Thursday, May 28, 2009

Bathroom birth.

Ya know, it's probably not a good thing to have your baby in the bathroom. Between the unsanitary conditions and the fact that your child may have difficulty sharing their birthday story with others....can you imagine when asked, "Where were you born?" You'd say..."In the bathroom of a birthing center." Maybe a little embarrassing, eh? 

Well, little baby Mark will have just that story to share. Wednesday's birth shift was quite the crazy adventure. We had planned on a dead shift as the intake board was pretty much empty...but by 6:30 am, my fellow peer, Holly, had received a patient fully dilated and wanting to push. We all gloved up and headed to her birth cubicle. She was definitely ready to have her baby....but just as the head was coming visible, another labor walked in and made a bee line for the CR (bathroom). I was up next, so I kept my gloves on and followed behind her to the bathroom. She had just closed the door when Lumen (my other peer) and I heard a huge gasp and a giant SHRIEK! The door swung open and there Rose was holding her baby's head in...I fell to the floor in catching position, Lumen supported Rose and she lunged into birthing position spewing amniotic fluid all over my head and all over my scrubs...some would considered themselves, I was not particularly "blessed". Thankfully, the amniotic fluid was clear and had no signs of meconium...that would just be so nasty. :)

Baby boy's hand reached out to grab mine followed by a very big head and a slippery purple body. Baby caught. Rose's bana rushed to her side after hearing the commotion and I handed Rose her crying, freshly dried baby in towel, picked up her legs while Lumen and Heather (my supervisor) positioned her in the wheelchair. I heard another baby cry....Holly's baby had just been delivered with Brianna (my other peer) at her side. Wheeled to the birth bed, Rose got situated, still connected to her baby by the umbilical cord. Baby immediately started to breastfeed and Rose's placenta came out shortly thereafter...NOT on the floor. :)  

Baby Mark, 7 lbs 4 oz. was healthy and strong.

Next came in copious amounts of baby checks, prescriptions to fill, and newborn screenings to do....then we heard another abnormal sound...yelling and honking from a vehicle just outside the door! The five midwives dropped everything and ran outside to discover baby out in a Multi-cab! Seems she had been laboring in a tri-c-cab and a Multi-cab driver had noticed her laboring while waiting at a gas station and offered to take her to Mercy. Well, little did he know, but her baby was coming too fast for his speed and she delivered a baby boy in the back of his multicab....delivered by her father and younger brother. Crazy. We got her into the wheelchair and wheeled her in. Everyone had a different position...I assisted the baby and the bantays, Heather caught the placenta and was her midwife, Holly made sure supplies were ready and at hand while charting the "birth", Lumen wheeled her in and Brianna assisted Heather. Meanwhile, another fully dilated labor walked in for Brianna. 
Yes, four babies were born and three more labors were walking in by shift change. What a day!

And today, I was on prenatal duty. I love prenatals. I had a very interesting conversation with a patient in English today. After talking to her in Visayan as I began her prenatal, she says in perfect English, "I have no idea what you are saying!" Ha ha ha...Apparently she speaks no Visayan as she is from Manila and only speaks Tagalog and English. I had a great time doing my very first prenatal in PURE ENGLISH! What a different experience! Ha ha ha.

Then my last patient was an interesting case. She was one of 3 wives of a Muslim man. She was sharing with me that though she was converting to Islam she was professing to be "Christian". I asked if she was Catholic and she said, "Of course!". So I asked if she believed that Jesus was the Messiah to which she replied, "well, yes." I asked if she believed that Jesus was God, she replied, "Well, not anymore because I am converting to Islam." I asked why she was converting if her beliefs were so very different and she replied that she loves her husband. I was reminded of Luke 14 that states that unless we hate our families, we cannot be disciples of this does not mean we hate people, it simply means that if we do not love Christ MORE than His Creation, we cannot be His disciples. Though I did not share this with her, I couldn't help but realize what she was forsaking by converting to the Muslim faith for the love of a man....a man who already has several wives, several children and will most likely forsake her in some way. I convicted to love my Jesus more. She was headstrong and determined to convert to Islam so I just simply asked if I could pray with her. 

Unfortunately, this scenario is all to common here. Faith goes only so far as tradition and ritual. Nothing seems to transform life or bring joy. My heart aches to be a light that shines brighter than the alternatives. I am praying that the truth of Christ and His unfailing love will penetrate her heart before the completion of her conversion. Though we may pray to the same "God", my Jesus spilled His blood for her and made the pathway to peace with God accessible....for this I owe Him my life and so does she.

That's about it for now. Fourteen days until take-off. Finances are scary right now and things are somewhat bleak, but alas, God has been uber faithful....we will finish the race and look forward to our rest.
Be blessed!

Saturday, May 23, 2009

Greetings! I had a great day yesterday.
On Thursday, my continuity, Irish, came sharing that she was only having a few contractions and was doing great...I asked when she thought her baby would come to which she replied, "Saturday morning." I said, "Okay, we'll pray for Saturday morning!".
Irish was having her second baby and seemed very "in tune" with her body, so I didn't fret or push any ideas on how to get the baby out on Saturday, we just prayed and I waited for her text.

Saturday morning arrived and at 8:00 am, Irish texted. "Ma'am, sakit." She was coming to Mercy. I gave a quick kiss to Tim and the Bird and headed to work.

Irish came in looking in pain, but coping really well. I did an internal exam....5 centimeters dilated. She would have her baby on Saturday, just as she hoped.

Her bana and I chatted a bit, ate a bit, joked a bit and waited for baby. Around noon, Irish was very active, though you wouldn't know it! She used the birth ball (a giant exercise ball) to rock back and forth between contractions and then breathed deeply and focused during the intense times. She was AWEsome. Seriously, I have never seen a woman labor better. She was peaceful, focused, and driven. My job was simply to ensure normalcy, which honestly didn't take much.

Around 1 pm, the baby's heart tones started to drop and I thought Irish was close to full dilation. The heart tones dropped a bit more, but seemed to respond well to position changes. We continued to monitor them. I asked Irish if she wanted to rest and lay down...she rolled over on to the bed and closed her eyes between contractions.

No more than ten minutes later she announced, "Ma'am...I HAVE TO PUSH!" Sure enough, head was visible....she was ready to rocket launch the baby's head out into the world, but I quickly and firmly said, "IRISH...HINAY, HINAY!" In other words, "SLOW, SLOW!" We caught each other's gaze and she literally blew her baby out staring into my eyes...I wasn't even looking at her baby sliding through my hands, I could not take my eyes away from her gaze...slowly, controlled and without a tear, her baby slipped through into my arms. Her little baby girl, Angel Beige, arrived after only 6 minutes pushing. She had the umbilical cord wrapped around her neck which accounted for the drop in heart tones. Perfectly healthy and 7 lbs, Angel Beige is beautiful.

The best part was watching Irish talk to her baby...they were deep in conversation for quite a while after birth. She breastfed immediately and lost only a tiny bit of blood. It was the best birth I have ever had the privilege of attending. We cried. It felt like a Holy moment. I know Jesus was smiling. I was, too. So here above and below is Irish. Her bana, Bernard, was amazing and Angel Beige is doing fantastic.
And above is Ivy and baby Xaviar. They came for a visit this passed week and we had a great time of prayer together for her baby. She prayed to Allah and I prayed to Jesus that the jaundice would disappear in Xaviar. She is an amazing woman and though this is her first baby, she seems so mature in her parenting.

And, did I ever tell you about Lenita, Rex and baby John? They came in for their 3 week (or s0) check up and things seem to be going great. Lenita is just getting over an infection in the cesarean incision, but other than that, they are doing well. Please pray for them, as Rex's job requires him to travel quite a bit, so Lenita is home with 6 children! She is amazing. Tim and I are hoping to visit them in their home in Calinan in late August. :)

And once again, the Bird accompanied me to work for a while this week, as Tim was swamped with meetings. The Lady Bird LOVES babies and is quite the social bird. Ate Estef and Kinshasa were happy to entertain her while I checked in a labor. We had an interesting shift! A birth in the CR (bathroom) and a host of labors walking in at shift change.
So that's just the Reader's Digest version. A busy week. I had to take my CPR training once again and received my updated certification, had quite a few busy work days full of hospital transports and complications. Alas, the week has ended and I am so looking forward to a break! Only 3 more weeks until we leave for Canada.

That leads me to a prayer request. Thank you all for praying for the immigration situation...please continue to do so...we haven't heard anything for a few days....please also pray as finances are pretty rough right now due to some promised funds for the water project that haven't arrived yet and we have yet to secure someone to stay in our apartment while we are away to help pay for the cost of living here in the Philippines while we are staying in Canada. God is always faithful and despite the added stressors, we are not worried.
Thank you all for praying! We'll see what God does next!
Be blessed.

Tuesday, May 19, 2009

Yesterday Bad, Today Good

Yesterday really, really sucked. I mean the colossal kinda suck. Like somewhere between your peppercorn steak being consumed by the neighbor's evil dog, and your new laptop being run over by an unnecessarily large SUV. Ok, so I've had a bit of Coke today, and I'm currently suffering from the shakes and some sort of dementia.

Yesterday, poor Bethany awoke to the sound of her mild mannered husband gesticulating wildly and cursing bureaucrats of all stripes. I had just received an email from my contact at the Canadian embassy in Manila, and the news was not good. She was telling me not expect a passport for Promise until July. This was in stark contrast to the information she supplied me with two months ago.

I tried for hours to reach somebody, anybody at the embassy. Each phone call ended with my anger level climbing to new heights, as I sat listening to that incessant ringing that would later haunt my dreams. I then discovered that I was being charged a ridiculous amount of money for each unsuccessful phone call. Awesome. Ironically, it was an American friend of mine who later reminded me that it was Victoria Day in Canada, and thus the embassy would be closed. Super.

Once I understood that the embassy was closed I calmed down a bit, but the damage was done. I wanted a mulligan. I wanted to undo my expletive riddled wake up call that had left me feeling guilty and ashamed. I wanted to get up on the other side of the bed (figuratively, not literally—Bethany's side of the bed lacks the charm and nuance that comes with laundry and old receipts strewn haphazardly upon the floor).

I moped for much of the day, feeling sorry for myself and wondering if I had screwed up the entire citizenship/passport process somehow. I have since determined that I played my hand as best I could, I just had lousy cards. I worked late because productivity makes me feel good and was my drug of choice.

Today didn't suck. I feel pretty good about today. I had Coke, so that kinda skews the suck-o-meter, but I'm confident that upon sober reflection I will still judge this day to be one of the better ones in a while. I received an email back from Manila at 10:30 this morning which gave me a glimmer of hope. The lady asked me to send her our travel itinerary, which she would forward to the powers-that-be in the hopes that it would bump Promise's application up on the priority list.

Long story short (19 emails to be exact), by 4:30 this afternoon I had been informed that we had received the initial citizenship approval, and we were welcome to send the passport application. I am told that if we have the application in by Friday, we can be assured of a passport by June 12th. We are scheduled to leave by June 14th, so while this is cutting it close, it is definitely better than the prospect of waiting until July.

I would love to tell you that I underwent some profound spiritual renewal in the last 36 hours. I could give you some nice little sermon about how I trusted in God and laid down my burdens, but it would be a load of horse manure. As Bethany has reminded me, I need to give this stuff over to the Lord. I've been waking up routinely at 3am every morning. The mature response would be to get up and pray, but nobody ever accused me of being mature before. Instead, I lay in bed listening to old episodes of The Shadow and Dragnet, trying not to think about my stress.

Oh God, help me to ask for Your help.

There, that's a start, yes? In the meantime, thank you all for your faithful prayers. I'm sure they helped to solve my problem much better than me cursing at the air and leaving stern messages for unsuspecting bureaucrats. Please continue to pray that I am able to complete the passport application and all it's requirements by the end of the week.

Don't pray about my Coke addiction. I'm not ready to give that up yet.


Sunday, May 17, 2009

Please please pray....need a miracle.

Greetings! As many of you know, Tim, Promise, and I are set to leave the Philippines June 15 for a much needed furlough. Most of our families and friends have not met Promise and there is a growing list of things we need to tie up in the West that have been put off until we were able to get furlough. All this to say, Tim has been diligent in preparing and submitting all the requests of Canadian immigration in order to allow Promise to leave this country and enter Canada. Here's where it gets tricky. The woman that Tim was receiving all his information from at the embassy is now changing her story basically saying that nothing will be available for Promise until at least July.

Needless to say, we are rather upset,as we based our travel times on her information and Tim even spent what little money we have on traveling to Manila to the embassy to get the ball rolling sooner. We have tried the American embassy (my side) and they were even worse on accommodating our strange, abnormal situation.

So, please pray that the paperwork gets finished and stamped with speed, that we receive a temporary passport sooner than expected and before our June departure date, and that this hiccup will not cost us anymore money!
Thank you for your prayers and we will keep you posted. This is not the first time immigration has been difficult to work with and we know that God is bigger than it all.

Tuesday, May 12, 2009

Water Filters Everywhere

I'm in a bit of a funk today. Combination of not enough sleep and a Vancouver Canucks loss (I wrote this paragraph 2 days ago—I'm getting over that hockey thing). Bethany seems to be in a similar funk, though I would be willing to bet that Luongo's substandard performance has little to do with it. I realize that I haven't written about the water project in a while. There's a reason for that: I don't want to.

Things aren't necessarily going poorly, but we aren't exactly firing on all cylinders these days. It's summer here in the Phils—yes April and May are even more uncomfortably hot than the other ten months of the year—and that means that our partners are busy with other things. They're running summer camps and stuff like that. Which is great, but it means they've got less time to distribute filters. Actually, that's good for us because we need to save up filters for a couple of large orders that will be going through in a couple of weeks.

So you see, there is nothing to tell you. We continue to build filters, but they're just sitting in the shop, waiting for a delivery of 260 units that is scheduled in a few weeks. How will we deliver so many filters? I'm glad you asked. The grant that was initially approved in January is due to arrive next week. We already have a really big truck picked out, and I'm hoping that nobody will buy it between now and then.

I should mention that one does not purchase "new" trucks here. All of the diesel trucks in the Philippines have been previously enjoyed in Japan. Apparently the Japanese have great disdain for any vehicle that is more than a couple of years old, so they are quick to discard them. We here in the Philippines recognize a good thing when we see it, so we import them, refurbish them, and use them long past their expiry date.

While we're waiting for things to pick up again, Toti and I have been working on a little pet project. It looks like Impact Nations will be delivering 100 filters to a poor community at the outskirts of Davao. I've written all about it, and you can download the pdf here.

Ok, that's all I have to say. Bethany and I have a baby sitter tonight and we're gonna join our friends Darrel and Shannon for a viewing of Star Trek. Wahoo! Here are a few pics of the Bird that have been hangin out on my hard drive for a while.


Thursday, May 7, 2009

The Virtual Prenatal!

Greetings! Since Tim is busy with water stuff and is waiting to update you all on the project until some deals go through, I am writing again. This time I decided to give you a play-by-play of a prenatal exam!

So as I shared a few posts ago, my continuity, Ate Lisa from church, is due in late August. I have been doing her prenatals at her home as she is a super busy mother and tends to an elderly woman as well. Because Tim and I are headed West for furlough in the middle of her pregnancy, I asked my friend, Beth (also Bethany!!) to accompany me into Agdao for her prenatals and take care of her while I am away. Beth is an awesome first year midwife that will be heading to her home in Illinois in a week to deliver her MOTHER'S 13th baby! Crazy! Needless to say, Beth has a lot of birth experience. :)

So pictured above is Beth, Ate Lisa and I as we began her prenatal exam...

I was able to take Promise with me....and Ate Lisa's oldest daughter jumped at the chance to play with her....the kids nicknamed her "Princess Promise". :) Promise loved the attention. We were also able to provide Ate Lisa's family with a whole lot of eggs...a pregnant mother's most vital piece of nutrition here in the Phils. :)

So first, I asked a lot of well-being questions such as, "Are you feeling tired or sick? Are you feeling your baby move? Have you had any problems? How is your family? Any pain? Any edema?" Ate Lisa shared that she was doing great. She looked great, too! I won't divulge everything...Then we took her blood pressure....normal!
Beth took notes in her chart....
The Lady Bird played with Ate Lisa's two other daughters...
We gave her the second tentanus injection....just a little pinch. Took her pulse and chatted about nutrition and a healthy water intake.

Then it was time to palpate the baby...GOOD GROWTH! We measured her tummy, felt all the baby's small parts...a foot, the's position is perfect.
Beth found the baby's heart tones...normal and healthy! We listened to the placenta sounds...whoosh, whoosh...everyone stood around anxious to hear an explanation of all the obscure tummy sounds...
We chatted a bit more about her family, previous births, scheduling and when to contact us regarding problems or labor signs...then we prayed for strength, wisdom, provision, joy, peace and health, thanked the Lord for His many blessing, hugged and took our last picture....
And here we are with all the neighbor kids, too! Beth, Olivia (our translator and friend), Promise and I headed towards home on the visit: June 5.
The end. I love my job.
Be blessed.

Tuesday, May 5, 2009

Almost there!

So I am officially FINISHED with ALL homework and assignments! HALLELUJAH! I managed to complete everything with 4 days to spare for studying AND to play with the Bird...And lots of time to visit patients like baby Xaviar and Ivy. Here they are at their one week check, Ivy is healing great and little Xaviar, though jaundice and small, is getting stronger daily. He is sporting some baby clothes you all donated! She LOVED them!
And pictured far below is one of my dearest patients ever. I took Lenita as a continuity way back in December. This was her 6th pregnancy and with 3 girls and 2 boys at home, she was hoping for another boy. Alas, her ultrasound said it was a girl. Lenita and I became good friends. She lives over an hour outside of Davao, so getting to her prenatal visits was a challenge at times. But she came as much as she could and I was throughly looking forward to delivering her baby.

However, her due date, April 28th, came and went and she wasn't even having contractions....and her blood pressure was high. Too high. We monitored it carefully and gave her some advice on how to bring it down. She didn't seem too concerned...but the baby needed to come soon, otherwise her blood pressure could put her in the hospital for induction of labor. NOT FUN!
So we waited and then at 4 am, May 1, I got a text: "Ma'am panabigon sa gawas, pero wala sakit"...Her bag of waters had ruptured, but she was not in pain. So we agreed to meet at Mercy as soon as she was able. That would be about 1 1/2 hours.

Meanwhile, Tim was taking off to Butuan. Good timing....NOT! So Promise and I headed to the clinic for a very early birth shift for Lenita. Promise was pretty good the first couple of hours as I checked Lenita in. Lenita, unfortuantely, indeed had ruptured membranes with thick meconium and was only 2 cm dilated...and high blood pressure. Not good. She had 12 hours to deliver this baby or we'd have to transport to the hospital.

Lenita's hubby, Rex, came in and we talked about the potential risks to the baby and to her. But first, we needed to manage the high blood pressure. After left-side lying for an hour, 4 glasses of water, 2 glasses of MILO (energy drink), an egg and frequent bathroom visits, we got her BP down to 122/82. WAHOOOO! Praise the Lord! We had a time of thanking the Lord and began to pray for a fast labor.

She headed outside for some exercising and walking with her hubby - by the way, he is a wonderful man! I had stripped Lenita's membranes to get contractions coming more frequently and to build intensity, so I was hoping that her walking, my stripping, her hydration and 12 hours to labor would get this baby out.

Promise started getting fussy around 11 am. Now, she had been up and entertained by Filipinas and midwives since 4 am...that's a long time...and she was losing grace for the birth room. My supervisor, Heather, shared that she had three helpers at her house with nothing to do because her kids were gone for the she called one of them up and Lisa came to watch Promise in the birth room while I tended to Lenita. What a blessing!! Promise thoroughly enjoyed her time with Ate Lisa! See below...she met every baby that came into the clinic!
Lunch time came around and two babies were born in the birth room...unfortunately, Lenita's was not one of them. Her contractions were picking up, but they were only lasting about 30 seconds. They were strong, but not strong enough. It had been over six hours since my last internal exam, so it was time to do another to check on the progress of her cervix and the position of the baby. She had only progressed to 4 cm was still high and the meconium stain seemed worse. With only 4 more hours to deliver at Mercy, I felt strongly like it was time to transport her to the hospital. Meconium can be dangerous if the baby sits in it too long and she was not progressing like the average multiparous women.

At 2 pm, a new supervisor came on and after sharing Lenita's history with her, decided to transport to DMC. Disappointed, but hopeful, Promise, me, Lenita and her hubby, Rex, headed in the ambulance to a very busy and hectic DMC. I thought for sure Lenita would have a very long wait in triage....but the Lord provided an out....because Promise was with me hanging in her sling around my shoulder, we attracted every nurse in the entire emergency kidding...I felt awful for the patients that had to wait as the nurses stroked Promise's skin, cooed and giggled at her and asked copious amounts of questions like, "Is her daddy a Filipino?" seriously...does Promise look like she has ANY Filipino in her?? I wanted to laugh and say, "DUH...whatta do you think?", but instead I said, "My patient is in pain and needs to see a doctor as soon as possible"...with a smile, of course....that got three nurses speeding passed me to get the paperwork filled out faster than speeding bullets! It pays to have a white baby.

Lenita was bumped to first class and it was time for prayer, a hug and then for Promise and I to head home. It was 4 pm. Over 12 hours of laboring insanity...but Lenita would soon meet her baby.

I waited all night for a text stating that Lenita delivered....none came. The next morning, I sent a few texts to her number asking if she had delivered her baby yet. Rex finally replied saying she was still in labor. STILL IN LABOR!? The doctor, apparently, was just now deciding whether to do a cesarean section....JUST NOW! It had been over 36 hours since BOW rupture with thick meconium! I was concerned and asked Rex to text me when he knew more.

Two hours later I received a text..."Ma'am, cesarean done, baby BOY! Doctor stitching up Lenita. Praise God! Thanks for prayers!" I was overjoyed! I quickly asked if the baby was healthy...."Yes, ma'am, but in NICU for observation". Lenita got her boy despite the ultrasound saying she would be having a girl. :) I told them to text me when she was in the recovery room and I would come with food and presents. (clothes from you guys, of course).

Tim, Promise and I headed to DMC and found Rex, Lenita, and baby AJ all together. Lenita was breastfeeding a healthy 7 pound baby boy. Apparently, the docs had tried to induce her further, but Lenita's mattress was just too tired and the contractions had stopped, hence the cesarean. They decided she needed a ligation, as well. Rex shared the frustration of the enormous cost of the ligation, cesarean and hospital stay. I chatted with Ate An An from MMC and she gave me some advice for them. We chatted a bit more about the next couple of weeks healing from the cesarean and adjusting to a very full house. They are set to come for a baby check this coming Monday. I am soooo looking forward to seeing them. I am hoping to head out to their home in Calinan before furlough, too.

That leads me to my next exciting bit of news....We're headed west June 14-August 28th! God is soooo good. In the meantime, Tim is tying up stuff with the water project and working hard to make sure things are set for while we're away. I am studying for my final final final exam on June 4th and enjoying the new freedom of not cracking open textbooks. Many blessings to you all!