Tuesday, April 19, 2011

Final Week

Well, my time here on Efate is ending. I am sitting at the airport on a Sunday morning awaiting the departure of my flight to Nadi, Fiji. It is a very lovely day here in Port Vila. The sky is blue with patches of big cumulus clouds. As I look out the airport windows I see a big mountain range in the background and in the foreground I see palm trees and other lush green trees. There is a group of Fijian young woman who are travelling today. They are cricket players who had played 6 games in Efate and won 5 of the 6 games. They are rejoicing by singing and clapping. The NiVans are friendly and have been good to me as a visitor to their country. I will miss walking down the street and exchanging many greetings…”Halo”, “Gud night”. I will miss the bus rides and seeing all the people walking around. I will miss the 24/7, 6 days a week out door “farmer’s” market. I will miss the sun and warmth. I will miss my daily swims. I will miss the women and babies at the hospital. I have had an unbelievable experience and feel very fortunate that I was able to make the trip to Vanuatu.

Friday, April 15, 2011

Tanna Adventure

Week 4: Tanna Adventure

It had been quiet at the hospital this week so I decided to go with the women from New Zealand to the volcanic island of Tanna for an overnight trip. I bought my plane ticket at the local Vanuatu Air ticket office and packed my hip pack and was ready to go. We left early Thursday morning in search of a bus to take us to the airport. We had walked to the end of the street and I realized I had forgotten my passport. So, I ran back and grabbed it. I return and the ladies have still not found a bus. I see one and flag it down.

We get checked in at the airport and to our amusement there is a low budget film crew from Madrid, Spain who are frantically running around assessing their filming site, the airport. Annoyingly, they are holding up our flight for ½ hour’s time. We had discussed why hadn’t this film crew arrive early to get their film shots. Finally, the film crew had completed its business and we board onto a small plane. Tanna Island here we come!

We step down the stairs of the airplane onto the tarmac and walk over to a tiny airport, through the doors and look for our driver. Our driver is not here. In fact, he never arrives. We have forgotten the name of the place we are staying and did not bring the brochure. A woman sees our distress and approaches us to help. I had a cell phone with me and we find the number of the place we are staying in the phone history as I had called them the day before to reserve a room. The woman talks to Dream Island Bungalows (our accommodations) to find out that the river had been high and the driver was not able to get over to the airport in time to pick us up and that he had just passed over the river. So, the woman finds a driver for us and we are off to the East side of the island.

We have about a 3 hours drive to our bungalow on a road that is quite bumpy. We cross the river and drive over miles of wide expansive volcanic ash at the base of Mt. Yasur (the active volcano on Tanna Island). We continue on the bumpy ever-changing volcanic ash road and arrive to our bungalow. It is a beautiful setting overlooking a lake and the ocean. We get settled in and decide to hike to the local beach, which is about a ½ hour’s walk to the white sand beach. We arrive and go for a quick dip, as the sea was un-inviting (the current was strong). As we walk back we get caught in a heavy downpour. This was the beginning of the heavy rains that pretty much ruined our Tanna trip.

We had heard that when it rains here that it is difficult to drive up to the volcano. Despite the warnings our driver attempts to get us to the volcano. We try one road and it is no longer accessible. When you see small waterfalls in the road, it is not a good road to be traversing! The roads on Tanna Island are made of volcanic ash and when it rains here the ash easily washes out and the road changes in a matter of minutes. There can be holes in the roads, big drop-offs, un-even terrain, etc. So, back to the adventure of getting to the volcano… Our driver turns around and decides to take us on the beach to try another route. We “slide” a short distance down the beach and suggest going back to the bungalows. The driver happily agrees and we start our drive back. As we are pulling into the bungalows the left front wheel of the truck falls off. Luckily we are very close to our accommodations and this did not happen miles away in the downpour. The driver and his assistant scramble to look for the 6 bolts to the wheel as the sky is beginning to turn to night. We head to the dining bungalow to wait for our dinner and count our blessings.

After dinner we are exhausted and head off to bed. Our accommodations are simple, 3 beds and a table. I sleep on the bed underneath the window, which ends up being a mistake as it pours all night long with heavy gusts of wind, which blow rain on me over the course of the night. Elizabeth and I hear something crinkling in the room. She turns the flashlight on to see that there is a rat in the room munching on the bread that was left out. This rat was big! The body was about 8 inches long. She puts the bread in her luggage. I now have some trouble falling asleep; rain falling on me, rats crawling around, fleas jumping, etc. It is going to be a long night, as I think to myself. Shortly after the rat returns and I see it crawling up Elizabeth’s bed near her luggage which she has up on her bed. I call out her name but she is deeply sleeping. I shoo off the rat, which was the last I heard of it that night.

We awake in the morning to more rain and it is suggested to us that we get an early start back to the airport in order to make our 3pm flight back to Efate. So after our breakfast we begin at 9am our drive back to the airport. To begin the drive to the airport, we have a truck in front of us with 8 men with shovels who are creating the road for us to drive over as the rains had destroyed the road. This was a slow process as you can imagine. I get out of the truck to assess the situation and watch what the men are doing and think to myself, what am I doing here. As I walk back to the truck I take a look at the wheel that had fallen off last night to see that they had only found 4 of the 6 bolts that were once on the wheel. Hmmm, hopefully the wheel will stay on this time! We inquire with the driver regarding the wheel and he tells us he will drive us to the river and then we will get in another truck. Oh good! We arrive to the river and it is too high to pass. So we all squat at the river for a couple of hours. The river is at the base of the volcano and as we sat there waiting for the river to go down the volcano would “grumble” from time to time. To pass the time, I immersed myself in the Mistress of Rome, which is a great book if you haven’t read it already. Meanwhile, the men are assessing the river.

We get the okay to get in another truck to cross the river. In this truck to cross the river, I am standing in the back on the bed of the truck holding tight onto these bars. Oh, so this is going to be like a roller coaster ride. Nice! We are all ready and the driver starts the car and then just as we think we are going he turns the engine off. Okay, false alarm. We wait another ½ hour and then we decide to cross. And it was a breeze crossing the river. We drive for about a ½ hour and something is wrong with this truck and they pull over to stop another driver of a truck who had crossed the river too. Our driver asks the other driver if he could take us to the airport. He agrees and we are now in truck three of the day to the airport!

Now, driver number three is quite in a hurry to get us to the airport. We are slipping and sliding down the road. We end up in the ditch twice. The first time in the ditch we went I was not sure that we would make it out. There were many times on this drive to the airport I was uncertain if we were going to get there in time to board our plane. Although we got to the airport in time with a ½ hour to collect ourselves and reflect on what happened in the last 24 hours. Stepping onto the plane and off onto Efate terrain was a very happy moment for us 3 women! Lesson learned, check the weather forecast before going to Tanna and go when it is not raining.

Highlights of the quiet week at the hospital included lots of gauze cutting and folding, cotton rolling, scissor sharpening, cleaning, stocking and organizing. As well, one of the baby’s I delivered was from a 19-year-old woman who had inverted nipples. The mom and baby are the perfect match because the 3.42 kg boy had a great strong suck reflex.

The end of my activities here on Efate is closely approaching.

Monday, April 11, 2011

Busy Week at Vila Central Hospital!

Week 3

Miliaria is gone! Once I started using the air conditioning at night it cleared up.

This was a very busy week for the Maternity Ward at Vila Central Hospital. To follow is a few of the highlights of the week. I hope you are enjoying this and let me know if you have any questions or are curious about anything that I have not mentioned.

There were 2 vacuum extractions performed by the Doctor that I observed. One was to assist a mom during 2nd stage of labor (pushing) because she had severe heart disease. Before the vacuum assist she had an episiotomy. This woman had a severe heart murmur you could easily see by looking at her chest wall. It was very unforgettable to hear and palpate. Her baby was thought to be somewhere between 36 and 39 weeks gestation and she delivered a 2.26 kg girl. The second vacuum extraction was performed on a woman who needed a little extra help and she had a big (3.92 kg) baby boy who had a cleft lip and hard palate. By the way, he did great with breastfeeding despite this anatomical deformity!

I continue to practice my suturing and observing the midwives suture. This week I have had lots of opportunities to strengthen this skill and I am feeling much more confidant suturing.

There were a couple resuscitations this week. One was on a 3kg boy who had AROM (artificial rupture of membranes). AROM is where the bag of waters are broken with a device called an amnihook. There was thick meconium in the bag of waters. His 1-minute, 5-minute and 10-minute Apgar’s were 5/5/9. He received suctioning and blow-by oxygen. Another was a 3.9 kg girl with 1-minute, 5-minute, and 10-minute Apgar’s of 3/6/10 and who was SROM (spontaneous rupture of membranes – bag of waters broke on their own naturally) with thick meconium. She received suctioning and blow-by oxygen. The mommy of this big girl had placental membranes that were slow to deliver and cervical prolapse.

A 24 year old G3P2 (3 pregnancies, 2 viable births) VBAC (vaginal birth after C-section) gave birth to a 3.14 kg girl with Apgar’s 9/10!

I observed another footling breech with a nuchal cord who had an emergency C-section. She had a 2.62 kg boy with Apgar’s 9/10. It was interesting to feel the little toes of this boy during the vaginal exam. I am very familiar feeling the heads of these little babies not little toes!

We had a baby girl who was BBA (baby born on arrival), which means that she had her baby at home. This woman had had her baby at home and her mother brought her in with the placenta still inside the mom and cord attached to baby. We clamped and cut the cord on the truck and wheeled the mom into the delivery suite where we tried to deliver the placenta. Unfortunately after a couple hours the placenta was not coming out. So we arranged for Dr. Robert to manually remove the placenta in the surgical ward. This is a very painful and invasive procedure that I witnessed and that I hope does not happen all that too often. She had been given the strongest analgesics and sedatives the anesthesiologist had. The placenta was completely manually removed and mom and baby are doing great!

Lastly, I had to help a mother a little with the delivery of her 3.4 kg baby girl who had been a little stuck and required me pulling her. It was not a true shoulder dystocia by the way.

For fun, I have been continuing my daily swims. The New Zealand midwife, Elizabeth, and her midwifery student, Angela, arrived. Angela and I went to go swim the swim course and dove into a group of jelly fish. I could not see any jelly fish but they were there. We both had this strange nerve tingling feeling all over our bodies. The sensation went away for both of us after a few hours. I have been scuba diving in the waters around Efate and the ocean environment is beautiful. I have been eating out a couple times to get a sense for the restaurants in the area. I had a wonderful fish dinner with mango chutney at a restaurant called Chill, which is located on the waterfront. It was during sunset and I saw a most magnificent sky. The cruise ship was leaving the port and oh my, this ship is huge! It had a big television screen, which I could clearly see the screen as it sailed away. I continue to enjoy my walks to the hospital whereby all the little children so happily greet me as I walk by.

Tuesday, April 5, 2011

Week 2

Well, I seemed to have gotten miliaria. No, not malaria! And for those who don’t know what miliaria is, it is a heat rash. For me, it developed on the backs of my hands and has spread to my lower arms, legs and feet. At first, I thought it might be an allergy to the latex gloves, latex is what is exclusively used in the hospital here. No latex free option for those who have developed an allergy to latex, which is a common allergy in those working in the health profession. It has been suggested to me to give it some time and my body will adjust to the heat. And to give myself a break from the heat, I have succumbed to using the air conditioner at night when I sleep. I have slept better since doing this.

Recently, I have been thinking a lot about life and death. A fellow peer at Bastyr was on a Nicaraguan study abroad trip this Spring break and drowned while swimming in a lake. Her name is Michelle Eustache and I knew her as a very enthusiastic and curious person and it is sad that she is no longer part of this physical realm. Please keep her parents and those closest to her in your thoughts and prayers.

There have been several deaths at Vila Central Hospital in the Maternity Ward…

Sadly, the 960-gram, 25 week old baby boy I told you about in the last post died.

And the baby in the nursery with the omphalocele that I also shared in my last post has passed away as well. It is very sad. The baby was healing well and the omphalocele was receding and seemed to be improving.

When someone dies in the hospital many people gather around and wail. It can go on for an hour or so. The echoes of this last loss still permeate in the memories of my ears. It is hauntingly eerie sounds that some women make. From my observation, it seems very healthy for the family and friends to be together and to discharge this energy.

So some birth highlights of week two here in Vanuatu…

Getting lots of practice in the artificial rupture of membranes. The midwives like to use this technique to speed labor progression.

So far, the youngest birthing mom is 18 years of age and the oldest is 37 years of age.

I manually replaced a prolapsed cervix of a 37-year-old G4/P4 woman. After that, I had educated her about Kegel exercises, which don’t seem to be something well shared here. These exercises bring tone the pelvic floor muscles, which get super stretchy and lax after childbirth. They are exercises we all can benefit from doing.

I observed an elective C-section of a footling breech presenting baby who had a nuchal cord times two (the umbilical cord was wrapped twice around the neck)!

And the largest weighted baby was a 3.92-kilogram girl (that’s 8.64 pounds) which is big for NiVans!

And for a little rest and relaxation, I have managed to go for a swim everyday since I have been here. The ocean is nice and warm and the pool where I am staying is a nice cool off from a hot day.

I went to church with one of the nursing students on Sunday. We took the “bus”. Which is a man who drives a van and will take you wherever you need to go for 150 vatus. We were taken to a rural area, which was well taken care of by the inhabitants. The gardens were lovely and well tended. As we walked up to the church, I quickly discovered that the NiVans have very strong and beautiful singing voices and I love the lyrics to some of their songs. They sing about the value of life and being thankful. It is interesting to hear them sing so loudly and strong because most NiVans are soft spoken, men and women alike. I have heard on a couple occasions a NiVan shout but mostly they talk softly. On this particularly Sunday there was a group of men soccer players from Mele village (a village that has the famous waterfalls on Efate island) who sang a song for us. It was interesting to me to see these men become quite shy and humble before us. They sang wonderfully!

More to come wait patiently…

Friday, March 18, 2011

First week in Vanuatu!

Hello! So this is the story of my adventure to a small "developing" city, Port Vila, in the Republic of Vanuatu on the island of Efate. I arrived last week safely and got started the following day of my arrival at the local hospital, Vila Central Hospital, in the Maternity Ward. My first day I arrived at 7am and was warmly greeted by one of the sistas (midwives). She casually showed me around as we waited for everyone to gather for the report from the night shift. So much has gone on this last week and I will briefly summarize. There have been 3 "sheksheks", otherwise known as earthquakes. One was 6.5 and 26K's beneath the Earth's surface, this one I was sitting at the Midwives station doing paperwork when the building shaked. It got eerily quiet for a few seconds and then after it was over everyone went back to their business. Last week I have been getting familiarized with procedures, language (Bislama), who people are and where things are at. Everyone has been super helpful and friendly. There were a lot of normal births early in the week, not much unusual last week. And with the full moon Saturday, the maternity ward became quite busy. Later in the week, we had a premature delivery of 25 weeks, one smol pikini, 960 grams, from one petit mother! The baby is doing well in the nursery. Unfortunately we had a delivery of a baby with hydrocephalus (excess fluid build up in the skull which leads to brain swelling) and an omphalocele (whereby the intestines stick out the belly button) and sadly this baby did not make it. Currently there is a baby in the nursery with an omphalocele and is scheduled for surgery this week for repair. One mom had a nuchal cord (a super long cord wrapped 3 times around the neck)! I was able to reduce it. Whereas another mom had a super tight nuchal cord wrapped around once and I was unable to reduce it and ended up clamping and cutting the cord on the perineum. This little one we ended up suctioning and giving some oxygen and within 5 minutes was no longer blue and was pinking up. In the short amount of time that I have been here I have become aware of how much I really do know through teaching the nursing students. I enjoy sharing the knowledge and they seem to be very curious. Until next time...

Thursday, March 17, 2011

I am Very Thankful, and Will Miss....

As my time here comes to an end, I am reflective and thankful for the people and all that I have learned. I will miss the constant smiles, even from mom's amidst their most challenging parts of labor. I will miss holding the hands of these women as they gently say, 'ohhh Mrs., ohhh Mrs.". It has been such a pleasure to help these lovely people and have them thank me after the birth when really it is them who deserve the thanks and praise. I will miss the kindness of strangers; the other night I was coming home from dinner alone and trying to catch a bus, it wasn't late but it was quite dark. I quickly realized that there weren't many of us on the street. A couple of men asked if I was alright, at first, due to apprehension I didn't answer. They asked again and I said yes, they didn't come closer but instead made sure to find 2 security guards who were close by and said, "make sure you help this lady get a bus and not a taxi, okay" (Taxi's are at least twice as expensive here). I thanked them and the security guard who helped me, and a bus was along in no time. I felt looked after. I will miss the students asking me questions and observing their learning. I will miss the beautiful babies who cry when they get their injections and then peacefully relax as they sink into my hands when I wash their hair and give them their first swim (bath). I will miss the family and community support that is so evident here. I am thankful that I have not only met and exceeded my "required birth numbers" during my time here (I have over 100 births total!) but that I have been able to help with many other tasks as well; whether it is making gauze, cotton balls, sticky strips to be used as band aids, cleaning the labor ward, assisting with breast feeding, etc. I am thankful that I have truly gotten to be a part of life at Vila Central Hospital. It has gone so quick! Over the past few days I have helped with more lovely, uncomplicated births and been able to see a few mom's who have returned to have their babe's weighed and I love being able to catch up on how they are doing. I plan to visit with a family in the next few days whose baby I helped delivery (my first week here). I am thankful that the little girl who I delivery at 30 weeks is still doing well. I am thankful that the cyclones that occurred while I was here didn't do any major damage, that the Tsunami warning that came in the middle of the night, went without impact and that the 2 earthquakes that I felt yesterday also have not harmed any of these amazing and open people. I am thankful for the babies that I knew, even for a small time. Their little souls have touched me, even the souls who left their bodies before I knew them have had an impact on me. I will miss the midwives generosity and laughter. Even though at times I wasn't sure what they were talking about, their laughter was contagious. I will miss a lot and am thankful for countless experiences and the beautiful, resilient people here.

Wednesday, March 9, 2011

The Downs and Ups


It has been a while since my last post in part because I have found it challenging to put words to the experiences that I had over the past week/weekend. I will try to recount the events as I experienced them, with the disclaimer that the following stories are sad, hard to read, and at times hard to re-live. I also want to make sure to note that I believe that those involved have done the best they can with what they have and know, although I would have handled the situation in a different manner. With that said this part of the post involves death and I advise skipping to "The Up's" at the bottom if you don't want to read about it. I am going to try to keep it brief.

I came to the hospital last week to find that a planned c-section had occurred for the purposes of ending a pregnancy. The mom was 30 weeks gestation (same age as the little one I delivered the first week I was here...who is still doing well). She had an ultrasound earlier in the week and the findings were that her baby had severe hydrocephalus (a condition where there is water on the brain and swelling of the head occurs). Sadly, they do not have the resources or ability to put a shunt in, as would be done in many other parts of the world. Knowing that the newborn would not survive and that the size of the head would continue to grow larger if the baby was allowed to continue in utereo, the family and doctors decided to do the C-section as a termination. The issue, was that most knew the baby was going to be born alive. I was not in the room for the section but one of the students (who I have become close with) was and she re-counted the events for me that left her quite sad. When the baby was born one doctor wanted to suction him to help him out, and another doctor said "no, just leave him." He was alive!

I was in the labor ward when one of the midwives brought the little bundle in, all covered in blankets. This little boy was very much alive, still breathing, and giving small whimpers. She said the doctors said we are to leave him here and she set him on the cold receiver (which had not been turned on). I walked out of the ward to get the story on this little one who looked just fine to me, although there was liquid on the brain that you could palpate. Once I realized that he was being left there to die, I couldn't help but return to the room to put my hands on him, uncover his sweet face and gently talk to him. Mom was still in post-op. After discussing the case with a few others who felt deeply touched by the situation I turned on the warmer and another midwife gave the little one oxygen. He gave little crys. I walked out of the room momentarily and then returned to find that the doctor had turned off the warmer, taken away the oxygen and exposed his little body to the air. I was in the room when the father walked in and I heard as the doctor described, "baby no good". The family knew that the boy wouldn't survive but I am unsure how much they understood of just how alive he would be, when he was born.

After the dad left, the midwife asked me to weigh the little boy. With tears mounting behind my eyes I picked him up, wrapped him again and gently carried him to the scale. He was 3 1/2 pounds. I cried as I brought him back into the ward, and I refused to leave him uncovered. He opened his eyes as I walked back with him and I saw that him mom was being wheeled back from surgery. I set him on the warmer.

The student who was so disturbed by the on goings at the c-section had left the surgery and saw me in the labor ward crying, she said, "Kate that is exactly how I felt". However, within minutes I had to very quickly collect myself as another woman was brought into the room, pushing! We needed the warmer (which doubles as the resuscitation area- if need be) to get ready for this next baby so we put the 30 weeker in a bassinet in the same room where he continued to give small crys. The head was right there for this mom of one, yet I could tell that part of her bag was still intact so to make it easier for the baby to come out, I broke her bag. A thick black substance like I have never seen before came out (an extremely bad sign), very old meconium. Next thing I knew the little boy was born but had clearly passed away at least 1-2 days earlier. I checked for a heart beat anyway and another midwife called a doctor in to confirm that he was in fact deceased. He also had some serious malformations. I was unaware that prior to coming into the labor ward, no one had listened for heart tones on this babe (there may not have been time).

One other time I have been involved in the birth of a still born, however the family was aware of the situation. I have never had to give a mom the news before. I was told that she was 35 weeks but after looking at her chart saw that by her dates she was only 27 weeks along (although the baby did look closer to 35 weeks). We later found out that she had a fall one week prior where "water came out", she did go to the antenatal clinic when this happened. She also reported that she hadn't felt baby move since the day before. I wiped the little boy down and wrapped him as best I could and handed him to his mom, telling her that I was so so sorry for her loss. It was terrible! And the other little boy was still in a bassinet in the room, alive but quietly and slowly leaving his body. It is an indescribable feeling to be surrounded by that.

After the delivery this woman's mom left to get clothes to dress the deceased boy in (as they do here) so she was alone and in visible shock. I asked her if there was anything that I could do for her. She couldn't answer me verbally but I know she understood me. I gently rubbed her back. After a while I was instructed to also weigh this boy- this was one of the hardest things I have ever done, I gently took him out of her arms and spoke to him as I walked to the scale, again in tears!

I returned and gave her the boy to cuddle with again. Her husband was a teacher so he was at work. I took the other baby (from the c-section) out of the room and brought him to his parents and extended family to spend his final moments with them. I let them know that he was still alive but I was unsure how long he would survive. He died about an hour and a half later with his family. The other boy stayed in a private room with his family for most of the day.

There were two more births that I helped with that day (that went very well) however the day had still taken a toll on me and I felt I needed to take some time away. I cried a lot that day. Many of the staff felt greatly effected by how the case with the boy with hydrocephalus was handled and there has been much discussion, reflection, and prayer. For the most part I am very impressed by everyone out here yet that day was a hard one, a day that has really made me thankful for the resources that I am privileged to have, should I need them. I have 2 step siblings who have a half brother that has hydrocephalus, when he was born he was "the size of a coke can", he is now 16 years old and a track star. I took the following two days off to reflect.

Another "down" to share, before we get to the good. Early this week a woman (almost 40 years old) came in, in labor with her 7th child. That is what she told us....although, her belly was flat, she said she was due the following month but had been having contractions. I palpated her abdomen but didn't feel anything, and we couldn't get a heart beat. With the help of another midwife I asked a few questions, "had she felt the baby move?" Yes, a lot. "Had she taken a pregnancy test?" No. "Had she sought pre-natal care?" She had been to the clinic once at the beginning. We thought it best to call in the doctor on-call to address the case. The midwife told me that this was the third case she had experienced like this. The doctor arrived and brought in his portable ultrasound machine to show the woman and her husband (who had brought all of the clothes and supplies along for her and the baby) that there was in fact nothing in her abdomen. It was very very sad, they thought she was in labor and in fact she was not pregnant! I am not quite sure what this woman's mental situation/stability was.

I returned home after a very long day (12 + hours) to find that a pair of my flip flops that I had left outside my door for the past 3 weeks, had been taken. Without energy to get that upset I was a bit annoyed and went to bed.


I woke to find that my flip flops had been returned. They were in the same place I had left them before heading to work early the morning before. I guess someone just wanted to borrow them for the night! This made me laugh out loud.

As I mentioned briefly before, I am happy to report that baby Sonya, the sweet little one who was born into my hands at 30 weeks pre-mature is doing well and needs less supplemental oxygen on a daily basis. She is still in the nursery and mom still stays at the maternity ward to give her hand expressed milk to the little girl every few hours. I have seen the young mom helping others out with their babies as well.

I got asked if I wanted to attend a portion of a 3 day conference that was occurring in town. It was about the state of maternity and neonatal care in Vanuatu and more specifically Efate (the island I am on). There were members from the WHO, UNICEF, UNFPA, doctors, pediatricians, midwives, and nurses in attendance. I came to the session on the Role of Midwifery Care. The statistics were interesting and the presentation really got the director of the WHO generating ideas for how to improve the numbers of midwives in the area and the conditions under which they work (long hours, understaffed times, etc.). I was glad to attend.

Last week the ambulance went to pick up a mom and her newborn who was 'BBA'- Born Before Arrival; this was her third baby and the previous one was a c-section. Baby was unintentionally born at home with the assistance of a traditional birth attendant (a community midwife, who has learned via experience). All is well with the new addition and mom.

Later in the week I attended a very lovely and loving labor. I have only been to one other birth where the partner has been in the labor room, and it was their 4th baby. This time, it was the mom's first pregnancy. She was a young 20 year old and her boyfriend was at her side, holding her head up, encouraging her, giving her sweet kisses the whole time! It was so nice to see. His mom was also there helping her along. When the baby came out she needed a little extra assistance to come around. I was so happy when she finally gave a cry and really came into her body. The uncle entered the room not too long after and I don't know if I have ever seen someone so overjoyed and excited for the family, her was laughing and crying at the same time! I helped this mom breastfeed for about an hour. Dad made sure to get my name and took photos of me on his cell phone. They had been discharged by the time I got to work the next day, (another sign that all was well) so I am unsure if there is a little Kate around or not but none the less, it was a beautiful birth with great support.

I have been able to help support the student nurses along their training and be by their sides assisting as they help deliver more babies and practice their skills. It has been rewarding to see how far some of them have come in just a few weeks!

One of the midwives met her 20 year old niece for the first time when she came to the hospital for antenatal care this week. She lives on another island, the family had moved there right after her birth so this midwife never got to know her. It wasn't until she checked the unusual name with the name of the father of the young girl that the midwife realized this was the daughter of her brother! I am not sure if she has had her baby yet but I hope the aunt got to be there if she has.

Also, I walked into the labor ward to see a woman pushing and the midwife asked if I wanted to do the delivery. Of course, yes! As I was coaching and supporting the 23 year old through the delivery the midwife informed me that she had delivered this young woman (23 years ago!!). That was really special!

And finally for now... there have been 70 births in the first 11 days of March here at Vila Central Hospital. This is actually down from last year (if you can believe it!) which means that the sex education that they have started to provide at some major events here (i.e. Independence Day- which is 9 months prior) may be working! However, I have also been told that some use the condoms that have been handed out, for fishing bait "because the spin so well in the water" =) Hopefully they are also being used for the intended purpose.

Can't believe I have only just over 1 week to go! This has been a truly amazing experience, one which I will forever be blessed to be a part of. I have told the midwives that if they ever make it to Seattle they will have somewhere to stay...in fact MANY places to stay as all of us that have experienced their kindness and tutelage would probably all be wanting to house them!

Thanks for reading!

Thursday, March 3, 2011

2 Sets of Twins!

I awoke at 6am at the hospital to get a report that the mom of twins was 5-6cm. I went to check on her as she was being monitored on the CTG (Electronic fetal monitor- for heart rate and contractions). I rubbed her back and gave her smiles, during a contraction she would quietly say, "ohh Mrs." At about 10am we moved her into the labor ward to get checked by the doctors who had also been over seeing her case. They decided to break the bag of twin I (the one who was head down) and advised to begin induction at 12pm if she was not in more progressive labor. I stepped out of the room for a minute to find we had a new admit. A woman who was having a planned c-section in 2 days, she had 2 previous sections, and also twins!

The NZ midwife asked if I wanted to help and we brought her into the other side of the labor ward to be assessed. We could tell by her breathing that she was having a urge to push. The midwife did a quick vaginal exam and found that not only was the woman fully dilated but there were 2 feet there!! She asked the woman to try not to push, said, "Kate can you put an IV in?" and with that, quickly left the room to get the doctors who were meant to perform the section. Soon after about 4 people came into the room and one doctor said, "On the ultrasound they were head down" - Not anymore. Moving swiftly we got another bed in the room and had her transferred to the operating theatre. I didn't think there would be time to get the epidural in before this set of twins arrived; however they managed to get her numbed up in time to get both babies, who were BOTH breech, out safely. We sent one of the students in to observe and she was over the moon when she came out of the operating room. Everything went great! The twin girls were brought back into the labor ward and placed on the warmer to await their injections, swim (bath), and scale (weight). As they laid arm in arm, our mom in the next room was surprised that they were out already and she told me she was feeling as though it was time to have hers. It seemed as though something might be holding her back though.

It is not uncommon here to have a Vanuatu Midwife say to the women with a stern but effective voice, "You no cry!" I went in to support the mom and she told me that she wanted to cry but the midwife said she couldn't. She had also shared this with one of the student nurses that was around. When the midwife was not in the room, I did a vaginal exam finding she was at 7cm at about 11:30 and I told her that it was okay to cry. Again, I rubbed her back and she repeated, "Ohh Mrs." Enter the midwife (who, don't get me wrong, I very much like). She started the induction and within 10 minutes the mom of twins was fully dilated. I got into place to catch twin I. She came out head down, screaming away, big and beautiful. Then the doctors and another midwife were in the room to assist with the breech twin if necessary. I smiled up at the mom in between births and reinforced what a good job she had done. Again I got ready to catch, I did a quick VE (Vaginal Exam) to confirm the position- it was a leg! We waited a few minutes for twin II to present. Next thing I knew, not only did a little foot come out, but so did a hand! Seriously! Imagine that, and straight away came his bum and the rest of him, except his head. Both myself and another midwife were hands on, within seconds and with a bit of assistance the smaller sweet little boy was born. I again gave mom (who had been silent through out pushing) a big smile. Many hands were around to help as I delivered the 2 separate placentas at the same time.

Right away another midwife brought both the girl and boy over to the mom for some skin-to-skin time. I have never seen a bigger smile in my life- it was so so beautiful to see this mom with her two little ones in her arms and her ability to express her feelings, that this time I couldn't hold back my tears. Slowly multiple family members entered the room to meet the two new additions. All three are doing well and I have checked up on them everyday since. It made my week!

Delivered a baby with very "sticky shoulders" yesterday, to a young 23 year old who was post dates. This would be her second pikinini, she was just shy of 8 pounds (large for here). And today, everything began very slow and quiet. I had time to make a whole box full of cotton balls, yes, by hand! They have a large roll of cotton wool that you pull apart and roll in your palm to make the balls. They also make their own gauze squares here (of which I have also made a load). Anyhow, in the afternoon a woman came in pregnant with her first baby. I stayed outside of the assessment room as the nursing students practiced their skills of blood pressure, pulse, palpation, and attempting to listen to the little one. The woman sounded as though she was in very active labour- close to pushing I would have guessed by listening from 5 feet away. After about 15 minutes I went in to check how things were going. The woman's water had broke in the car on the way to the hospital and I asked how far dilated she was, they told me 5cm (half way there). She didn't want to sit still and was trying to take the monitors off of her belly. I asked her if she wanted to get up and she said yes. I told the students that she was welcome to get off her back and stand up as long as they could continue to monitor the baby. I watched as the woman began to silently push - I felt as though she may just be trying to push prematurely and feeling baby's head (as can sometimes happen)- the vaginal exam of 5cm from 5 minutes earlier had also been confirmed by the doctor.

Next thing I knew the woman who had started to get off the bed, quickly got back up and I saw a head and shoulders emerging! No time for gloves, I grabbed the sheet that was at the foot of the bed and caught the little man as the rest of his body was very quickly born! I rubbed his back and blew a little in his face to get him to come around and within about 30 seconds he was singing away with his cries. Poor mom had gone into labor just under 2 hours earlier! When she said she needed to push, she meant it! I was so thankful that she managed to get back onto the bed in time. I helped to get baby onto the breast after the midwife repaired the 2nd degree tear and made sure he had a new warm blanket on. I have heard that babies "fly out" here and this birth was truly one of those cases! After going over a few things with the student who had helped out, and cleaning the assessment (turned labor) room I headed back to my bungalow for a shower and dinner. I am sure tomorrow will bring more excitement, but hopefully we will be able to get all the mom's into the labor ward this time, before they push their babies out! All is well =)

Wednesday, March 2, 2011

Another Lovely and Busy Week

Since last week, the weather has affected the phones (which are still not working) and the internet where I am staying so it has been challenging to add to the blog- but every so often I find an internet connection so here we go! This week has proved to be just as eventful as the last 2! I am continually amazed by the strength of these women and the community that surrounds them. Often I ask the support person if they are the mum (of the laboring woman) or a friend and sometimes this is the case but also I observe cousins, aunts, and neighbors stepping in to help. It is really quite beautiful how everyone looks out for each other and how extended families live together under the same roof. During the week one of the mom's who I helped last week returned to the ward to have her baby weighed. Her older sister has taken the family in as the new dad is not able to be around (due to school commitments) for the first 6 months. This is the mom (that I wrote about previously) who left the hospital after I had done an initial assessment on her and didn't return until the next day when I found her vomiting in the hallway. She and her sister are both lovely, I was able to visit with them for about an hour as we had an unusually slow period and they waited for the pediatrician. At their request we exchanged e-mails and they told me that they would really like to see me before I leave and wanted me to be able to see baby Uriah again. It made me feel wonderful; I actually ran into the sister in the supermarket a few days later and almost felt like a local as we both greeted each other with large surprised smiles and the traditional kiss on either cheek. I look forward to meeting up with them in the weeks to come.

I have been blessed to help out with many more births over this past week, in addition to assisting the Vanuatu nursing students with their required births and skills training. It has been a great combination to be perfecting and learning new skills myself, as well as teaching and reinforcing knowledge with these great young students. I have formed relationships with a few of them and I love it when they come and ask me questions about IV's, injections, bleeding, newborn breathing patterns, or anything in between. I have watched as some of them catch a baby for the first time. And sometimes it is a group effort. In fact, a few days ago one of the students did his first catch and after inspecting the perineum we noticed that the mom had a first degree tear, the midwife there at the time turned to me and said, "okay and now Kate will sew this up". I was glad to work on my skills again and this time it didn't take an hour.
More beautiful babies are in this world!

Saturday was quite eventful... I got to catch 3 babies and in between help out with a few other mom's. I was sitting at the front desk writing up the birth report and entering names and statistics into the one of many books they keep records in, when a Vanuatu woman quickly walked to the desk speaking in Bislama, the words that I understood were "blood and come now!" I followed her to the showers where I found a mom who had given birth about 2 hours earlier (with the help of one of the students), she was standing in the shower and there were a few very large blood clots at her feet. I had her sit down immediately and quickly went to get another midwife to help out. We got her into a wheel chair and took her back to the labor ward, where she passed out in the chair just before getting to the room. See quickly came around and we got her up onto the bed to assess her bleeding. As we re-inspected the perineum I pointed to something that looked "different", the midwife replied "oh that's the cervix" however I just wasn't convinced so I continued to inquire....turns out what we were looking at were retained membranes (hence the bleeding-even a very small piece can make a woman continue to bleed, or get an infection), once the piece was removed and a bag of fluids had been put into the woman she was doing very well. I stepped out of the labor ward to find a very concerned looking man and I asked him if he was with "Celine", he was very pleased to have me tell him that his wife was going to be just fine and thanked me (more than once) and I could see and feel that relief sweep over him.

Not too long after this, one of the nurses asked if I could help pick up one of the postpartum mom's who had "fallen out of bed and wee'd all over the floor". Poor woman, she has been at the maternity ward for almost 2 weeks now as her newborn needed extra help and was in the nursery. Women stay as long as their babies do (we have someone who has been there 52 days!). This mom had been waking every 2 hours to hand express milk and then feed her newborn. When we got to the unusually obese woman she was on the floor next to the bed and very confused. I thought she may have had a seizure, but after asking more questions to those around this was ruled out. We moved her to a room closer to the front desk where she could be monitored closer and called the doctors in for a consult. She has very high blood pressure, very low hemoglobin, and was extremely fatigued (among other medical concerns). After getting a unit of packed cells she seems to be doing much better- I give her a big smile anytime I see her walking about.

Just after this happened I brought a laboring mom into the delivery room, to assist I broke her water and soon after she was ready to push out her son. I had just finished sewing up a first degree tear and making sure baby was feeding well, when I turned around to see another woman in the labor ward getting ready to push her little boy out. I was there in time to catch him and make sure all was well (according to her dates she was only 35 weeks). No suturing this time =). 8 hours at the hospital and I was ready to head home for dinner.....yet there was a mom of twins who had been admitted earlier that day and I really wanted to be around for the birth so after dinner I returned to the hospital for another 6.5 hours. No twins tonight but I got to help a postdates (43 weeks) mom have her 3rd boy. She arrived at the hospital and had her baby in her arms 2 hours later.

I was able to assist another 17 year old with the birth of her sweet son. Her water broke the night before she came in and I took her case. She was not contracting and by her dates (which are often off here, even by a month) this young mom was only 33 weeks gestation. She received steroids to assist in the development of her unborn babe's lungs. After 36 hours of ruptured membranes she also was started on antibiotics to prevent infection (not common practice for us). Finally after being at the hospital for days the doctors decided to begin induction. Everything happened very quickly for her and as I was supporting her while she was having a CTG (Cardio Toco Graph- records the heart beat of the baby and contractions), she literally was getting contraction on top of contraction and was climbing the walls and crying. The trace of the heart rate didn't look great and intuitively something felt off so I called in the midwife for a consult. We did a check for dilation upon my request and found that babies head was right there!! I didn't even think we had time to move her into the delivery room but we wrapped her in the gown that we had handy and quickly took her across the hall. In about 5 minutes this young mom had her screaming (very term looking, which means at least 37 weeks old) baby in her arms.

I was still waiting for the twins to arrive. Earlier in the day when I was looking after the mom of twins- who would be pikinini's number 7 and 8 for her she started speaking to me in Bislama....after a little while I smiled a big smile and said, "sorry, my Bislama is small small" to that she replied, "I said, that I like you very much". It was heart warming, I told her that I would love to be around for the birth of her babies. So when I left the hospital to have dinner with my 2 midwife friends from New Zealand on a nearby island, I made sure to put a pair of scrubs in my purse so that I could have the bus take me directly back to the hospital that night. When I got back, still no twins but there was an emergency ectopic pregnancy removal about to occur. I went into the operating theater for observation. After the removal of the one fallopian tube this woman had remaining I left the operating room with a heavy heart- that was not was I was expecting to see, although I was happy that this woman was alive because a ruptured fallopian tube can easily lead to death. It was about midnight, I had shared the banana's and passion fruit that I had bought at the market earlier with the Midwives on duty, the pregnant mom of twins, and her support people (one who happened to be her first born 18 year old daughter). Then I decided to take the Midwives up on their offer to lay down in one of the two private rooms that they have (for mom's), making sure that they knew to wake me if the twins decided to become more active. I felt like I was back on call again! Kind-of exciting, waking every so often to the sounds of newborn cries from the babies near by.

More on the twins in the next entry....stay tuned.

Wednesday, February 23, 2011

The Cyclone is Gone and the Babies Keep Coming!

Well I am happy to report that the cyclone has come and gone without much excitement. There was loads of rain and wind but fortunately no real damage to the island. However, as I suspected it might, the low pressure and change in weather did bring lots of babies (pikinini's). I wanted to go into the hospital on Sunday but all my scrubs were being washed and due to the extremely wet weather had yet to dry, so instead I stayed close to my bungalow as I was advised to do. Thankfully I had rested up for the days to come.

On Monday I spent the majority of the morning and into the afternoon with a lovely primip (1st time mom) whom I will call 'Jane'. She was 21 years old and there being supported off and on by her mom. Usually we have the women walk around as much as they can if they are 4 or more centimeters dilated, checking in every so often on mom and baby. The policy at the hospital is every 4 hours however, I tend to see how the mom's are doing and listen to heart tones on the pikinini's more often. We usually do not bring the women into the delivery room until we have checked them and they are "fully" (meaning 10 centimeters or fully dilated) or until they have told us that they feel as though they need to "sit, sit" (literally shit shit or push). This morning was a bit slow and it was very hot (nothing new) so even though 'Jane' was only 7cm the Midwife in charge said that it was fine if I brought her into the delivery room - the only room in the labor ward with air conditioning. The next 4 or so hours would find me trading off between fanning 'Jane' with the large clip board (which is covered in small pieces of tape to be used to secure IV's) and holding her hand through contractions as she softly said "Ah wei" (Ouchy). After some time 'Jane' was understandably getting tired and worn out. I started a bag of IV fluids to give her a bit of hydration. I checked her again and she was still 7cm maybe a generous 8, with a large bulging bag of waters still present. Her baby's head was making it's way down nicely and I knew that we could get things moving (so-to-speak) if I were to break her water; but I wanted to be patient. Still, after more time and an even more tired laboring mom, she had only progressed to 8cm and was verbally in quite a bit of pain (this is not something that is common here...most women literally just push their babies out without the verbal outward signs of the inward pain that they are no doubt experiencing). I suggested to the Midwife that maybe I "break her bag", she agreed that this was a good next step.

I informed 'Jane' of what I would be doing and told her that it would hopefully speed things up. I was very happy to see clear fluid upon AROM (Artificial Rupture of Membranes) and literally within about 5 minutes she was in rocking labor and fully dilated. I coached her through pushing and she did a lovely job! Finally she had pushed out a crying (before his body was out!) 5.3 pound 'wee boy'. Her mom, who did not want to be in the room for the actual delivery came in after he was out. She told her daughter that she needed to thank me, which 'Jane' had already done. Then she said that they should name the little boy Kate. This was a very sweet gesture and I know that there are a few kids running around the island with names of the Midwives that have delivered them. Although an amazing thought I also felt that it could be a bit difficult for a male named Kate and hoped that maybe they would pick another name =) I checked on 'Jane' and her partner later that afternoon and the next day and have been constantly thanked by the family, to which I whole heartedly reply, my pleasure (which it always is, and a true honor). Finally, before the family was getting ready to leave I asked, "So what have you decided to call him?" I was happy when their response was Jimmy.

The next day proved to be one of the busiest I have had thus far and truly earned me a day off in the sun today. On Tuesday I managed 3 births and helped out with a 4th in a fairly short period of time and also sutured twice! Each time I carefully sutured the women it took about an hour and I had a couple nursing students observing me as I learned to perfect my sewing and they learned about tear repair. I feel very thankful for the experiences and to the MW's who oversaw my technique. I am happy to report that all of the babies delivered are doing well, although one did give me a bit of a scare.

I was supporting one woman who was almost "fully" when the Midwife brought another laboring mom into the room and drew the privacy curtain between the two women laboring side by side. She popped her head around the curtain and said "she is fully, do you want to come and help her?" Not wanting to leave the first woman but knowing she had lots of other support around her I happily agreed. When I re-checked this second mom I felt a large budging bag of waters and the MW suggested AROM. Upon breaking her bag out came moderately meconuim (newborn poop) stained water (this can sometimes mean a distressed baby so you have to be a bit more on your toes). Again the nursing students were there doing their maternity rounds, I turned to them and explained what the color meant and that it would be good to be thinking ahead about the possibility that suctioning (baby's mouth, throat and nose) may be necessary. A few minutes later out came a screaming (thankfully), covered in poo, little girl with a hand by her face....no suction necessary. I barely had time to help baby latch on to the breast when I was called to the other side of the curtain.

I checked in on baby by listening to heart tones and helped coach mom through pushing. After a few minutes I had an intuition to listen to baby again (something they do less frequently here than I have been trained at home). When the woman who was supporting mom turned the monitor on for me I watched as baby's heart rate went from 120 to 110 to 100 then to 60 bpm! The normal range is 110-160 (with a few exceptions during pushing), I quickly got mom off her back and had her continue to push in a side lying position (also something not frequently done here). I kept my hand on the heart rate monitor and my eyes on the numbers as they came back up into a normal range. I tried to stay calm but on the inside I knew the urgency of getting that baby out quickly as to not see any more decelerations in the heart beat. For more pushes the 17 year old first time mom, stayed on her side. As baby was crowning (head appearing) the MW had her return to her back but we kept the monitor on and baby seemed okay and the birth was imminent. After what felt like an eternity to me, but was probably only 5 minutes, this young mom pushed out a baby boy who was not breathing. I quickly checked the pulse on the umbilical cord to get baby's heart rate, which was above 100. I rubbed his back, drying him off and trying to stimulate him and blew air on his face, all the while talking to him and asking him to come into his body. I called out for suction and this is what he needed to give him a bit of an extra push to come around. I kept talking to him and warming him up and felt that he was entering his body. A few seconds later (which feels like hours) he was coughing and started to cry. I almost couldn't hold back the tears of relief myself. I picked him up, thanking him for coming to join us and placed him on his teenage mom's belly. After a few deep, calming breaths, I checked her and saw that she would need stitches. The students gathered 'round as I dripped with sweat and was assisted through my first "real" suturing job. One of the students even took a piece of gauze and wiped my brow at one point; I gave a small sigh of relief after the hour was up and a large smile to them when I was done and thanked the mom (who had baby with her the whole time) for her patience.

Fourth baby of the day....I came into the delivery room and the MW asked if I was tired or if I wanted to do another birth? Of course I wanted to catch another baby and I had only been there about 6 hours (although a lot had already gone on). With some help, out came a large (by their standards) 7.7# boy and mom had some unique tears that also needed stitching. After another hour long suturing job, and no break for lunch in between births....Now, I was tired. I sat down in the tea room and had a little reflection time. Then I weighed this little sweet one and explained to the students the injections that I was giving him. Vitamin K in the right leg (which helps to clot the blood) and Hepatitis B in the left (the vaccine). I gave him a quick snuggle and then found a family member to give him a swim (bath). I was going to check on mom again when the MW's said, "go home, go home, have a swim and get some sleep...you have done a lot today!" Another Midwife said that I really should enjoy the weather if it is nice (today) and take the day off.

I went home feeling happy with a successful and hard worked day. Had homemade dinner with 3 lovely midwives (also working at the hospital) who are all living in New Zealand now, but come from England, Italy, and Brazil. We talked about the state of health care in each of our countries and compared our different training and schools of thought with regard to midwifery. It was very nice. I told them that if I decided to take the day off today I would call them to do something. When I awoke to the sunshine I decided I deserved to enjoy spending the day seeing a bit more of the island.

We spent the day snorkeling, enjoying the sun and then laughing as we got absolutely drenched by rain on the trip back to the main land on the boat. The beach at Hideaway Island is covered in coral and beautiful shells and the sea life was unbelievably colorful! I saw small schools of neon blue fish, huge parrot fish, fluorescent purple coral, large blue starfish, and so much more. Had a nice walk to the large supermarket this evening after the heavens stopped talking to us (the thunder and lighting are unreal here!)....one of the cleaning girls stopped to say hi when I was standing in awe on my porch and said, "the sky is tripping" - funny expression. I am ready for another happy and eventful day at Vila Central Hospital tomorrow. Thanks for reading!

Saturday, February 19, 2011

My bungalow won't blow away, will it?

Tropical Cyclone Atu has formed just North of Efate (the island I am on) and it is intensifying, as the news reports claim. It was a loud one last night! Lots of intense wind and rain, and there is just more of the same today. All guests where I am staying were given a notice about the cyclone this morning; We have been advised to stay close, bring outside tables and chairs in, and close our wooden shutters if necessary. Most of the coconuts and large palm branches have been removed from the front of my bungalow- in the event that they should want to come through my windows =)

I have asked a few workers the above question, "My bungalow won't blow away, will it?" Somewhat seriously and somewhat joking.... To which I am greeted with large smiles and "of course not, you are safe here". This type of weather and high force winds (possibly gusting upward of 100Km/Hr tonight) is apparently the norm here, around this time of year. The owners say that it is just a "wee bit of wind". Okay, we'll see as this develops further. Atu certainly has made things cooler, which is a welcome change.

Friday, February 18, 2011

What a week!

I don't even know where to start, it has been an incredible week to say the least! Every day my heart is filled with countless experiences and I always intend to come back to my bungalow and journal or write a quick note on this blog.....and then after an 8-10 hour day (or 11 1/2 as today was) I come back, shower and pass out. Life here is amazing, wonderful and exhausting! The people here are beautiful and the women are so strong. Everyone is very friendly and I am always greeted with multiple smiles and "Gud Morning" on my brief walk to the maternity ward. Every birth has been memorable however I will only comment on a few, as discussing all 15 that I have already been blessed to be a part of would just be too much.

The first little girl that I caught for a lovely first time mama had BOTH of her hands up by her face when she came into the world-and no tear for mom! Everyday when I come in, I go into the nursery to check on the 26 weeker who was born on Monday night weighing just under 2 pounds (he is still doing well) and now I also check on the 30 week old little girl that I caught yesterday (born to a very sweet 17 year old mama) who was only 2.8 pounds! I feel a special connection with this mama and papa and give them big smiles every time I see her heading into the nursery to syringe feed her hand expressed milk to her little one. Rarely are the partners in the actual delivery room here, it is usually a female relative or friend supporting and fanning the woman down (if anyone). When the young woman previously mentioned was in labor I asked her if she wanted her boyfriend in the room with her, she said yes and I went out to get him but he had gone to the store....he returned fairly quickly post-partum and found his "wee baby girl" was born =) That same morning I did an initial assessment on a woman whose water had broke the night before but she wasn't contracting yet, when I checked her she was 2-3cm and at this time (especially with the water broke) they are supposed to stay in the ward.....she told me that she didn't have anything for the baby and asked if it would be okay to go home and get some stuff, I checked with the sister midwife and she said it was fine. Hmmm, later in the afternoon she was still not back in the bed I had made up for her and the next morning she wasn't in the bed either, I was starting to feel terrible that I had let her go, who knows how far away her village was. In the discharge book one of the options for reasons a person is discharged is 'absconded' (along with alive or dead), I now understand that a bit more. Sometimes people just don't come back. Then in the afternoon there was a woman who sadly was vomiting all over the floor in the hallway, I went to help her and realized this was my lady from the morning before! I was so so happy to see her and I think she was happy to see me as she had told me the morning before that she hoped I was there when she had her baby. Her little boy also decided to come out with a hand by his head (just as I had suspected he may when I palpated her belly earlier), and again no repair necessary! I check on her a few times a day just to see how she is doing.

Two sets of twins have come into the world this week and I was fortunate enough to be a part of both (or all four) experiences! I did the first assessment of a 30 y/o mom at 39 weeks who came in to the ward in labor. With help I made sure that twin 1 was head down and confirmed that twin 2 would be breech (if after the delivery of #1 we could keep #2 from turning transverse). I started an IV on the mom "just in case we needed it" and we went back into the delivery area. Twin 1 came out head first, weeing all over the place and crying, it was beautiful. Then came twin 2, not bum first as we had anticipated but all of a sudden a foot came out!! There was a pediatrician on hand and 2 other midwives in the room and they coached me through the delivery of the footling breech who pooped all over the place - before his head was even out! That was a sight! And he too was crying upon arrival into the outside world! Both boys weighing 6.8 and 5.9 pounds respectively received apgars of 9 and 10. They are identical and you could tell literally from the minute they came out, and the proof was in the placenta (mono-di as they call it). And this morning I went into a c-section for twins. I was asked by the pediatrician if I wanted to "receive" the second twin, to which of course I replied yes! All in the room waited with bated breath for these two to come out, because the reason for the c-section was that this young mom (21 y/o) had 2 previous still births and the doctors planned this section to give her the best chance possible to have healthy babies (she was 36-37 weeks). I almost couldn't contain my tears of joy as one after the other both girls came out with a large wail! They weighed 5.1 and 6.2 pounds, I was so pleased to be able to bring dad into the room where they were resting waiting for mom to get out of surgery. They are both doing well and are with mom in her room, along with 3 other women-which is a luxury because the other moms share their space with potentially 7 other mom's. It is quite a site to see all of these beautiful women breastfeeding their new little ones in one big space, all with their colorful wraps and helpful families, brings a smile to my face every time I walk past that area or through there to pick up a baby to get examined.
With all the joy there has been sadness as well for some families. It is a challenge to see something difficult and have to go right on to the next birth and contain my emotions. My second day here I witnessed a still birth (we all knew baby had died in utereo) and then went straight away to the birth of a woman (the same age), occurring across the room-it was terrible. Everyone was treated with complete dignity and mom and dad cuddled with baby after she came out and was placed in a blanket. She was 34 weeks and baby had some severe congenital abnormalities that I will not describe here. It was terribly sad to hear the crys 15 feet away as I coached the 18 y/o first time mom that I was with (with an anterior lip for a while-bless her heart) through the birth of her son. I had just about collected myself on my walk home and then I saw one of the workers from the place I am staying and he asked how my day had gone and I couldn't hold it back anymore. I think about that family often.

Due to the amazing efforts and hard work of a very dedicated New Zealand midwife, trying to get Vila Central Hospital established as baby friendly, all babies (unless they need extra attention) go skin to skin straight away on mom after delivery. A few multips (moms who have had one or more babies) that I have helped seemed a bit shocked by the gooey baby that I have landed on their tummy but after I explain (as best I can in English and broken Bislama) the benefits of this, they all seem fine. We try to keep baby with mom for atleast an hour, cuddling and breast feeding. That is of course unless we need the delivery bed for another birth, as happened tonight when almost 5 births were occurring within minutes of each other! I barely had time to put gloves on when a 32 y/o mom pushed her fourth boy out in 1 push tonight! The midwife who was going to assist me left the room literally for 1 minute to get something and returned to hear and see the 7.1# little man crying away on his mama's tummy when she returned- all was well. Mom and baby share the same birthday =)

After 11 1/2 hours at the hospital today with much excitement, I felt I had put in enough time and things were calm enough for the moment that I decided to come back to my cozy bungalow. I got a security guard to walk me home and as exhausted as I am wanted to finally write about some of my experiences here. I think I may take tomorrow (Saturday) off, sleep in, and see a bit more of the village. Although I greatly look forward to helping more mama's, bathing more beautiful babies (who I swear give a little grin when I wash their hair for the first time), and sharing smiles and experiences with the Vila people in the days to come.

Saturday, February 12, 2011

And the journey begins.....

Well, after days of travel I have arrived safely in the beautiful capital city of Port Vila, Vanuatu. For those of you that are new to this blog and this adventure, here is the brief....Every year a few senior Midwifery students venture to the South Pacific to learn, help, teach (other Nursing students), and complete their "baby catching" numbers (100 are needed total, to sit for the Washington liscense exam). We have a lovely relationship with the sister Midwives here at Vila Central Hospital. The population of Port Vila is 38,000 and I am on one of the 83 islands that make up the Y-shaped chain of Vanuatu. In this blog stories are shared about daily life and hospital adventures. I feel so very blessed to be apart of this and exchange with these women. I am also thankful to my mentors and those that have come before me in this journey.
Usually when I travel abroad I like to disconnect from phones, computers, etc. so "blogging" will be a very new experience for me. I hope if you are reading this you are well, and I hope to have many stories to post along the way. Kate