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 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.