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. 

Playground, Hospital and Hope

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So we are in Zambia. As we mentioned before we have our own house WHICH IS SUCH A BLESSING!! I can’t even begin to describe what it's like to have our own place after 9 months of living dorm style.  It's truly a blessing on multiple levels. Since the kids have been living dorm style with us they're used to seeing all their aunties all the time, sharing meals and playing with them constantly. That's all going to end in 9 short weeks and this separation of our family from the rest of the team is really going to help the transition to go much smoother. It has also helped them transition into Zambia. They really relaxed right away and settled in. We have not experienced a lot of the usual backlash after a move and they have pretty much treated this as home from day one (or is that a bad sign?). The kids also LOVE the playground that is a 2 minute walk away. This is something they haven't had since Perth and they are having a blast. There are also a lot of local kids to play with who live in our compound.

Here are a few shots of the house.

Sunrise from the water tower by our house.

Abbie playing barbershop with J

It's still really hard to believe that we are about 10 weeks away from completely finishing this adventure and moving on to the next one. We are very much looking forward to being stateside from mid-June to at least January. We can't wait to be visiting family and friends and (sorry, this may be the pregnancy talking) eating foods we love! We are also looking forward to some relaxation after this intense school and welcoming our new little one.

The weather in Zambia has been great! It's almost like Fall weather in the Midwest! Such a nice change from the heat and humidity of the Tanzanian coast. With that said allergies and asthma flare up have come with the territory. I had a terrible first 2 weeks before Bruce realized we had a whole bottle of Zyrtec which is pregnancy safe!! Feeling much better now!!

pics from the park

being silly

Monkeys playing in the trees at the playground

Monkeys playing on the ground.

Bruce found some friends.

Abigail found a friend.. big surprise I know.. this is a daughter of another missionary family that lives minutes away. They were fast friends.

Missionary friend and his daughter

Josiah and Isaac

So the hospital… 

Its definitely the best we have seen so far in regards to cleanliness and order. With that said, we have seen some pretty terrible situations in our short 6 months of government hospital work. This is the main referral hospital in this area so they get EVERYONE. The staff has been very nice and helpful and great to learn from. They also seem very equipped to handle most of their tasks and motivated to do them. They still struggle with a lot of the same issues as other developing countries, i.e., they are over worked, under staffed and struggling to function with a significant lack of supplies. The mothers themselves have been so sweet and it’s been amazing to communicate with them as most speak English fluently!

I haven’t really shared many individual stories in these updates. Zambia is a bit different on the photo end of things. Tanzania was a bit similar but here it's even more difficult to take pictures. In the hospital they do not want us taking general pictures of moms and babies. The only way is if you have had a relationship with the mom and she consents but even then we have to be careful. I have been building some relationships with a few moms at the hospital so may be able to snap a few now and then but I just wanted to let you know that if you don’t see a lot of the people we are reaching out to, this is why.  Sometimes the mom stays for such a short time that you don’t have the time to build the relationship. But I’m hoping I can paint you a picture by sharing some stories and maybe along the way I will be able to get some “snaps”.

Here is one from this week.

Hope, (not her real name) is a 14 yr old girl who had 4 hrs previously delivered her 2.8 kg son at home in her village. She bled a lot during the delivery and her mom brought her to the local village clinic where they tried to assess her bleeding but she refused to let anyone near her.  Her baby was also grunting and needed medical attention. The clinic referred her to the hospital and she made her way into admissions on Friday.  She was scared, still bleeding and clinically shown to be anemic.  She had been bleeding now for 4 hrs.

 It was an emergency situation and as the doctor and I tried to assess her she kept tightening her body and refused to let us do any examination on her. I tried calming her down by talking to her. And I tried reasoning with her about the seriousness of the situation.  We held her down to give her an injection of a oxytonic drug in hopes that it would force her uterus to contract and stop the bleeding. But during the few seconds we had of an internal examination we found fragments of membranes which isn't good. Unless the rest comes out the bleeding will not stop. We also held her down to give her an IV for fluids as she was in desperate need of fluids and blood.  The doctor tried several times to examine her and each time I was talking calmly, explaining we were there to help, try to relax, etc. No good. Each time she tightened up so severely that it was impossible. 

I was frustrated. Here is this girl in serious trouble and not receiving the help she so desperately needs. Then I looked at this scared little girl and thought… no 14 year old child should ever have to go through this!  I don’t know the circumstances that got her there but I suspect by the way she responded to us touching her that she was abused.  Each time I would reach up to stroke her hair and she would flinch. Regardless, it takes two to make a baby and usually these fathers aren't in the same age bracket as the mothers. They finally decided to sedate her to complete the exam and hopefully stop the bleeding. I had to leave before it was all over. The baby was receiving care in the nursery.

There are many stories like these that break your heart. Another one from last week is a 17 yr old who is a double orphan. She lived about 30km from the hospital and walked there (!) because she was in pain.  She was 30 weeks pregnant with her second child. She lost her first child when she had an early C-section due to Pre-eclampsia (pregnancy induced high-blood pressure that can lead to seizures and death if baby is not delivered soon enough).   She had not received any pre-natal care up to this point and because she had no way of returning to the hospital for a re-check she had to be admitted for a complete work up. She's already at risk for Pre-eclampsia because of her first pregnancy and she had a severe yeast infection which, if left untreated can sometimes cause pre-term labor.  She laid alone on a bench and was terrified. Remember, this is a young girl from the village.

You wonder how these situations came to be but then part of you doesn’t have time to wonder because you're too busy. Sadly you know the cycle will continue unless these girls are educated about their bodies and pregnancy yet even educated many of them still wouldn't have a choice. Many of the staff at the hospital have become jaded to these situations. Many of them have adopted the attitude, “You got yourself into this situation so what are you whining about?” 

For me, I really believe these kinds of situations stem from the impact HIV/AIDS has on these developing countries. You have parentless children raising themselves, forced to be adults before they should be, sometimes taking care of multiple siblings and one of the side effects is premature mothers. My heart just goes out to them because having been through birth myself I realize they must be terrified!  

There are many other stories of normal deliveries and women with complicated deliveries. I have really enjoyed my time with the mothers and am learning a lot. Today I had my first opportunity to watch a C-section and assist with the baby.  It was a first time mother with Cephalo-Pelvic disproportion.  A fancy way of saying the labor was obstructed because either the baby's head was too big or the mother's pelvis was too small. Either way the baby was not coming out.  I really have been impressed by this hospital how quickly they come to make the decision about needing a C-section. I say this because at previous locations the mother would be in labor for 3 days with no progression and we were begging the doctors to come and assess the need for C-section and then once it was decided it often became an emergency situation before the patient would actually get into the operation theatre! Here, so far, it seems that the midwife detects the need for it and the doc comes on rounds and confirms it and the patient is prepped and off. There have been days were staff is low and only one theatre is in working order and it's not that swift and easy but as a whole, it seems to be the way it goes. 

Today Ruth (the mom) was scared and it was really great to stay by her, pray for her, and share my story of having my first by C-section.  It was an honor to help her welcome her little son into the world! Mom and baby are doing great!

Abigail's self-portrait of her teeth coming in. :)