What I love about Vanuatu.....

It's been a great couple of days- busy with nothing but goodness- and the first of our baby doc family has departed..... Liz and her hubby Craig headed back to Australia yesterday :( After sharing brunch at our favorite spot, La Tentation (don't be confused, we finally got to the bottom that this is not a misspelling nor the Bislama word for temptation, it is simply French), we said our goodbyes and the rest of us loaded up as the sailing crew on Cassiopeia. I steered as we sailed out towards our destination, where we dropped anchor, snorkeled and relaxed, and then as we tacked our way back into the harbor- no small job. I must say, weaving in between boats and buoys with a huge wooden sailboat can put a bit of pressure on a novice sailor. However, our captain commented that women are often much better at the helm, so I took that as a compliment for my ability to keep the wind in the sails and not hit any other boats, snorkelers, or reef! I was also pleased to see that no one appeared to be white knuckling their closest handrail.

As my time here in Vanuatu quickly comes to a close, time of course, feels like it is speeding up. Alex, Mel and I headed down through the quiet Sunday streets this morning to do one of our last dives together. These 2 baby docs and I completed our dive course together so we're trying to get a few more dives in before I take off next Sunday. We headed out to do a wreck dive.... my first, called Konanda. This was a 45 meter ship badly damaged by Cyclone Uma in 1987. It is still intact (including some mugs and a tea pot on the top deck) and overall was just a fun dive to be able to explore the nooks and crannies of an old boat underwater. After finishing that dive, we headed to another site to join in on some environmental restoration at a popular dive and snorkeling site. There is an invasive species that is populating the reefs here, called the crown of thorns, and we spent a couple of hours rounding them up into bags, in which they will spend their last moments in the sea. I worked with one of the Ni-Vanuatu dive instructors, Jerry, and we floated above beautiful coral and fish, scanning for the infamous circular and spiky creatures. Jerry had the tool for spearing them, while I carried the bags and together we championed the cleanup effort, collecting 73 crown of thorns! After an afternoon of diving, a gray sky, and a cool breeze, my lips were blue and I was chilled to the core, even though the water is a pleasant 24 or 25 degrees Celsius, 3 hours even with a shortie wet suit makes for some shivering. After a hot shower, finally starting to warm up! The company that I have been diving with is called Big Blue and for those coming to Vanuatu I would highly, highly recommend them. http://www.bigbluevanuatu.com/. Tell them you're volunteering in the hospital and you get the local discount! Very nice! Good fun and fabulous people.

On our long boat ride back into Vila, I was reflecting about what I've appreciated most about the people here.... and undoubtedly what I will miss! First of all, many of the Ni-Vans wear flowers behind their ears- men and women- in the market, playing volleyball, coming in to give birth..... it's beautiful. Secondly, the people of Vanuatu exude happiness and are amazingly friendly. Walking down the street children and adults, men and women, say hello, good morning, good night..... some sort of acknowledgment, and sometimes going out of their way to do so. The people I have worked the closest with here are the midwives and the dive crew and all of these folks fill the interactions with laughing, cracking jokes, smiling, and generally enjoying what they are doing. Beautiful people, truly, inside and out, who will flash you a smile and give you a pat on the back or grab hold of your hand when they see you. It's particularly notable because although life here appears more simple and functions on Island time, it is in no way to say that it is easy. I think many of our prior posts can attest to this.

As for births this week, I caught a couple more babes.... another Star-gazer baby! Silly little one, she came out facing up and had her cord all wrapped around her neck and her shoulder and belly....but pink and crying in no time. After wiping off the babe and moving her to the warmer, I turned around to see that the mom was bleeding.... quite a gush, about 200ml.... separation gush.....and soon out came her placenta- Duncan style. This is when the part of the placenta that is attached to the uterus (rather than the side the baby is snuggled up against)is what you see when the placenta arrives. Most often the placenta flips in on itself so that the shiny part where the umbilical cord inserts is what you see when it comes out, and you have to flip it inside out to see the other, maternal, side. In the 130 or so births I have attended in my lifetime, I can recall 3 placentas coming out Duncan. I always thought it mostly had to do with being a low-lying placenta, but Elias did some reading and sounds like it can be a sign of other things to come, mostly a hemorrhage, which this mom did have. Her total blood loss was about 600ml, not frightening by our U.S. standards, but since the women here bleed so little since they all receive the antihemorrhage meds after birth, 600mls is concerning, especially since this mom also received those meds and she still bled. An IV with even more syntocin got it all under control and made for a very firm uterus. She had a small first degree tear that was easily sutured and was the first suture job here that I really felt great about- my skills are improving!

This week I also observed my first VBAC (vaginal birth after cesarean) birth..... my first here and anywhere, since so few out of hospital midwives in Seattle do them anymore since malpractice insurance in Washington doesn't cover VBACs. This mom told me that she really wanted to experience the pains of giving birth to know what it felt like after having to have a Cesar with her firstborn in 2004. I can understand that, as I would feel the same way since giving birth vaginally is so central to our female anatomy and physiology and for some, seemingly tied to female identity .... the ability to create and sustain a baby, to give birth, and to feed the babe....it's amazing the design, and one of those things I just absolutely want to experience. And so did she.... and she did it! After 2 hours of pushing, an episiotomy and lots of help getting the babe's head born, her sweet daughter was born vaginally. Strong mama, strong baby! 3.3kg, healthy and hungry as could be! And both mom and babe settled in for a long afternoon nap.

And on that note, speaking of nap.... off to get some much-needed sleep. Elias is already in bed, his eyes begging me to turn off the light so darkness and good sleep can reign. Hope to post some photos on this one tomorrow.