mama t: "I have found the paradox that if I love until it hurts, then there is no hurt, but only more love."

I was involved in a delivery this week with a young mother who was fearful and anxious for the better part of her laboring pains. She was really hurting. As I did my best to console her she clenched onto my uniform and begged me with her eyes not to leave her side.  I, of course, willingly obliged. It was past the cut-off time for me to be able to “conduct” the delivery so I called over an MD intern and asked if he would be willing to take the delivery. I could tell he was apprehensive but that was just because he wasn’t 100% sure of what he was doing.

“But this is your patient, you have to do the delivery,” he said following a few more other excuses as to why he shouldn’t do it.

It wasn’t my patient. In fact, I was just cleaning the labor room on this day. I didn’t have any patients.

“I’m going to stay with you, I’ll help you,” I assured him, all the while talking to his nerves.

He put on a pair of gloves as her membranes began to bulge. She was a first time mom, but we both could see that little bub was going to follow out as soon as her membranes broke. When he slipped on his gloves the mother glared at me and shook her head “no” without him seeing. She spoke no English but our nonverbal communication made it clear that she didn’t want this young man delivering her baby. She pointed to me with her finger gesturing that I should check her cervix instead of him.  I just smiled and gave her free reign to clench back onto my clothing, which she did.

Its safe to say that it hurt me more than her that I couldn’t deliver her baby. I had connected with her at this point and there’s something so special about delivering the baby of a woman who trusts you. But quickly I let the disappoint roll off as I got to see that just being there with her and my assisting this new doctor was sufficient enough for her. She was lying down but she wrapped her arm around my waist pulling me snugly into her body. I breathed with her. Pushed with her. I enjoyed being this close to her. If I was catching her baby I would have missed this.

Babies head came and I grabbed her hand to place between her legs and feel the top of her new little ones head. It’s like saying, “don’t give up. I know it hurts but there’s hope! She’s coming!”

Some screaming, some waiting, some “okay push now, mama!!!” happened and babies head and torso was delivered but the lower part of her body remained inside her mom (where it was safe :]) It didn’t stop baby from opening her eyes and letting out a scream as though saying, “hellooooo, I’m here!! What is this place?!? I’m not sure I want to come all the way out yet.” But mama gave a strong push and the intern tugged on the little body and welcomed the baby in its entirety onto mama’s belly. Baby was healthy and alert and alive. 

Mom loosened the grip she had on me, only enough to allow me to breath but not enough to move from her side.  Tears welled up in her eyes,

“Thank you sister, thank you, thank you, thank you. Oh, sister, thank you.” She told me in Swhahili a multitude of times. She looked up at the intern and thanked him as well. I was glad he got the acknowledgement he deserved.

“Congratulations, mama. Thank you Jesus!” I told her back in her own language.

And then together we thanked Jesus for the baby. My Swahili skills ran out here and again I found myself grateful the intern was there. I asked him to translate as I told her how beautiful her baby was, how much the baby loves her already, and how well she did. There was a lot of gratitude going around.

Lying on her mothers bare chest baby opened up her little eyes and gazed up into her mommas face and they shared a look that almost audibly spoke eternal love. To say it was just “sweet” would rob the moment of what it really was.

Photos of different mothers I worked with this week

It was a beautiful encounter, a beautiful delivery, and a blessing to be apart of.  

When a baby is born it does nothing to deserve love and yet it is just that: loved- uncontrollably, unconditionally. In fact, it has done nothing yet in the world except cause its mother excruciating pain often subsequently causing the father to fear for the life of everyone involved. It’s fair to say it’s been a royal pain in the butt. (sometimes literally) A pain though, that’s quickly forgotten with the first stolen glance between the mother and the baby. A love that truly has no words.      I have never experienced this myself, but what a joy it is to watch someone experience this for the first time.  Those motherly instincts come immediately, like a button that gets pushed. Maybe baby flicks a little switch on its way out, an ‘okay now you’re a momma’ switch. Watching a woman become a mother for the first time is priceless. To see someone love another with such a wholesome, pure love is infectious.  The baby doesn’t have to look the right way or say the right thing. It doesn’t have to have the right credentials. There doesn’t have to be guarantees of the little one becoming someone great, its just unconditionally loved as it is in the moment. 

Got me thinking, what if I loved people this way? Loved people the way a mother loves her newborn. Without criticism, without expectations, without comparisons.There must come a moment when our parents or somebody we know fails us and we think we have to earn love because it doesn’t just come naturally. We think we have to be the right person or say thing right thing or being going the right direction in life to be worthy of unconditional love. What if we loved people without conditions though? Without expectations? What if we loved people the way a mother loves her baby when she first sees it?

More importantly what if we loved people the way the Father loves us? Because, after all isn’t a mothers love just a reflection of His love for us?

I think a love like this could change the world.

It was a good week this week and I continue to learn far more in the labor room than I bargained for.

Here's some fun photos from my week:

 

when the good gets better

I love what I get to do. I love caring for pregnant women and welcoming babies into the world. I just can’t imagine doing anything else. After about another 3 months this school will come to an end. Some people who are doing this school will only work as a midwife for the time being but most certainly remember the experience for a lifetime to come.  How could you not? I am confident though, that they will go on to do some other incredible things. I am blessed to work with some really amazing, beautifully loving, caring, and compassionate women. Some students though, will continue in the direction of maternal and child healthcare. Midwifery, obstetrics and gynecology, or whatever it may be.  Everyday I feel myself more and more certain that I belong in the latter of the two categories.

Many who meet us and find out what we do will often ask, with a slightly perturbed look on their face, “does that ever gross you out?”

And I often wonder back, how could it? I’m fascinated by the way the pregnant body functions and grows. I’m mesmerized by what I learn and see and get to touch and be apart of. It’s a lifetime of learning but I’m in it for the long run. This is what I want to do. I can’t imagine a more fulfilling and fruitful career or calling than welcoming life into the world. Or caring for a woman. Standing with them, encouraging them, watching them turn into warriors, battling the most excruciating pain of their life for the most gratifying reward of their life: motherhood, family, being apart of creation. This is what God commanded: to multiply and fill the earth.  I get to be apart of one of God’s greatest commands. And as I have said so many times before, I have really learned that this is an incredible tool for sharing Gods heart and His love and compassion with the nations. This is my opportunity to be Jesus to someone- to a woman, to a baby, to a family, to a doctor or a nurse, to those who are pregnant and suffering because of it. Ultimately this should be our purpose in everything we do. And I have found my nitch.

Over the last several months I have really been seeking God on His direction for me. I know what I want to do, I know what I am called to do, but the avenues I can take to get there could be in a million different directions. After much prayer and consideration (and a bit of struggling through doubt, confusion, and laying down my rights) I have decided and officially been accepted to join the school as staff for the next 2 years. 

Whew, never thought I’d say that.

So what does that mean? It means I am going to continue forward with Midwifery in developing nations and I will officially be called a “missionary.” Of all the things I had in mind for my life, I am not sure ever once did I want the title of a missionary. But here I am. I was wooed into it and although it is not an easy decision to make, I can say with confidence that I know it’s the right one to make. There are many fine details that are being worked out right now and I am happy to answer any questions or hear your heart/concerns/ideas. For those who have been faithfully reading my post and following my stories I want you to know that I value your opinion and I continue to be overwhelmed by your support.

Here comes the worst part (okay, not really but it sure can feel that way sometimes) I’ll need to ask for money…and that’s never a fun thing. But I have also realized it doesn’t have to be a terrible thing either. Its acknowledging that God has put the great commission on all of us and for some that means spreading the word in your home city, in your offices, and your neighborhoods. It means you still have the ability to get a paycheck, and I think that’s great.  However, for others, it means providing healthcare for a woman who might not get it if no one was there. And while the rewards for receiving babies into the world far exceed any earthly riches for me, I don't receive any income for the work I do. So I am asking that you, my dear reader, would join me in prayer as I am beginning to seek monthly donations. I want to continue to be an advocate for changes in women’s health. I want to continue to fight for good healthcare, clean hospitals, sterile supplies, and offer assistance to the hundreds of thousands of healthcare workers around the world who are burning the candle at both ends. I want to continue to help women in pregnancy. I want to continue to welcome little ones into the world, and welcome them in Jesus name. I want to see preventable maternal mortality eradicated from this earth. And I have a feeling you just might too, which is why you continue to read my stories and cry with me and feel moved with me and even frustrated by the circumstances with me.  

If you have any additional questions or want more information/details about my future or my vision with this school, please feel free to comment here or email me at laurae.brager@gmail.com

I look forward to hearing back from some of you.
Bless you all.
 

India

Midwives for the nations!

Indian princesses (or at least we like to pretend)

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)

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.