June 12th, 2007

Here is a picture of Joyce and I.  We are signing my Montana apprenticeship. The Lord chose a wonderful midwife (and sister in Christ) to get me going in the right direction.  She is so gentle and a gifted teacher.  I am not nearly as nervous as I used to be.  Thankfully, we have become very close friends.  It is so wonderful to share this time with her.  In a way, I wish this time in my life would never end.  I am having so much fun.

Joyce Vogel, CPM  Libby, Montana.  She has a birthing center in Libby, Montana called Family Birth Services.

Babies!! Babies!! April through June

Here are some really cute pictures of our babies born in the months of April through June.  I am so blessed to be a part of each birth.  Each experience teaches me a lot about myself, about babies and helping moms labor.  In August, I will have completed my Doula and Christian Childbirth Educator certification.  I am appreciative of the strictly Christian emphasis of Cascade Christian Childbirth Association, as I am working through the other midwifery material towards my NARM. 

My heart is at home....

Here is a picture of our home.  It is June. The flowers are gorgeous...the grass is green.  I love to sit and relax in our yard with the children on a blanket.  We read, or even just talk.  It usually dissolves into a wrestling match with our 5 year old son, Jayben. 

We have Dorrisa, a registered collie, Daphne, a very special black and white mutt and Matchen, a German Shepherd.  The German Shepherd is mine.  We go for walks together down the road or through the fields.  She looks scary, but has a timid nature and a soft heart.  She was rescued from a kennel and is still a little kennel shy.  She is much better than this past Fall when we got her at 11 months. 

Our barn is empty now, except for a lone, very old horse.  Lucky is very gentle.  The girls can ride her and I am never worried.  She hangs out in one corner of the field next to the fence line of a neighboring draft horse. 

Our garden is mainly a snack for the children.  With a family our size, it takes a lot of corn, beans and green stuff to make a meal.  The children weed a row a day, when it is hot out.  We also have a rototiller to go between the rows to make the weeds more manageable.  The strawberries and raspberries are pretty thick this year.  I look forward to eating berries...if I can get there before the birds and children!

On our way to the Philippines via Texas...

At the airport!  Tom and I got up at 4:00am to meet Julia and Abe at the airport at 4:45.  We checked in, got through inspection with no problems this time.  I braided my hair, banded it and walked right through without setting off the alarms.  They did run my suitcase through twice scratching their heads a bit, as all my medical gear and things were stuffed (literally not an inch to spare) and zipped up, barely.

My backpack is not too heavy and my pillow and box of textbooks are bungee corded to the airline carry-on suitcase with wheels.

I cannot believe that I missed Jamiee’s birth last night.  On the way to Spokane, Joyce called to say that Jamiee was in labor.  Tom and I talked about turning around and going back home.  But the time factor would make getting back to Spokane from Libby, Montana, was really tight.  And I would have been totally exhausted.  So we decided to go on to Spokane.  Tom was also committed to delivering trusses and measuring a job for work by 5:00 that evening. Well, I am overjoyed to say that Elida, Joyce, Martha and Michelle got her through with flying colors!  I am so proud of Jamiee.  I am so grateful to Joyce and Elida! A wonderful baby boy, straight forward birth with minimal bleeding.

Thank you Lord!

Julia and Peggy

The plane ride was uneventful… until we landed in Dallas, TX.  We were surrounded by fire trucks, police cars and aid care.  Apparently they thought we blew a tire on the runway taking off in Denver.  The pilot didn’t tell us until after we landed!!  We did land without a hitch, so they figured out that the tire that was actually lost was from another plane.  We just wondered what happened to the other plane…

Julia and Peggy eating dinner (Sonic’s hamburgers and fries).  Julia and I spent the afternoon, evening hanging out at Peggy’s Birth Center where she works.  I was surprised at how much I appreciated just holding still for a while after our plane trip.  Peggy is driving us to Killeen, TX for our Association of Texas Workshop and Prenatal Exams.  She, Julia and I are all a little concerned about how we are going to do on the tests… It matters a lot to us if we pass!

Family Birth Services in Grand Prairie, TX, is a beautiful center housed in a 100-year-old house.  The midwife that started it 25 years ago still owns it and comes in almost everyday to review charts, pay bills and keep things going.  All of the midwives and students here are single woman, under 35 who have a great working relationship.  It was so fun to spend the afternoon and evening with them.

I've arrived in Davao!

After having a nice cold shower, I can think to answer some of your questions better.  It is 10:00 am here and it feels like 6:00pm.  Yikes, how am I going to make it all the way through today!

The customs went great.  No problems at all.  I made my hair into a braid and just got through with no beeps.  Except for in Nagoya, we had to disembark the plane while they cleaned… and then go all the way through customs again.  So, I had to quickly rip my hair pins out of my head and throw them into the canister to go through x-ray.  I have a picture of me in Nagoya, Japan, with my hair all askew.  I look terrible, because I have now been up 24 hours without any sleep.  I did finally take a little nap from Nagoya to Manila.  I felt much better.  I dosed from Manila to Davao too.

We got a taxi to the old domestic airport for 150 pesos.  I guess that is the going rate.  No problem there.  While we were at the old Manila airport, waiting for the plane to Davao, we had just arrived and sat down on the cold cement floor.  About 15 feet in front of us, a huge rat with a dead mouse in its mouth came scurrying by.  Julia and I found it very funny and tried to take its picture.  It did come out again, but I wasn’t quick enough.  The people around us didn’t even bat an eye.  They thought we were pretty funny for laughing at the rat.

Here I am snacking and laughing at that rat!  We had almost 5 hours to kill, time wise, so we went over by the wall by the carts and put a movie in my computer Something To Sing About, and watched it until it was time to get in line.  We waited in line to get a seat on the plane.  They wouldn’t let me take my airline suitcase on the plane, so it had to check it in.  I said that there was a lap top in there so be careful.  What did they do? They put a big sign on it that said “Be careful, lap top inside.”  Oh great, I thought, this is just an advertisement for someone to come steal my suitcase, laptop and all.  Anyway, it all landed in one piece and was fine.  Here are some pictures of Davao as we were coming in for a landing.

Quiet tonight... but not for long!

Tonight is very quite in the birth center.  This is unusual… as they have 200 births scheduled for the next few weeks.  It may have something to do with the typhoon left overs we are having tonight.  Some wind and hard warm rain.  Still muggy, still sticky, but at least not hot.

I think I am adjusting to the time change.  This morning I awoke having a horrible head ache with migraine nausea.  I thought I had to be at work at 6:00am, but had clinic at 8:00am instead, so I went back to bed with 2 Motrin for an hour.  I woke up feeling 100% better and have functioned the rest of the day.  I did 8 prenatals today and found 2 births I might be able to have for continuity among the 40 some ladies lined up for prenatal exams.

The language barrier is not extremely bad.  I can use sign language and I have a cheat sheet with Visayan words that match what I am trying to convey.  My next clinic day will be the new moms having Initial History prenatal exams which will more of a challenge to get the right point across and spelling etc…  One of the other interns, Sue, let me use her prenatal form that she translated into Visayan, so if I can manage not to butcher the pronunciation I will do O.K.

One of the times I went to get a patient (they use this term instead of client or mom) I called out for Liza….. no one stood up.  I was trying to think of any other possible pronunciations for Liza when one of the ladies said  Leeeza…???  Yes!  There she was.

One of my patients was just tiny.  She was very thin, her babies heart tones were consistently low (had been since she began coming for appointments) and has gained only 5 pounds since becoming pregnant. Her tummy is as tight as a drum and the baby seems smallish, but not tiny.  She only measures 24 cm and only has 5 more weeks until due date.  We’ll see if she comes in or goes to the hospital for transport or whatever.

I have enjoyed the food cooked so far.  We had soup much like I fix once in awhile at home.  Broth, small pieces of pork instead of my usual chicken.  Greens, galloiou chucks (kind of like potatoes, only stickier and chewier) galangal, ginger, lemon grass.  This was served with rice.  They had a very salty, stale tasting, dried fish I took a small bite of, but didn’t prefer.  Tonight they had fish cakes (probably from the same fish) that were good, to go with the soup.  Tiny baby bananas were for dessert.

I have been making sure to drink at least 48 oz of liquid, but I think that this is not enough.  I am going to up it some more tomorrow. (Maybe even right now!)

I got to meet Matt and Krys today.  We had an orientation meeting and discussed the various needful points about being here.  How to get along in the culture and how the seniority system works for births, etc … being quiet and keeping my mouth closed will be a good thing to remember.  All these woman, I am sure that offenses happen some times.  It is very different for me to be living so closely with someone other than my family. The Pinoy woman are all very smiley and friendly.  The are very nonconfrontational, and will go out of their way to avoid offending someone. 

Up in the office, I am happy to pay the amount for the copies on the copy machine.  They are charging a little for each personal copy made by the interns and students.  1.5 pesos per page.  I am using this quiet time to go over the Protocols for the birth center, as I can see that not every midwife here has the same idea of what they mean.  I guess I will do my best on that one.

Well, three hours left to go on my shift, and I guess it will be a no show night.

Here are some pictures of the first baby I caught by myself.  It is sink or swim here, to a certain extent.  I enjoy the challenge and pray that I don’t get any bleeding complications right away or a stuck shoulder.  The baby’s head from last night was a little dark, due to shoulder coming slow.  But the mom did not tear at all.  She did loose about 650 cc of blood, but I guess that is not unusual for here.  It sure looked like a whole bowl full to me.  One of the things that we do is collect the blood (with gloves on) in a measuring bowl that holds 500 cc.  The bowl was overflowing.  I scooped and scooped, scraped the placenta off and the clots too. 

Today (not my patient) a mom lost about 1,500 cc of blood and they just about transported, but she stopped bleeding.  They do IV’s here when the patient looses too much blood.  2 moms have had IV’s so far.  I hope that sitting by my moms and keeping the fundus firm right after birth will avoid a huge bleed…. But sometimes it just happens due a piece of placenta still stuck in there or whatever.

 It is much nicer than I imagined.  They keep things very clean, but not overly so. They mop everyday, but it doesn’t reek of a strong soap disinfectant.  We do not wash our hands every 5 minutes, or even between patients for prenatals. But no one gets sick… at least they come back each week looking well enough from a germ standpoint.  Many moms cannot afford even a small amount of protein.

“Home” for the students and interns is a fairly new building.  It is actually very nice.  I am impressed with how nice everything is here.  2 big kitchens, lots of bathrooms, lots of food.  The showers are all lukewarm, to cold, but believe me, I have not wanted a hot shower since I got here. Even this morning early at 4:00am a cool shower was wonderful. I wash my hair with each shower, because the wet hair feels cooler around my shoulders…for awhile until it dries, then I want it up off my neck.

I am wearing the scrub pants and shirt that all the midwives are wearing.  But I am thinking of trying the scrub dress I made tomorrow.  There are also scrub skirts downstairs that I might give a try one day too.  I am not used to wearing pants all day long.

The little geckos scurry around the tops of the walls.  There are lots of them and they are kind of cute.  I am watching one now about my head.  He has been staring at me for the last 2 hours without moving.  They can go really fast if scared.  Like the one in the kitchen this morning when I turned on the light to make my breakfast at 4:00am.  I think he scared me as much as I scared him!  They are grey, only measure about 6 inches long and have big, black, beady eyes.  I haven’t seen too many ants yet.  A few tiny red ones, here and there, but certainly not annoying.  The smallish, thin, wild cats outside give me a start if I go out at night.  They are everywhere, but all stay outside, even if the doors are all open.

My first transport

After assisting / observing a birth this morning and doing the postpartum and baby exam and going over all the paperwork, I went upstairs to work in the prenatal department.  I love this part…

I did 12 prenatals today, finding altogether 5 patients that I can call my continuity births.  I need altogether 25, for Montana and NARM, but I am going to try for just the NARM 3 I need right now.  Joyce and I can get the rest at our leisure over the next couple years.

One mom I was going to choose looked really sweet, but she handed me her lab slip and her HCT (iron count) was only 24.  Yikes… if she lost just 100cc of blood that would be disaster city.  Most moms loose a lot more blood than that here.  Just last night, a mom lost over 1,300 cc and almost transported.  Thankfully she stopped.  There seems to be a fine line between O.K. blood loss and let’s get her out of here to the hospital…  It varies with each patient.  This mom had a high iron count to begin with, so she fared well in the end.  She was up and around this morning and left around lunch time.  The moms here are amazing.  They are strong, give birth, get up, go to the bathroom, and leave just a few hours later. 

We had a great Bible study this evening with the Director his wife and the other midwives, interns and students. There were about 20 of us altogether. The Lord is so alive and real here.  They rely on Him for everything…. Prayer is a very integral part of all that we do here.  We pray with each patient that comes in for each prenatal, for each baby…during the births and when she goes home.  We pray at meals, we pray with each shift change.  It is so wonderful!

I am on shift all night tonight 10:00pm until 6:00am

11:20 pm – I just got back from a transport to the Davao Hospital.  The patient started having hard contractions, one after the other…  in fact, her tummy felt like a rock.  Her baby’s heart beat was over 200!  We monitored her for a while, started an IV and oxygen.  No improvement.  So we loaded up into the little, cute blue ambulance and zoomed down the roads, this corner and that, weaving around people in the streets.  We arrived, got out and went into the emergency room.  All I can say is that it is better than Calcutta!  There were very sick people and their family members almost packed into a large room lined with beds. (About ½ the size of our gym at church)  The beds are about 2 ½ feet wide and about 3 feet apart.  The room is divided into extra emergency; moderate emergency and the you’re ‘gonna wait outside section.  I don’t think anyone goes there who is not an actual real emergency.  Believe me, people don’t go there for an ear ache.

          I will describe what I saw, but I want you to know that I think they are doing a fabulous job with what they have.

          The hospital entrance has no door.  A huge, open, arch way that is about 12 feet wide.  A simple desk sits in the middle and two people, along with the uniformed guard admits in who he pleases and discerns whether you are a real emergency, or moderate. The building is stone and plaster, with the typical concrete, white stone or marble flooring.  I think they keep the place fairly clean, but with so many people, so many different body fluids landing on the floor and being tracked around before it gets mopped, it looks dirty. 

          The 5 of us (2 Pinoy midwives, me, the bana (father) and birth mom, still hooked still to her IV) slipped past patients on gurneys, patients sitting on the floor, patients standing in line, to a small back room, where two exam tables against the wall waited.  One table was full (about 3 feet away, the other patient watched us the whole time, cross-legged on her exam table.)  A large, used, bloody, orange, flattened rubber bowl lay at the end of the table for our patient to scoot her bottom down onto to catch any fluids.  It emptied into a garbage can lined with plastic on the floor.

          The doctor was actually very kind and gentle, unlike many others who are woman OBGYN’s and very mean to the midwives when they bring in patients sometimes.

          He measured her tummy, listened to heart tones, and did an internal exam.  She was only 50% dilated.  They will probably decide to induce her with pitocin, or if the baby is still in distress, do a c-section.  We left her and drove home in the ambulance.

 I am impressed with the kindness that the Pinoy people show each other here in the hospital. Even in the stressful situation at the hospital, no one was going crazy or yelling, or crying out.  It was noisy, but strangely silent too. Worried parents held children, husbands and wives sat or stood next to their loved one and just waited patiently.  Everyone must wait in a long line.

And yet, it wasn’t like the huge long lines in Calcutta, India, that ran outside the hospital for a block or more, where children died as they waited for help.  This hospital was functioning and getting people help. (Albeit with not much privacy… but maybe that doesn’t matter much when you are truly in very real need.)

                   At first, I thought that maybe the Philippines had socialized medicine and that the medical help was free.  But it is not.  At the government hospital (where we went) a normal delivery costs around $4,000.00 and it is set up so that patients cannot leave until they pay in full.  I cannot imagine where they would get money like this, when they cannot even afford protein at meals.  A c-section, like the patient we probably transported today will have, costs around $10,000. 

Second transport tonight...

It was early morning 3:00am.  Our next mom that walked in, was measuring way too small.  She was in active labor, and her baby felt tiny inside her.  We did not feel comfortable doing the birth, so off we went again in the little blue ambulance.  Her mother went with her and her bana followed behind in a TricyCab. (A Tracy Cab is a motorcycle that has a cab on it at least that is the best way to describe it.)  She was disappointed at not being able to birth at the center.  We arrived at the same hospital, but it was much quieter this time.  Families lined the covered street and benches out front of the hospital, sleeping soundly.  The benches are barely big enough to sleep on, and so people were also balancing on the tiered cement walls behind it and on the pavement itself.

We were able to get right through the 3 admission desks and walked to the doctor's desk.  He was sitting in his chair, sleeping soundly, with his head on his arms on the desk, exhausted from the night's foray.  It is early morning now....almost 4:30 am  The mess on the floor was cleaned up from earlier and people were sharing beds, 2 sometimes 3 to a single bed, sleeping.  A child screamed in pain in the emergency section, as they attempted to start an IV in his little arm.  In this hospital, to be admitted, you must have a family member caring for you at all times.  In addition, someone must provide all your meals We timidly said, "Good morning, Doctor...”  No response.  We tried 3 times to carefully wake him...so we just sat down on the bench to wait until the last paperwork cleared the desk up front.  Finally, getting a little desperate, our mom painfully contracting beside us, we whispered a little louder and set the now cleared paper next to his arm on the desk.  He awoke suddenly, and grabbed the papers and tried to focus on them.  Unfortunately, at that moment, we realized that we had forgotten the ultrasound results from last month at the center.... Oooops.  He was very gracious, as he was earlier in the evening, and admitted her.  One of the hard things, is that we won't know whatever happened to our patients after they leave the center and are transported.  I can really see that these doctors work incredibly hard, with not many tools and materials to work with.  The nurses all wear the old fashioned nurse dresses with the small pointed hats and the doctors all seem to wear ordinary polo shirts and slacks.

We came back to the center and everyone, except me crashed asleep. I guess I get to watch the two patients we have for awhile!  I get to go to sleep in a couple hours and sleep part of the day.  I am on again in 8 hours after that.

Another mom came in and we sent her home.  She is a first time mom and in early labor.  She came in this morning also.  I feel bad for her, I know she would just like to get that baby out.

3rd transport...what's going on???

I am feeling a little emotionally weary.  I had another transport this afternoon.  This makes 3 for me....  What in the world???  This mom was fully dilated, but refused to push.  She was exhausted and I think mentally a little slow.  Her guardian was quite a bit older than her.  She was 27 but had the mind of a 10 year old or so.  I spotted her a couple days ago when I was doing prenatals.  I am so glad I got her.  We were very gentle with her, but she was like a wet noodle, wouldn't move around, cried out and moaned through each contraction.  After 2 hours of pushing, we decided to transport.  Her baby was just right there... ordinarily just a few pushes would have eased her out.  But she would give a little push and then stop because it hurt and then moaned the rest of the way through the contraction.

      Anyway, it was off in the ambulance again.  This time we had a female OBGYN.  She was very nice to me. The hospital was very, very busy, wall to wall people.  It took us a few minutes to get through the triage paperwork.  I had to get a little pushy at the desk and elbow my way to get paper through the window.  There is no such thing as organized lines here in this place.  EVERYONE is desperate.  They wouldn't be here, unless they were. At least my height can be used to some advantage. (I am almost a head taller than most of them, even the men)

      I was getting a better understanding of the lack of privacy issue.  Culturally, they are very comfortable with having people close.  It is how they live. In sorrow, in pain, in happiness having others very close is what makes them at ease.  This how they are happy.  Now I understand why it is not a big deal to have just a curtain, or nothing at all between beds.  They are not into the privacy thing.

      Tonight it is raining very hard.  It will be dry again by morning.  It cools things off a little.  It wasn't as hot today or muggy.

      For dinner tonight, I had rice, vegetable stir fry and side dish of chopped pieces of fish in a vinegar, lime broth.  It was really good.  A little bony, but very tasty.

            The native midwives keep asking me what I think of the hospital.  They cannot believe that I am impressed.  Most of the interns that come here are horrified. I can see that at the hospital, they are at least providing care. People are being served and in a semi-timely fashion.  They do not close their doors on patients and no one is waiting ready to die in the parking lot in a line.

       It is amazing to me. No universal sterilization techniques here.  They reuse dirty gloves and other tools. It seems normal here.  Everyone must be used to a heavy germ environment. I know that many of the families have dirt floors at home. I also know that most of the families keep their homes very neat and clean.  They are very clean people, too.  They bathe 2 times a day and their clothes are worn, but spotless.  I have not seen any lice or skin problems here at the clinic. 

      Outside of their homes and yards, it is another story.  It seems that public property is the government's responsibility and they do not feel personally responsible to pick of trash or any other mess.  It is the government's job and it they don't do their job, oh well... So, when driving around, it looks like a garbage dump in some places.  Along the streets, although you see people sweeping picking things up, it still looks littery.  There are some beautiful places too.  Some families have cultivated along their yards.  The native plants, banana trees, huge Rhododendron looking plants with huge white flowers, lots of jungle looking plants with big wide leaves and vines twine up the walls.  Very, very pretty.

      I did get to see a birth today, though. A mom came in just as my shift finished this morning at 6:00 am.  I stayed and assisted and charted.  A nice baby girl. 

      Julia had a birth today.  She was pretty thrilled.  Her mom pushed and pushed.  They pulled and pulled the mom's perineum apart during a contraction trying to get that baby out.  Eventually they did.  Whew! I decided to go home and get some sleep so I missed the birth.  After being up all night, I was getting a little rummy and hungry. 

       Julia is really motivated to get her observes in.  She just marches right in and gets what she needs.  I am feeling a little worried about offending the local midwives and stepping on other people's toes so to speak.  Sigh... I am such a people pleaser. 

      It is hard not to feel like a bit of a failure at this so far... all my moms are being transported!

A morning off and some fun...

Julia and I had the morning off, so we decided to go get the cell phones we three will be needing and some groceries.  We took Carmen with us, one of the supervisors that has graduated from here.  Walking along the road, we took the quick route to Victoria Plaza, the mall.  Small side roads selling everything from single cigarettes to bananas lined the road.  It was busy, and I felt like we were dodging the cars.  In order to cross the road, you just start.  No, you don't wait until all the cars are clear.  (The never are).  for a 4 lane road, you look for a break in the first lane.  Stop.  A break in the second lane (you are now standing in the middle of the road, cars are zooming all around you.  A break in the third lane.  Run for the side of the road.  Phew!  Cars honk, people slow down.  It is amazing that no one gets hit.  The smells are well, interesting. We had a good rain last night, so the deep ditches on the side of the road did not smell like something died in them, like they did yesterday on the way to the hospital.  The air is redolent with light cooking or garbage smoke, car or motorcycle exhaust and a humid earthy smell from the rain. 

We arrived at the mall and had to wait, as they did not open until 10:00 am. (We had spent the last 2 hours singing harmony with the 2 hymnals Carmen has and that was very wonderful while we waited at home.)  Upon entering the mall, most people are searched, patted down style.  I wasn't.  Even with my big old back pack on.  "Good morning, Mam (pronounced mom)" The guards greeted us.

So now we have 3 cell phones ready for action. This is to help Julia and I get those birth observes in for each other.  We will text each other when our mom is fairly close to pushing the baby out. The next stop was the ATM machine.  I am going to need to renew my passport in a few weeks and I wanted to make sure I had the funds early.  I am going to get in line in the morning first thing, so I don't have to wait all day.  It takes several hours to shuffle papers from one person to another, to another, to another.  It is gated, locked building and the guard lets you in and locks the gate behind you.  Shiver.

The ATM machine was empty of money.  So was the next one.  Well, we started back to the mall and went to the grocery store to buy some items.  I got a bottle of fabric softener and some shampoo.  Julia got some Laundry soap, cranberry juice and snack items.  The ATM machine worked now, after a guard gestured me over to try again.  No one is allowed to take bags, packages, or back packs into the grocery store.  All items are checked in at a counter before entry.  We emptied my back pack with the now 3 cell phones, camera, wallet and such into Carmen's tummy pack.  After making our purchases, we claimed our stuff and hailed a Tricy Cab to take us to the open air market.

The market is a unique blend of old stuff and new.  Lots and lots of fruit (the same kinds in each stall with some variation)  Durian looks like a football with spikes.  Jackfruit is a huge oblong fruit; they open up in the stall, peel back the rough, pointed all over, shell and carve out columns of yellowish fruit.  I also saw Ugly fruit.  Rambutan, which I bought a bag full of, look like a red hairy, oblong golf ball.  The tough hairy skin peels back, like the skin of a golf ball too, to expose a clearish white, sweet fruit with a pit in the middle.  It is mild sweet, with a fruity flavor.

Julia bought some mangos and some mangosteens.  The mangosteens are 3 inch round shaped fruit that resembles a persimmon in shape.  It is dark purple and has a green thick stem.  You pull it open to find am smallish, bright red stringy, very bitter, flesh just inside the shell and in the middle is an opaque segmented fruit.  Only the middle segment has a seed.  It is sweet and very good.

After our market purchase, we headed back home to eat a lunch of fruit and some veggie soup that Julia made last night. I took a nap in our air con room and got down to my swing shift and here I am.

My patient is a G4 P2 and is steadily getting stronger contractions.  She wasn't dilated very much when she came in, yet we didn't want to send her away with it being her #4.  She is puttering around and I check her vitals every hour. 

Quick birth... and very sweet little girls...

                  Soon after I came into the birth center this morning, my patient arrived in very active labor.  Many Filipino women, when they are in active labor, look like they are just having a slight cramp.  Let the midwife beware!  I took her back to a bed to check her vitals and see where she was at in labor.  She asked if she could push.  I wasn't sure if she was serious...  She certainly did not look like she was ready to push a baby out.  I did the vitals, not rushing too much, and then sploosh! Her water broke.  OK!  She was serious!

                After 10 minutes of pushing, looking like she was at a garden party, she pushed a head out.  I worked a little at getting the shoulders out, as the baby was good size.  6 lbs is good size here.  Baby was 6.5, a sweet boy, with quite a cone head from getting through the pelvis.  Baby was so cute with lots of back luango (baby " "fur"), and tons of vernix.  He brightened right up, gave a nice lusty yell, saying hello to us.  Mom delivered placenta 10 minutes later and had minimal bleeding.  This was a nice, butter birth, as Joyce and I call them.

They did not smile much, but the 3 little girls that waited outside on the bench for mommy to have her baby were very, very cute.  They were so anxious to see their baby.  I think that maybe they have never been around glass windows very much up close, as they were having a blast playing, tapping, banging, and smooshing their faces against glass.  The dad is a Triceycab driver and the mom is his housekeeper.  Many people are not married, because the paperwork is expensive.  At the birth center, we sometimes don't know if the bana (man or husband) is actually the patient's husband or not.  Anyway, this particular bana was taking really good care of his "housekeeper".  They lived near by, and he went home really quick and brought her some chicken, broth and rice right after the baby was born.  The children seem to love him and he them. 

Today is Sunday.  I have worked all day, but got up early to enjoy a good Bible time and prayer.  I also got to talk to Tom and some of the children today which was really special.  I can see that the Lord is covering them in a special way during this time.  They seem to be coping very well without me... I know that they miss me though.  Mercy and Sheraya have been writing me e-mails faithfully. It was good to hear their voices.  There is a 3 second delay over the lines and it takes some getting used to so you are not talking all on top of each other and saying, what, what??  We'll get the hang of it.

I am still enjoying the food that the Filipino women are cooking.  It tastes extra good to me in the heat.  I guess they must know what works in the humid heat.  They don't seem to mind me eating with them.  I lavish compliments and help with washing dishes occasionally too. (Which is a no-no, sort of, but I can't help myself.  Washing dishes makes me feel less homesick.)  Today for lunch I had a bowl of chicken, lemon broth, with several chunks chicken too.  To put in the soup were several bowls of things. There were greens that tasted sort of like Swiss chard, and then there was a bowl of bitter melon.  The bitter melon tasted like a cucumber that might have been water deprived in my garden at home.  It was tolerable, but definitely an acquired taste.  Actually mixing it in the soup gave it a milder flavor that I didn't mind. I then sprinkled everything with a soy, garlic, onion sauce that really brought the flavors all together.  For a side dish there were sliced bananas in a coconut sauce that were frozen.  I thought it all tasted great!

Someone made banana bread at the house and I think that I have eaten 1/2 of the whole loaf between yesterday, last night and this morning's snack.  I think that I am doing pretty good eating.  I am feeling good and energetic.  I have had a bit of my tummy getting used to the different bacteria's, but mostly just cramps, rumblings and nothing very serious.

Bananas are a big part of their diet here.  They are very small 4 - 5 inches and a little yellower.  They are sweeter and slightly different tasting.  I love them.  I eat many everyday. I will take some pictures of the fruit I was talking about earlier and show you.

I  had one morning in my bed before work, where I was teary and cried a bit, but otherwise, I have been holding up really well and not getting homesick.  I was looking at the pictures of Tom and our family I swiped off Tom's desk at work before I left.  The Lord comforted me and after praying for a while, I got over the hump.  I think I was having a hard time really feeling confident enough to do this.  I know all the head knowledge.  I know where all the supplies are, and I have really gone over the protocols here... It's just that I don't want to make a mistake.  This morning's birth was the first one that I did not have a big adrenaline rush.  I was relaxed and doing well with the whole process. It helps when there are no emergencies!  I guess finally getting into the groove without stressing out is totally normal here and they say that everyone is the same way when they first come.  I guess you just do enough births that it just becomes natural.  I don't think it will ever get boring though.

The clouds are covering in a dark way.  Night falls very fast here.  5:45 dusk.... 6:00 dark.  We are probably in for more rain.  It is the rainy season here... so of course it is going to be wet.

Well, 6 more hours to go on my swing shift, and it could be busy or quiet.  The quiet evenings, I actually get to nap.  Busy nights we are kept hopping from one bed to the other.  I, trying to see as many births as possible for my observes.  I realized this morning that I could almost not really care about the numbers deal.  What I really want is to know how to handle emergencies.  I am getting lots of experience in deciding when to transport.  My mom last night that I left ended up transporting, because the baby's heart beat went down to the 80's and 90's during a contraction and she was only 4 cm along.  Cord compression probably, as I was hearing a lot of cord sound down low, almost so noisy that I couldn't hear the heart beat its self, just cord or placenta.

Rambutans and Mangosteens

Here are some pictures of the Mangosteen and Rambutan fruit.  the Mangosteen is purple and the rambutan is red and hairy.

Today was a busy day.  I worked day shift and now am on for night shift as well.  I did a birth this afternoon and then assisted 4 others.  I guess the rest of tonight would count for tomorrow.

I have the morning off until swing shift.  I am planning on going to go pick up Joyce and Monica at the airport tomorrow at 9:00 am if I am awake and functioning at 8:30 am or so.

After my day shift, and I was off at 2:00,  Carmen and I went to the produce market.  It is really large, with tables and mounds of all kinds of vegetables.  We bought quite a bit of veggies, stuffed them all in our back packs making them pretty heavy, and then took a jeepney home part of the way, and a Tricycab, then a motorcycle!  the rest of the way.  I balanced my heavy back pack on my back, the squash I was carrying in one arm and held onto the cycle seat with the other. The motorcycles certainly don’t travel very fast, with all the people and cars crowding the streets.  The motorcycle was able to weave around the taxis, jeepneys and triceycabs to get us home faster.  We were late in getting dinner made.  We had stir fry and rice. 

I have gotten money out of the ATM machine once so far.  I took out 8,000 peso’s, about 125$ or so.  I will need a bit more around the 24^th to get my passport renewed.  I am paying for the internet here for my use, which will be about 75$.  This is actually a bill that is late and needs to be paid at once, or they will shut us off.  Here you have to go directly into the office and pay the bill.  You don’t mail in a bill.

This evening I then took a 3 hour nap in the cool room, and then jumped out of bed 15 minutes before I was on for shift at 10:00pm, scrambled into my scrubs, hurry-hurry brushed my teeth, grabbed my tools, pillow, laptop and books and ran to the clinic.  I made it just in the door as a mom was pushing, so I grabbed some gloves and assisted the birth.    I then assisted at another birth about 30 minutes later and now I can sit down and record it all.  My camera is working really well.  My system for recording births is good, as long as I keep up on it and don’t loose track of which picture goes with which birth/ patient.  Tonight’s births were during a big thunder storm, with torrential rain.  We could hardly hear each other and had to really speak up to get charting done.

I had initial history prenatals today.  I now have 28 prenatals total,   3 primary births where I caught the baby, and 5 observes.  This morning was the first birth that I didn’t have a big adrenaline rush. (Did I already tell you that??)  It is sort of a mile stone I am happy to have gotten to.  Carmen says it takes quite a birth to get her adrenaline going….

In prenatals, we check for anything odd or concerns or problems.  We give tetanus shots; we listen to the baby, measure Fundal height and make sure their iron count is sufficient.  I really like the prenatals, although a lot of the students, midwives, interns do not.  One of the students gave me a language cheat sheet that worked absolutely wonderful today.  It took all the stress out of communicating.  I always ask the same questions over and over again, so I get fairly good at pronouncing the words.  I appreciated the Spanish course I took a little bit of, because Visayan has many Spanish similarities and words.  This makes me fairly understandable.  The only problem I am finding is that when I am speaking Visayan to them, they assume I can speak more than I really can.  So I have one of the midwives come over to translate if there is a problem.

(I just jumped a foot off the couch, as a gecko appeared under my feet)  He has turned white, as the floor is white.  Such big beady eyes looking at me.  Doesn’t he know I could step on him???)

In between births, we can sleep if we want to.  Unless you have a baby and mom to tend.  It will be hard to nap tonight, as there are several moms and babies waiting to be discharged.

Last night a taxi drove up outside in a big hurry and honk-honked his horn.  We ran outside, and a mom was getting out of the cab.  She was in active labor but not pushing.  The taxi drivers hurry to get to the birthing center, however, if it does happen that a baby is born in their taxi, it is considered very good luck.  They are usually very happy and talkative.  There have been babies born in the cab, right outside the birth center entrance and in the doorway or kitchen of the clinic too.

Today is much quieter in the birth center.  Yesterday was Sunday and the neighbors were home all day.  They started in the morning with loud, wild sounding interactive video games with the kids.  Afternoon it was boxing. Evening it was horrific sounding, violet movies. Although I cannot understand the language, the sound effects are all bad enough with screaming, crashes, gun shots, etc... That is much more stressful than a very busy clinic.  I wanted so much to just plug in my headset from my CD player and listen, and even brought it, but the batteries were dead.  I was so glad when my shift was over to get away from the noise.  The neighbor’s house is less than 10 feet away and everyone’s windows are completely open to catch any breezes.  I guess they don’t like the sounds in here when moms are birthing, and we don’t like their noisy sounds and music/TV either.  Thankfully that was the only day that was very bad.  Most times they are pretty quiet, save for cooking noises, children playing and family ruckus.  On Saturday, they broke 2 glass somethings…   Well, privacy is not on their list of priorities here.  The Filipinos that come into the clinic like it just as it is.

Joyce and Monica have arrived!

My bedroom               The kitchen     Laundry with my clothes  and living room

I have lost all real sense of day or night type schedule of sleeping and awake. This is good, as I don't feel sleep deprived at all.  I nap when it is slow down in the birth center.  Like last night, I slept almost all night, after 1:30 am and awoke feeling refreshed and ready to go.  If I'd have worked all night, it would have been a different story.

Joyce and Monica arrived today. They had quite the adventure getting here. Los Angeles was actually the worst. Krys, Julia and I drove to the airport and met them. I gave Joyce a huge hug.  It was solo good to see her. 

I went to the market to get fruit with Carmen.  We went to Agdow market and carried home back packs full of mangos, rambutan, a watermelon, bananas, and pomelo (kind of like a cross between a grapefruit and tastes like a pomegranate.  We rode home in a taxi this time, as our load was too heavy to be adventuresome. (No motorcycles today)

I was looking at some yummy mushrooms in the meat market.  I am craving mushrooms.  Carmen started laughing... those are chopped goat intestines!  Oh well, I think I will pass...

Included some pictures of my room / spot, my house and what it looks like outside. Someone suggested that I go to the beach for some recreation.  I told them, "No thanks" I wouldn't have any real fun without Tom there.

 Today I unpacked the 5 boxes that came.  The Filipino midwives were thrilled with all the stuff.  They promptly unpacked everything and put it away.  They had to rearrange all of their cupboards, but managed to store it all away. Maybe the US girls will enjoyed the Farm, Reminisce and Taste of Home magazines. One of the Pinoy midwives grabbed a magazine and promptly started copying recipes out of it for herself.  They oooed and ahhed over the pictures of everything in the magazines.  It must seem as strange to them, as their land is to us. 

Tonight one of the intern midwives are making cinnamon rolls, fried potatoes, a breakfast for dinner. The cinnamon rolls are homemade and I am looking forward to them.

After last night's crazy thunderstorm and births, it has been quiet today.  I am sort of glad, as I wanted to spend a little bit of time with Joyce.

Busy day today...

7:00 am -  Today started bright and early with a transport to the hospital. Baby’s heart beat was 185- 200  and mom was only 7 or 8 cm.  She had been in labor since 3:00am and was really crying out with each contraction.  This is unusual here.  Most times, the ladies labor very quietly, with minimal facial grimaces even.  After her baby started getting stressed, we gave her some water to drink.  Then we check 5 minutes later and it still was rising.  We started an IV , loaded her up in the little blue ambulance and zoomed to the hospital.  I took Joyce with me to the government hospital and she was floored. ( She had never seen anything like this.)  Blood on the floors, very sick people everywhere.  We left our patient there.  As far as them doing anything about the baby in distress, Krys said that they would probably just continue the labor, in spite of the baby’s heart rate.  I feel so badly just leaving her there.  "Can I take a shower now?"  I remember kind of feeling the same way the first time I went to the hospital.  We both had to settle on washing our hands, as we were still on shift.

8:00 am  I did 7 prenatals. There were about 75 women there today.  They start coming at 6:00 am signing in with the guard.  Women are seen first come, first served basis.  At 7:30 they all file upstairs to a large room and sit on wooden benches.  The Pinoy midwife hangs, with clothes pins, a handwritten paper (poster board size) up on a clothes line strung across the room.  After prayer, the midwives play the guitar and start leading a worship chorus time.  The songs are beautiful and they sing the same ones often, so I am catching the melodies of some.  They words I can hardly fit my tongue around, but that is getting easier too.  The ladies line up to get a blood test for their iron, and are singled out to get gram stains if they have pus or blood in their urine.  Yesterday we did pap smears and vag exams.  Joyce and I got through 7 ladies today… and were called away early, as a mom came in fully dilated.  She was just sort of hanging out without pushing, so I went back and finished my last prenatal. 

                      This particular lady I was doing the prenatal on has a very small baby (measuring 29 cm at 36 weeks and her baby was oblique in position. (sideways, sort of).  She is one of my continuities that I saw last week and after seeing her last week, I fretted and wondered about her.  After seeing her today, I had no doubt that her baby has IUGR or something that is preventing her baby from growing.  This is so sad.  The mom is about one of the sweetest ladies and smiles all the time. I am pretty confident that she will not be able to have her baby here, unless she starts eating some protein and gets that baby a little bigger by about 4 weeks. 

11:00am  I did postpartum exams on 3 moms and 3 new baby checks.  These are moms and the babies that I caught last week.  They come in for a check the day after the birth,  3 days, 1 week, 3 weeks and then a 6 week visit.  These are all free for them. Sometimes they come, and sometimes they do not.

1:00 pm found me cramming a bowl of white rice and pork pieces with veggies,  and pineapple chunks into my mouth, in between helping with a laboring mom, fully dilated and still just hanging out with contractions every 10 minutes.  2 hours later, (Yes, really she hung out fully dilated for 2 hours!) Medula (a student midwife from Switzerland) and I finally caught the baby in mid air, as the mom was standing, hanging onto her bana.  During a push, we were looking at the perineum with the little mirror and suddenly, there was the face looking at us.  Then sploooop, that baby was out into our hands.  We then got the mom sitting onto the short birthing stool, bringing the baby back through her legs at the same time (quite a feat).  Baby was doing terrific, giving lots of good crys and having great color.

2:30 I did another postpartum check and baby exam

I finally sat down at around 3:30 and promptly fell asleep amidst a whole lot of commotion for a 5 minute nap.   One of the midwives came over to tell me a mom was here to see us, and jumping up, I did another postnatal and newborn exam. Things have finally slowed down now.

This afternoon I made some salsa while I was on shift, in the Pinoy midwives kitchen, in the clinic, for the girls at the house.  They had never made homemade salsa and are having enchiladas.  No store salsa to be had in the stores here.

Hey! A gecko just ran by my feet!  They are so cute, but startle me sometimes. A tiny ant keeps running across my computer screen.  I think that it might be trying to chase my lap top cursor!

About those ants.  They are very interesting.  They stay out of view, unless there is a tiny morsel of food on the floor, counter or where ever.  I have not figured out where they all come from in such a hurry.  I dropped a piece of rice on the room in the birth room, while I was stuffing lunch in.  Within 10 minutes, there must have been 50 teeny, tiny ants dragging this rice piece away.  They are itty bitty. One of the midwives dropped some food down the front of her shirt and after awhile started feeling very tickly in front.  She looked down, and saw a marching line of them maneuvering across the inside of her shirt.  They mean business.  Food and survive.  The rats might get it first!  (Not in the shirt, I mean, of course…)  Thankfully they do not bite.