smaller facility than Coconut Palms, but it still has a small saltwater swimming pool, ping pong table, gas BBQ, and kayaks available to be hauled down to the lagoon. The housekeeping staff will do your laundry for you for 1000 vatu, or you can use the machine yourself for 500. We hand wash. There's a clothesline setup alongside each apartment (which are each stand-alone).

Hillary probably has something to add on this count -- she stayed at another resort (Mangoes) and got an even better deal, but she was there during the wet season. Mangoes, Tradewinds, Coconut Palms are closest, then Poppy's on the Lagoon (where some folks stayed a few years ago) and then other resorts further out. If you're going in a big group you can rent a house.


Beware the following:

  • Your bank will probably charge you to use someone else's ATM (or if they're evil enough, like ANZ, their own ATM)
  • Your bank will probably charge you a foreign transaction fee for the currency conversion when pulling out cash
  • Your credit card will probably charge you a foreign transaction fee for the currency conversion
  • Local businesses are charged for their credit card transactions, so they charge you to use a credit card

Bank of America has a partnership with Westpac, which has ATMs easily available in town. I'm a BoA customer and have yet to pay an ATM fee (though I do pay a 3% foreign currency transaction fee, I think, although in retrospect I see no evidence of that).

Speaking of fees, almost everyone in town charges an extra fee to use your credit card. This can be as high as 5% on top of your bill, so most of us use cash most of the time. If you're going to use cash to pay your hotel bill though, you need to work around your bank's ATM daily withdrawal limit and also deal with the ATM fees (if you have them), so in our case, the hotel's 3.75% credit card surchage was close enough to the ATM foreign transaction fee, and I was sufficiently disinclined to pull out that much cash, so I just used the card. Capitol One is one of the only credit cards that doesn't charge a foreign transaction fee -- I got a Capitol One card just for this trip.

Bank of America also has a foreign currency order service. Before I left I ordered currency online, both Vatus and Australian dollars. They were delivered to the branch of my choice for a $7 delivery fee and took around 2 days. (They can deliver it to your house, too, but you have to be there to sign for it.) I got a pretty decent exchange rate, and I had the comfort of knowing I'd be set for money for a little while, and the pleasure of showing off the pretty money to folks before I left. The huge foreign currency service in the States didn't carry Vatus, so I'm pretty impressed with Bank of America.

Au Bon Marche (the big supermarket) doesn't charge extra to use a credit card. Everywhere else I use cash.

The hospital:

I had the intention of wearing scrubs. I bought good quality scrubs, knowing I'd be washing them a lot, and wanting the pockets all down the side. It's like wearing jeans in the tropics. Within a week and a half I'd switched to wearing my cargo shorts and a scrubs top. Nobody wears pants at the hospital. The midwives and nurses wear uniform dresses, the doctors wear shorts and t-shirts or island shirts. Actually, the nursing students wear white pants and tops, but they're the only ones. Nobody wears closed-toe shoes. Everyone wears sandals, closed cell polyethylene clogs (aka Crocs), or flip flops. I got closed-toe Nothinz-brand clogs (which are cushier than Crocs), but the closed-toe nature means I sweat hugely in them, so I wear them with socks, which I powder liberally in the morning. If you go into the operating theatre they have clean scrubs there to change into.

Bring a tote bag for your hospital stuff. I bring a supply of gloves (sterile and non), food, water bottle, headlamp, and reference material.

I sweat profusely, especially when I have to suture, so I've acquired a couple bandanas/headcoverings from the operating theatre. My sister also sent me a Croakies to keep my glasses on, since they just slide down my nose. Thanks, sister!

Travel insurance:

I got it through STA. It was only a few hundred bucks for my 3-month trip (it's priced based on length of trip), and covered medical and electronics, and since I got it within 2 weeks of booking my flights, covered terrorism and the airlines going out of business. You can get a rider for sports, too. Some diving outfits offer their own travel insurance.

Wednesday, March 10, 2010

Last Days

I am relaxing listening to the sound of rain and wind. Contemplating going for a surf in this weather. Its my last few days here. Savoring it. I worked with Lissie last night, I hate to pick favorites but she is my favorite. She has such a warm heart and makes me feel appreciated. She always gives a little clap and a smile when I walk in to her shift. She pulled me aside and gave me a little purse with that says Vanuatu. Made me cry, it was sooo sweet. I will miss her. Nothing of particular interest has happened on the maternity ward, I have just been developing my skills, gaining muscle memory and learning a few new things. I had one of the interns to teach me to put an IV catheter into an infant, I have done one short straight forward neonatal resuscitation and I have done enough suturing now that I feel like I can effectively use the instruments. I am a little worried about what it will be like to go back and do births in the US where women don’t just slide up onto a table when their fully dilated and push their babies out. I am used to looking at my watch and feeling like 30 minutes is a long time to push. Back in the states I think an hour is closer to average. My perception of certain things is skewed. I used to get squeamish at giving babies shots, I hate to hurt them when their brand new. But I have put so many needles into baby thighs here, I barely think twice. It will be interesting to go back and feel what it is like to do homebirths and practice as midwife in the US again. There are few things I wish I had the opportunity to experience… a breech birth, a shoulder dystocia, but all in all I have learned so much. Last weekend one of the chief pilot’s brother came into town. I was taken along for the ride of showing his brother a good time. Wined and dined, gambled, drank kava, stayed up late laughing and raiding the pool at their resort. Then I would wake up tired, and they would pick me up to go for a surf, I’d do several hours at the hospital and meet them for dinner to do it all over again. It felt like an episode of entourage or something. I ‘reckon’ I will never experience anything quite like this again. Loving my work, picking my schedule, learning, playing hard, enjoying the sun, honing my intuition as I am free from structure and schedule. There is a reason I haven’t been on the blog in a few weeks. I have been too busy living life to the fullest to spend time writing about it on the computer. I will miss the beautiful smiles on the mammas on the maternity ward, the sweet moments bathing the babies after the birth, the giggles of the midwives, the warm waves, the Australians that seem to speak a foreign language that makes me laugh with every conversation, the relaxed sense about life in island culture. To all who have followed my adventures: thanks for listening, this was an important part of my process here

3/3/09 Surf and Sky

The maternity ward has been slow. Lots of scrubbing the beds, making cotton balls and folding gauze. I have really grown fond of the midwives. They are such kind souls, we make faces at eachother, discuss their culture and laugh. We laugh a lot, now. Always something to giggle about, its so much fun to be in on the ward and feel like I am really helping and I am so glad I have a few more weeks here. Outside of the maternity ward, I have taken up surfing. I go out to the point every chance I get rent a board and head into the crystal blue water. It is reef break so I can only surf at high tide. I have stopped working regular shifts at the hospital and go into work based on the hours I can surf. The water is warm and the waves are small and perfect for learning. The kids all chatter, scream and call out and cheer me on. Its such a joyful place. I love being out there, its been a while since I have taken up a new sport its great to get my body to learn something new. I also have made friends with a gang of pilots. The one airline over here, Air Vanuatu has about 30 young guys from Australia and NZ that work for them and they are all tight group of friends. It a click that reminds me of capoeira a little bit and I have good time hanging out with them. Its nice to have a crew of people to do things with. This trip has been perfect, time with my mom for a couple of weeks, lots of alone time for a couple of weeks and now it looks like lots of going out with new friends for the last couple of weeks. I love Vanuatu!

2/23/10 For Autumn

Today I am missing my friend. She was killed in an accident 3 years ago today. Its nice to have time a space to contemplate her. Woke up did sun salutations, one for every year of life and one for each of the years of her life I have now missed out on. She was golden. I wasn’t sure if I wanted to go into the hospital or just sit with my memories but intuition drew me into the maternity ward. It was busy! Two women were being prepared for ceasar (c-sections), which never happens (two at once) and there were several antenatal women getting close to delivery. The midwives and nurses were all busy. I took one women back to the delivery room, she was saying that she wanted to sit sit (push). No one was around to help me so I prepped everything, hemorrhage meds, IV ready to insert if need be and layed out all the supplies. I did an exam and she still had a bit of cervix there, we tried to push it back but it didn’t work. I had her do some sidelying contractions, still there. I could tell that the baby was a little asynclitic or crooked coming down by the sutures on the babies skull. This mamma had been up all night, she was exhausted and kept begging me to help her. Much to her dislike I made her get up out of the bed and put one foot up on the stool and do some lunges while I helped support her through a contractions. She cried while we swayed and then switched feet for the next contraction. Suddenly she started to grown so I had her get back onto the bed and slipped on my gloves. With the next contraction the babies head was crowning, it worked!!!! After the head I felt and there was cord around the babies neck. I told the mom to stop pushing so that I could try and slip it over the baby’s head… it was too tight. Another strong contraction came and told the mamma to pullum wind (breathe) through the contraction so I could cut the cord but she couldn’t stop it and the baby was coming. We learn this technique to sommersault the baby out in school but I had never actually done it. I held my breath and pinned the head to the inside of the mom’s thigh and the baby flopped out of her in a forward roll. Future acrobat maybe. The baby was quite blue and for about 30 seconds didn’t take a breath. My heart raced as rubbed the baby, trying to get it to cry. It let out a cough and then strong scream, and its skin started to get pink. Phew!!!! I gave the mamma her shots, delivered the placenta, examined her perineum and she had a small tear. I set up a sterile field, gave her 5 stitches, one of the best I have done and then took the baby out be weighed and given its shots. No other person came into the delivery room the entire time. I knew they were just out in the hallway and only a shout away if I needed help but it felt like such a sense of accomplishment and competence to be able to do it all on my own. Through a cervical lip, a nuchal cord and a tear. I starting to really trust my skills and feel proficient in my craft. Thank you Autumn, you are always giving me beautiful gifts…. I miss you!

Sunday, February 21, 2010

The Lighter Side

By the sounds of my posts you would think its all serious and intense here. I think that is just what inspires me to write. The first week here, the peace corp had brought all the volunteers from the outer islands to give them some flu shots and do some training. I met tons of lovely people from all over the US doing really interesting projects in villages across Vanuatu. Living in the villages they had many wonderful insights into the culture that have helped in my work in the hospital. They happened to be here during the superbowl. There is a bar / microbrewery here called the Wild Horse Saloon owned by a couple from Colorado. They have a big projection screen and we had a Monday morning (I am living in the future) USA style super bowl party. Followed by guitar hero sillyness. My mom was wonderful company cooking and doing laundry here, she eased me into the culture shock and helped get through the intense few weeks. We went on tour called the Caloonga cruise. Where we took this 80 foot old sailboat out to a deserted beach accompanied by dolphins. At the beach we did some amazing snorkeling with insanely bright coral and marine fish in a marine sanctuary and then had a barbeque. And yes I ate the beef. After 10 years of being a vegetarian. Adventures in traveling I guess. I also met this lovely Australian fellow who invited me along to a tour in Tanna, the island with the Volcano. We flew over in a Cessna one afternoon and then took this amazing four wheel drive road across the island passing villages of grass huts with kids screaming and waving and women in brightly colored dresses and huge old Banyan trees. We got up there in the late afternoon, it was a bit rainy and foggy, which made it more dangerous cause it is harder to see if the lava rocks are coming at you if it goes big, so we stayed back from the rim at first. As night fell we went over to the rim a bit closer and you could here it go off the smoke coming up would glow red and then lava would shoot out. We sat and watched for a good while and as we were all saying we were over it and ready to go this one dude said one more, lets stay for one more. Well the next one was huge lava came shooting right out of the volcano in our direction. The guide yells for everyone to stand still and only move away if it comes close. Once all the lava hit the ground, the guide tells us its TIME TO GO! As we walked past where we were sitting before there were these two huge glowing hunks of lava rocks. Then as we were driving back home, just 15 minutes later as we came around the back side of the volcano there were two HUGE eruptions that shot lava rocks half way down the backside of the volcano. The back side had a higher rim so they had to be pretty huge eruptions to send lava that far. The guide said we were lucky we weren't still up there. Kinda sketchy. Definitely got the heart racing, but it was amazing to see. You could hear the Volcano rumble all night from the spot where we stayed which was pretty incredible because we were on the opposite side of the island with big mountain range in between.

The Mundane: I get up every morning and have a breakfast of tropical fruit, check my email, then I either head for the hospital to do the day shift or go out for a day adventure to swim and snorkel at some white sand beach and come back to do the evening shift. Somewhere in there I cook some food, stop by the hotel bar to chat with the fun people I meet and have a Richard special. Richard is the bartender here and he makes this amazing cocktail with rum, mint, lime and lychee. When I get back from the hospital I always go for a dip in the pool whether it is 3 in the afternoon or 2 in the morning. Life is not so bad.

2/19/10 Stillbirth

I see why everyone told me to stay for 6 weeks. I have been here for nearly 3 weeks and I am just getting fully competent in the procedures of the hospital. Now I can really be useful. If I had stayed a month then they would only get a week of that. Yesterday I was the admissions girl. Doing the initial evaluation of the multitude of women coming in to the hospital. A young 18 year old woman with gorgeous skin and an infectious smile came to me and handed me a card, I got her chart and brought her into the admission room. I felt her belly determined which side I thought the back was on and asked her then normal run of questions. Had her water broke, has she seen any blood, has baby been moving, when did her contractions start? I put the the Doppler on her belly to check the fetal heart rate, nothing. I tried the other side of her belly nothing. I slathered her with gel and glid the Doppler across her lower abdomen, occasionally a rate of 50 something would flash but no beat. I went to get the midwife and inform I couldn’t find a heartbeat. She came and repeated my steps, still nothing. And in fact she hadn’t felt the baby move since yesterday. She went and got a doctor so that we could send her for a scan or ultrasound. He found nothing, she was four cm, plenty of time for a scan. About twenty minutes later I saw her walk past the admission room, tears streaming down her face. They hadn’t found a heart beat. For the rest of the morning I saw her walking gracefully, moaning through her contractions all with sad eyes brimming with tears. She delivered that afternoon, a small quite blue baby. We wrapped it blankets and the family passed it around rocking it and wailing. I sat behind the curtain just listening to it the melodic wailing. Some peace corp workers told me this time is important. It is essentially the only time they are allowed to express their grief. When someone dies they wail initially and until the funeral and after that it becomes inappropriate. I will always remember the father. He came into the delivery room with his sunglasses on and tears streamed out from underneath, covering his cheeks. I was surprised at the amount of emotion displayed. He did not wail, he just cryed. He watched as I weighed and bathed the baby. The room was silent except for his sniffling. Its true, they are still born. Several babies were born after that, and I often caught him standing at the door, watching me as I weighed and bathed the other babies. These little ones screamed in discontent and being uncovered and I would try and soothe them with my silly little cooing noises. I wonder what was going through his mind.

2/16/10 The Night Shift

Everyone once in awhile there is this mark on the board: BBA. It stands for born before arrival. Baby is born at home and then they come in or it is born on the bus on their way to the hospital. For whatever reason baby doesn’t wait until the delivery room. Even though most of the time I am clueless that it is coming I know when its happening because a wheelchair heads into the delivery room instead of out of it (most women walk into the delivery room when they are in labor). Last night there was such a wheelchair so I followed it into the room to see if I could help with something. This woman could not even get up out of the chair. The boyfriend, the student nurse and the midwife lifted her out of the wheelchair and set her on the delivery bed. As she settled on the bed I noticed that her arms and legs were covered in bruises. I gasped. I thought DIC a disorder where the body clots and bleeds and nearly always causes death. Then I noticed her hands were huge and swollen. Lissie pointed out the bruises to me, as if I hadn’t already noticed. She had the umbilical cord hanging out of her, so we grabbed a clamp delivered the placenta. I heard them inquiring about the whereabouts of the baby. I gathered that the baby had not lived and had been left with the grandparents at home. The boyfriend was sent out of the room as we delivered the placenta and after it was determined she had no tears, the energy of the room settled and Lissie asked what had happened. He eyes were white and glazed over and she had barely spoken a word since she arrived. Just whispering her name and address as I filled out her intake. There was a woman with her from her villiage, she stroked her head and told her to tell the doctors the truth to tell us what happened. First it came in small bits and slowly she got comfortable and the story unfolded from the beginning. On Sunday, her boyfriend had become suspicious that she was having relations with another man, so he began to beat her (7 months pregnant) with a stick to try and get her to admit it. This went on all day and all night, she was not allowed to sleep. He told her if she would just tell him the truth he would stop, so she told him that it was true so that he would stop. He continued to hit her wanting her to divulge details, which she was unable to provide since nothing had happened. This went on through Monday and into Tuesday morning. He pushed her and she landed with her belly on a table. Her water broke. She tried to tell him she was going to deliver and to get help but he thought she was lying so instead he kept hitting her with the stick. The word for hit or strike in Bislama is killim. I sat there listening to the story thinking of the irony of that. She was describing it, “he was killim mi, killim me.” Which sounds like he was killing me, killing me. And in fact he had, only he killed his daughter. She was born dead in his home and only then did he go and get someone to get his girlfriend to the hospital. Lissie suggested that she file a police report and press charges but I think she was too scared. She made me promise noone would see the history I had taken. Then he stayed there in the hospital most of the night, caring for her in this very sweet way. For her protection I had to force myself to look down each time I saw him so that he wouldn’t see my rage, that I knew the truth.

Sunday, February 14, 2010


Interesting how life doles out experiences to you. The first delivery that I did after my last post was a woman who was having her second baby after her first one was a stillbirth. It was so moving to be helping her after what I had just been through. It is interesting because in my experience in the US after the baby is born and in their arms women are usually crying tears of joy and are very emotional. Here after the baby is born women sort of seem to check out, barely interested in holding their baby savouring the relief of being done with labor. This women looked up as the baby came out and with the first cry, tears began rolling down her cheeks, it was amazing. There were also twins born yesterday. Very exciting to see my first twin vaginal delivery. There was an intern in the hospital yesterday so she got to do the delivery and I just assisted. The first baby was coming down asynclitic, which means the head is tilted a little sideways. She wasnt making much progress after about 4 pushes so the doctor pulled out the vacuum and helped her get the first one out. It took several long pushes, with lots of pulling on the doctors end and an episiotomy and the first one a boy at 3.6 kg. Both babies were head down and after the first one was born there was about a 8 minute pause and then her contractions started again and two pushes later the second one, a girl at 2.7 kg was born. Two perfect beatuiful, healthy babies. It was awesome!

Tuesday, February 9, 2010

Warning: Graphic

My second day here, I got the low down on how to do all of the paperwork. In their chart you fill out the newborn information. There are two boxes on that page: live birth and stillborn, the stillborn box is then toggled in to two more boxes: fresh and macerated. The first time I read through this, I thought, “gnarly, I hope I never have to deliver a macerated baby”....

When I arrived at the delivery ward this afternoon it was slammed again. Most of the beds were full, a mom was about to come out of c-section, several moms were written in red meaning that they were antenatal and waiting to deliver. One of the student nurses came up to me and asked me, "how do you call it when the baby dies inside?" Fetal demise I told her, and helped her spell it out in her little notebook. That's how I found out there was a woman in the ward waiting to deliver a dead fetus. Part of me really wanted to participate in this experience and part of me was terrified of it. I went about my business running from here to there trying to make sure everything was getting done, when at around 8:45 one of the student nurses grabbed me and asked me to check a mom that he thought was getting close to delivery. It was the mamma with the dead baby. My heart sped up but I went in and checked her and she was 9 cm just a small lip on the right side. I had her lay on that side and checked with midwives about how to proceed. They recommended I go and break her water and then check her again in a few minutes. I grabbed a bedpan and amnihook and knowing that meconium was coming held my breath as I snagged her bag of water. Thick dark brown water came pouring out. I had never seen anything like it. After a little while I checked her again, the midwife asked if the baby was head down or breech. She was fully dilated and as I began to determine the position my fingers ran across the cord, at least I think that is what it was, it had no pulse so I couldn't confirm it. The presenting part was bumpy and not smooth like all the heads I have felt so I guessed that the baby was breech. I had one of the midwives come by and double check and she said she thought it was breech and felt a cord also. It would make sense a cord prolapse would be a definite reason this baby didn’t survive. It was about 9 pm when we determined that she was fully dilated. This was getting intense I was about to do my first breech delivery, and my first and hopefully only stillbirth. The midwives instructed me to just let her continue to have contractions until she could not resist the urge to push and not encourage any pushing until that point. So I sat in the delivery room with this mom and coached her through contractions and supported her the best I could, constantly wondering if she understood what was going to happen. As I sat there the two beds in the second delivery room filled up with two moms almost ready to push and then a fourth mom came in and started pushing in the bed next to us. It felt so chaotic. Not what I wanted for this mamma that was about to do something so difficult. Finally, a little after 11pm, pushing was irresistible and there were clear signs the baby was getting close. One of the midwives was standing with me coaching me on what to do when a student ran over to say that the mom in room two was about to deliver so she left to go catch the baby. Mind your room 1 and 2 are connected by a sink room where they was the sheets and instruments. As I gowned and gloved up, a round circle with hair appeared on the perineum. I was slightly confused because I was sure that baby was breech but I just let the events unfold. My heart was pounding and my throat was totally dry, I was very scared of what I was about to witness. The top of a tiny round head began to emerge, I went to support it and was shocked by the soft consistency of it. The head kept coming sort of oozing out of her body I wasn't sure if I just let come or support it or support her perineum. I was freaked and at a total loss for what to do. Finally the face appeared and with another little push the body slipped out after. As all of this was happening you could hear the mom in the next room pushing and newborn baby crying. A stark contrast to the deafening silence coming from the baby I had just delivered. I never imagined the joyful sound of a new baby’s cry would be so tormenting. I couldn’t believe these two things were happening at once it seemed so cruel to the mamma I was helping. After the baby, came placenta about the size of the palm of my hand. I kept looking up at this mamma that was staring at me blanking. I was wishing I could know what she was thinking and feeling, wanting to take whatever it was away. The midwife came back over to check on how things were going. She told me that I had to go and weigh the baby. I was mortified and then I was mortified that I was mortified. I didn’t want to touch it. Its head felt mushy with a few disconnected cranial bones and its skin was splitting and peeling. It turned my stomach when I lifted it up to carry it to the scale, I swallowed hard to hold it together. It broke my heart that I was reacting like this to this poor sweet baby. 1.5 kg and then I put him in a crib wrapped in a blanket and cleaned up the mamma. The shift was changing and sweet, sweet Lissie who had just come for the night shift came in and took the chart, put her hand on my shoulder and sent me off telling me to go home. I walked to the nurses tea room and just burst into tears. Everything felt so intense, I couldn’t imagine being the mom. Once I pulled it together I went back to the delivery room and held the mammas hand as she cried watching Lissie diaper and dress the baby and then wrap in blankets. The family gathered and the weeping began and I slipped out to head home. When I got back to the hotel around 1 I slipped into the pool, it is the first clear night since I arrived here usually there are a fair amount of clouds in the sky. And the stars were fierce. Glinting and glowing in slight shades of white, yellow and red. I have heard some legend somewhere that the stars are the souls of all the unborn babies.

Thursday, February 4, 2010

I arrived to the ward this morning to sounds of many women wailing. Someone was sobbing and crying out. At first I thought someone was having a difficult labor and was in a lot of pain but as I walked up to the desk the midwives informed me that the baby that was born a few days ago with meconium aspiration and just died a few minutes before I arrived. They lost two babies in the ward last night, another one had died a few minutes after birth due to meconium aspiration also. In my grief and loss class my teacher Beth Coyote had told us about the wailing in St. Lucia when there was a death there and I kept thinking of that as I walked the halls. Eventually the grandmother carried the baby out of the nursery with family and the midwife following to bring the baby to the morgue. They had to hold the mother up as she walked sobbing. A few tears dripped down my face and the midwives giggled at me. I am definitely not used to accepting that kind of loss like they are. It is a good learning experience. In happier news there were triplets born there yesterday. The women came in expecting twins while I was there on the evening shift. I waited well into the next day and finally exhausted they convinced me to go home and rest, when I woke from my nap I was trying to decide between getting some dinner and going to the hospital and I decided to eat and missed it. So bummed, I will probably see another set of twins but not likely triplets. There are all healthy and doing well and weigh about 2kg. Everyday since I have been here the ward has been "full up." Every bed full with mothers in labor wandering the hall waiting to deliver. They have had 41 babies as of 3 o'clock this afternoon already in feb. Thats almost 10 per day. I have done 5 deliveries in 3 days. One of them today hemorrhaged. They actively manage here, which means they give meds to stop bleeding before the placenta comes to prevent women from bleeding. Most women dont lose much blood at all and I had already gotten used to it. When this mom kept bleeding and bleeding, filling up one bowl after another, my heart was pounding I gave her all the meds I had available to me while one of the nurses put in an IV. I kept massaging her uterus trying to express clots and get it to clamp down and this mom was screaming at me and pushing my hand away. We sent for the doctor and just as he arrived they put some syntocin (anti-hemorrhage meds) in the IV and the bleeding slowed. I stayed with her for about an hour keeping an eye on her blood pressure and then when the nurses decided she was stable enough to move to postpartum I was helping her to the wheelchair and she collapsed in my arms, I set her on stool and she came to, she kept trying to shake her head to "get clear" The midwife brought her some warm water with sugar and after a few sips we got her into the wheelchair and back into bed. I went out to the store by the hospital and bought her a box of juice and some crackers hoping some food would help her energy and improve her blood pressure. They were so grateful, it made me want to buy crates of juice so that we could give them to every mom postpartum.

Tuesday, February 2, 2010

First Day, Four Babies

Spent my first day working at the hospital. I was super nervous.... here all by myself, don't speak the language, not sure what I am diving into. There was nothing else to do but jump in, so i threw on my scrubs and headed over there. I hung back and observed today so I could get the flow of things here, they do things a little different from the meds they use to the way they chart. I kind of expected someone to walk me through it, and explain what I was expected to do but no one did, so I just watched everyone do it and took careful notes so that I can do it right in the future. There were four babies born on the day shift today. Apparently it has been super busy here lately, over 250 babies born in the hospital in Jan. Nearly a record. The first two babies today were born 15 minutes apart and the midwife was running back and forth between them, directing nursing students through the deliveries and I jumped to help everywhere I could. Then things calmed down for a bit and it was about time for a shift change when someone came in saying that there was a mom that was about to deliver in a bus outside. We grabbed a delivery kit and a wheelchair and headed out there. We easily got this mom from the bus to the delivery room but when the midwife broke her water there was thick meconium. We coached her to push hard and fast to get the baby out as quickly as possible. The baby came pale and floppy and it was well after a minute before there was an attempted breath. They suctioned her over and over again and tons of green gunk came out of her nose and mouth but she had aspirated some of the meconium and was in respiratory distress. One of the Chinese doctors came over to check her out and gave her an several medications but her oxygen saturation wouldn't climb above 65%. The doctor said he didn't think she would survive the night. First day,welcome to Vanuatu. I kept standing by her and talking to her as she struggled to breath and everyone scurried about trying to get the delivery room ready for the next mamma that was complete and ready to push her baby out. We moved the sick baby into the nursery just as mamma number four got ready to push. By this point I was more familiar with the routing and took the baby to be weighed and vaccinated and brought her back to her mamma to feed. At this point I was well past shift change and totally spent. It was an exciting first day and I am ready to have a more active role tomorrow.