Birthday Roadtrip!! To Livingstone I presume.

So, Monday I celebrated my 36^th birthday. And on top of getting a really cool hat I was blessed with a weekend to travel with my family to one of the most amazing places on the planet.

Livingstone, Zambia is about a 7 hour drive south of Lusaka where the Zambezi River creates the natural border between Zambia and Zimbabwe. It was named after the famed Scottish missionary/explorer David Livingstone who was the first non-African to set eyes on what is today Victoria Falls. About 10 years later he went inland again, from Zanzibar along established slave trade routes with the purpose of sharing the Gospel with people who had never heard of Jesus, finding the source of the Nile and working to end the slave trade,. Today he is one of the few European explorers who is still respected by modern-day Africans.

Victoria Falls in a word was stunning. We had brought light rain jackets to ward off any spray but it was like standing in a full on shower so you really have no hope of staying dry. Super fun! Makes it hard to take pictures though. As you walk along the viewing area you come to a deep gorge and “Knife Edge Bridge” which is what it sounds like but probably safer. When you’re close to the falls there’s just tons of mist and spray and 70% of the time you don’t see anything and then everything clears and, wow! “Majestic” can be a pretty cheesy word but this is a place where I would use it unreservedly. Majestic, stunning, yeah. “Wow” might be the best word.

There was also a nearby game park. It was pretty small but perfect for us to do an early morning and late afternoon game drive. Some of the gamekeepers with their AK’s even took us on foot to see the rhinos. What a great birthday! Enjoy the pics

Redbilled Hornbill

Warthog (Pumba?)

Heather and the kids eating lunch in the car because of........

The nearby hippo wanting to join us. Cowards!

An impala marking it's territory. One of the weirdest things I've ever seen.

Buffalo herd.

You lookin at me?

Wildebeast

This is a mama rhino with a 2 year old baby.

Baboon.

Victoria Falls. Seventh natural wonder of the world. Beautiful.

You can just make out the bridge through the mist that connects Zambia to Zimbabwe.

A leguan. I almost hit him with the car. Oops!

More impala. I had impala stew the first night in Livingstone. Yum!

If you're familiar with Go Diego Go you may know about symbiotic friends.

A bit of light afternoon grooming.

This scene was great. It was like grandpa baboon got stuck babysitting again.

 So while putting this all together we left Abigail and Josiah playing in the nearby dirt pile. After a while Abigail had a plastic cup and I could hear her making frequent trips to the water tap behind the house. I knew what was coming. Sure enough...

Good times. But I think I'll invest in a deworming treatment before leaving the continent.

Life and Home Stretch Musings.

So praise God! After one week of paperwork and tons of running around by our amazing staff, we are all legal to work in Zambia. This is amazing since in Tanzania it took us 2 weeks to get approved and 3 months to get an actual legal  stamp in our passports. We actually got our stamp just 2 days before leaving Tanzania!! Whew! So this is much improved and we are really blessed to be back up and running in the hospital.  

Just wanted to give you update of the 15 year old hope that was bleeding from a post or 2 before. Remember the young girl who had delivered at home and was bleeding, yet wouldn't let anyone near her? Well I got and update from the doc I was working with that day. They ended up taking her to operating theater because even the senior doctor could not examine her even with sedation.  She ended up having tears throughout her entire birth canal.  Thankfully operation was an option because she would have kept bleeding and not made it.  Today she is doing well and her and her baby were discharged in good health! 

I also heard word about the young 15 yrs old momma who had a baby in distress but was waiting for hours for a c-section.  She was finally able to get the operation and the baby is still in the hospital. I am unsure if the baby will make it but so far it is alive!

It’s good to be back in the hospital this week. I was in the labor room last Tuesday and spent all day with a laboring momma. This was her 5^th pregnancy so I thought was gonna be a fast one. She had her first by emergency c-section 13 yrs ago because the baby was 3.9kg and obstructed. Since then she has had 3 normal deliveries so she was in the clear so to speak for her 4^th normal delivery. Since her first four babies were large and her first delivery was a cesarean the doctor was concerned and kept asking me to monitor her for signs of shock. This can be a sign that the uterus is actually rupturing. Everything was progressing along fine until she reached about 9 cm and I noticed some active bleeding. I did a quick V.E. (vaginal exam) and although most of the cervix was gone there still remained a segment not dilated and very swollen.  With the bleeding and the mysterious tissue that I deemed was a portion of the cervix I decided to inform the docs. The first doc came in and said the tissue was actually placenta and that she should be rushed to theatre. The second doc said it’s probably just swollen cervix but with the bleeding and her slow progression past 8cm she still needs to go theatre in case of a rupturing uterus. Her vitals had also dropped and labor slowed way down in the last hour. I went with her to theatre and a beautiful healthy chunky baby girl was delivered.

Afterwards the doc was really nice and spent time explaining the risks and signs of a rupturing uterus and some of the signs the patient was presenting. She also said when you’re in a position with limited monitoring resources sometimes you just have to go with your gut and to do what’s best for mom and baby. If her uterus had ruptured with that current amount of staff and supplies there was a good chance that mom and baby would lose their lives.

 In India they didn’t usually even attempt to let moms try for a natural after c-section. Sadly they will even go so far as to let a baby in distress die with the thought, “Once the mom has a cesarean she’s stuck having cesareans for the rest of her pregnancies and if she can’t afford the medical costs she’s better off letting this one go and trying for a natural delivery again with the next pregnancy”.  This was an actual conversation I had with a health professional there during a labor! Thankfully our team was able to spend a lot of time with the staff advocating that every life is worth fighting for and in that particular case above, thankfully a beautiful baby boy was born that day. 

In Zambia and Tanzania they’ve been more willing to let mothers labor after c-sections. This is partly because they don’t have the surgical staff or the after care staff to give every woman a c-section for her future pregnancies. I’ve seen mothers with the vertical incisions labor and do well.  However, this last weekend a woman lost her life because her uterus ruptured (this wasn’t a VBAC) and despite surgery to remove her uterus, and over 7 liters of transfused blood they were unable to save her. This was one of 3 ruptures that happened that week. 

Again, I’ve really been thinking a lot about why I wanted to get this training and constantly trying to make sense of everything I am seeing and experiencing in these 3^rd world settings. I came across this statistic this week from the World Health Organization.

“About 1000 women and almost 10,000 newborns die every day due to largely preventable complications during pregnancy, childbirth and the immediate postnatal period. In addition, every year, nearly 3 million babies are stillborn. Many of these lives could be saved if every birth were attended by a midwife.”

I know these statistics seem high but I’ve seen these things. I’ve seen so many babies with heartbeats hours before being born dead because someone didn’t pick up on the baby’s distress early enough. I’ve seen babies not even make it to term because of malnourished or anemic mothers. I’ve seen mothers come close to bleeding to death because their uterus failed to deliver the tiniest portion of membrane (left over from the birth sack) or their uterus was unable to contract from being tired but their life was saved with IV fluids, an oxytonic drug and a staff member with training. Our team has been fortunate not to have lost mothers but mothers have died at these hospitals during our time in these places and we had been monitoring the mother that was in the case above.

I’ve also seen babies born completely flat and God bring them back to life, sometimes through resuscitation, sometimes through straight prayer and intercession. I’ve seen mothers stop bleeding after praying when everything else was failing to stop it. I’ve seen God do things that make no medical sense.

I can’t make sense of everything but what I can say is that God loves life. God wants life to be fought for and he is looking for God fearing midwives and other medical staff to fill the gap. I am so grateful to have had this experience, to have this training and to know that I could be available someday to save a life. God loves people so much and has a special place in his heart for mommas and little ones growing inside them. They are loved. They have value. 

I leave you with a few pics from the past 2 weeks. 

Teaching, Crocodiles, Easter, Work Permits

So 2 weekends ago we ventured out to the local crocodile farm. I (Heather) am not a fan of crocodiles and snakes and I would rather stay ignorant about the creatures looming in the bushes next to me. But Bruce wanted to visit and he wanted to try a crocodile burger that he had heard that the restaurant there served.
So off we ventured 45 mins down a bumpy dirt road where I am pretty sure we saw the other side of the earth in some of those holes and half way through the trip I said "Have I mentioned yet that I hate snakes and crocodiles?" Labor of love for my dear hubby and it really wasn't all that bad. The walls were high enough for a sense of security and the poisonous snakes were behind glass. (Thank the Lord) I don't know why that brought me any comfort being that one could be lurking behind me in the bushes in their natural habitat. Haha!
There was a fun playground for the kids and they had some massive crocs that could only move about 2 feet at a time before they needed to take a break. (Part of the side effect of not hunting your own meat but being fed by humans).  We had a fun day and Bruce even got to try his Croc burger. I had a beef burger but I tasted it and I felt like it tasted a little like a tuna pattie.

Harmless bush? look again..

Puff Adder

 Did you know? Puff Adders are viviparous (give birth to live young), giving birth to 16 – 40 young, which are born in the late summer. The young are highly venomous upon hatching and are capable of inflicting a serious bite. The Puff Adder holds the record for giving birth to the most amount young by any snake, 156! Their venom is Cytotoxic and highly dangerous. EXCITING!!
(Sorry for the snake pics Michele!)

LUNCH!

This week and yesterday (Monday, since Im a couple of days late) We had 2 teaching opportunities.  Teaching simple healthcare is part of our training. Simple Health Care is basically empowering people with simple information that in many cases can save a life. This week we went to a community to teach some women and also taught some young people at an after school soccer program that is run by some YWAMers here in Zambia.
I had to laugh at the day we went to the community because it was SO Africa.  The directions we were given were this... walk about 20 mins down the road, turn left at the corn field and walk through it and ask for the "new school" WHAT?? contrary to what you may think the directions got us there. 
The problem was that when we got there... there was no one there.. oh yes.. African time vs. Muzungu time (white people time). after about 30 mins a handful of kids showed up and we were seriously starting to wonder if this was our crowd. We sang some songs and got some hair braided and then after 45 mins 6 women showed up! We gave a teaching on ORS (Oral Re-hydration Salts). We had asked the women how many of them knew of a child who died because of diarrhea and all 6 raised the hand and the translator said "of course!" !!!! We have gotten responses where 2 or 3 out of a large group know someone, but never every person and it to be an of course answer. This is why simple healthcare is so important in these communities. Diarrhea is very treatable and ORS can be made with salt, sugar and 1 liter of clean water; something that can be found in every house. It is so great to be able to teach these women and empower them to teach others by sharing the information and hopefully save some of these lives.

Where ever you are in Africa you are guaranteed to find a group of silly kids to have fun with.

our class of beautiful women.

Yesterday we taught youth in a soccer field about ORS. We also shared about Identity. Bruce and the kids joined our team of 3 as well.  We had a great time and had fun playing games to help them remember why ORS is important.

some of the soccer youth

This last week in the hospital I was able to deliver 2 babies.  The first was a little girl. It was the second child of the the Mom I was helping. She was having such a hard time getting her mind focused and pushing adequately.  After about 40 mins of pushing the baby started to show signs of distress. I was pretty confident that the baby could come out if she just focused so I basically had to get in her face to focus her. She did great and in a few mins her daughter was born with only a heartbeat. Our students were able to give her deep suction and resuscitate her successfully and within a few mins she was doing much better.  She was transferred to the nursery to be watched because she had labored breathing. A few days later she was released to her mom and sent home and both are doing great. After the birth the mom told me how grateful she was that I was so caring and helped her through it. I said to her that obviously she doesn't remember me in her face telling her to get serious and push. She laughed and said that most people wouldn't care enough to do that.  This mother also hemorrhaged after she delivered her little one. Thankfully she didn't end up needing blood but only some IV fluids. She gave me a call on Saturday when she got home with her baby and said that she was the happiest mom in the world. I love when things end well. 
The second birth I attended was almost purely accidental. I was in the room next to where the delivery happened talking with my staff and telling her I was heading to lunch.  I walked into the next room by chance and I saw a head! Apparently this woman was just transferred in and was fully dialated! To add to it it was her 6th birth!! I barely got my sterile gloves on and caught the little one just as it was about to hit the table! Whew! She essentially delivered her little boy herself.  As I am cleaning her up I ask the awkward question "So... what's your name?" "I'm Heather... nice to meet you." Haha. An easy birth after a string of difficult ones. 

The only picture I got of little Jonathan before my camera died. I thought Johnny Rocket was an appropriate name for him since that's how he entered this world!

The bed next to this mom sat a young girl of 15.  She had stopped progressing and was stuck at 8 cm for hours. The doctor had come in and prescribed an oxytonic drug to stimulate more contractions and I had come in to start monitoring her 3 hours after that.  I checked her paperwork and although they were doing a good job of monitoring her vitals nothing was recorded for the baby's heart rate.  I quickly checked the heart rate and it was low. I checked again to be sure and it was lower than the first time. The girl had been doing everything right, walking around the room, squatting, changing positions. When she squatted to empty her bladder I saw it. Meconium. The first stool of the baby usually indicating distress of the baby.  I stopped the oxytonic drip and called the doctor.  He verified that even after 3 hrs of the drug she was still at 8cm and the baby was in distress.  He ordered a c-section.  The problem was that this little one was in distress and there was a huge line in the OP theater. Hours later this young girl was still waiting.  Her baby was obstructed and most likely would not make it out alive. Worse yet, every hour that she sits with the baby obstructed it could be damaging her body as well.  I sadly don't know the outcome of this young mom or her baby as we left before anything happened. 

I am really starting to process what being a midwife means.  

The more I learn about midwifery and the natural birth process the more I realize how serious complications of that process are. We have lost so many little ones waiting for interventions delayed or ignored.

In the States you can choose how you want your birth to go always knowing that if anything goes seriously wrong, medical intervention is still not too far away. This gives us the illusion that complications are rare and abnormal and when intervention comes we wonder if it is really necessary. We can even go so far in this safety net as to scorn the medical profession for intervening and so keeping us from the natural childbirth process that we wanted. I am guilty of this myself. Of course I'm not saying it doesn’t happen. There are many women in the West that get bullied into unnecessary cesareans/inductions.  But for every natural birth I see (and it doesn't get more natural than Africa), I see 3 that without medical intervention either the baby or the mother would not make it.  It’s a sobering discovery and one that really makes me think about the things I have come to believe about the process of birth.

In India where oxytonic drugs are used on almost every mother to speed the process I was more apt to question if the medical intervention was leading to many of the sad outcomes. But in Africa, oxytonic drugs and c-sections are a rarity overall and epidurals only exist in the operating theater. This is not to mention the natural births at home in villages where medical help is a long ways away.  

I do believe God created us to birth naturally and that our bodies are capable of this.When it happens naturally and smoothly it’s such a beautiful thing. You stand back and say, "Wow, that’s so amazing." But when you see complications before or after birth resulting in death or permanent damage it quickly becomes a nightmare.  Never did I think that being a midwife would mean fighting so much for life; praying hard for mom and baby to keep their lives, and comforting the mother in her sorrow when the worst had happened.

All this to say that being a midwife here has made me realize:

1.     We are indeed fearfully and wonderfully made! God has designed our bodies in such a way that they know just what to do. We should let it happened on its own while not being ignorant of the problems that can arise.

2.    It’s a fallen world. And when things don’t progress in the natural way medical intervention when done right is also a mercy from the Lord.

We had a good Easter this year. On Saturday we had an egg hunt with some new friends (another missionary family with 3 girls) and then on Sunday we went to church and then had a Easter dinner with the girls from my school.  It was a good day of relaxing and spending time celebrating the amazing gift of life that Jesus gave us! 

yes we let them eat chocolate eggs for breakfast. I'm not proud.

hunt for Easter tupperware??

We dyed brown eggs because thats all that exists here. and it worked well!

This week was a little different because we were in the process of getting work visas. On our transit into the country we were granted 30 day business visas which allowed us to start work in the hospital immediately. Our hopes were to as soon as we were here start the process of getting a longer term work visa before the business visas ran out. We were down to the wire this week and were unable to be in the hospital this week because of it.  We spent a good amount of time in prayer as a team asking for things to happen quickly because this is Africa and things take time. A lot of time. The good news at the end of this week is that we were able to obtain all the paperwork we needed to apply for the new visas and we were given 2 days grace to get in the paperwork. So hopefully our visas will be processed today! And hopefully Monday we will be back in the hospital again.