Wednesday, June 25, 2014

When Life gives you Ants...

Ants.... those tiny creatures that are hard workers.... the ones mentioned in Proverbs?...yes, those little guys.... lets put them in the spot light for a bit...

Just so you know, they are EVERYWHERE here in the Philippines!
Now, before you jump to conclusions PLEASE do not get me wrong... I am NOT complaining. I have learned a LOT from them!

Here are a few of those lessons...

#1. I have learned that they are a part of everyday life here.
#2. I have learned to wipe the counters, tables, and stove multiple times a day, even when they appear clean.
#3. I have learned to check my towel before I use it as one of their favorite trails runs near the towel rack in our bathroom.
#4. I have learned what an ant bite feels like and to be alert to anything that feels like an ant crawling on my skin.
#5. I have learned that even when you clean the entire kitchen and spray existing ant trails with baygon (bug killer spray) they ants will still return within a few hours.
#6. I have learned that ants generally float.
#7. I have learned that ants can get into any place and always show up uninvited.
#8. I have learned that ants love any kind of food they can get to.
#9. I have learned that ants can chew through anything.
#10. I have learned that ants taste good. (or at least don't taste like much and flavor is easily masked)

Yes, you read that correctly. I have eaten ants on more than one occasion since living here. Maybe it is partially due to the fact that it is easier to eat them at times than to spend forever picking them out of rice (or any other food). Maybe it is because I have just decided a little extra protein won't hurt me. Or maybe it just makes for a great blog post. Either way, they are hardly noticeable most times...

The other night we decided it was time for a treat. Our dorm had been saving a bag of hint of lime tortilla chips for just the right time. I found a can of re-fried beans & jalapenos on the shelf and there was some salsa in the fridge. Time for a delicious treat!

We opened the bag and soon discovered our lovely friends had made it there first.The clever creatures had chewed tiny holes all throughout the bag!

Not sure if you can see, but there are numerous little ants all over that chip...that isn't just lime seasoning ;)  But did it stop us? Absolutely not! Who would let a few ants ruin our special meal? Definitely not us!

When life gives you ants just add beans, salsa and lime!

One girl mentioned they were still crawling around. I quickly determined that by placing the beans and salsa on top of them you could pretend as if they were not even there! It is hard for an ant to crawl with beans and salsa on top of him!

Lami Kaayo! (very delicious!) Would I do it again- absolutely! What wonderful memories!

Monday, June 23, 2014

17, Young and Excited

She was 17, young, and excited as she entered the clinic. “Cring-cring” was expecting her first baby. She had named her little girl Trixie (suspected per ultrasound). I asked her about her labor and discovered that her bag of waters broke at 2am and contractions started around 3. A quick glance at the clock showed that it was just after 6 now. 

“Cring-cring's” contractions were not very intense but evaluation of her progress showed that she was in fact in labor. The supervising midwife told me that if her contractions progressed, she would be able to stay at the clinic. I advised “Cring-cring” various exercises to stimulate her labor and brought her some water. 

Moments later the supervisor came to tell “Cring-cring” that her mother was on the phone. I looked up in confusion. Normally the parents would be waiting outside or on their way. Ate told me that her bantay (companion) was actually her nanny and that her parents would come later in the afternoon. "Cring-cring" was a single mother and living with her parents. There was no boyfriend or father of the baby in the picture. “Cring-cring” finished on the phone and told me that all was well. With a smile on her face she set off to walk around and exercise with high hopes for bringing on more contractions. For a young and first time mother in her situation, her confidence and smile was surprising and refreshing!

“Cring-cring” labored beautifully! Her focus, determination and strength was amazing! Around 9am she ran in with intensity and informed me that she wanted to push right now. Seeing that her contractions had just started to become painful, I encouraged deep breathing and massage to help her cope. The various techniques appeared to work and “Cring-cring” gained her composure after each contraction. 

Around 10:15am, I could tell that “Cring-cring” appeared close to giving birth. I spoke with the Ate and after a few minutes it was determined that she was indeed ready to push. She tried a variety of positions. It was neat to see how connected this young girl was with her baby. I grabbed a mirror and she immediately locked her focus on her baby and progressed. However, despite various positions, baby's head would not descend past the pubic bone. Finally after many positional changes and 46 minutes, at 11:19am baby entered the world!

Baby was placed skin-to skin with mother and I suggested she look at her baby. A midwife gently lifted baby and “Cring-cring's” eyes widened. We all laughed as I stated “Nope, definitely not a little Trixie!” (I had seen he was NOT a girl as soon as he was born and enjoyed the look of welcome surprise).

Matteo James was a small little guy weighing in at only 2300g or 5 pounds 1 ounce. I enjoyed spending time talking with “Cring-cring” and her newborn son. They recovered well and no problems arose. Her parents were on the phone shortly after rejoicing in the news. 

I was blessed again today to visit with "Cring-cring" and Matteo. They are continuing to do very well. According to her dates, baby may have been slightly early (36 weeks). Regardless, he continues to do well and "Cring-cring" is showering him with love. I am excited to see how this young girl is blooming into a mother. Yes, life's circumstances may be sad, but when life hands you lemons- make lemonade!

Tuesday, June 17, 2014

Breathe... 2.... 3....

Breathe...2...3... Breathe...2....3....

The words repeated in my head as I heard the heart tones drop to 90, 80, 70. Part of NRP training the algorithm for PPV flooded into my mind and I prayed it would not be needed. I had long before taught myself to review the routine before each birth and again if heart tones dropped. I said the words again in my mind.

Breathe...2...3... Breathe...2....3....

I stood by the bedside as the baby's head emerged in the caul. The midwife quickly removed the membranes and wiped thick mud-like meconium from the blue baby's face. Her body was limp and I helped her lift the baby to the mother's chest.

Time seemed to slow. I helped clean the baby and avoided stimulating her as the supervising midwife suctioned her airway. Thick meconium secretions were removed as baby slightly opened her eyes. Then they closed. Her midwife called out a heart rate of 90 and dropping. The cord was clamped and  cut.
I lifted the limp, blue baby onto the resuscitation board and turned for the mother to see her baby briefly as I reached with my other hand for the bag and mask being handed to me. I started PPV.

Breathe...2...3... Breathe...2....3....

I said it aloud as I ran to the ambulance with two experienced midwives.

Breathe...2...3... Breathe...2....3....

I continued to provide PPV as one midwife found the heart rate to be 60 and started chest compressions. My rhythm changed to match the "1 and 2 and 3 and breathe and" pattern. "Lord help us!" we prayed aloud! Thankfully baby's heart rate quickly rose again and I reverted to the pattern I had before...

Breathe...2...3... Breathe...2....3....

we were almost at the hospital now... I continued...

Breathe...2...3... Breathe...2....3....

she gasped once then stopped.... "Come on Baby... just breathe!" I cried as I continued...

Breathe...2...3... Breathe...2....3....

I continued as I jumped from the ambulance and rushed inside with the midwives. We ran through the ER to where the doctor immediately accepted us. The nurses and staff took over and SALAMAT SA GINOO! (Thank the Lord!) the baby finally gave another gasp and a weak cry. After ensuring the doctor had been fully informed, we left and returned to the clinic.

The words continue even now to ring through my head. Breathe...2...3... Breathe...2....3.... I am thankful for the training the Lord has provided. I am thankful for His faithfulness and goodness to us. I am thankful that even when the most horrible things happen, I can look to Him for strength as I know He is in control. I have since only heard that baby is breathing on her own. Please pray for precious little Abby (named for her midwife) and her sweet parents (They have been reunited at the hospital). Pray that the doctors will have wisdom and be able to provide appropriate care for her.

 I will update when I hear more!

*Update 6-18-14: I just found out that baby Abby passed away this evening around 5:30pm. Please keep her family and midwife in your prayers. Thank you!

Monday, June 16, 2014

Opening Eyes

The familiar sound of my alarm went off. I slowly opened my eyes, looked at my phone, knowing it was much to early for my alarm, and realized it was a call from the clinic. As I answered with a sleepy hello, the midwife on the other end gently explained that "Divina" was at the clinic and actively in labor. She offered to send the guard in 5 minutes in order for me to get ready. I thanked her and quickly climbed down from my bunk bed.

I had just enough time to put on scrubs, grab my backpack, and fill my water bottle by the time the guard arrived. On the short ride to the clinic, the guard explained that "Divina's" bana had left to go home and get some things without asking. Thus, she was without a bantay (watcher/companion) at this time. I tried to force my mind to wake up as we pulled up to the clinic and I jumped out.

As I entered the clinic, I saw "Divina" on her hands and knees near the post partum area. She was having a contraction and looked up at me pitifully. She whimpered "Help me". I quickly rushed to her side and helped her breathe through the contraction and then supported her to the birth room.

"Divina" was a sweet girl. This was going to be her third baby. However, she had lost her first baby 2 days after his birth due to prematurity. Her 2nd baby, a girl, was healthy and strong. During prenatal care, "Divina" had appeared to be scared about this baby and birth. I quickly tried to reassure her that all was normal to this point and we would do all we could to help.

As she reached the bed, I could see another contraction come over her. I encouraged her to breathe as  fetal heart tones and vital signs were monitored. She had only been 2-3 cm an hour before. As the next contraction came, so did a gush of fluid and tufts of baby's black hair were visible.

8 minutes later at 3:58am little "James Aldritch" entered the world. I was so thankful to be able to see this mother grasp her new son and welcome him with tear filled eyes. It was less than 30 minutes from the time I first opened my eyes until I watched this little baby open his eyes for the very first time. An hour later as the sun peeped through the clinic windows, I knew I had a long day ahead, yet I also knew there was no better way to start the day then to welcome a new life into this world.

Friday, June 13, 2014

A WILD Ride!

Sirens approached. We heard them outside the clinic, and then we heard shouting. I pulled on gloves and ran outside with a birth tray in my hands- ready for anything (I thought) "A midwife" "Help" "Baby at home" "Veloso St" were the broken phrases I heard. The next thing I knew I was ushered into a 911 Police truck by two officers and we were off. My mind quickly pieced together what had happened. I had no clue what adventure lay waiting ahead!

The sirens wailed as we drove along. It was a quick ride, but seemed to take forever. The Philippine sun was hot as it beat down. The wind whipped my hair in my face as we flew down the street. I tucked it back, not wanting it in the way. As we screeched to a halt three gloved midwives jumped from the back of the 911 Police Truck- one carrying a tray with birth supplies, another with prepared injections of an oxytocic drug (for hemorrhage prevention/treatment) and another with other supplies. The midwives hurried to follow the police into the little home.

I entered the dimly lit house and saw a woman laying still on a bamboo bed. Between her legs lay a blue baby boy. His cord wrapped once around his head, once around his arm and a third time around one leg. I avoided a puddle of fluid on the floor, which I presumed to be amniotic fluid, and quickly moved in closer. The first midwife set down the tray, grabbed the baby, unwrapped his cord, and started stimulation. The head midwife assessed blood loss and the third injected the mother with pitocin.

"Baby's first Apgar score is 7" spoke the first midwife as she clamped and cut the cord. "Current estimation of 50cc blood loss" assessed the head midwife. The third helped hand necessary supplies and find a plastic bag for the blood. There was lots of commotion as little children milled about crying and scared. Some had eyes wide open in wonder. The police waited at the door and the father moved back and forth as if unsure what to do.

The first midwife continued to stimulate the baby who had a weak cry while the other midwives tried to talk with the police and father about bringing mom and baby to the clinic. Suddenly the first midwife noted that the mother had started to bleed again! She called out to the head midwife that the mother was bleeding and jumped in to rapidly deliver the placenta. She sat at the end of the bed and used a method called continuous cord traction (CCT) while supporting the uterus. The placenta followed with a gush of blood and the head midwife gave a second injection. "300cc estimated blood loss" said the first midwife to the head midwife who was firmly massaging the mother's soft uterus. It rapidly firmed and the third helped wrap the baby in a clean blanket as the other midwives examined the placenta to ensure it was complete.

No stretcher was available. The mother would need to be carried to the truck. The head midwife covered the mother with a towel as the first midwife grabbed the mother's head and shoulders while a policeman grabbed her legs. Together they hoisted her out and into the truck where she lay across their laps- the floor was much to hot from the sun. The head midwife grabbed the supplies and the third midwife held the baby. Sirens were again on and we sped off.

Once at the clinic, everyone again jumped into action. The guards rushed out with a stretcher, the first midwife followed her in and helped to stabilize her. The head midwife reported to the supervising midwife and the third rushed the baby to get some oxygen as he was still blueish from his shocking birth. He recovered quickly and was returned to be placed in his mother's waiting arms.

The midwife who helped to stabilize the mother continued to care for the mother and her little son. She learned this was the 41 year old woman's 8th baby and her 3rd boy. The mother had no prenatal care anywhere. She knew of the clinic and once she realized a taxi would not arrive in time for her to go to the hospital, she told her bana to call for help. The 60 year old man hurried out the door and yelled to the police who happened to be at a small eatery a few houses down. They rushed in as the baby's head was birthing and the mother told them to get a midwife. The poor policemen rushed to summon us- and the rest has been told.

One never knows what each day will bring! I am thankful that I was able to help welcome this little guy into the world- even if I did only witness the birth of his placenta rather than him as well! Happy birthday Baby Jerome! Born at approximately 12:25pm June 12, 2014 weighing 3600g (7lbs 15oz)!

Monday, June 9, 2014

A Taste of Home

Some days you really need a taste of home. Something familiar. Something comforting. Let me share with you the story of a recent blessing! This is the story of a bowl of a blessing!

The other week I strolled down the aisles of the grocery with my dear friend Melissa. Those who know me very well know my LOVE for shopping. (Though I must admit, it can be fun if you are with the right people) Anyway, as we wandered the aisles filling our cart, my eyes landed on a lone can on a discount shelf. One little can, but the label jumped at me and stood out among the many other bigger and brightly colored objects.
I gasped with recognition and said aloud “I know where that is!”

Yes folks- Real Maine New England Clam Chowd-ah some how made it all the way here to Davao City- THE PHILIPPINES! Just for me! I was so very excited! I could imagine how delicious it would taste! Then I stopped. This was (obviously) imported and may be expensive. However, a quick check showed the Lord had me on His mind. After seeing that it was in my price range, I readily added it to the cart. I smiled knowing that a delicious treat would be in my near (ish) future. We finished up shopping and returned to the dorm. I placed it on my shelf and there it sat...

Today was a good but long day. After spending my day at the clinic and studying, I returned to the dorm hungry and worn out. Tonight was “fend for yourself” dinner night. I placed my back pack on my desk and looked up to the lone can on my shelf. I smiled- CHOWD-AH! I had a delicious dinner ahead! A few minutes later the sweet aroma of clam chowder wafted to my nose as I stirred the pot on the stove and ladled some into my bowl. YUM!

It was wonderful! Definitely not like homemade or fresh chowd-ah, but it was a taste of home! I felt so blessed as I enjoyed the flavor! God is so good to me! He sent that little can all the way to the Philippines just so I could have a taste of home! I am wicked blessed! Ayuh!

Sunday, June 8, 2014

Fashion Show

I had the opportunity the other night to attend the fashion show of the year! What a fun opportunity! Hope you enjoy the photos (below)! I also was thankful to spend some time hanging out with these great kiddos! We had a lot of fun!

I am wicked thankful for the friends the Lord has given me in my “home-away-from-home”. I am so blessed!

WhenTime Stands Still

I met “Sha-sha” at the beginning of my shift. She was happily expecting her 3rd child- which they believed to be a little girl. “Sha-sha” was very responsive to help and readily tried a number of suggested positions which greatly helped her cope through the strong and regular contractions. Though she was only 5 cm at 6am, labor was strong. However, she was stronger. “Sha-sha” focused well. She breathed through each contraction and pressed into her bana for support.

I should note here that her bana was also amazing. He brought her food, milo (a chocolate type drink), and water. He breathed with her, whispered to her softly, and gently massaged her back. When her hands and feet started to cramp, he massaged them and talked quietly with her. He was so kind and gently yet a strong support for her! I wish I saw this more often!

Around 8am, intensity increased. “Sha-sha” had a more difficult time breathing, but still could. When I asked how she was doing, at this point she told me “Not so good now Ma'am”. Further evaluation showed she was doing wonderfully! She just needed a little encouragement and she and her bana labored on.

9 am came and I could see that “Sha-sha” wanted to bear down with each contraction. I tried to help her breathe or blow through each contraction, but it was not effective. I suggested a hands and knees position. It helped for about 15 minutes, but with each contraction it became more and more difficult for “Sha-sha” to not push with force. A short time later I discovered that she had almost reached full dilation. With the next contraction or two she was fully dilated and the baby's head descended into view.

I alerted the supervising midwife and she quickly appeared. Ate picked up the chart as Emi assisted me. As the baby's head began to emerge, I saw that Violet had entered the cubicle for backup. I was glad. My instincts told me something was not quite right. The head slowly became more visible with a contraction then disappeared without one. This repeated itself with the next contraction. My alert sense heightened. I turned to Emi and told her this was called the Turtle sign and could indicate a nuchal cord or impending dystocia. As she checked the baby's heart tones, they came loud and clear. I prepared myself for what I expected to come and as I looked up I saw Violet thought the same thing. She had called for Brittany to be on “stand by”. 

Violet moved closer as the baby's head emerge from the perineum. Ever so slowly it came out and retreated. Finally the head was born. A nuchal cord was immediately ruled out. The anterior shoulder was not coming as it should. Immediate action was needed. Time stood still as the team sprang into action. The next moments happened quickly, yet felt as if time had stopped.

The anterior shoulder was not coming so Violet and Brittany performed McRobert's maneuver (straightening and then hyperflexing the legs. This movement rocks the pelvis and often is enough to dislodge a “stuck” shoulder). It did not help. We called for the “edge of the bed” as I saw the baby's face turn a deep purple. I knew we had to act quickly. If this baby did not come quickly, brain damage or death were real possibilities.

While still inside searching for the shoulder, we grabbed “Sha-sha” and turned her to the edge of the bed. With the sacrum off the bed in this position, it can help to open the pelvis and give baby more room. Still no shoulder. McRoberts was swiftly repeated. Nothing. We tried it a second time. As Brittany and Violet moved her legs into hyperflex, there was movement. My heart lept for joy! The shoulder was coming!!!

Seconds later, baby Jasmine's body followed and we all praised the Lord! Time seemed to resume at a normal pace. As I looked up, I saw the bana standing in the corner sobbing. My heart went out to him! He was terrified. “Sha-sha” was thankful to hold her precious daughter and slowly, her bana moved in for a closer look. We gave Jasmine a little oxygen to help her “pink up”. She was born at 9:57am and her APGAR scores were 7 and 9. 

A little while later (after things were cleaned up some and both mother and baby were stable), I sat down with “Sha-sha” and her bana while I explained what had happened. I told them how the baby's shoulder had become stuck behind the pubic bone and how each of the positions helped baby to be born. They both understood. My mind wonders what the alternative outcome would have been if no trained attendant was present.

I am always surprised how time seems to slow when you are in the midst of an intense birth like this one. The should dystocia “only” lasted 1 minute and 20 seconds, yet it seemed like time stood still. I am thankful that the Lord allows this to happen at times. The Lord helped everyone remain calm, controlled and focused. Some say that with a shoulder dystocia one has 3-5 minutes before brain damage occurs. I am thankful the Lord helped the baby come quickly!

Despite the “difficulty”, it was an amazingly beautiful birth. I loved the experience of teamwork in the midst of a complicated birth. I loved watching the parents interaction before and after. I saw once again the true beauty of midwifery! I also have an even greater appreciation for the training I have received. God is so very good!

Proud Parents who are thankful for their 7lb. 3oz Miracle

The Amazing Team! From Left to Right: Ate Ermie, Sarah, Violet, Emi, Brittany, and Rio

I am wicked blessed! **All photos and names used with permission!