Asha

I did the pelvic exam while the doctor stood back.
“Doctor, this baby is not cephalic, its breech. Meconium stained liquor and she is fully dilated. Will she be able to have a normal delivery?”

(Meconium stained liquor means that the baby has passed feces already which indicates there could be fetal distress)

Asha, my first African momma

the twins

“Check the fetal heart rate, if its ok then she will deliver normally, if not we will take her for a cesarean section,” he responded.

There were four of us in the Intensive Care Unit today. It’s only my third day in the hospital, and my second day in ICU I am still figuring things out here. And I didn’t expect deliveries (Oh, how I have learned this week though, to always expect deliveries.) We searched for the heart rate of the baby. It was more difficult than normal to find. At first we heard a weak, slow, pulse but checking several minutes later it was 120 beats per minute. That’s good. We reported to the doctor and he ensured us that she would be fine to deliver normally.

“Will you conduct this delivery, please?” He looked at me.

Of course I will. I began to monitor the mother and my team and I continued to check on the baby. The heart rate stayed strong but after giving birth to 4 other children and being fully dilated, the baby should have been progressing better down the birth canal. The mom had little to no contractions. It wasn’t normal, but the staff, as loving and gentle as they are, we uninterested in her case. We patiently waited for the bub to arrive. After about an hour and a half momma started with some pretty strong contractions and the little bum began to come out. Sina, my instructor and a Medical Doctor from Germany, assisted me with the birth. I knew right away that something wasn’t right. The little bum was so small, too small. We lifted her out of her mom and placed her up on her mother’s tummy. She didn’t cry. She didn’t breath.

She didn’t make it.
And it didn’t take long for me to notice she wasn’t alone.

“Twins! I think there’s twins!! I think there’s another one,” I cried out.

This is when I am so grateful I work in a team. I have a baby who I am pretty sure is dead lying on top of her mother’s belly, a mom who has no idea she has another baby coming out of her OR that her first baby isn’t breathing and I need to somehow resuscitate the baby and be with the mom to deliver the next one ALL AT ONCE. Stress and panic try to take control in this situation, and they would, if it weren’t for incredible teamwork but I manage to stay calm. We search through the woman’s birth bag to look for something to cut and clamp the umbilical cord with. We must get this baby oxygen. She has nothing. (The women must bring their own supplies for a delivery) My instructor remembers she has a clamp in her bag. Someone runs to get it. When she comes back with it, Sina cuts the cord and takes the baby. A teammate of mine follows and together they fought for the life of that baby. Unfortunately, the first African baby that I welcomed into the world didn’t have a chance to be apart of it. She was pronounced dead minutes after her birth.

I can’t cry. I’m in the middle of another delivery here. I am working alone now and I am with a woman who doesn’t speak a word of English. I hold my index and middle finger up to her, making a “two” sign. I have to tell her she's not finished yet.
“Two, mama, there’s two.”

She shakes her head no. I can hear her thoughts, “It cant be. I’m 8 months pregnant here. I would have known I was having twins. I had prenatal care, I’ve seen the doctor, and someone would have told me.”

Between me insisting and the fact that her contractions weren't subsiding, she was finally convinced that she would be having another baby. She shook her head a few more times in disbelief.

the sweet baby boy, twin 2

This is my first twin delivery. I haven’t studied or learned much about the procedure. How quickly should the baby come out? Do I need to intervene or shall we let the baby come out in its own timing?

I have a lot of thoughts happening right now. I just lost a baby. And I have been monitoring this baby and I had no idea there were two. I missed it. I don’t have a scanning machine and I’m still a student, learning. Shouldn’t I have known, though? But she has a doctor. How did no one, at all, catch that she had two babies inside of her? This is reminding me of India. How did no one know she had a breech presentation and meconium stained liquor? Why am I the one to tell the doctor all these things? I monitor mom and baby while mentally processing. 15 minutes pass and there is no progression.

We check the fetal heart rate again. Its dropping.

“Doctor, I think we need to give her oxytocin,” I say. (But who am I to tell the doctor what drugs to administer?)

“We cannot,” he says. “You cannot give oxytocin to a mother with twins. Check her cervix and see if it’s closing,” he tells me.

I don’t know if this is right or not. I really don’t. But I have no option but to trust his word. Even though he just missed a lot of crucial things on the first baby, even though I had to correct a lot of his findings, I still can’t override or think I know more than him about what drugs to administer.

I insert my hand to feel for the baby. It’s coming out headfirst but its not far enough down. The cervix is starting to close. We need oxytocin. I am learning a lot about medication and drugs and I know, when I practice, I want to be as natural as possible-but I have also learned what a gift medication can be. How it really can save someone's life.

My instructor, who is also a doctor tells the African doctor that we should administer the drugs. We see him second guessing his initial reaction. We see he is unsure of the situation. I can't be working with a doctor who is unsure. I need someone confident in this situation. I need him to be sure in this moment. I need him to be the doctor and make the right call. I want him to have the solution.

“the heart rate is dropping, doctor we need to get the baby out.”
He comes to listen to the heart.
90 then 80 beats per minute. This is dangerous.

“I have called my superior doctor, he will decide,” he tells us.

the heart rate goes down to 60 beats. We’re losing the second baby.

The four of us begin to pray out loud, we are crying for the life of this baby now. The doctor hears us and doesn’t stop us. I feel the thickness in the spiritual realm. Its weird to say this and hard to explain but there is tension in the air. Darkness is trying to take over, death is winning.

Sina says, “doctor, this baby wants to come out.”

“Ok,  you do whatever you think you should. Give her oxytocin if you think its best.” He says. He’s placing his trust in Sina. He doesn't know what to do.

We search through her belongings. She didn’t know she was having two babies so she’s lacking in supplies now. Thank God, she had some leftover oxytocin. One administers it while the rest of us continue to pray.

“This could distress the baby,” Sina warns me. “It needs to come out quickly”

We keep praying and listening to the heart. It’s beating faster, it’s getting stronger. A miracle is happening. It’s back to 120. And within minutes his head pops out. He is born and with a beautiful cry I place him straight on his mommies belly. He’s here. He’s alive. He’s healthy.
He is a miracle.

We all gave a sigh of relief. He is okay. The doctor comes back to see and he laughs with joy.
“Congratulations,” he says to us. Like we were the ones who just birthed a baby. But I understood what he meant. Congratulations for making the right call, for making the right decision and for saving this baby.

“You prayed. You prayed and the baby lived, “ he noticed. And we all knew we just saw a battle unfold before our eyes. We fought for a life and we won.

Just then the senior doctor walks in. He laughs as well and we hear the first doctor telling him what we did. They smile in approval.

I think for the first time in an hour, I take a breath. Have I been holding it all this time? My back aches and my heart hurts a bit. But we survived. We did it. Thank you, Lord.

It took the mom a few minutes to remember she gave birth to two babies. Now she holds her two fingers up to me and speaks Swahili. She’s reminding me she had two babies. Like I could have forgotten.

“1 baby, Momma.” I say as I just hold up one finger now. No one that speaks her language is around to tell her that she lost the first twin. And although we have a huge language barrier, it becomes my job to tell her.

She continues to try and remind me she gave birth to two babies. She’s persistent in showing me both of her fingers. Two. Two.

I shook my head no. “One baby now, mom.”

I see the lines on her face change. She understands. Now I can cry. It’s okay for my heart to break with her. I tell her in Swhahili I am very sorry.

“Pole sana mama, pole sana.” She looks back at me with consolation on her face. She lost a baby and yet somehow she consoles me?

And just for a brief moment she let herself feel grief, feel the loss of a baby she didn’t even know she was having- and then she recovers. You recover quickly here. Fetal death is normal. So it might hurt, but mom knows to expect it and then to get over it. This is the life they live. Your lucky if your baby lives. I get her cleaned up and she thanks me a multitude of times. Her and her new son are doing great. And my workday is coming to an end.

Momma, resting after the delivery of her son

And this is has become my first delivery story in Africa. It might not have been what I was expecting, but hey, they never really are. I wonder if I would have been able to catch that there were twins fror her abdominal exam would I have been able to save the life of that first baby girl. It’s possible. It’s possible that she had already died before I even arrived today too. I don’t know the answer to that. Today, I was forced to learn in the moment and I did learn- but I lost too. Today, I left the hospital feeling gratitude towards my teammates, joy for the victory, pain for the loss, and exhaustion from the week. It’s a lot of emotions to carry but again,  I am so grateful I don't carry them alone.

dar

and we're back in business!

What a week. I’m exhausted- in a good way.

We started the week off learning and being assessed on Obstructed labor. Took a day off on Wednesday while we patiently waited to hear the status of our visas. It was Seinis birthday, so we all headed to the beach and enjoyed the sun and the water, never ceasing for a moment to think if our visas were getting approved or not. Towards the evening, we headed home still unsure of what our tomorrow would look like. We wanted desperately to be able to start back at the hospital, but with no word coming through we started to think there was little hope for starting on Thursday. BUT lo and behold, in the late hours of the night I heard the words spoke out and they echoed through the hall straight to my heart,

“APPROVED! We’ve been APPROVED!!!! We’re starting tomorrow!”

And just like that, our waiting season, our praying and questioning and stretching time has come to an end. (Well, in regards to visas at least) And I have to say I’m grateful for the time we had outside of the hospital. I had a pretty stink attitude about it for the first little while and then God, in all His greatness challenged me with the question, “are you just here to serve me in the hospital?”

I had to step back, step out of myself and think about that question for a minute. I keep talking about how midwifery is a great way to share the love of God with people-and I still believe it is (the best way, for me) but if I have come to be a blessing to people, to help people, to love people, to show people there is a God who loves them- then I better be doing that just as much outside the hospital as I am inside the hospital. I better be practicing what I preach.  And thankfully I caught that lesson before it was too late. So while I desperately missed the mommas in the hospital and the work there, I learned to love my neighbors here in Tanzania. I got to know the culture more, the community better. I spent an afternoon in a Muslim village where I met two beautiful families. One was a young girl who had Tuberculosis and I got to be with her and pray- To Jesus for her. I got to go into a home of a mother of 5 adult children. All 10 of the grandkids were running around and they just graciously welcomed us into their home and we laughed together and we told stories and we got to know one another. We built relationship. I got to spend some times kicking a soccer ball around with a young group of boys. Those are my friends now. I was apart of evangelism, an open air, prayer walking, bible reading, befriending people, praying for people, and learning that I have a life to live outside of the work that I have found I love so much.  My patience was tested. I was tried and confused and I still don’t know why we had to wait 3 weeks to work in the hospital but I also know I don’t need to know the answer to everything. I just need to trust and follow and love. That’s my job.  Whether it been inside a labor room or on the unpaved streets of a village.

So I am indeed back in the hospital now. And as much as I did enjoy my learning and growing time outside of the hospital I am SOOOO glad to be back. It has been amazing. We hit the ground running. In our first 3 days back we have welcomed 21 babies into the world. We have been apart of 2 Cesarean sections, and have had the opportunity to provide healthcare for many women. We’ve laughed, we’ve cried, we’ve learned and it’s been beautiful. I have seen two incredible miracles already and I can’t wait to share some stories. 

Thank you for praying with me for the visas! We saw breakthrough guys, hallelujah!

Bless you all. I’ll be writing soon.

Welcome to Tanzania

Jambo! After much build-up and anticipation I have arrived on the continent of Africa!  There’s music playing in the air.

Wait, what? Is this a joke? I thought that only happened in the background of movies??

Nope, African beats actually are (constantly) playing in the air. I love it.

We are welcomed into the thick, hot air at the airport where we didn’t get the right visas (more on that later) and made our way out to the bus that would be transporting us to our new home.

And just like that, it’s on to the next one.  (I ‘m pretty sure I coined that from a Jay-Z song, btw)

There really is no way to compare India to Tanzania but its hard not to.

I have been in Tanzania now for almost 2 weeks. Already more acquainted with the country but the customs and beliefs and what’s exactly culturally appropriate still remain a bit of a mystery to me.  As I type, I am sitting under a mosquito net to protect me from malaria. I am pretty sure I sleep on a pile of ants, but besides that I don’t see too many creatures crawling in my room. (I had a mouse crawl on me while I slept 3 times in India) Off are the Punjabis and Sarees and scarves from India and now we are adorned in simple skirts and shirts. That’s definitely different. I no longer am living in what looks like an orphanage with 10 other girls. Instead, I am in what looks more like a youth camp accommodation (which is actually a catholic Friary compound) and now I only have two roommates. Don’t worry though, the others are just down the hall in their own rooms. And  oh, we have an air conditioner…that usually works. Hallelujah, hallelujah!!

We have started class already and it’s refreshing and slightly peculiar, all at the same time.

We did a tour of the hospital. We were warmly welcomed by the staff- even invited to the staff meeting to be introduced to the doctors and nurses we would be working alongside. That’s very different from India.

The hospital looks completely different. We are no longer just at a maternity hospital so we walk by wounds and old men with coughs. We first entered in through the pre and postnatal ward where hundreds of women were lying. A couple women are together on one bed, and many, many women are laboring on the floor. I would venture to say that the hospital is much cleaner, but its still unbelievably overcrowded.  Stepping over pregnant bellies we eventually get into the next room, which leads us into the actual labor room.

Ah, and it smells familiar... and...I don’t mind it. How have I grown to sort of like this stench? The women labor here completely in the nude. There are still all together in one room and it’s still on metal beds but there’s more space between the beds and the actual room is much larger. I notice I don’t hear as many high-pitched screams. It looks more like a quiet day in the room, there’s maybe only 6 to 7 women in there right now.

The women- well they are stunning. As expected. They don’t look as young. They look like they actually might know what their doing. They look big and strong. Like pregnant warriors. (this is compared to small young Indian women, after all!)

There’s  a lot for the eyes to take in and not enough time during the tour to really get a feel for the place, but I am sure that it is very different from what I am used to.  I am reminded of how foreign it felt to be in the labor room for the first time in India and now, only a mere 3 months later, it doesn’t feel foreign at all. It feels like I’m right where I’m supposed to be. Nothing was shocking or hard to look at, in fact, it was exciting and hard to take my eyes away and keep my hands off.

“Yeah, this is going to be good,” I concluded.

Now the only thing keeping me back from jumping in is the opposition we have gotten at immigration. There was a little bit of miscommunication from our school to us and we were never told to get a certain visa that we were supposed to get before leaving the airport. We thought that it would be an easy issue to correct but 2 weeks later and we are still without our working visas. It’s challenging. I am learning a lot through it. I believe that God has called me here to work in this hospital with these women and I believe that we will get our visas, eventually. But my prayer right now is that it is sooner rather than later. We only have 12 weeks here. Right now we are waiting until Monday or Tuesday to have our next update on the status of our visas. Please join me in prayer as we ask that we have favor at immigration so we can begin at the hospital. I want to serve these women. I want to help and learn from these doctors and midwives and I want to be apart of what I know God has called me to be apart of. So while we have faced opposition I continue to hope to see break through soon. I will appreciate your partnership in prayer and I look forward to bring you good news soon!

So with that, I say welcome to this new journey with me. I wish I had more to say or explain but I find myself to be lacking the words to express myself right now. I am aware that there is a lot going on. There’s a lot of adjusting that I must do. And I’m still in that process.

the compound where we live

where we have lectures..and lunch, for that matter.

ringing in the new year at prayer meeting...

first photo of 2012

you try traveling with 20 people

We left India in the middle of the night. Arriving to the airport the scene was a little scarce. We were the last people (of 20) at the check in counter. We loaded our luggage and silently prayed that we wouldn’t be over the allotted weight. We are traveling with a lot of bags from a lot of women. And we have heaps of medical equipment and gloves that come along with us. Naturally, the weight is something we must consider. After all our bags were placed on the counter the gentleman behind handed me a small piece of paper. 103kgs and a price to go with it.

I don’t understand?

“This is how much your luggage is over. The plane is about to leave, are you going to pay the price or do you want to remove some of your stuff?  I am giving you 10 minutes and then I am closing this window.”

I’ve never heard an Indian be so direct before.

Ah, what to do? Either we pay $2,600 dollars that we don’t have or we need to lose some luggage. Thankfully, I am traveling with an incredibly gracious group of people. Within 5 minutes we had removed 40kgs. That’s pretty impressive, but it wasn’t enough. We began to throw our boxes of sterile gloves, knowing we didn’t have anything else we could lose. We begged the manager and people behind the counter to donate all the gloves to the government maternity hospital. They obliged. We began to pray as we continued to remove things from our own luggage. The manager continued to look down at his watch ensuring me that the plane was about to take off. After a few more mere moments, he looked up and said, “ok fine, I will allow you to take the rest of the luggage through. Just get to security already!!” ....So he let us in with an extra 60kgs of baggage! Talk about grace. And just because God is so generous with us, the manager found me a couple minutes later and let us know that he was donating all but one of the boxes of gloves back to us.

Thank you, Lord! Thank you, India.

Because we were already (apparently) late??? we were pushed through security and walked immediately onto the plane. I was one of the last to get on, we thanked all the staff that let us have our gloves back and the extra baggage and then stepped onto the plane. Of course we are all seated on the back so we pushed through the crowds and the screaming children and the man who always takes too long perfectly situating his suitcase in the overhead compartment and then …finally…we found our seats. I looked for a place to put my carry-ons (which had now just increased in order to lower the weight from my luggage) but there was no space left. Before I knew it though the plane was already moving!! …and I was still standing!

“ma’am, you’ll just have keep your luggage on your lap. Please take your seat.”

I squeezed into my middle seat with two bags and pillow and I just barley taken my seat and we were already in the air.

Contemplating the fact that I am leaving India? There’s no time for that. I felt like I was on rollerblades the whole time in the airport and now here I was already leaving the country I have grown to love so much.  I was already in the air and I didn’t even remember walking into the airport. Now I am going to Africa and my whole world is going to change.

I am reminded of a song by Misty Edwards, who is in fact quoting Jesus when she sings,

“Take up your cross

Deny yourself

Forget your father’s house and run, run with me.

You were made for abandonment and wholeheartedness

You were made for Someone greater, Someone bigger

So follow me

And you’ll come alive, when you learn to die.”

So I am following now. From one country to the next -aware that I must choose to deny myself, be abandoned and wholehearted and run with the One who leads into what’s next. 

packing up in India

Arriving to Tanzania