Maraming Salamat, Ate Pami!

Stenciling in our main delivery room

I've just had a marathon of a week, beginning with sitting through horrific traffic for over 4 hours on Monday to pick up a team from my home church from the airport during their 10 hour layover back to the US, show them Shalom, and take them back to the airport to catch their flight. One of the team members, Jane, stayed to stencil Tagalog Bible verses on the wall of our new clinic. It's GORGEOUS! I dropped her off at the airport last night.

Touching up in our alternative delivery room

But one of the things short term visitors like to do is take a walk through one of the local communities we serve. You see, Shalom is actually located in a rather quiet area. We have a cock-fighting farm on one side, a farm/overgrown jungle on another side, and a subdivision on the other sides. Looking around, you really don't see too much poverty if you don't look too closely. However, just a 3 minute walk up the hill leads you to a very densely populated squatter community.

So, when Jane asked if we could go, off we went! As soon as we stepped off the road, we were inundated with children following us, asking for us to take their picture so they could see it on the digital camera. We stopped and bought a P1 (2c) miniscule bag of chips for a snack and continued on. When we stepped into a new area, a group of 8 kids went running up to me, "Ate," ("ah-tay," which means "big sister"), they cried, "I was born at Shalom!" All the other kids parroted the first kid. Of course, I had to get a picture with them...these kids, our legacy. These beautiful laughing children.

The awesome, photo-loving kids, doing our "wacky" shot

Later on during our walk after dozens of high-fives and spontaneous hugs, a young lady with a baby in her arms came running (literally, running!) up to me, "Maraming salamat, Ate Pami!" (thank you, Pami), "My baby was born at Shalom!" The little dude is 10 months old and an adorable chub. The mom was beaming and so excited to show off her son.

 And this folks, is why I love my job.

Because no trip to the barrio is complete without pop-in-a-bag

Nurse, interior designer, and....ambulance driver?

I was already in a grumpy mood on Saturday morning. I found out on Friday night that we were going to have a meeting with our cabinet maker the following morning at 8am to discuss the plans. Now for most people this is no problem, the day's practically half over for them. But for me who needs one morning a week to sleep until my body naturally wakes up (nope, no kids yet!), I grudgingly agreed...

I woke up at 7:45, skipped the shower and make-up routine, threw on some clothes, and walked over to the clinic sans breakfast and coffee. I wanted to be able to go back to bed when I got back. Shortly after I arrived, Mavis finds me and says, "Did you get my text? I need you to take a post-partum patient with a large hematoma to the hospital." I was later disappointed in myself with how UNexcited I was to be able to serve in this way, but I knew that the other nurse had a volleyball tournament to go to (which her daughter was a player for)...

I walked back home to get my SUV and cracked a few yawns in the process. I pulled up to Shalom and saw the young mom, her mother, and two younger brothers, along with the sweet baby boy. The mom was obviously uncomfortable and very unhappy. Normally they are very grateful, but this mom was sullen and clearly miserable. We all piled in my car and after getting directions to the nearest public hospital that could help her, took off.

As we cruised down the road (I was so thankful this was not an emergency!), I started talking with the grandmother who was holding the baby. This was the first baby for the 19 year-old mom. She was worried about getting home, because her older daughter was there with her two little ones. The father of this other daughter was unemployed and out with his "barkada," or group of guy friends, drinking. He had left her and now her older daughter was a single mom with no source of income. She was worried the same was going to happen to the daughter laying on my back seat. The boyfriend was a lazy bum with no trade and frequently drunk. I glanced back at the daughter and she just glared at me.

We arrived at the hospital about 30 minutes later and I stayed in the car while the family helped get the patient out of the car. (Note - I would have liked to have helped, but as soon as they see a foreigner, the prices sky-rocket as the foreigner usually equals money)

My heart breaks for this new little baby. When I mentioned her attitude to the other midwives, they all agreed that she was very "suplada," Tagalog for snobbish or stuck-up. I have a feeling the grandmother will be raising this little boy, along with his two older cousins. Please pray for Nene, that her hematoma will resolve with no problems, that she will wake up and mature into an amazing mother, and for the new little one born into such tough circumstances.

A Trip to the Bowels of the Earth

Ever since I was a little girl, I can remember taking trips to one of the world's largest open-air markets. I have no proof to support this statement other than I cannot imagine there being a larger market than Divisoria. When you step off of the jeepney (public transportation vehicle), you step onto a never-ending conveyor belt of humanity moving every which direction. The smells of raw, open sewage singe your nose hairs, you constantly have to watch where you step for fear of an open man-hole or banana peel, you clutch your bag tightly to your chest to keep all your possessions yours, and you hold your bladder for as long as you can, all day if possible.

My 2010 Christmas card was taken in Divisoria

This truck was trying to navigate the narrow streets.
The guy with the stick is lifting up rope that vendors
string across the street in order for the truck to
pass under it

But, if you want to find cheap school supplies, just about any type of fabric, upholstery or pleather, China-made kitchen doo-dad, buttons, wedding gowns, wedding favors, Christmas decor, shoes, backpacks, suitcases, towels, blankets, ribbons, netting, fishing wire, autoparts, or just about any other item you can think of, the best place to go is Divisoria. So you brave the stench, the crowds, the sweat, and even the abject poverty and descend into the bowels of the earth and just hope and pray you come out alive.

Cindy perusing some of the options

Today it was curtain fabric. Cindy (the other American RN) and I needed 50-some-odd yards of different material to "treat" our windows. We were armed with our most comfortable shoes, big bags (back-pack worn in front for me), color samples, water bottles, and money and set off. It was driving my vehicle to some random subdivision to park then walk to the start of the Metro Rail Transit system, a 30 minute ride to the other end of the line, and then a 10 minute jeepney ride. We arrived just as shops were opening.

At first we were kind of disappointed...we were not looking for polyester Christmas material, school uniforms, or wedding dress material. Just plain cotton will do. After shooting down numerous rat holes in condemned buildings, we stumbled across several vendors. Slowly our bags filled and our backs began to ache. By this time my shirt was mostly soaked. While looking for our last few yards, we stumbled back into the light of day and onto a busy street. We found a vendor with a huge tarp on the ground and bolts and bolts of random fabric.

Diving into the middle to find what we like

What caught our eye was beautiful Christmas tablecloth material which we both decided to grab for the upcoming holidays...While the vendors were busy cutting up some pretty Christmas plaid fabric I spotted, I suddenly hear Cindy gasp and yell, "Oh-my-goodness-they-have-Thanksgiving-too!" That just might have been the most excited I've ever seen this woman! I might have spotted a tear of overwhelming delight spring from her eye. Then Cindy literally (!!!) dove into the mass of fabric and found some perfect damask for our green-themed alternative delivery room.

After the fabric was cut, packaged, and our bags filmed to the brim, we treked to the corner McDonald's (that didn't use to be there when I was a kid!) for some sustenance before beginning the homeward journey. Wanna see what fabric we got? You'll have to wait until it's in the windows! :)

Exhausted after a successful trip!

Update on the wee one, Google

Whew! We've finished 10 days of antibiotics for the little guy, and at 3 injections a day, no one can be happier than him! He's been turned into a veritable pin cushion.

I cannot tell you how much better Google looks since his birthday. He's gained nearly a pound (birth weight 4.12lbs, today 5.9lbs) and he's smiling, cooing, and eating like a champ. His mom is doing great, too, praise God!

It doesn't always have such a wonderful ending like this, but when it does, we sure do celebrate!

and he shall be called, "Google."

This is the story of a little boy named, "Google."

Last Wednesday started out normal enough. Drag myself out of bed, blindly prepare my first cup of coffee, start to feel halfway human and get ready for Wednesday morning prenatals. It was normal until about break-time at 10am. We've had a slew of tricky deliveries and preemies and had just prayed for all these circumstances and kiddos during our Tuesday prayer time. One of the midwives mentioned that it happened again this morning...a thick meconium stained baby that had to be resuscitated for a good while. He was a week overdue and looked to be malnourished, barely five pounds. He was stabilized and resting with his mom. The midwife asked if I would assess him. Would I? Hmmm...let me think about that. ;)

Mavis lovingly pokes the cute cheek of Google

I grabbed our infant stethoscope and headed back to our overflow room where four moms and babies were recovering. Daisy and her little boy were on the only bed. I noticed this little guy seemed lethargic and had slow reflexes. His heart and respiratory rates were normal and his lungs were clear but I couldn't tell if he was super sleepy (normal at 3 hours of life) or if it was something ominous. I helped Daisy get situated to feed him so I could assess the process. It was mostly a failure as he was too sleepy. I admonished that when they were discharged to not pass go, do not collect P200, but go straight to the pediatrician for further assessment.

As I finished up prenatals, I got to think and feel more unsettled about this newborn. I went back in and took his temp, which had dropped to the danger zone (cue theme song). I got him bundled up skin to skin with his mama to raise his temp and contacted a pediatrician friend and asked if I could bring him by for assessment. At 1:30, I loaded Daisy, her neighbor who had come to help and be her companion (it's a cultural thing), and the baby into my car and off we went. Dra Glo was concerned enough to give us a prescription for some antibiotic injections and an order for a CBC. We picked up the meds and went back to Shalom. I administered the first dose and gave orders for strict breastfeeding and antibiotic compliance. The midwives were going to bathe the little tyke and send them to the lab, then home.

Daisy, Google, and me...before the injection.

Next morning I showed up at 0700 to give the next round of meds and found out the mom's blood pressure had spiked just before discharge and she'd been sent off to the hospital...baby went home with dad. At 8:45am Dad and baby showed up. Mom was doing ok but baby was supposedly not allowed to stay with mom (!!!!). I pleaded with the dad to try to take the baby to the mom so he could get the important antibodies and immune protection from his mom's breastmilk and he promised to try. Baby boy looked 100% better. Praise God! Strong reflexes and good temp. The dad later texted that baby was with mom in the hospital and the nurses there would continue the injections. yay!

Yesterday, Daisy and her baby came back. Daisy was fine, blood pressure normal, and baby looked great. (Though he's not a fan of the injections...don't blame him!) He was 100% exclusively breastfeeding! yay!

 Saw them again this morning. Praise God he keeps getting stronger and stronger! Oh, and his name? Kenneth, but dad has nicknamed him, "Google." No joke.

10:45 pm update - got a text from Daisy. The neighbor nurse who was supposed to give him his pm injection got extended at work and can't give him his injection. After calling her, we decided to meet at the town square. I mixed the med, assessed Google, and gave him his pm injection in the backseat of my SUV using the dome light and a flashlight. A day in the life of a missionary nurse. :)

World of Colors

By popular demand *cough Corina cough*, I snapped some photos of our colorful clinic rooms in our new building. These were painted just this week! Each of the rooms has a color theme (Filipinos LOVE bright colors) and the drapery will match. For example, our postnatal room has one pink accent wall, pink floral tiles in the bathroom, and will have some kind of pink in the curtains (maybe brown with pink polka dots?).

Here we go!

Alternative delivery room has a green theme.

The tiling in the bathroom has a pretty leaf design that I hope to carry out through birth room with live plants.

Our main delivery has a lavender theme, with one colored accent wall.

Here you can see the tile border in the bathroom as well as a small sliver of the accent wall

This is our lemony yellow prenatal room. It is a dark photo, but the regular walls are the same taupe color that is throughout the whole building

This is the bathroom of the prenatal room that has a nifty window leading to the next room for urine specimens

Our postnatal room has a pretty pink accent wall, per Ate Mavis' request.

Close-up of the tile in the postnatal bathroom

Our staff room has a blue accent wall

with fun tiling in the bathroom

This is a bit blurry picture of the main waiting area and entrance. 

Just another day

It's been a while since I've blogged, and rather than try to catalog in a most boring fashion all the exciting things that happened (trip to the US, a wedding of a friend, too many miles to count traveled, etc...), I'll begin with just another day.

It was prenatals again this morning. Unless it's pouring rain and storming outside, we're pretty much guaranteed at least 100 patients each prenatal morning. It was a long morning of lots of new patient interviews for me with a sonogram tossed in. I love it, but my back was sore by the time I finished. After our Tuesday prayer time with the staff, we walked over to our new building to look at the new paint in each of the rooms. Amazingly beautiful! I can't wait to get fabric for the curtains and decorate.

Finally about 1:30pm, I was getting ready to head for home and walked through our old building. On my way out I saw this young couple, exhausted with their newborn baby lying between them, trying to catch some sleep after the chaos of a prenatal morning. The young mom had given birth around 10am, right in the middle of our prenatals. Since we have just one room for everything, prenatals stopped while she delivered. After she and her baby were cleaned up, they were transferred to a cot on the floor while we finished up. Once the prenatals were over, we moved her to the one "real" bed in the room where she and her boyfriend took a huge sigh of relief and reveled in their new little one. I just couldn't resist snapping a picture with my phone...

Why short term missionaries are GOOD for long term missionaries

There's quite the heated debate going in the world of missions right now. Do short term missionaries (STM) cause more harm than good? Books like "When Helping Hurts" and others weigh in on the matter. Some argue that without the history and relationships, STMs can sometimes unwittingly undermine the work of the long term missionaries (LTM), not to mention the effort and time it takes an LTM to host STMs. But this is not a blog post on the pros and cons of STMs. (FYI, I am pro STM when it's done right.)

From a purely selfish standpoint, this IS a blog on the perks of having a short term missionary. Lori came in late January and stayed with me for 4 months: four months of hilarity, late nights, an unending pile of data entry, popcorn, lots (and I mean LOTS) of Coke Zero, and so much more.

Part of any STM's stay should be a chance to see the beauty of the country they are visiting. We can't just lambast them with the poverty and difficulties of the culture, even if that's where we spend 99.9% of our time. An LTM should take the opportunity to take the STM to see some positive aspects that are present in each and every culture and country.

Here's how you make sure your STM has fun:

You go jumping off a waterfall (Bunga Falls)

You go canoeing up a river through a jungle for an hour and a half...

...to see another waterfall (Pagsanjan Falls)

You see the Guiness Book of World Records qualifying spin of the world's largest top

You take them to see the world's smallest active volcano. Incidentally, it's an island within a lake, within a volcano, within a lake, within a (extinct) volcano, with an ocean

If you have a staff team-building day, bring the STM with!

And every STM needs a debriefing retreat...and if you're in a country consisting of 7,100+ islands, the beach is a must

If parasailing costs the same as a meal at TGI Fridays, then by all means... (first for me, too!)

And view as many gorgeous sunsets as possible while at said beach debriefing retreat

For the record, we DID do work...and lots of it. Lori single-handedly entered and scanned over 3,500 medical records, accounting for over 7,000 deliveries at our birthing home. That's nothing to sneeze at! Data entry, folks. Tedious, mind-numbing, cross-eye causing data entry.

Thanks so much for all your hard work, Lori! We miss you already. And thanks for giving me the excuse to put down the stethoscope and fetal doppler to get out and see some of the gorgeous country I live in.

How to Ultrasound, Pami Style

Now that the beautiful ultrasound machine is up and running, I'd thought I'd give you a pictorial of how I roll.

I'm so blessed to get to be the first person to use the new building! They finished this basement room early so I could have a place to do ultrasounds and house all our records (thousands of them!!)

Makeshift exam bed. Please notice the lovely privacy curtains that I designed, bought fabric for (including netting), and had made. :)

Gooping up the belly

Such an amazingly clear picture!! (baby's head is to left, rump to right)

Next purchase is a small monitor so the mama doesn't have to crick her neck to see!

Showing the mama her baby

going over results

Documenting results on her prenatal record

I always close in prayer...

...thanking God for the mama, her new baby, and for wisdom as we care for her

Afterwards at midmorning break, we sit around and discuss life and interesting patients

The end.

an uncreative post

I seem to have hit the infamous writers' block. I have no witticisms, no cute sayings, and very little motivation to write anything at all. I think it's the heat, at least that's the easy culprit. No amount of time spent in this country can prepare one for the all-encompassing, impossible to escape heat that assaults the country like 300 people squished into a 50 ft sauna every April and May.

It's the heat that has reduced me to joining my dog by lying belly-down on the less-warm tiles, next to the blasting fan. Yes, I have no pride...or shame.

So, instead of eloquence, I give you bullet points in no particular order.

• Great time in Hawaii
• Lots of meetings
• Lots of networking
• A really big meeting with a really big foundation followed by a really big meeting with the Philippine director hopefully this week
• I didn't get sunburned!!!
  
• AMAZING sunrise Easter service on the deck of the USS Missouri, aka Mighty Mo
• Got back to Manila on Tuesday night
  
• Got to use my new, pretty ultrasound machine for the first time on Wednesday morning
  
• Have a short-term team arrive from the US tomorrow night, staying for 10 days to work on our new building
• My visa got approved so I will most likely be on the mainland US this summer for a short 4 weeks to be in the wedding of a dear friend and visit some churches. yay!

Life isn't slowing down amidst the dripping, 4 showers-a-day heat. But I will count my blessings, starting with thanking God I'm not pregnant like our patients in this dreadful sweat bath. :)

(Picture below is with one of the Bible Study groups I met with)

Exchanging Mabuhay for AloooooooHA!

On the last day of March, I present to you my March prayer letter. :) It was written a couple of weeks ago, but because of an insane schedule of speaking engagements and limited internet access, it's only now being sent out.

So, if you want to download it, click here.

If you want to view it online, click here.

Enjoy!

Alooooooooha!

Hello Blogger, my old friend, I've come to talk with you again...

Last October, I had the awesome privilege to go to the island of Palawan for a medical outreach led by Compassion International and First Presbyterian Church of Honolulu. Never did I imagine that as a result of that trip, I would be invited to fly to Hawaii to attend the Hawaiian Islands Ministries conference and share our needs at Shalom with various groups and organizations. But God has indeed opened that door and I fly out tomorrow for three weeks of meetings and hopefully a glimpse or two of aqua colored water.

Please be praying for me as I meet with folks, that God would be glorified and honored every time I open my mouth. And please be praying for divine encounters with folks who might like to get involved in the ministry at Shalom. This is more than just a trip to raise the final funds needed for the new building; this is about building partnerships for prayer and encouragement.

In the meantime, ministry at Shalom continues to be full with over one hundred prenatal visits every Tuesday, Wednesday, and Friday. We are eager to hire more newly licensed Filipina midwives who will see the work there are a ministry, an opportunity to impact lives, and not simply a paycheck. And of course work continues on the new building...

Maraming salamat, po!

I'm sorry, your baby is dead

Those are words no one wants to hear or say. Just last week, a fellow missionary had handed me a brochure with one woman's story of hearing those words. Of praying the ultrasonographer could find a heartbeat. Of hearing the heartbeat of the baby in the next cubicle and praying it was her own baby's. They were words I dreaded to ever have to say.

Wednesday was busy. It usually is as I don't do ultrasounds on Tuesday so I usually have catch up to do with the women from Tuesday and Wednesday prenatals. I had just finished my 5th and was going on to my 6th. She was an unusual woman for here. Short hair. A rambunctious 4 year old girl at her feet. Big belly. Very matter of fact. I could tell her time was stretched thin.

I introduced myself as I walked her down the hall to the exam room. I asked her why she had been referred for my care.

"The midwives said no heartbeat."

Oh Lord, I thought. I took a bit of her history...4th pregnancy, 32 years old, breadwinner for her family. I palpated her belly, a bit boggy.

"When was the last time you felt your baby move?"

"I'm not sure," she said. "But my belly keeps getting hard. Not really contractions, but not normal with my other pregnancies."

I gooped up her belly and applied the probe. A little head appeared, baby was breech. I brought the probe down the neck to the chest area and nothing. No movement...and it wasn't even round anymore. My heart started to race in protest. I searched and watched. Nothing.

Silence.

The mom's eyes were watching me earnestly, not the monitor. They followed my every movement. Never have I felt the weight of a gaze so strongly. I took a deep breath and grasped her hand. "Wala na, po. Patay na ang puso ng baby mo."

No more, m'am. Your baby's heart has died.

Is there ever a kind way to say those words? She looked at me with that burdened gaze, "But why? What did I do wrong? How will it come out? Do I have to have surgery?"

I explained that often times there's no way of knowing why the baby died, but that because the head was still firm, if she went to the hospital right away, they could induce the labor. It sounded to me as if she had already started to have weak contractions.

I brought in a wonderful Filipina nurse to help explain more fully in Tagalog while the mom broke down in sobs. Why had this happened to her? Just two days before I had scanned a woman whose baby could very well have died from medications she had taken before she knew she was pregnant, but that woman's baby was perfect and alive.

All I can say is I am so grateful the choice is not up to me. I am not sovereign and I am ever thankful for that. I do the best that I can to give love fully, to touch gently, and care greatly. The rest is up to God. We prayed for Rosa before we gave her a letter of referral for a local hospital.

Would you pray, too?

“For who has known the mind of the Lord,
or who has been his counselor?”
“Or who has given a gift to him
that he might be repaid?”
For from him and through him and to him are all things. To him be glory forever. Amen.
(Romans 11:34-36 ESV)

"Beware of fainting fits, beware of swoons"

Movie quote? Anyone?

I absolutely love teaching. I love showing a mom where her baby's head is and having her feel that hard noggin in her belly. I love having students show interest in maternity care and teaching them how to discover the baby's position and where to find the heartbeat. It's like opening up a whole new world and most people love learning about it.

And I love having high school girls come to volunteer a few hours to help file records and hopefully watch a live birth. Last week, I had a junior in high school who is interested in medicine come for a few hours. Let's call her Charise. I saw that there were quite a few women in labor, so I was hopeful that she would get to observe and help with the birth.

After filing a few records, we gave a baby her first bath. Shortly after, one of the laboring women started showing the classic signs of transitional labor. It was time to push. I got Charise her own pair of gloves and put on a pair myself while we waited behind the curtain with the midwife. I positioned Charise standing in the 12 inches between the bed and wall, while I stood on the other side. Jheny (midwife) stood at the end ready to catch.

Sure enough, a head popped out followed by a slippery and wiggling body. Jheny placed the little girl on her mama's belly while Charise and I vigorously dried her. I kept checking Charise to make sure she was doing ok, because birth is not a typically beautiful thing...and it can get very claustrophobic behind those curtains! Charise kept exclaiming how cool the whole thing was...and how little blood there was.

After the little babe was dried, we placed her skin to skin on her mama's chest and draped a blanket over her to keep them warm. I darted out to get the oxytocin to inject after the placenta was delivered. When I came back in, I saw the midwife inspecting the placenta, then glanced up at Charise...she was white as a sheet! I quickly asked if she was ok. No response. Uh-oh!

I leaned over the mama and baby, quickly grabbing Charise's torso, forming a bridge over the newly delivered mom. Charise started to sag while I held on to her. I asked for the baby's father to help manuver her from between the bed and wall, then met them at the head of the bed, draping Charise's arms around my neck while I "danced" her over to the recovery bed. The sweet mom already on that bed moved up her legs while I draped Charise on the end of the bed.

As soon as Charise laid down, she came to...giggling! She was LAUGHING! I was wishing for a video camera as we talked about what had just happened and everyone in that tiny little room just burst out laughing, even the mom still on the delivery table.

I went back to helping Jheny with the mama and baby, forcing Charise to keep her head down for a few minutes. Afterwards, she was something of a celebrity as everyone repeated the story and whipped out their cellphones for a picture with the American girl who had fainted.

Awesome.

And the movie quote is said by Fanny Price in Jane Austen's Mansfield Park.