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.