Who says threes a crowd?

Don't get any ideas, Mom.

 To say the labor room was "exciting" yesterday, would be a grand understatement. It had been a little over a week since I have been in the actual labor room so I was really excited to work today. I made my way through the flimsy curtain and saw 9 laboring mamas. I was with a team of 6. Outnumbered once again, but defeated...not a chance! I made my way to the back of the room and found Sakina. She wasn't screaming or crying or demanding attention, but I found myself drawn to her. Once I approached her I noticed the big tummy she carried on her petite little body. Not thinking much of it, I started a partograph and decided I would monitor her. I made my introductions and took her vitals when a doctor and a few midwives approached her bed.

"Tatu," they told me in Swahili.

Three? Three what? Three hours in labor? Three centimeters dilated? Three previous pregnancies?

They pointed to her tummy.

Triplets.

I tried to contain the fact that I wanted to jump up and down in my excitement. Three babies, in that belly, and I get to be her midwife? This is almost better than winning the lottery, twice.
As much as I would have liked to carry on by myself, I knew that I need a few extra hands. I found Steph, who was just finishing up helping out in a breech delivery down the way.

"Triplets, Steph...." I began to say...I could hardly finish my sentence before she had already agreed to take on the task with me. So we teamed up and together we began to monitor Sakina. We found three little heartbeats on her belly and marked each one with pen. We monitored more frequently than normal, knowing that this could get really risky at any moment. Our MD instructor, Sina informed us that she thought it was better Sakina goes in for a cesarean section-that's what would happen in the western would, but the doctors on duty continued to insist that she was capable of a vaginal birth. We took every precaution we could and prepared a birth plan, including finding three extra sets of hands to receive the babies once they were born. Together, the three of us labored for hours. (although, Steph and I didn't endure even of a fraction of the pain Sakina did) The doctor told us to be ready to conduct the delivery at 12pm. When 12 o'clock came and went we knew it was time to reevaluate her condition. I did a pelvic exam and found that she was only 8cm dialaetd. This could be a bit longer than we originally thought.

As we continued to monitor her and the babies, the time continued to pass and the contractions seemed to be ceasing.

After some more time passed, it was time to do another pelvic exam. Our findings indicated that she really was not progressing the way she should have. The clock was ticking and I began to be concerned about the welfare of all the lives involved. Worst of all, I knew my shift was quickly coming to an end. As much as I would have been willing to stay until I couldn't stand any longer, when my instructors say its time to go...it's time to go. I not only felt the sting of not being able to deliver her babies with Steph, but more importantly, I worried that I was abandoning her, knowing that the staff was not concerned with keeping a close eye on her case.

And what I dreaded most came to be. It was time to go. The fetal heart rates were still good but momma was not progressing and her contractions had ceased. I found a doctor before I left and begged him to take her to the operating room for a cesarean section. Maybe Sina was right after all. I pleaded my case and explained to him how I really wanted all three of these babies to live. He told me there is a back up of 8 people before her in the operating room, but he assured me he would send her.  I felt frustrated by my situation but I had to walk away.



 I got on the overcrowded bus to head home when I received a phone call, it was Maj, " I have a proposition for you..." she said, "you want to come back and watch her surgery with me. We got premission from our staff to stay as long as we don't do anything."

I grabbed Anna Elisabeth and we immediately turned around.  I was so happy to hear she was going in for her surgery sooner than expected. The babies still had a chance. When we got back to the labor room, the chaos that had been there only half an hour prior had seemed to calmed. There was only one midwife on duty and a student nurse. There were no doctors in sight.
Sakina was still lying on the bed where I had left her.

Shadrach, Meshach, and AbednegA

I protested a bit about how they needed to get her in for surgery, but to my surprise Sakina began to go into real labor. The first head was coming. Rose, the midwife made her way over to deliver the baby. I stood back, prepared for the worst but hoping to see 3 miracles.  Baby 1 came out beautifully and just then the mom two beds away began to deliver her twins.  This baby was delivered and it was time for baby 2 from Sakina to be born. From here, it became a bit chaotic. Ten babies were born in somewhere around 30 minutes. Triplets, two sets of twins, and 3 single little bubs popped there way into the world.

Baby 2 and 3 from Sakina needed stimulation, oxygen, and resuscitation- we were on it. There were some moments of doubt, but between me, Maj, Steph, Anna-Elisabeth, and Rose we rejoiced and laughed and thanked Jesus because at the end of it all every baby was okay.

One of the beautiful babies born yesterday

Maj with one on of the sets of twins

It's Saturday today, and my day off but I just had to go to the hospital and check on Sakina and her three beautiful babies. Momma's hands are full but she was looking great. We checked her health just to be sure, after  all, she did just deliver three babies and the risks of complications are pretty much through the roof. We found that she had a high bp and some protein in her urine, indicating she was at risk for preeclampsia, but after speaking with the doctor they began to treat her as necessary and I am confident she will be well taken care of by the staff and then pretty busy for the next....I don't know... 18 years.

"What the caterpillar calls a tragedy, the Master calls a butterfly."

I was posted in ICU on this day and I knew it would be a good opportunity to go into watch some surgeries. I mentioned it to the nurse as soon as I got in the door.

“Any c-sections today? I wanna go!”

She told me no, so I went ahead with helping some mothers breastfeed and discovered a high fever on a newborn. It was a slow, quiet day...or at least I thought it would be.

“Lolaaaa…” I heard just 20 minutes later. “Hurry come, there is surgery now.”

So I met Simon. She has another name but this is what she was continuously referred to as, so I’m going to stick with that.  She was a beautiful momma and I was excited that I got to go watch her surgery. I didn’t have the time to find out any other information about her before I helped wheel her into the operating room.

I left her for a few minutes to change into a sterile uniform. That’s when I saw Dr. Walter. Normally, an overly sure himself, highly confident (ahem, cocky) doctor who works in the obstetrics ward. He knows his stuff though, so while it’s a bit challenging to work with him, it also tends to be highly beneficial and I’m okay with.

“Doctor, you will be performing the c/s today? I am coming to observe,” I said, matter-of-factly.

“Yes,” he nodded and smiled to me, “Karibuni! (welcoming me to come and watch) Have you ever been in a c/s before?”

“Yes, several.” I responded.

Then the floodgates opened and all the questions came at me. (Which I should have expected with him):

“What is the indication for her surgery? What is her gravida? Her parity? Past obstetric history?” He continued, “tell me the two different types of incisions that can be made and which incision you would recommend for this case, and why.”

“Uh…uh…uh...”

So many questions. These are things I know. I could have responded but seeing that I just met Simon a couple minutes ago and know nothing more about her than her name and the fact that she needs a caesarean section, I found myself forgetting how to speak. And this isn’t the right doctor to be unpaired with.

I had to admit that I was just eager to get into a surgery, “I don’t know anything about her case. And I don’t know much about the differences between the two incisions.”

Hurts to admit. And the slight sting of humility sets in.

“Well, do you know how to scrub in?”

Scrub in? Do I need to "scrub in" to receive the baby? I thought to myself.

“Uh, yeah, um... I mean….yes. Yes I know how to scrub in.” I said, only slightly perplexed.

“Show me,” He responded.

Great. He practically pulls out a magnifying glass as he watches me rub in between my fingers and put the soap up to my elbows.

But I scrubbed in well.

“Wrong!” he responds. And I think I hear a loud buzzer go off. 

He proceeded to show me the way he thinks is the best way to do it.

So together we washed our hands, 3 times. And only briefly did I feel like I was in kindergarten again. He then proceeded to show me how to put on two sets of sterile gloves and slip into a surgical coat. I realized I was being prepped for more than just being handed a baby.  

It took some time of waiting around for the anesthesiologist but eventually it was time to begin.

I stood back and the two surgeons looked at me.

“What are you doing? Come, stand here.” Dr. Walter said while he pointed to the empty space right next to him. He handed me some gauze and a clamp. And before I knew it, I was assisting in a c-section.

I didn’t do anything too significant, besides mopping up some blood and cutting away and assisting with some sutures, but it was an amazing experience. It confirmed my pending suspensions that I’d love to know a bit more about obstetrics than midwifery. But, I know my time for that has not come. And I love what I get to do right now.

As the surgery finished up Dr. Walter left the room and I helped the other surgeon finish up. (Pinch myself, what a dream!) 

As we cleaned up the woman I noticed between her legs the severe female circumcision that had been done to her. I was shocked to see it, so I immediately pointed it out to the surgeon.

“Doctor, she has FGM.”

“Hm, yes, it is part of her tribal tradition.” He said with a rather sad look upon his face.

I learned about this back in Perth. Female Genital Mutilation, often referred to as FGM, is a custom that is practiced still in many tribes.  The World Health Organization describes it as, “the partial or total removal of the female genitalia for non-medical reasons…FGM of any type has been recognized as a harmful practice and a violation of the human rights of girls and women.”

Depending on the severity of the incision, a part of the woman’s vagina is cut off or sewn together, or both.

I have strong opinions about this practice and it kills me to know that there are women and young girls around the world who are be mutilated because of a belief that does nothing but harm them. In addition to increasing the risks of infection and causing complications in childbirth it completely destroys their ability to ever enjoy sex. Is this too taboo to talk about? Well it’s reality.

I am positive that God did not intend for this practice to ever take place.

I remember being heartbroken in Perth when I heard about the prevalence of this being practiced today. I remember crying over the statistics and then in an attempt to do the only thing I could do while I was in Australia, I prayed. I prayed that this practice would be eradicated and that God would protect girls from this procedure.

As I was thinking all of this over in my head, I remembered the beautiful little baby girl we just pulled from her stomach. She was healthy, normal, and intact and I didn’t want to know that something so harmful could potentially happen to her.

This mother had been pregnant 6 times. Before the birth of this baby girl she only had one live child. The rest of them have died. She has had obstructed labor, resulting in a fistula and she’s had several miscarriages. I can’t blame it all on FGM but I know that such a destructive procedure can lead to many other complications.

This baby girl could be saved from that. I knew I had to speak up.

We were just about to move her off of the operating bed onto the gurney.

“Doctor, wait, we must tell her she shouldn’t do this procedure to her daughter, ” I said.

He looked at me and stopped the nurses from moving her over to the gurney. He nodded and went down to her face. He sympathetically looked into her eyes and talked to her in Swahili for a few minutes. I watched their gentle communication back and fourth.

After some time he looked back up at me, “Okay, she knows. She will not allow this to happen to her daughter.”

Because I couldn’t understand the conversation I had to just trust that the doctor told her what ever needed to be said. I could only hope and pray she really did receive what he was telling her. I decided to go to check on her the following day anyway because I wanted to ask her some more questions about her FGM and I wanted the opportunity to explain to her in more detail how harmful it would be for her own daughter. I was very grateful for the surgeon’s response and his willingness to speak up about something that’s usually just looked over though.

When I arrived at the hospital the following day I found a translator and Simon opened up to tell me that her mother was the one who cut her when she was 10 years old. She said she does not experience pain there anymore. But that’s because she has lost all feeling in the area. After I shared my heart and God’s heart and intensions with her, she reassured me again that she wouldn’t allow this to happen to her new baby girl.

I finished off the conversation by praying for her and her new family, especially the precious daughter who she held in her arms.

It is a shame that Simon is permanently damaged. It’s a shame that she has lost so many children. But it was beautiful to see her look into her healthy daughters eyes with such love and tenderness and I know I could walk away sure that the future of one woman could forever be just a little bit better.  I was blessed by an incredible learning experience in surgery and to top it off, God was able to use me.

So what did I learn from all this? Well besides the pros and cons of different surgical incisions- I learned that it’s okay to ask God for big things. It’s okay to pray for Him to stop FGM or even to end war, cure cancer, feed the hungry. It’s okay to dream big with God even when what we are praying for seems impossible. I learned that God really does want to answer our prayers. And sometimes He even chooses to use us to be apart of seeing those prayers get answered.

And that’s pretty amazing. 

Normal birth is indeed possible

I tried to get that toothless grin outta her, but it just wasn't happening

I had the privilege of working with a 47 year old mother this week. I helped her deliver her 14th baby, 11 which are still living. I wish I had a picture of her sweet smile. She was toothless and slightly wrinkled and unbelievably beautiful. I'm pretty sure she knew more than me about the whole process. Her first baby was born in 1985, 3 years before I was even born.  Imagine, that's like an entire lifetime committed to being pregnant and having children. I really felt like I had the opportunity to learn from and work with a pro this week. The delivery was quick, smooth, and easy as expected. She labored silently, only occasionally grabbing the lower part of her back, which I faithfully massaged for her. She didn't speak a word of English and she laughed at me as I butchered some phrases in Swahili to her. As the head began to descend, the lines on her face hardened and she held her breath, indicating to me that the contractions were getting harder. Ladies, it still hurts, even after 13 other times.

Between her strong contractions she sipped on hot tea... (okay... so maybe it doesn't hurt as bad) Finally, the pain hinted to her to recline back and prepare to welcome her next child.  I quickly prepared her oxytocin for her intramuscular injection after the birth, as I knew that once the baby was ready it was practically going to Rollerblade out. I sliced my finger open on an a glass ampule of medication and just as I saw the head coming my thumb leaked out a significant amount of blood.

No time to bandage it, shoot.
I put on a pair of non-sterile gloves, and somehow managed to quickly slip on two pairs of tight, sterile gloves over my injured hand...in just enough time to welcome baby Abigail with one, brilliant push into the world.

Baby let out an immediate cry, and I knew she was going to be okay. No resuscitation needed today. Salima and I both laughed as she rubbed her new little one on her back.

"Wakiume? Wakike?" she asked me.

and I lifted her daughter off her tummy for her to see the gender.


"wakike," we both said as we looked between her legs with a laugh.
I wondered how many of those she already had, but knew there was no sense in even trying to ask because of our language barrier.

Abigail continued to whimper and mama just shushed her with a proud glow on her face. I silently whimpered along thinking about my throbbing thumb that was filling my first glove with my own blood. Never a dull moment around here, even if the delivery is "normal"


It was a good day. And every so often, they just are. Period

she might look like she doesn't love me or want me to take the photo, but I am pretty sure she's just never had her picture taken before. We were buds.

enjoying some porridge after her delivery. girls gotta eat.

cry, baby Abigail!

This mama, is 15 and was laboring just across from Salima. What a stark contrast to what I was working with. Reality.

and sometimes I get to enjoy Zanzibar....

The heavens declare the glory of God,
       and the skies announce what his hands have made.
 ² Day after day they tell the story;
       night after night they tell it again.
 ³ They have no speech or words;
       they have no voice to be heard.
 






  ⁴ But their message goes out through all the world;
       their words go everywhere on earth.
    The sky is like a home for the sun.
 ⁵ The sun comes out like a bridegroom from his bedroom.
       It rejoices like an athlete eager to run a race.

 


 ⁶ The sun rises at one end of the sky
       and follows its path to the other end.
       Nothing hides from its heat. 

i think office jobs are great, by the way.

For the first time this week since starting do this, since learning about midwifery and delivering babies and providing health care for women, for the first time since I have put on my uniform and stepped into the hospital- I felt like giving it up. 

For the first time, ever, I found myself thinking, I don’t want to do this.

 It seemed fun at first. It’s never really been easy per say, but at least there was the joy of being with women and then the gift of delivering healthy cute babies to look forward to. Even when it was hard, it was manageable.

But this week I watched a woman bleed to death.

And I couldn’t do anything to help her.

And I am overly aware that it hasn’t been and it wont be the last case I see. I know this.  And I’ve already seen more death in my short few weeks here in Tanzania than I have seen in my whole life combined. There is some type of life threatening complication that arises every single day we go to the hospital. If it’s not a mom, it’s a baby. And I’m just so tired of seeing dead babies. That’s something that just wares on you, you know?

I left the hospital wondering, what am I thinking?? Who in their right mind would ever subject themselves to this kind of pain? To this kind of devastation? Why sign up for this? No ones forcing me to be here, why would I commit to this type of work?

I contemplated taking a casual jog away from the hospital, telling myself I could just run away now and never have to look back. Perhaps I could get a nice office job and wear cute shoes and be stressed out by something less life threatening-like whether or not I should part my hair to the side or wear it down the middle. I’m just not equipped to handle this on a daily basis. And I’m sick of death.

I walked aimlessly around the hospital for a bit, I think I was processing but in the moment I wasn’t sure what I was doing. Somehow though, I found myself right back where I started, in the labor ward. I went into the resting area for the hospital staff and although I was desperately hoping I could have a moment to myself in there, I opened the door to find a few doctors having a little break.

The doctors were having a casual conversation that I found myself interrupting.

“Doctor, why couldn’t we give that woman blood? Why did this happen? Something must be done to change these circumstances.”

You see, she died and it wasn’t just that she had HIV or that she delivered a stillbirth or even that she had post partum bleeding but it was mostly because she was a poor African and subsequently from family who couldn’t afford to send her to a private hospital where they don’t run out of blood donations. Where they have the proper equipment to handle emergencies. Where they have the resources to educate women and provide them with proper antenatal care.  Where the doctors are making more than 300 dollars a month for the thousands of patients they see by themselves.

Doctor: “ Za problem is za gova’ment. Zey don’t give us monies. Zey are not helping us”

I get that. But I just wanted them to understand that they cannot let that stop them from trying. Apathy fills the air in the hospital. They know their poor. They know they don’t have what they need. So as a result they just accept it, sometimes mumbling or making jokes about it being a problem- but I am seeing no indication of anyone taking steps to make it different. And I don’t judge them or blame them for it. It’s an oppression that they are under. In the moment though, I sat on the bed looking into this doctor’s face and I just wanted to see that motivation stirred up in her. I wanted to tell her she has a voice and even if she doesn’t have the money to do something, it doesn’t mean she completely lacks the means to.  The truth is there are enough resources in the world for every human being to have adequate and good healthcare. There is not a shortage of blood. There is not a shortage of medical equipment, there’s just a shortage of people taking the responsibility to get it. Last week the sterilization machine went out and I think I was the only person in the hospital to ask about what needed to be done to fix it. I got paraded around the whole hospital while everyone was told that I wanted to know what needs to happen to fix a machine that must work in the hospital? This is common sense to me. What was so strange about me asking a question that needed to be answered? But I quickly saw that it wasn’t common sense to people who are used to never having what they need.  As a result of asking, they called a technician and then told me they would let me know what he says. (ME, a student in the hospital. Not a director, not a manager or someone in charge of finances or billing, not even a technical employee of the hospital, but just someone who asked a simple question instead of accepting the answer of : this woman cant have a c-section she needs because our sterilizer broke. ) But, I’m going off on a tangent here. The point is I don’t have a lot of money either and I cant buy things necessary for the hospital either but that doesn’t mean I am okay with sitting back and watching people die. It means I have to be apart of making things different. So I get on my knees and ask the only One who has the answers what can be done, knowing that He provides, knowing that there is a solution. I wonder if more of the staff at the hospital pressed into God to see a release of things they need if they would even need to protest their bad circumstances or try and figure it out by themselves? I am sure God wants to release to them in abundance. I positive that His heart is not to have a hospital without the necessary things a hospital needs.

And this is just what I wanted to communicate to the doctor. Somehow, someway let her know that she is capable of being apart of the change. I tried to find the words to express this to her. 

I pride myself in being a pretty good communicator, so while all these thoughts raced through my mind I tried to order them in a way that would easily be received. I sifted through the ideas but then…. in all my confidence…. all I could muster up the ability to do was cry.

CRY?!

Anything else but showing weakness in the moment seemed like a better idea.

But the tears just streamed down my face. And I noticed people in the room start to get a little itchy, as they slowly crept towards the door hoping the crazy white girl talking about the government and making changes wouldn’t make any sudden movements.

As I cried everything I wanted to say escaped my mind and all I could do was apologize.

I told her, in a cracked voice, that I was sorry her country was experiencing this type of problem. I told her I was sorry that they have to be apart of something so devastating, something that they feel so helpless in. And then I asked for forgiveness on behalf of my country.

“I am from America,” I told her in my broken English, “sometimes my country forgets to look outside at its brothers and sisters. We look so much at ourselves and our own problems that we forget other people who are suffering on daily basis. I am sorry we are not helping you more.”

I told her that we DO have the resources that they need and I asked that she would forgive us for not being a bigger part in seeing things change in her country. I was surprised by my own tears. By my own response. It’s hard to look at my own country and acknowledge we are falling short. I know my country does incredible social work and relief aid for people all over the world, but when you see people die because of lack of resources in the hospital it becomes very blatantly obvious that we aren’t doing enough. What we have an abundance in, they lack desperately in. And I think it’s foolish that we have so much when our brothers and sisters in Tanzania have such a great need.

As I finished my apology I looked up at the doctor and she was crying with me. Her hardened response suddenly softened and the two of us sat alone in the break room and together we cried over the injustice in this world.

She opened up to me, “these women are so poor. The only joy in life they are able to really have is the ability to have children, to create a family. Do you know what its like to have your child come up to you and hug you or kiss you or show you affection?” she asked me. “This is a simple joy, but it’s a joy that is costing them their life. They are just fulfilling God’s command to fill the earth and multiply and then they are dying as a result of it. They are coming to this hospital and they are dying because we don’t have enough syringes to give them a shot they need, or enough blood to give them a transfusion.”

We both agreed that this was not God’s heart.

And then I remembered the question I had asked myself just moments earlier, “who would ever subject themselves to this?”

I would and I will.   

So while I contemplated making a run for it, I quickly saw that if I run I will only be missing out on being apart of something I so deeply desire to see changed. And even when it hurts, I wont give up the fight. And I will rejoice over the happy, easy times but I will not lose hope or faith in the difficult times. Or at least I'll try not to.

"Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day.  For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal." (2 Corinthian 4:16-18 NIV)