Sunday, November 13, 2016

Vulnerability, Fear, and the powerful Gift of Presence


It was Sunday afternoon....my day off.  I had just had an enjoyable lunch with Jim and I was getting ready to lay down for a bit.  I had some reading and weekly to-do list planning on my mind.  We have a busy two months ahead of us and it is essential for us to stay on top of things if it is all going to get done.  I had just laid down when the phone rang.  It was Dr. Sana, asking me to come assist with a delivery.  I knew immediately that something was off.  He rarely calls for help, even when he should not be attempting things alone.  I said I was on my way.

I arrived to find a 15-year-old in labor.  The family was from a nearby village.  Gnoumou had been in labor for about 30 hours, 16 of which had been spent in our clinic.  She had arrived at 10 pm the night before, and it was now around 2 pm.  This was her third pregnancy, but the other two had resulted in stillbirths. 

I chatted with Sana a bit and then went in to see her.  Poor thing was exhausted....They had been up all night.  As I examined her stomach, I was sure it was twins.  The position of the baby and the feel of the uterus were too unusual to be just one.  She was nearly fully dilated, and baby's head was engaged.  I was concerned that she didn't seem to be making any progress.  She seemed unable to push, which we attributed to exhaustion.  We made her squat, walk, etc., hoping that gravity would be on our side, but nothing helped.  

After 1.5 hours, I called Jim, warning him that it might be necessary to make an emergency run to the hospital....which is only about 40 miles away but takes over 2 hours.  Ours is the only vehicle in either town and riding on a motorcycle was not an option.

I talked with Sana and the family about the need to take her.  Talk of going to the hospital strikes fear into everyone's hearts.  Not known for good, competent care or bedside manner - no one ever wants to go.  But I didn't see any choice.

Jim hurriedly packed a few things and loaded up the truck.  He locked down the house as well.  I ran home quickly and threw a few thing in, including some leftovers and some granola for breakfast.  We went to the clinic and loaded Gnoumou, her mom, and our apprentice, Kanko, into the truck.  I tried to think of everything we would need in case a delivery by the side of the road became necessary- bucket, gloves, water, towels, cord clamp, suction, resuscitation equipment, headlamp, etc.  Off we went.

Now the road between us and the hospital is awful.....tons of potholes and bumps.  Nearly every time we hit one, Gnoumou cried out.  Jim was trying to balance driving quickly to get there, and yet not hurting the poor girl in the back.  We stopped twice when she complained of the pain worsening for me to check her...but nothing had changed.

We rolled into the hospital around 8 pm and took her directly to the delivery room.  The hospital campus was dimly lit...with lights on in only a few rooms.  The delivery room had lights, but it is an open window place, so huge bugs were flying everywhere. We got her up on a table and they sent her mom to register her.  The staff was fairly unfriendly...barely talking to us...just barking instructions to mom and Gnoumou.  The midwife listened for a heartbeat, checked her, and set a c-section in motion.  

It was getting late, and it had been our intention to hand them off and then head to a nearby village to our guesthouse for the night.  But Gnoumou had other ideas.  She lay on the bed, clutching my hand...BEGGING me not to leave her.  "Please" she begged...."don't go.  Do I have to have an operation?  I am so scared that my baby is dead.  Can't you do the operation?  These people are so mean.  Does the Dr know what he is doing?  Is he just a student?"  I tried to reassure her....I prayed with her, asking God to give her peace and health.  

She was drifting in and out of sleep and settled on clutching the neck of my scrubs in her hand so that I couldn't sneak out while she slept.  Her mom popped in for a few minutes....the staff didn't want her there.  I told her of our plans to go and a panicked look washed over her.  She grabbed my chest and begged, "please don't leave us.  Please make them do the surgery with you watching.  I am begging you.  Please stay until she is out of surgery."

And so we stayed.  A tech came in and started an IV and placed a catheter....mostly by the flashlight of our apprentice's phone.  A Cuban doctor came in, barely said 2 words to us, and was out the door.  We waited and waited, the minutes slowly ticking by....Jim sleeping in the truck, me sitting by Gnoumou -my shirt clutched in her hand.  Every few minutes, she would open her eyes, look at me, and sleep again.  Finally, it was time and we walked over to the operating room, her clutching my arm.

The surgery went fast.....only about an hour, as we stood outside waiting for news.  Finally, it came.....baby was stillborn, mom had a ruptured uterus that the Dr repaired.   Still no word to the family......I didn't know if I should be the one to break it to them.  Eventually, they rolled her out, plopped her on a bed with no side rails, and left her there.  She was still mostly under from the anesthesia.  They took us in to see baby and the midwife explained everything that had happened.  

We called Gnoumou's mom in, and then her husband - more explanations, more words of condolence, more cautions that she should NOT get pregnant anytime soon.  Never saw the doctor again at all.
Around 11:30 pm,  we said goodbye to the family and left to spend the night in a nearby guesthouse.  Mom kept thanking and thanking us.  So did the husband.  Mom walked us out to the car so that she could thank Jim as well.

The next morning,  on our way back through town,  I ran in to see Gnoumou.  She saw me and gave me a huge grin.  I told her how sorry I was about her baby, and how grateful I was that she was ok.
As I think back to that night, many things strike me.

Yes, we brought her down to the hospital in our truck.  It was a sacrifice of our time - and something that they could never have done on their own.

But once we got to the hospital, I really didn't do anything medically.  The staff seemed frighteningly uninterested in her medical history.  They never asked her name, never looked her or mom in the eye, never explained what they were doing. They just did....She was just a case to them.

Now, I am not saying that there are not good nurses and doctors there....I am sure there are.  And I know that much of what I said was cultural.  But it was hard for me.  The fear and vulnerability in both mom's and Gnoumou was overwhelming.  My clutched scrubs,  tight in her hands.....the begging and pleading.  I did less as a nurse and more as  person....providing the Gift of my presence.....the being close, the assurance that they were not alone.

I was reminded how vulnerable hospitals make people feel.....even the high-tech ones.  Fear of the unknown......it is so powerful.  And of how much we can offer to people.....just being there.....no words necessary.

This morning I was sharing with my friend about the experience, and she said, "It is really bad there.  They don't have any compassion. Sickness is so scary.  But the mission hospital you took me too, that was different.  (She was referring to Hope Clinic...where her son had surgery.)  Those people show that they care.....they rub your heart until you aren't afraid anymore. "   And then we talked about the healing effects of compassion.


So there you go.  No medical degree needed.....just your presence... not words or wisdom or knowledge....just your presence!

Tuesday, August 2, 2016

The Long Road Home



It has already been a busy season in our lives.  The past few months have been filled with seminars, conferences, and travel - all good and meaningful and helpful for us personally and in our ministry.  We were nearing the end of a long stretch - and looking very forward to returning to the village with Hannah - to spend a few months in the quiet chaos of the routine, yet different, daily life in the village.  This would be our last months with her in the village, as she just graduated from high school and will soon be heading to the US.

Now remember, for those of you who know me, I kinda like routine, and lists, and plans, and calendars……I “do” that well.  So life was cruising along as smoothly as life can in a west African country…..a few hiccups of delayed flights, but nothing this girl couldn’t handle.  And then it all fell apart!

We had been in Senegal for two weeks, celebrating Hannah’s graduation.  We had a great time - visited with friends, relaxed a bit, got some work done, visited a sustainable agriculture center, celebrated Hannah - and now it was time to go home.  With flight schedules being what they are, we were “stuck” in Dakar a few extra days after graduation - waiting for our return flight on Monday morning at 6:30 am (which meant a 4 am departure from the guesthouse.) 

Hannah was returning to the village after being at boarding school for 3 years - and she had managed to accumulate quite a bit of stuff.  We sorted and tossed, and participated in a garage sale.  But there was still much to bring back.  No worries, I thought - we each get 30 kilos to bring back - and Jim and I didn’t have that much stuff with us, so we would be fine.  So confident was I that I even went shopping at the “American” store and bought a few overpriced goodies to bring back with us.  We had been carefully watching our budget during our 2 week stay - rarely going out to eat  - knowing that the guesthouse was going to be a big expense. 

As we packed, it became apparent that Hannah had more stuff than I anticipated.  We were able to off load a bit with friends who were traveling back to Guinea by vehicle…. but by the night before we left, I could see that we were clearly going to be over the weight limit.  We had NO idea what that would mean at the airport.  We had friends over for supper Sunday night and I gave them a bunch of food - including some of my goodies from the American store that just wouldn't fit.  Hannah left lots of stuff behind for the guest house workers and we finally got the trunks to weight (and our carry ons to a bit over - but we decided to just try it and hope for the best!)

Monday morning early we got into our rented taxi and took off for the airport - arriving around 4:30 am.  As we entered the airport, we noticed that our flight was not listed on the monitor.  I wasn't overly worried, as they are not always accurate - but it was a bit concerning.  We had our trunks wrapped with plastic wrap and went to find the check in desk.  No one was manning the desk…. but it was still a bit early.  5 am came - and still no one.  So I went to the airline office.  I knocked on the locked door and waved at the lady behind the desk and the man talking to her.  Nothing - except a motion to wait.  So I did, for about 10 minutes.  More people started coming - more knocking - more motions to wait.  Finally someone squeaked the wheel and they opened the door.  We asked why there wasn't anyone at the desk. 

NO flight today….. 
Because???

No one had a answer and they were unwilling to say when the next flight would be.  Ok then.  So we finally gave up and left - grabbing a taxi at the entrance - whose driver insisted our stuff would all fit - and it did (barely) - with Hannah and I and 3 carryons and 2 backpacks shoved into the back seat of a little taxi.  Back to the guesthouse we went, sneaking back into our old rooms and crashing until we could talk to the manager.  We were hungry and tired - but we had given away all of our food the night before.  Eventually we were able to grab something to eat, confirm that we could spend another night or 2 if necessary, and got ahold of our travel agent to ask about rebooking.   And then we waited. And we waited.  Flights in and out of CKY are not easy to come by…..  There was no sense in going to the grocery store, since we didn't know how long we would be staying.  We took a nap and then walked to a restaurant to eat a nice lunch.

After lunch, we were watching a show and “surfing” the internet when we got a text from my mom, saying that Jim’s mom had been desperately trying to get ahold of us with bad news - our brother- in-law, Art (Jim’s sister’s husband) had died unexpectedly a few hours before.  We were heartbroken for Renee.  We were able to call right away and talk with the family - to cry together and express our love and sympathy.  We got off the phone and I told Jim - We need to look into getting you back to the States.  We decided to contact our travel agent - just to see what that looked like - flights, costs, etc.  We sent out an email and also gave him a call to verify that he was working that day.  He was - and within 15 minutes, he wrote back to say that there was a flight leaving at 9 pm - and could Jim make that?  That meant that the flight left in about 3 hours and 45 minutes.  

 International travel recommends a 3 hour early check-in time,  meaning Jim needed to be out the door - grabbing a taxi - within 30 minutes or so.  Wow - ok - not much time to decide.  We decided to go for it.  We hurriedly emailed to say - YES, buy the tickets, and tried to get Jim packed.  It is hard to think when you are moving so fast - processing and packing and contacting people.  About 10 minutes before Jim walked out the door, I said - Man, it is too bad we can’t send a trunk back with you of Hannah’s keepsakes!”  He said - Why not? 

So we took a trunk and dumped it upside down on the bed - and opened the other 2 trunks, and started throwing things in.  We missed a LOT that we could have sent - but we got about 25 kilos in.  I kissed him, prayed over him, and sent him out the door.

It felt a bit like - WHAT just happened????

I moved into Hannah’s room and we grabbed some supper.  We got frequent texts from Jim - letting us know that he had arrived (after running into tons of traffic, getting stuck in the sand, getting into a fender-bender, and his taxi driver nearly coming to blows with another driver!), checked in, and was waiting, and then boarding the plane.  He was even able to text us from Brussels to say that he was ok and had arrived.

Tuesday morning, we still had no confirmation that we could get a flight back to CKY.  It was a frustrating day of communicating with the travel agent in CKY and the airline office in Dakar.  They found a flight for Wednesday AM - but kept issuing tickets for Jim and I  - and not for Hannah - no matter how many times I explained that Jim was on his way to the US and Hannah and I needed tickets.  I didn’t want the guesthouse manager to leave before had a chance to get tickets printed for our return.  Finally, late Tuesday evening, we had it confirmed and tickets in hand for an early flight the next morning.

Another 4 am trip to the airport - this time with luggage that was clearly over the weight limit.  WE had learned that we were going to pay about $2 for every pound that we were over - and we were about 45 pounds over - including our carry-ons.  I was praying for grace - but prepared to pay.

When we went to shrink wrap our bags, the worker asked what airlines I was flying.  I told him - he said, oh, these are too heavy.  I said, I know - I am going to have to pay.  He said - Let me find someone on the flight who doesn't have much luggage and they can claim some of yours……
What a sweet gesture from a humanity standpoint - but a horrible idea from a security one….. apparently it is done often here.  I told him- no thanks, we will be fine.

We checked in - the agent told me that the bags were over the weight allowance - I explained why - and she sent me to the office with a ticket stub to pay - though she only wrote down what we were over in the trunks  (not the carryons)— so about 22 pounds over.  When I got to the office, I was supposed to be charged about $42 - but when I explained everything, she ended giving $10 back to me.  I was so thankful.  The extra 48 hours in Dakar were not cheap - with eating out, taxis, and more nights at the guesthouse.  This extra bit of grace was a blessing

Finally we were checked through and waiting at our gate.  Our plane was on the runway - that seemed like a good sign.  We were scheduled to arrive in CKY around 8:30 am, which would be perfect timing for me to get to a talk that I was supposed to give to some interns about medical work in Guinea.

We sat and visited, even saw some friends who were flying out on a slightly later flight than we were.  They were called to board before us, which seemed strange.  None of the agents seemed to be getting ready to board the passengers for our flight.  6 am came and went, 6:30am, and then 7 am….  no movement.  I finally found the agent who had checked us in and asked what the problem was.  Explanation:  the crew was napping!  What?!?!?   

Apparently they were on a scheduled break, napping on the plane while we sat waiting…..  “They need their rest.”  Ummm, me TOO!!!!  Since I got up at 3 am, I was getting a bit fussy.  I needed my rest too.  Finally, around 8 am, I saw someone pull a stairs up to the plane and knock on the door…… and it opened.  Movement started and we were boarding around 8:30 am  - so much for making my 9 am appointment.  Seriously!!!

We finally landed in CKY, breezed through customs, grabbed our bags, and were out the door to find Mr. Bah waiting for us.  We drove straight to the compound where I had my meeting, grabbed lunch, and then headed back to the guesthouse.

Now, our BIG, overwhelming job was to find a new guesthouse apartment in CKY.  The owner of our current guesthouse apartment had decided to sell the building and we needed to get out ASAP.  The manager had a villa that he would rent to us, but the cost was more than we could afford without someone subletting the studio apartment and we had not been able to find anyone.  We could live there for 3 months at the same price we were paying for our current apartment (since we didn't get the 3 month notice), but that meant moving again - which I was NOT interested in doing, if I could avoid it.  I had contacted a guy who helps people find houses/apartments and he had a few ready to show me.  We were going to start early on Thursday.  He said - “I found one that is so great - 3 bedrooms, 4 baths, nice pool, tennis court, and the same price as your pay now.  The location is near where all your friends live.”  Whatever - sounded WAY too good to be true so I didn’t have my hopes up.

Thursday Am we took off to see this “perfect” apartment - and it WAS!!!  So beautiful, great location, great people to work with, same price (except a few extra utilities we didn’t have to pay at the old place)!  Amazing!  Because he already had others lined up, we saw 2 others.  One would have been workable - though there was no way to do laundry there, which would have been a huge bummer.  And we took off to see the last place.   

When we arrived, we learned that it had already rented, but the man said that he had a different apartment we could look at.  So we wound our way up a tiny staircase to a little 2 bedroom apartment that looked like something out of the Hoarders show.  We could barely walk between the piles of stuff (including canned peas????) on the floor.  There were about 6 men sitting on couches in the apartment, and there were dirty dishes everywhere.  They said - we can move out right away - no problem.  I was like - Ummm, no thanks…..

By Friday AM, I had contacted the owner of the first apartment, set up a meeting, and signed a lease.  They were busily trying to finish up some work on the closets and cabinets and promised it would be clean and move in ready by Monday.  So Hannah and I spent the weekend packing and sorting.   I said to Mr Bah - this isn't going to be hard.  It is just 2 rooms of stuff - not filled with personal stuff.  And he said - You never realize how much stuff you have until you try to move!  Wise, wise man!!!  Apparently he has helped white people move before!

Mission guesthouses can be a “crap trap” - since no one lives there full time, people are afraid to throw stuff away.  Take for instance the pile of padlock keys sitting on the desk.  I gave Hannah the padlocks we had (for the doors) and said, throw away anything that doesn't match.  And she did.

Monday morning, bright and early, the big truck we had hired (Mr. Bah “knew” a guy, as usual) , complete with the strong young men, arrived to help us move.  I had arranged for some friends to meet us at the new apartment to help us unload on that side.  And so the moving began, dragging a 2 bedroom apartment full of stuff down the stairs.  As we loaded furniture from the bedroom, we discovered one of the chairs would not fit through the door.  Apparently it had been brought in through the patio door.  They asked me to open it - and that was when I discovered that it was locked in 3 places with padlocks - which apparently “matched”  some of those keys that I had Hannah throw away a few days before!   

We were in trouble.  We very rarely ever open that door - so I had COMPLETELY forgotten about it.  I called a friend and asked him to bring a hacksaw.  He agreed.  As the guys continued to load the truck, a thought hit me.  Maybe the trash hadn't been picked up yet.  So I ran downstairs to the trash barrel and began to pull out bags.  Now, trash and African heat are not a pleasant combination!  I found one that seemed right and ripped it open.  Digging through the maggots,  I found the pile of keys Hannah had thrown away for me!  They matched….


We packed up the big truck, along with our Hilux, and headed over - running into tons of traffic.  We arrived to find that the apartment was not nearly as “move in” ready as we had hoped…  they were still cleaning and fixing.  But we didn’t have a choice - we just started stacking stuff in the corner.  Once unloaded, I gave our friends money to get lunch for everyone and ran back for another load.  We were pulling in to the new place and were unloading the last piece of furniture when it began to pour.

We were able to set up beds and start unpacking and cleaning.  Tuesday we unpacked and ran a few errands.

Now that we were moved, I could start my shopping for food to take back to the village, so Wednesday we spend the day doing banking and shopping.  We showed up at the bank, and filled out a withdrawal slip to get our $5000 that we had wire transferred over.  They called me into the office - No dice, we could only have $4000 - we needed to come back another time…..  Ummmm, no thanks.  The bank, while in CKY, is all the way downtown - meaning at least a 45 min drive (one way) - or more on a bad traffic day.   Well, the guy said, you will have to talk to the manager.  Me - OK!  Do you think I should hold his feet (a way of begging) or start crying?  The guy was alarmed - PLEASE don’t do that!!!!  It made me laugh.  I begged and they consented and we walked out with the money.

Thursday I ran more errands, and then went to pick Jim up at the airport.  The parking lot of hopping - as several flights were all coming in around the same time.  We parked in the back lot.  After a while, Mr Bah spotted a parking space closer to the exit and we moved.  I saw Jim’s plane land and texted him to let him know I was waiting.  I was SUPER excited to see him after 10 days.  When people started coming out of the airport, I got out of the truck to wait for him.   

A security guy motioned me forward saying, “You can’t stand all the way back there.  The person you are waiting for will think you didn’t come and will take a taxi home.”  I said - there is ZERO chance of that happening since I am waiting for my husband.  ‘Oh,” he said, “then I will help you find him.”   ??????  I was thinking - You have never seen my husband - how are you going to find him for me?  He ran up to the front of the exit and waited.  Then he ran back to report that Jim hadn’t come out yet (thanks for the update!) and then ran back to his waiting spot.   

A few minutes later, I saw Jim come out.  I waved and he waved back.  The security guy noticed us waving and fell into place beside Jim - walking with him to the vehicle.  “See, I found him!”  Excellent - couldn’t have done it without you!!!!  We got the stuff loaded and the security guy wanted some money for “his help”.  Umm, I don’t think so!  I shook his hand and told him thanks and we were on our way.

Friday and Saturday we finished up shopping, ran errands, and collected and packed a medical shipment waiting for us at a warehouse on the mission compound.  All was set for us to head home on Monday - we were hoping to make it to SLM where our team has houses - but knew that we could stop at a mission compound closer if the trip took longer than expected.  We would be driving two vehicles and that usually makes the trip go more slowly - as the road is windy and you often get stuck behind other vehicles and passing can be hard.

By Saturday afternoon, I started to feel achy ALL over - by that evening, I felt horrible.  I was running a fever, threw up once, and had runny belly.  By Sunday morning, I could barely put one foot in front of the other.  I knew there was no way that I would be able to drive the whole way home on Monday. 

Often Mr. Bah drives for us - but this was in the middle of Ramadan and he is a practicing M**lim.  They are required to fast during daylight hours - and then they eat like crazy at night.  They eat way more meat (pretty unavailable in the village) because they need the energy to get them through the day.  (And this is probably very un-PC - but people who fast all day, every day, for weeks at a time get crabby and move slowly.  I feel like people should have their licenses revoked during that time.  You would be AMAZED at the number of fist-fights between drivers during fast month!)  Because arranging feeding for his trip was going to be complicated, we decided that it would be better for Jim and I both to drive.

We delayed leaving until Tuesday.  Tuesday AM, at 5:30, we headed out - Hannah and I in our Land Cruiser and Jim in our teammates Hilux.  Both vehicles were loaded - but not overly so.  The Hilux had 2 mattresses and a metal cabinet on the roof - not super heavy, but bulky.  The trip as progressing well.  Normally it is about 5 - 6 hours to Mamou and about 9 total to SLM.  About 3 hours into the trip, Jim began to notice the the temperature gauge on the Hilux was climbing.  We stopped and checked fluid levels - everything looked fine.  We kept driving, but it wouldn't cool down.   

The road was starting to get mountainous, and he turned on the heat in the truck- but no go.  We stopped and let it cool down a few times.  Finally we decided that maybe the wind resistance from the load on top was causing the problem, so Jim and Hannah managed to slide it over onto the Cruiser and strap it back down.  That sentence makes it sound SO easy - but it was bulky and awkward!  As we were pulled over, a white Land Cruiser pulled in ahead of us.  It was colleagues of our who live in Mamou (a few hours away) - they were on their way home after being gone for a few weeks.  They asked if they could help, and assured us that that they had a mechanic in Mamou who would be willing to look at the truck once we got there. 

Finally we were back on the road, hoping that lightening the load would do the trick.  It wasn't long before I saw Jim put on his blinker and pull over.  No dice.  Still overheating!  We were hoping to limp into Mamou - still about 2 hours away - so we drove a bit, and stopped and let it cool off, and then repeated the same process.  We stopped for lunch alongside the windy highway - the vehicle barely off the road.  We found a sort of clear spot and prayed that we didn’t get bitten by a snake lurking in the grass.

The mountains were getting bigger - and we had barely taken off after lunch when Jim pulled over again.  We finally decided that I would need to tow him.  Towing is NOT my favorite thing to do - even on a long, straight path.  But add to it windy mountainous roads with crazy traffic, and you have the ingredients for an ulcer.  But we had no choice.  We hooked up the 2 trucks, and with Hannah watching behind, we headed out.  It actually went pretty well and soon we were in a nearby town where I pulled into the parking lot of an abandoned hotel.  At least now we were off the road and not in danger of being hit.

We called Dan in Mamou and asked if he could send his mechanic to us.  There were issues with the mechanic’s motorcycle, so Dan graciously offered to drive him to us.  It was about an hour drive from Mamou.  We were running out of water, so Hannah and I took the Cruiser and went into town to buy some bottled water.

As we waited for the mechanic, I began to think about the 2 coolers of meat and other stuff we were transporting to the village.  We had packed the coolers the night before - and it was certain that we would not get home that day.  I was worrying that the food would get too warm.  Along with that, we had about $2000 worth of vaccines with us - a combination of meningitis and Hepatitis B.  It was now about 4 pm, and I knew that we had about 4 hours left to go before we could reach SLM.  We began to talk about whether or not Hannah and I should continue on, leaving Jim with the truck, and allowing us to reach SLM that night and head into our village the next morning.  We could open and clean the house, and put the cold stuff in the the freezer, and be ready for Jim when he got home the next day.  

 We needed to make the decision fairly quickly, because we were on the edge of being able to make it to SLM at a decent hour.  We usually avoid traveling at night if we can, especially if it is just 2 women.  We decided to go for it - so we shifted some loads around, made sure Jim had food and water, and took off in a race against the clock.

It all was going well - for the first 5 minutes.  But on the other side of the town, we ran into a snag.  A semi truck had been coming across a one way bridge and broke down just as he was about to exit the bridge.  His tires were touching the ground but the rest of the truck - stuck on the bridge!!! SERIOUSLY????  I started laughing…..it had just been that kind of day.  Hannah decided to take a nap as we waited to see if another semi could tow the first semi - BACKWARDS- off the bridge.  The line of people waiting to cross was getting longer.  Not only were we stuck on our side, but Dan and the mechanic were also stuck on the other side!  Soon a soldier knocked on my window to inform me that some people were using a bypass - through a river.  GREAT!  Sounds fun!  :^(   

We headed back to the bypass and found a narrow passage through a river - where it was necessary to weave between the big rocks that were underwater, along with the men bathing in the river - who were seemingly paying no attention to the vehicles slipping and sliding through the water beside them.  Each vehicle that passed made the exit and entrance to the river more and more slippery.  Every truck bottomed out as it tried to exit on the way out on the other side.  I was terrified.   

We had a heavy load that we were trying not to shift back and forth - but I knew that the rocking motion of climbing over the rocks was going to be rough.  On the other hand, IF I did get stuck, there would be LOTS of half clothed men to help push me out!  A van cut in front of me and waited for his turn.  Someone came and said something to the driver and he began to turn around.  He rolled down his window to inform me that the bridge had just opened up.  PERFECT!

We turned around and passed easily.   But the delay cost us valuable time.  By the time we reached the gas station in Mamou - it was 6 pm.  We would not arrive in SLM before 9 pm at the earliest - assuming that nothing else went wrong - and frankly, it had NOT been that kind of day.  We decided that it would not be wise to try to continue.  We turned back and went up the hill to the guesthouse where Melodie welcomed us.  We got settled and made some supper - and waited for Jim.  The mechanic spent a while taking apart the engine and trying a few repairs - and they finally decided to try to limp it back to Mamou.  It took them several hours- finally rolling in around 9:30 pm.  Jim was so happy to find us there - as he had been worrying about us traveling at night.

The next morning, Hannah and I headed out again to SLM - hoping to make it all the way home to our village.  We succeeded - arriving in the early afternoon.  We found everything in order - except our cat, who was quite pregnant!  Hannah was thrilled - me less so.

Wednesday passed, and Thursday, and Friday - and the mechanic was still not able to fix the truck.  Jim was frustrated, I was frustrated, the mechanic was frustrated.  We were working hard to maintain a good attitude.  Jim was safe - the truck was parked inside a compound - he had a nice guesthouse and friends to stay with - he had food - this was NOT our only vehicle - Hannah and I were able to make it home and found everything in good condition - the food and the vaccines were fine -  SO much to be grateful for - and yet we were tired and discouraged. 

The mechanic wanted to try another part that was not available in Mamou so Mr. Bah traveled from CKY to Mamou with the part.  No go!  Finally we decided that I would drive back to Mamou (about 5 hours one way) and load up our Cruiser - and bring Jim home.  We would leave the vehicle parked there until we would find the energy and strength to try to deal with it. 

Early Saturday I left Hannah at home and started out.  I was a bit nervous about leaving her behind.  Originally we didn’t have a phone to leave for her - therefore no way for us to communicate with her.  But I found an old phone, pieced it together with a battery from a different phone, and used a SIM chip from an internet key to be able to leave behind.  (I felt a bit like MacGyver!)

The trip went well.  We off loaded everything from the Hilux- into the Cruiser - and headed home, arriving around 8 pm.  Hannah had the house looking great and a nice meal on the table!

Wow!  What an experience!  I don’t EVER want to do something like that again!  As I write this, the truck remains in Mamou and we are trying to figure out a way to get it CKY.  But we are slowly recovering from the trauma of all of it - processing it and what we learned from it!  Hopefully, if there were lessons in all of it, we are learning them so they down have to be repeated!

Sunday, March 27, 2016

Call The Midwife





*Disclaimer: There are medical terms related to birth and breastfeeding here so read at your own risk


Have you ever seen the show “Call the Midwife”?  It is a fun show set in England with a group of interesting, quirky midwives who serve the under-served in their area.  Well, in the village here, we also have a group of interesting, quirky midwives, of which I am a member.  Actually, traditional birth attendants is probably a better term, but midwife rolls off the tongue more easily!   

Two of the three that I work with are mostly kind, helpful women.  But the head “midwife” is just one of those people who can get under your skin.  On a regular basis, she can make me laugh, want to cry, or on occasion, want to strangle her.    (pictured from left to right - Rougie (head midwife), Aissata and Matron Boye (assistant midwives) and Aly (community health agent and village chief).

I have know Rougie for about 5 years - and we have settled into a mostly amicable relationship.  There are, of course, the normal culture clashes that occur in the field of women’s health.

For instance, when I first started attending deliveries with her - she was well known for something that made me nearly insane.  In an effort to stretch those newborns - who had be scrunched up inside mom for ALL those long months - she, after bathing them, would suspend them by each appendage - one at a time - and gently shake them - first one arm, then the next, then flip them upside down - and suspend them by one leg - and then the next - in an apparent attempt to loosen those little limbs.  Then she would take each arm and pin it wayyyyyyy behind baby’s back and then repeat that on the other side.  

 I can only imagine the look on my face when I first saw her do this!  This was then followed by gently pushing in on any hematoma that may be on baby’s head - and then, after checking to make sure that baby was not tongue-tied, she would give the baby some of the bath water to drink - to show the family that it could swallow.  The whole thing was capped off by blowing out any water that may have gotten into baby’s ears.    

The whole thing nearly gave me hives - made worse when they did it all in cold water.  I would stand there with a blanket - arms raised - waiting to take the baby and dry and warm it.  Sometimes, with the smaller babies, who are chilled, I will tuck them under my shirt - up against my skin - to try to warm them back up.  This - along with my reaction to the shaking - always amuses the other midwives.  “Oh, Gulun-nga, you are SO funny.”  I think - yep - hand me that baby!

Most days, she is great with the laboring moms.  Often, there are 5 - 6 of us women in the little room.  Almost ALWAYS, the laboring mom saying - it hurts, it hurts - and we all echo back: yes, having babies hurt.  They tease me because I only had 3 - seems wimpy to them!  I say - yep, only three. Then they beg me to have just one more.  And I say - nope, I am satisfied - waiting for grand babies now!  And we all laugh.

Now mind you - laboring moms are not really allowed to cry out or be to loud - or they will be hit.  (Not by me mind you - though I did ONE time tap the mouth of a young, angry laboring mom who kept trying to bite me - and anyone else within the range of her teeth).

It is not unusual, in the late night/early morning hours, if labor is progressing slowly, to find the midwives sleeping on straw mattresses - waiting.  On occasion, I can be found curled up on a twin sized straw mattress on the floor beside one of the midwives  (SUPER COZY) - trying to get a nap and working hard to forget the mosquitos and bats flying around in the darkness. 

Rougie has been a midwife for a long time.  I can only imagine what she has seen in the delivery room.  That, coupled with the different way of looking at death, causes some issues when we face death together.  The most stark example of this was a woman that we delivered about 2 years ago.  I was called to the clinic one day and found a woman from another village in labor.  I started trying to get a brief history on her and assess how far the labor had progressed.  It seemed that she had delivered 7 children, but only 2 were still living.  Most women here have lost at least one baby, but still, that seemed like a lot. 

Labor progressed - and eventually a little girl was born.  She seemed to have trouble crying and was very sleepy - so I asked the midwives to bring me some sugar.  I mixed a bit of sugar with some filtered water, and gave it to baby - and she perked right up.  I turned my attention to mom, who had still not delivered the placenta.  Working with mom and Rougie, we tried and tried but to no avail.  I tried to reach in with my hand and manually extract the placenta - nothing.  I gave her injections of oxytocin - trying to restart contractions.  Nothing.  She was losing blood - and I was starting to get concerned.  Mom was starting to get agitated.  I tried to hang an IV - but she ripped it out.   

We tried manually extracting the placenta again, but she kicked us away.  Finally, we called the family in and instructed them that they were to take her to the hospital - 2 hours away.  They refused.  Apparently she had had the same problem before - often retaining the placenta for 4 - 5 days after birth.  I begged - PLEASE.  This woman will die if you take her home.  I started to cry.  That freaked everyone one.  Rougie kept saying - STOP crying.   But I couldn’t.  I continued to beg - but they continued to refuse.   

So they loaded her up on a motorcycle and took her home.  Several days later, they were back - with the woman unconscious in the bed of a truck - wanting us to help.  Dr. Sana was there - and having heard the story from me earlier - told them to go straight to the hospital.  She died on the way.  It was the first (and only) mother I have lost in delivery in my 11 years in Africa as a nurse.  For weeks, I was so upset. I was able to Skype then with an OB-GYN who works in Mali and talk through what happened.   

A few weeks later, Rougie and I were sitting in the clinic with some other people, and she began to talk about what happened that day.  She was laughing - not about the woman dying - but about me crying. I think it freaked her out - and she wasn’t sure how to deal with it.  Every so often, it will come up again and she just laughs and laughs.  Just about 2 weeks ago, I was seeing a patient and she said - do you see this woman’s husband?  Do you recognizing him?  I didn’t.  Well, she said, it is the husband of the woman who died that day.  I said - oh, you mean the day I cried?  And she started laughing again - recounting the story.  :^(

Her other favorite delivery story with me was when we delivered a breech baby - who was positioned cross-legged with its arms folded - presenting butt first.  I had to reach in and pull out each leg, one at a time, then each arm - then the head got caught.  As I was working to deliver the baby, they were trying all kinds of traditional stuff - including burning a chicken feather.  I was only mildly paying attention to them - focusing instead on trying to get baby out alive.  Finally Rougie said - Gulun-nga, we have tried EVERYTHING.  You need to pray to Jesus, because He is the only one who can help you now.  So my prayer went something like this - OK God, you heard what she just said!  PLEASE help us.  That little girl is now about 4 years old - healthy as can be and terrified of me.

The midwives also help in the clinic.  They do the cleaning and washing of the sheets that we use on the beds - well, the two assistant midwives do - carrying out the orders of Rougie - head midwife.  They also help translate sometimes when I am seeing patients and assist us in whatever way we need.  It is not uncommon to find one or two of them curled up on the exam bed, taking a nap.  I have to move them off (or over) to assess my patients. 

Rougie is notorious for taking the time  - with each patient - to explain HER OWN medical problems as well.  She suffers from gastritis, so ANYTIME we see a patient with the same problem, she lifts up her shirt and shows everyone in the room where her pain is as well.  :^P  She usually wants free medicine - sometimes I give her a few TUMS (on those days she likes me) and other days I make her pay (on those days, she says, you are NO good.) 

HIPPA compliance officers would develop ulcers in our clinic.  Dr. Sana and I really try to stress privacy for our patients, but Rougie has a different sense of what that means.

Two weeks ago, we were seeing a new mom in the clinic - along with Matron Boye.  Baby about about 10 days old - and this was the first for this mom.  Baby was not nursing well.  So I checked baby out first - he was pretty small, and also was a little tongue-tied.  So I clipped the underside of the tongue to free it - and then told mom that I wanted to see him try to nurse.  She lifted her shirt - and her breasts were huge - so full of milk - that the nipples were almost flat against her breasts.  Well, SEE, exclaimed one of the midwives - it isn't her baby or her breasts - it is the breast noses that are the problem.  It took me a minute to figure out what they meant:  breast noses = nipples.  It made me laugh.   

We worked with mom and bit and gave her some encouragement.  Then I asked them to wait in the waiting room for about 30 minutes - as I wanted to make sure that baby wasn't going to bleed after having his tongue clipped.  It was a SUPER busy day - and I kind of forgot about them out there.  After a while, the dad stood up and got my attention - asking if they could leave.  I called them into the office, and checked baby - no bleeding.  So I sent them on their way.  As they were leaving, Rougie leaned out of the doorway, and called out to them - in front of the 30 or so people sitting in the waiting room - “Dad - NO need to worry.  It ISN’T her breasts - those are fine!!!!  It is JUST the breast noses that are an issue!”    I just laid my head down on the desk - so much for privacy.

The next day - a young mom came from another village.  She was coming for a quick check-up, and had left her 2 month old at home.  It took a while for us to finally see her - and then she asked if we could bump her mom (who was also waiting to be seen) up in line - so that this young woman could go back and nurse her baby - as they had come together on the same motorcycle.  I said - well, we see people by turns here and if we move her ahead, then other people will get mad.  So if you want to go and explain why we are moving her ahead, and they are ok with it, I am fine with doing it. I did feel a bit sorry for this young girl - this was her first baby - and she needed to get home to nurse- as breast milk was leaking down her shirt.   

Rougie decided to handle it herself.  She went out to the waiting room - called in the grandma - and turned to the others and made this announcement.  “Everyone - please forgive us.  This young mother came from another village.  She is not a good mother - because she left her baby at home and now she has breast milk running down her front.  So we are going to see her mom as well, so she can go home and nurse her baby.  Sorry.”   With that, she marched back into the office and we continued.  I shook my head!

She tries hard to be a patient advocate - begging me to see patients after hours - to make an exception for “just one more”.  She loves to tell people that we work together in the clinic.  She gets frustrated with me when I insist on following the rules - especially if it applies to one of her family members. 

Of course, I am sure that I also frustrate her sometimes as well.  If SHE had a blog,  and wrote about me, it could probably include things like - I just don’t understand her.  She is SUCH a rule follower!  I don't know why she cries about things that are Allah’s will.  She worries SO much about cleanliness.  Some days she makes me want to laugh, some days cry, and some days I want to strangle her!  :^)