Third Day - Advocate

In the morning we prayed before we went. Still feeling a little wary from the day before, we prayed for life, and against the spirit of death.

On the car ride there, I remember asking God to help me to be willing to do small things. I didn’t want to be just waiting around for big things, but even in small things I want to be willing and joyful.

So we get there, and wow is it busy!!
Nothing like jumping right in!

Women with babies were three to a bed, packed shoulder to shoulder and back to front in the hallways, probably 60 women with babies, in a 18 foot x 25 foot space.

It was newborn immunzations today.

The babies were getting their polio and tuberculosis vaccines, and then the mamas can be discharged to go home. Lined up in rows, nurses with a handful of loaded syringes going down the line, setting off cries from the babies like a domino effect.
　　

On the other side, the labouring side,
there are so many mamas!!

With thermoses of soup and porridge, sitting 4 or 5 to a bed, some are pulling out mattresses and laying on the floor. To even change someone’s IV drip, you have walk on careful tip toes to dodge those sitting cross-legged on the floor.

There is a woman lying on a bed, in obvious pain that she’s almost delirious, slowly vomitting onto the plastic mattress, and it is seeping underneath her body. I see her, find some gloves and start to clean her up.

There are no extra materials around. No "hospital towels". You use what the mama brings. So I use her soiled kanga to wipe up the mess and get a new kanga from her bag to wrap her in. She’s due for C-Section, and as I clean her up I notice that the amniotic fluid (the ‘water’ of when people say ‘my water broke’) seeping out is not clear. It is olive green and thick. This is a sign of fetal distress! It means that the baby is stressing out and pooping in the womb. Not so good.

All the doctors and nurses seem to be consumed with a different woman laying down, almost unconcious... her placenta has separated prematurely, so the baby’s oxygen source is cut off... and also she’s hemorrhaging inside. She’s also anemic, and the baby is too big for the pelvis. There is no more fetal heartbeat and the doctors are trying to come to a decision so that the mom can still survive. Yikes.

So my C-Section woman is at the moment, overlooked. I let the nurse know about the fetal distress, and she says that the baby is breech (bum first). Oh. So this makes things a little less worse, but still, it’s not so good.

No one is taking action about getting her prepped for C-Section, so they ask me to catheterize her and then I just stay by her side, praying that she will get to go soon.

There are only 2 operating theatres for the whole hospital, so sometimes there is a bit of a wait too. Which is not ideal if your baby is in fetal distress. I keep staying by her, so that she will be noticed, and finally after some time they get her to sign the consent form. Her writing is shaky from the intensity of labour contractions. Agnes Ezekia. 24 years old.

Yay! They wheel in the stretcher! I help her on, and take her down to the operating theatre.

I gown up in green and put a mask and cap on, and slip into sterile shoes. While I’m getting ready, Taylar (from the Post-Operative Maternity Ward) runs in. She’s here to watch the C-Section too! Yay! So we step into the germ-free environment together, and converse with muffled words through the masks.

There is a lot of waiting though.... about an hour later they can finally start the operation.

First we’re waiting for the surgeon to arrive, then we’re waiting for the anaesthesiologist, and then we’re waiting for the utensils and gauze to come out of the sterile oven.

Then boom, everything begins. The spinal anaesthetic goes in, and the incisions start. Through the layers, they quickly get to the uterus. As soon as they make the cut, thick green fluid bursts out, and the atmosphere changes to alarm. We all hold our breath and look on, as the surgeon plunges his fist inside to save the baby. After a few seconds, he emerges with a green-grey baby.

Praying, praying, praying....Cord is cut and baby is brought over to get some special attention. It has been hours of fetal distress ... Baby, hello? Wake up!!!

Welcome to the world, little one!

Suction in his nostrils, and mouth, getting out anything in the way of his breathing.... bag and mask.... breathe baby, breathe baby...
chest compressions: 1-2-3-breathe, 1-2-3-breathe,
Taylor is compressing with her two fingers on his

tiny sternum "You-will-live! ... You-will-live! ... In Jes-us-Name!"

Finally a breath on his own! And a cry!

Praise the Lord.

I take a much-needed deep breath.
This baby was not going to come this far, and not make it. Not on my watch.

We wrap the baby in a clean colourful kanga, and whisk him down to the ICU (Post-Operative) to wait for his mom to come there after she gets stitched up.
Watching the surgery was such a treat.

The surgeon was so nice, and he was telling us everything he was doing. Taylor and I looked on with sheer amazement!

And, just for us, when he finished stitching the uterus, he moved it to the side, and showed us the fallopian tubes and ovaries! And the bladder, and the intestines! It was like an interactive Anatomy textbook! Talk about a teachable moment!

We observed and conversed while he stitched 5 different layers from the peritoneum to the top layer of skin, telling us all about the different types of thread to use and which ones were absorbable and how long they took to absorb... you know, interesting stuff like that!

We were there when Agnes woke up, we helped clean her, and helped move her to the stretcher again.

We de-gowned, said thank you again, and then we were off, rolling down the cement walkways to the ICU. I helped Agnes get set-up on the Post-Operative side, and it was so nice to be there when she finally came to. A familiar face, among all the wards and hospital staff.

I never left her side that day, it was a nice feeling. And now she has a happy, pink and jolly baby boy waiting for her in the next room.

Thank you Lord.
and P.S... No babies died that day.

Just what we prayed for.

Second Day - Helpless

The day started out pretty calmly, but then quickly progressed to taking alarmingly swift action to save a life.

Among the 40 or 50 women, there was a 15 year old girl, Hadija, who was on the Antenatal side of the ward,
waiting to dilate enough to be moved along to the labour room.

The next thing I knew we heard the phrase
"cord prolapse",
and ran to the examination bed to see what was going on.

Cord prolapse is a very serious, dangerous, and rare occurence.
It is when the waters break and then the umbilical cord falls out into the open air... and no baby comes with it.
So there is a loop of cord just hanging there.
The reason this is dangerous is because the cord equals oxygen for the baby. When the contractions come, and the cord is not safe inside the uterus, but rather outside, the cord gets squeezed from the pressure of contractions and cuts off oxygen to the baby.
So a happy healthy baby of 9 long months can die within the last few hours.
So I’m praying. A lot.

The baby is also breech... feet first.
I feel like there’s nothing I can do, except pray and speak up to get this girl an emergency C-Section, or delivered NOW!

Hadija is on her knees with her bum in the air and her forehead on the ground, which is good. It’s taking unnecessary gravity pressure and weight of the baby off the cord.
The doctor says the cord is still pulsing. Thank you Jesus!

Just yesterday there was a cord prolapse in the labour room and the baby died in the womb because there wasn’t quick enough action. More fuel to my prayers.
As she waits there, trying not to move, I notice a thin purple piece of cloth tied around her waist. I thought it maybe was signifying her tribe, but others who are more familiar with Africa concluded that it was from the witchdoctor. Like a curse on the baby.

And now what a predicament we find ourselves in!
Cord prolapse, and the baby is breech, and she’s most likely not fully dialated which means the baby won’t be able to pass through.
After some minutes another doctor comes in and decides to try to deliver the baby,
right here, right now.
They tell her to push, they get two little blue feet out, but that’s as far as it’s going.
Now it’s even more serious because the feet put more pressure on the cord.
They wheel in a metal stretcher, we help her get on, and they tell us,
go straight to the labour room -- immediately!

My instructor and two of my classmates go with her, so I figure I should stay here on our ward. I tend to little things, all the while praying for this birth, feeling helpless and overwhelmed.
About 45 minutes go by, the three still aren’t back yet, and our ward is relatively calm, so I run over and check what’s taking them so long.
There I find Melisa and Marchien holding Hadija’s hand as she gets sutured up (she tore during birth) and Emily is like a mother hen furiously looking after Hadija’s blue baby boy on the resuscitation table.

I quickly get filled in on what happened:
they said it was "not a good birth to see".

They said it took a very long time for the body to be born and the head was still inside and would not want to come out... probably due to the fact that she wasn’t fully dilated. Ouch.
They said the doctor was being so rough and twisting the baby’s legs this way and that (but desperate times call for desperate measures),
and the way he was twisting on the little baby’s neck, when the head finally did come out, something was wrong with him being able to hold up his head;
very weak, very wobbly.
The baby looked dead when it came out.
A 1 out of a possible 10 points. Blue, not breathing, no muscle tone, no cry....
Emily took the baby and resuscitated it, prayed a lot in the name of Jesus, and had been caring for it since.
I saw him on the table; he had oxygen in its little nostrils...
still looked bluey, but he was breathing.
"Look," she said, and she showed me his left leg.
From the knee down it was dislocated and his foot turned inward.
The rough delivery, the twisting and wrapping.
And his poor neck... Emily thought he might have some kind of cerebral palsy from now on.

They said Hadija was in a lot of pain:
she was screaming and had terror in her eyes.
The doctors and nurses forcefully told her to be quiet and at one point closed her mouth with their hand.
She lost a lot of blood, probably enough to count for a hemorrhage, and now to be sutured without sufficient anaesthetic.

This is when I walk in the room.
Hadija’s teeth are clenched and her face winces as the doctor quickly stitches the best she can.
I was heart broken.
　
There is something so devastating about carrying a baby for 9 months, all for it to amount to nothing.


There is a verse in the Bible,

"We were pregnant, we writhed in pain, but we have given birth to wind." Isaiah 26:18

Instead of bringing forth a baby, how it makes the heart sick to only give birth to wind!
No substance, emptiness, no happy ending.

This is how I felt.
　
Hadija; her firstborn now with a twisted leg,

trouble breathing,

and a vulnerable neck.
She tore,

had a traumatizing painful birth,

and now with an unsure outcome even through all of that.

I observe the suture, and do a double take over my shoulder to the bed in the corner as a small baby is being born feet first!

He’s the second twin and having a hard time getting out... it’s almost painful to watch as the doctor puts stress on his little neck, and twists and overextends his fragile back in efforts to deliver the head.

Finally he’s born and lies still on the bed.

Once again, blue, and motionless.
I start praying again.

The long metal cord clamp fumbles out of the nurse’s hand and falls on the baby. The baby flinches.
Thank you Lord.

Oh man.
So much adrenaline.
It never seems to stop around here!

And the 4 BAS students that are stationed here in the labour ward are away on lunch break, so it’s just us and the few hospital staff. We are supposed to be on the postnatal ward, but we can’t really leave in the middle of this, can we!
My eyes follow the small, limp baby being carried to the Rescusitation Table behind me.

No breathing, no effort.
!!!
Quick, clear the airways! Suction out his nostrils and mouth!

"Where’s the tube?"
"The tube’s dirty."
"Where’s a new sterile tube?"
"I don’t know where they are! I’m not on this ward!"
"Ask the nurse!"
"Nurse! Nurse!"
"Yes?"
"A new suction tube! Where are they found?"

The seconds feel like precious minutes being lost, this little one need every second he can get.
The nurse clears the airways. Nothing still.
Bag and mask! Bag and mask!!
Puff--puff--puff--

breathe baby, breathe baby, breathe baby...

Each little burst of air fills his lungs and I watch the little chest start to suck in and out.
It feels like time has stopped, or has extremely slowed down.

The busy nurse puts oxygen in his nostrils and secures the tubing behind his head.

I am left with him. He’s getting slightly more pink, but still gasping for air, and I can see his skin stretch around his tiny ribs when he tries his hardest in attempting to inhale.

His small chest, his precious little hands... you can do it baby!

I watch over him for about 20 minutes, he isn’t necessarily getting any better, but he’s not getting any worse either.

I look over at the first twin, just as tiny, quiet and sleeping, but seems to be recovering.
We really need to go for lunch, and then back to our own ward.

How can I leave him?

Just lying there, with no one attending him, no one checking up on him.

He should only progress for the better now, right? He’s got oxygen...

It’s chaos in the labour room, there is another woman screaming, another one shrieking, another one taking frail steps to a delivery bed.

"Can you do this delivery?" We get freely asked by the nurse. Our instructor declines.

The understaffed doctors and nurses have their hands full and are working hard to be where the emergencies are.

The loud emergencies, that is.

The ones they can hear, the ones they can run to.

What about the little one who is silently gasping by the window?

The nurse asks me to weigh him. My instructor asks me to come for lunch. Together, we take out the oxygen for a moment and I gently place him on the scale.
1.5 kg.
He really is small.
I place him back on the table, oxygen goes back on, I stroke his head, and say goodbye.
　
　
A quick lunch break, and then moving on. Back to Antenatal/Postnatal Ward.
A very tired lady is wheeled in. She just got transferred here from a different hospital... She has quite the condition...
She slowly gets onto the examination bed for the doctors to take a look.
The baby is in fetal distress, the baby is too big for her pelvis, and she has a bulging cervix that is visible.

Cervixes are not supposed to be visible! Ouch.
All of this together equals an emergency C-Section.

But no one is rushing around.

A team of doctors discuss and talk about what the next actions are...
the 2 operating theatres are full right now, and since this is a delicate case, and enhanced by the intricacy of a visible cervix bulging and perhaps becoming gangrene... they decide they do not have the facilities to do this.

So she needs to get transferred again, to the national hospital across town...
I’m getting frustrated. They’re so casual about it!

Isn’t this supposed to be an emergency?
She’s still lying on the table...

I ask a few more questions and find out that they can’t take her yet because the ambulance isn’t back. So the ambulance isn’t even here!
Wow.
So there’s no transport at the moment.
I keep my eye on her and her fragile cervix that I shouldn’t be able to see... (the cervix is supposed to be way inside)... it looks so dangerous.
And the mama says she has the urge to push--- noo!!
She’s so thirsty, she asks me for water.
But there is no water available, you must buy it. I get the 30 cents from our team and rush down to the canteen to get some.

Finally

after 1/2 hour the car comes.
So we get her in the ambulance, and two other mamas with sick feverish babies... but now the transport nurse isn’t here to go with them. And the driver is not here either.
I’m so shocked. By this time it’s 3 pm and we need to go home.

The ambulance still hasn’t left yet, and I’m so frustrated.

But still, the staff are doing the best they can, they are just really short on people!
On the car ride home,
we hear the stories of the day. The girls from the labour ward said that some twins died.
There were 2 sets of twins that day.

Earlier on in the morning,
the first twin was born dead. The nurse said it had been dead for about 8 hours in the womb, and the amniotic fluid surrounding it was milky white. It is supposed to be clear.
They found out that the mother used some traditional medicine to "make the labour go faster" and put some leaves or herbs near the cervix (the opening).

Turns out that the first twin (closest to the opening) died during that time of labour.

The second twin (furthest from the opening) survived.

Later on in the day,
there were another set of twins. (the ones I saw).
They said that about an hour after we left, one of them went to check on the babies... and the second twin was dead. He had no heartbeat, no breathing.
The second twin. My little guy.

Alone and left to fend for his tiny little self. Only 1.5 kg, having a rough start, but with no one to watch over him, no one saw that he was struggling. And he died.
When I heard that,

that threw me way off.

The whole rest of the day I felt I was off kilter,
mourning, grieving.... my first encounter with perishing life.

That afternoon we had intercession. We prayed for the mothers at the hospital, the babies, and Emily prayed for Hadija and her little boy, that his leg and neck would be healed. It was a desperate and powerful time.

We realized after that day that there is so much warfare in those moments. As midwives we stand at the gate of life and death.

It really is a battle. And it is worth fighting for.
　
　

First Day at the Hospital

More than I could ask or Imagine.

Today was our first day at the Hospital Temeke.

We got there, and got a quick tour of the 3 maternity wards.

First, a look into the Antenatal & Postnatal Ward, then walk down the hall a little, hear the shrieks (sounds like a party in there!) and yes,

you guessed it,

the Labour Ward,

and then at the end of the hall is the ICU, for post-operative C-Sections and pre-eclamptic or eclamptic women.

So much is new, the sights, the smells, the masses of bulging bellies...
I was in the Antenatal & Postnatal Ward.

On one side there is the calm, docile and relaxed mothers, nursing their newly born babies and resting on beds.

On the other side is filled with women wrapped in kangas, sitting wherever they can... waiting.

Waiting for dilation to 4 cm.
Waiting for contractions to progress.
40 women and 7 beds.

Some are on the floor, some faces are wet with tears of pain,

some are crunched up 6 to a mattress.

There are 2 ladies waiting to be catheterized for preparation to be transferred for C section.

The catheters get put in and extra urine pools and spills over to the bodies nearby.
I look to my left, and see a cannula get forcefully jabbed into a forearm.

I look to my right, and a woman grimaces as the doctor performs an internal exam.

Behind me are many women sitting on a simple wooden bench awaiting their admission to the hospital.

In their hands they grasp a pack of sterile gloves, their pregnancy card, and one bag of kangas to labour in and wrap the new baby.

Some have drinking water.

It is hot in here. I’m so happy there is a fan.
"Do you want to put in a catheter?
Do you want to take blood?" The nurses freely ask me.
I’ve been here for less than an hour on my first day, and surprised,

I say "Thank you but I’ll observe first."
(I’ve never even seen a catheterization, and I’ve only tried taking blood once!)

The helpful nurse comes up to two of us and says that one of us can come with her to the theatre to see a C Section
!!

I guess my face said it all because Emily said,
Fia, you go.

Wow. A C-Section??

Of course I want to see it!

but will I faint?

The last time I saw blood coming from a woman, I passed out. It was a large combination of circumstances, but still, it leaves me feeling a little gun-shy.

How will I react when I see a real operation!?

In theory I love it, but what about reality?
Could I be any more overwhelmed!? This is the real deal.

I run to get a drink of water, take a few breaths, Emily comes in too and prays for me.

I feel like my legs are made of chalk, and I’m a little girl in a new and twirling world.

The metal bed wheels in, and the catheterized woman slowly gets on, and we wheel her outside and down through the hall.

I take deep breaths as we turn corners at quite a clip.

Adrenaline pulses through my blood and I’m praying that God will give me the grace to stand and be strong.

Down this corridor and through this entrance... I’m wondering what is going through the mother’s mind. I’m praying for her, praying against fear and the unknown. I adjust the sheet that’s covering her and we keep going.

The Operating Room.

Gowned in green and masks and caps, they are awaiting our arrival.
We go back and get the second woman, make sure she’s "comfortable" on the metal stretcher, and wheel her down to the OR as well.

The smells of the OR:

cold, blood, and sterile machinery.

My legs feel even weaker, and I focus on breathing regularly.

I too put on a green cap and gown and mask over my mouth.

I change my shoes and shuffle to the Operating Room.

Everything is ready, everyone is ready, they give me sterile gloves to put on.
I look over and the incision has begun.

All my anxiety turns to awareness.

Thank you Jesus!

I feel as clear as a bell and am fascinated by what I see.

It’s like a textbook, but real!
I can see the adipose tissue and the uterus! I ask the doctor a question about the membranes, and she kindly points out the perimetrium (the outermost layer of the uterus)!

Whaat!! What an amazing privilege!
Scalpel.
She then starts to make careful repetitious strokes deeper and deeper into the uterine layers, suctioning back blood and fluid with each cut. Once through the uterus, we see black curly hair!
"Cephalic," the helpful nurse murmurs.
I nod.
The doctor reaches her fingers inside and pulls out the baby in a split second.
A hearty cry from the new baby girl, the cord is promptly cut and the grayish baby is given to the nurse, and we whisk the baby away to give it a rub down and suction anything out of the mouth and nostrils.

Wow. Just like that.
New life.
The baby takes its first breaths and cries... what a life-giving sound!

A rosy pink colour quickly spreads across her body from the heart to the extremities, getting more colour with each strong breath.

Welcome to the world, baby!

We show the mom, wrap the baby in a new cloth, and I get to hold the sweet bundle of life in my arms and bring it to the post-op ward.
I de-gown, feeling totally exhilarated, make a cozy, nestled embrace for baby and walk with swift steps to the next ward.
Thank you Lord.
Wow, what a gift to have experienced that.
This is the first delivery I have seen!

I drop off baby, wish her well, and get back to my ward, glowing.
I feel like I can do anything!

No longer a little girl helplessly watching the world turn around me,

but a woman who witnesses and welcomes in life.

We grab lunch, take a quick rest while we eat, then come back to a calm ward.

It seems like there’s nothing really to do... mothers are nursing and resting and the others are waiting to dilate.

Hmm... what to do.

We start taking new women’s cards who have just arrived and registering them in.

One of them is young, and holds only a green slip of paper.

She gives it to us and says something in Swahili... the writing is all in Swahili and we just look apologetically blank at her... and soon through a translation we understand that she delivered and her baby died.

Oh my.
She gets walked to the postnatal side. Among the nursing moms she sits, having no baby to nurse.

This is terrible. Who will go comfort her?
　
I hear a bustle to my left and discover more action.
A woman has dilated, and upon examination, has a breech baby and meconium staining.

She becomes catheterized for C-Section prep, and has an IV drip going.

She gives the occasional howl from the increasing strength of the contractions... the main doctor comes in, feels around and says it’s a footling breech and that we can deliver.

Now.
So we quickly clear a bed, grab a birth kit and get the mama up on the mattress, as other dilating mamas get herded to one side of the room and look on with anticipation.
The mama’s belly is so huge that the baby's head doesn’t even look the slightest bit engaged into the pelvis.

The doctor asks us a rhetorical question,
"Why is the fundus so high?

.... She has twins."

!
First, a foot. Then the other foot. Limp and blue.
Push mama!
Then the body. Then the tricky part is the shoulders.
I am looking on with utter amazement. What an honour to see a breech delivery!
The doctor explains to us how to deliver the head:
Find the mouth, hook your finger in and then pull down and then up and then a little to the sides.

Sure enough the head delivers and one baby girl on a fresh yellow kanga.
Small and limp and blue.

Uhh...

the room falls silent.
Please Lord Jesus!
A small weak cry.

A flood of relief and joy fills the room. Thank you Lord.
Cord is cut.
The baby is not crying and not really responding, so I am told to

"Take her to the Resuscitation Table in the Labour Ward!"

(where’s the Resusc. Table?!)

We find it and suction her mouth and nose, but she’s still not crying or pinking up very much.
We rub her and try and stimulate her, her heartbeat is fine, but baby make some noise!!
Slowly, slowly she’s getting more pink...
15 minutes later comes the other twin!

Another girl!
This one is a bit more vigorous, giving hearty cries now and then.

No one else is with us, just myself and 2 other BAS students.

As we are trying to get these limp little babies to liven up,

it occurs to me that we are kind of responsible here for the progress of these new little lives.
We are all praying and speaking life over their little bodies... trying to keep them warm and slowly they get more pink in their face and start to coo a little.

The doctor sees us cuddling and rocking the little ones, and says to put the babies down and we must finish the job and go back to the mom!
We go back to the other ward, and see the smiling yet exhausted mom.
There is blood mixed with amniotic fluid on the floor, and so Emily grabs the mop and cleans it up.
The mom seems fine, and recovering well,

so we go back to work at the admission desk,
and we notice a strangeness in the commotion of the crowd outside...

there was a maternal death on Ward 6, the Surgical Ward. She had a postpartum hemorrhage.
We see a stretcher wheel down the hall with a white sheet over the body.

Life and death... so close together. All in one day.

Tell me this isn’t real. Tell me that a mother didn’t just die.

Tell me that this is some kind of practice run and we can "cut" the cameras rolling and rewrite the script.

We have time to go back to see the twins... I want to check on them!

It has been maybe an hour since delivery and the mom is telling us she wants to see them.

They are exactly how we left them, and well enough to bring to mom.

Babes in arms, Marchien and I look at each other,

in a semi-ecstatic, semi-bewildered state...

here amid the chaos we are holding two freshly born healthy baby girls!

What a moment.

We take a piece of tape, write the information and tape it to the bundled up kanga.

Holding precious warm life we take them to the mom, beaming all the way there. We introduce her to her two new daughters, making sure to say "One" and "Two" saying who was first and second.

The look on the mom’s face was one of such peace, such confidence, such ease. She had her two, safe with her, and now all she had to do was relax.

Life-- and death. Within earshot of each other.

The whole day seemed like a whirlwind, I don’t know when it will sink in. I don’t want to be able to say ‘born’ and ‘died’ in the same sentence.

It is not how it is supposed to be.

The staff work hard and do the best they can, they really do.

But there are just so many people.

The hospital is just so thrilled to have us, to have extra hands and people to give care. We’re kinda thrown into the deep end at first, but hey, that’s one way to learn how to swim!

On the drive home, the car erupting with chatter, everyone was telling their own exciting stories of what happened,

and to sum it up, all I could say was how thankful I was for that day.

It was filled with up and down emotion, adrenaline, and focus--

but it was the best first day ever.

Africa

Africa. I am sitting here by the window, with a moist, warm night breeze breathing on me, I can hear the crickets outside in the darkness, and the nearly full moon is like a celestial street lamp.

I am in East Africa, a few hours from the equator, and 25 kilometres outside the capital city ofTanzania: Dar Es Salaam....Arabic for House of Peace.
Amen!

We live on an 81 acre plot of land, and indeed it is very peaceful. It’s the simple life here; the base grows their own vegetables, makes real coconut cream from the towering coconut trees above, and we all have a hand in sorting the rice and beans to rid them of stones and tiny insects.

We rise early with the sun and watch the stars bright against the dark sky at night. And when the power cuts out, orange glows of little candle flames can be seen in all the rooms, and we continue to go about our evening.

We take bucket showers outside, drink freely from the fresh well water that fills the taps, and wait patiently for the massive mango trees to yield their fruit in season.

We have entered our Applied Lecture Phase... lectures in our breezy African schoolhouse coupled with hands-on learning in clinical settings.

For the past few weeks we have been able to experience helping and observing in the nearby Birth Clinic; learning the ways of Antenatal Care, checking a woman’s progress, and feeling little kicks inside of growing chocolate bellies.

Clad with our student-midwife uniforms: baby blue collared zip-up dresses

(which could also pass as 60’s air hostess outfits), stethoscope, and official name tag

around our neck, we have been able to do simple teachings on pregnancy at the clinic, and even step into the delivery room!

A few weeks back I saw my first labouring woman, it was pretty intense. She had been in labour for about 6 hours already and was so tired that she had no energy to push. The nurse told us in confidential code that she was HIV+ and explained that lack of strength/weak pushing is usually the case for them. This young mother was just recovering from a bout of malaria, with an already weakened body from the virus, and now having to muster up all the strength she could had left her utterly exhausted. They were trying to give her handfuls of glucose and eventually resorted to giving her some sugars and salt through an Intravenous fusion.

After watching two failed attempts at digging around with a very long needle for a good vein to hook up the IV to, becoming aware of how hot and stagnant the room was, having not eaten for 7 hours, and seeing the desperation and intense pain of this woman, I actually fainted!! In the delivery room!

I know, I was shocked myself. It was definately a combination of circumstances, as I am usually good with blood and those types of things. My memorable First Labour Room Experience.

ha!

As we walk through the neighbouring village, visit little shops and meet more people, we are constantly reminding ourselves to “be relationship-oriented and not task-oriented”. It’s the African way. Relationship far outweighs how much you can get done in a day.

We chill with plenty of little African children, and are learning tidbits and phrases of Swahili from the locals.

And yes, I can validate that “Hakuna Matata” from the Lion King really does mean “no worries” in Swahili.

We have finally been granted our Work Visa Permits by the government to work in the Hospital, and tonight is the eve of that. We’ve been bustling around, preparing our things, and now we climb into our bunks, tuck our mosquito nets round us, and wait with anticipation for tomorrow to come. I will be on the pre-delivery and post-natal ward this week.... I am so excited to set foot in the hospital! Thank you Lord!

I know more exciting stories are just on the horizon!

Looking forward,

Fia

Breathe baby...

Hello hello!

September has been very neat.... as you may have known, our finances as a team for the 8 month outreach were due, and in the end we saw full provision, for all students, all families, all couples. That’s a whopping $232, 538.75. Thank you to those who responded to the Montoya family’s need as well. They went from owing $17, 000 to $10,000, to 0 in a week. From contributions all over the world. They’re a great family of five, leaving American luxuries to minister to the poorest of poor.

These past weeks we have been covering newborn care, assessing mother and baby immediately following delivery, and also a few days afterwards. This is my bunkmate Synnove and me learning how to wrap the hips and belly for a nice secure hold and relieves backpain for mom. Synnove is so great, she’s a Norwegian that has lived in Denmark all her life, she speaks perfect English (without an accent!), and loves songwriting and singing. She is one of the most thoughtful people I know, she’s always humbly leaving little presents for people here and there, discretely, for no glory at all. She’s also such a jokester! Her sense of humour is hilarious. Her and I have a lot of fun together.


(<--) “The Iwata Obi” Japanese Maternity Lumbo-Sacral Support Wrap.


On Thursday, we had such a privileged day. We got to go to the hospital! My favorite place! haha... well that’s kind of true actually.

When I was little, we went to the hospital to visit someone ( I think it was my grampa after knee surgery) and I remember looking at all the beds of people spilling out into the hallways and thinking it was “cozy”. It just seemed like such a peaceful place, everyone was sleeping all bundled in fresh white sheets, the lighting was soft, people talked quietly and the nurses shuffled from room to room. Holding my mom’s hand I remember saying, “Mom, I love hospitals! They’re so peaceful.”

Not the common response, eh?

I myself never had to be admitted to the hospital, so the only times I went to this mysterious place were to give nice hand-made cards and flowers and visit a smiling restful relative, and look out at the view of the city from their bedroom window. Sounds pretty nice to me!

Later, when I was 17, I volunteered at the Children’s Hospital twice a week before I left for a New Zealand Bible School, and it was there that I was confronted with more harsh realties. My first training day we went up to the different wards, and I was introduced to a bald 15 year old girl that had cancer, and as I said “Hi,” expressionless she turned over and threw up from the chemotherapy drugs. The next girl we visited was hospitalized from anerexia. Her hair was thin, and her clothes draped on her like on a hanger. The next girl we saw didn’t really acknowledge we were there.... she was sitting on the edge of her bed staring at a point on the floor. She was admitted because of a drug overdose.

I came home that day, with a new perception of hospitals. This is reality for those girls.
The hospital was not just a place where I went to visit moms and their newborn babies and family that had successful operations.

Anyway, so we got to go to the hospital, and were taught Newborn Resuscitation by the midwives. We learned how to do chest compressions to get their heart going, and how to use a bag-and-mask to give them little puffs of air for their breathing.
The rate of how fast you do it is about 40-60 times a minute, which you can pace by saying:
breathe baby,
breathe baby,
breathe baby,
breathe baby...

It all seems so hypothetical, we were doing it on plastic baby dummies. It’s hard for me to imagine holding a real baby and doing that. Oh Lord...

We also got to look at a real placenta! Which was highly interesting for me.

We leave for Tanzania in 11 days. Am I ready for Africa?

Travelling by plane continues to confound me. How is it that you can be standing in an Australian airport at the beginning of the day, walk through some aisles and machines, grab your bags, sit for a while in a seat, and then walk down another aisle and you’re in a completely different continent. In a matter of hours. Doesn’t make sense. But that’s what’s going to happen!

Because we’re bringing heaps of medical eqipment, our personal bag can only be 11 or 12 kg. So the packing challenge begins!





But I have a great praise report.
Over the past month or so, I have really started to think about a digital SLR camera. I appreciate good photos so much, and if I’m gone for so long, in such interesting settings, would it be worth it to invest in an SLR? That being said, I don’t really have “extra” cash to buy it with, but I was willing to put out the money now and then pay it back as soon as I could. For weeks I was reading up about cameras, the different models and prices, went on classified ad sites, contacted a lady in Perth about her used camera, etc. But really just prayerfully pondering why I had this longing in my heart for a digital SLR, yet being at peace with either outcome.

Anyway, last Friday, a girl I know from the base comes up to me and says, “Fia, I want to lend you my digital SLR camera for your outreach. God’s been speaking to me about holding things loosely.”

!!! That’s an 8 month outreach, and she loves photography! I had just briefly talked to her about camera advice the previous week for about 3 minutes before class, and now this?

What an unexpected, amazing answer to prayer!

I also got given a blank-page (no lines) journal that week as well, which comes at the perfect timing, (my journal is just finishing up) and blank pages are the only ones I use now, and they’re so hard to find!
God is amazing (isn’t He always!), but yeah, through those incidences He’s really shown me that He delights in my creativity, and love for expression.

Praise the Lord, even when we have little, he still gives good gifts. Amazing.


“Every good and perfect gift is from above, and comes down from the Father of lights, in which there is no variableness, nor shadow of turning.” James 1:17

Behold, I will do a new thing...

Hello again!

Hope you are all doing well!

I want to start off jubilantly saying that all the finance has come in for my outreach!
Yippee! Sound the trumpets! Clang the cymbal!

The Sausage Sizzle was a hit, and we did indeed sell 500 sausages over the weekend.
Thank you everyone for sponsoring and partnering with me in this. Even small amounts add up and seem to get multiplied.

Just a heads up though:
We got a memo saying that the flights that are being held for us may have just switched to be $400-500 more, each! So please join with us and pray that we will get the original prices, and that they will drop!

Anyway, meanwhile....
In my life,
these past two weeks feel like there has been a “change in the winds”.
Let me explain:

Lately, I’ve been thinking about “the future”. I feel like God's prompting me to think about what to do after BAS. It's kind of an exciting place to be, because I haven't been prompted or released to think about my future for almost a year. But now, little nudges, and I'm exploring with God. Pieces here and there, remnants, dreams, options... I am writing a lot these days.
I am still very much in the process of gathering thoughts, ideas, desires, and holding them in my heart.

I have 9 months to go.
Symbolic?
Prophetic?
The time it takes to birth,
to bring forth a future...

Behold, I will do a new thing;
now it shall spring forth; shall ye not know it?
I will even make a way in the wilderness,
and rivers in the desert. Isaiah 43:19

You know the moment when driving a standard car, and you switch gears? I feel like I am in that moment, when it’s taken out of one gear and waiting to be switched into the other.
Let’s call it “transition”.
Or “change”.
Or “straining towards what is ahead”. Philippians 3:13



On top of this,
I have been very homesick.
I have usually been able to fend it off,
but,
It's been 8 months since I last saw my family.
I still have 9 months to go. I don't know how exactly to handle it, what does one do?
Except to ride it out,
yearn for the familiar,
embrace the fullness of emotion,
and know that it will pass soon.

I really love my family!! And my dear friends! You are all so special.
And my dear country! The Canadian landscape!

The rugged mountain slopes,
The wheat fields that go on for days,
the salty brisk ocean air,
the driftwood on west coast beaches,
the vibrant green mosses of the rainforest of Vancouver Island.

I love Canada!

I'm homesick. I miss home.
Yet, I don’t WISH I was home. I do reminisce often though, and smile with a full heart when my thoughts take me to Canada.


hey! If you do desire to send a letter or a small care package, you have the next 2 weeks to do so. (takes an additional 2 weeks to get to me)
You can send it to:

Fia Merkeley
PO Box 8501
Perth Business Centre
Western Australia 6849
Australia

It would be lovely to hold a piece of home, read handwritten words, see photos of the summer!

Here in Perth, everyday is still exciting and beautiful, and I am so thankful for the uniqueness of this time in my life. We go to Tanzania in a month!
And then Beloved India.

This is one of my favorite pictures of Nepal.
This is my "Yes!! I love this moment!" face.
I’m on a mountain-top. Wearing my Leaf Punjabi.
It took about an hour to climb to the summit. Kind of forging our own trail, and taking the occasional goat path. I love climbing mountains! The view (and the journey) is always worth it.

Much love to all!



Held by Grace,
Fia

Psalm 131:2
Calm down my soul...



~~~~

Like a Rushing River, Misty Edwards- Unplugged

Like a rushing river am I
Like a raging torrent inside
I find that I’m free-falling again
I'm letting go of the mountain view
Letting go, but what into?

I've been crucified with Christ
Yet not I, but one thing I know
You make all things beautiful
Just in time

So into Your hands
Into Your hands I fall

So calm down, my soul
Calm down and know

His yoke is easy
His burden is light
It simply costs everything
But it's not too mysterious

So calm down, my soul
Just calm down and know

No one who waits on the Lord will ever be ashamed
For wisdom will be justified

Calm down, my soul
Be quiet within me
And put your trust in God
From where your help comes from

From where your help comes from
Just calm down, my soul, and wait
It's just a matter of time

Buds and Roos and Bellies and Babies

It is the beginning of spring: the noonday sun does not have its harsh chill, and the rainy bleakness is coming to an end.
The days have been so full, weeks go by like that (*snap fingers*), and there is lots to process and absorb.

Hmm, I’m wondering now how I should go about doing this blog, because the lectures we have are, you know, about newborns and pregnancies and labour and things like that. Not exactly dinner conversation, but nonetheless interesting and exciting.

Well first of all, before I say anything more,
I want to say thank you to all of you.
Many of you have come alongside me and supported me financially, making generous commitments to partner with me monthly, and not a day goes by that I am aware that I am only here by each one’s contribution.
It is with great, great pleasure that I can say that the money has come in that I need to have for the 8 month outreach to Africa, India, and the Phillipines. And to this, I thank you!

Actually, just thinking about it, almost makes me cry... I am overwhelmed! The humility God has walked me through, and the gratefulness that I have towards everything that I have in my life. Because of your support, whether large or small, it has all come together so that now, I am in Perth, in a classroom, everyday seeing more of this dream shift to become a reality.

Each one of you are investing into something much deeper, much larger than an 11 month midwfiery school. Real mothers and newborns will be watched over, cared for, loved. Women will be taught simple health care, and locals will be equipped with the gift that cannot be taken: education. It is not abstract, it is tangible. Direct to the people. And then of course the ripple effect into families and communities. What a responsibility, what a privilege! wow.

Thank you.

There is however a need for a few details extra to the outreach costs that I always forget about. There are a few immunizations that I still need to get for Africa, and the medical equipment... Blood pressure cuff, stethoscope, fetal pinnard, scrubs, closed-toed shoes.

If you would like to support me in these final details, amounting to roughly $300, we are doing a Sausage Sizzle this weekend, which is a fun way to raise money and stand over a barbeque. Please email me if you are interested in participating!



This week’s lectures have been the real deal: Labour and Delivery.
Delivering Babies 101.

haha! It’s pretty intense.

(This is us watching a video for class; we were just previously being pregnant ladies. It's pretty fun. Anything can happen in the BAS classroom!)

Last week, we learned about changes (and danger signs) during prenancy, and my favorite wonder so far: palpations!!

We got to palpate a pregnant mother’s belly. You just place your hands on her stomach and feel for the top of the uterus and the little baby inside! It’s quite remarkable. Then you find the heartbeat and listen.
This week we learned more about the baby and how it navigates down and out. There are so many mechanisms, it is pretty genious.


On the weekend we drove up the road a ways to a place called Kangaroo Island. It’s kind of like a safe haven for kangaroos that have been hurt or injured in the wild, so they just hang out in this safe, vast area, and hop around among the trees and bushes. We went on a search and sure enough found a couple nice roos. One was so tame and laid back, he let us pat him, and he hung around for quite a while. I named him Kanga.


The relentless pursuit of getting a good picture with Kanga!

We also had a dance party, Black and White themed, and another Canadian and I went as a pair of dice. We had a hoot sewing those boxes onto our belts!



Oh, also, everyday, I have the amazing privilege of sewing costumes for an Islander Dance ministry. They show God through traditional tribal dances from all over, Tahiti, Fiji, New Zealand, Hawaii.
Drumbeats, voices, clapping, sticks, feathers, shells, the whole bit.
All doing for the redemption of cultures, and embracing another venue to show the love of Christ. Since it is also with YWAM, it is non-profit and they make all their costumes.

They just had a performance this week, it was amazing. So powerful and done with excellence and precision. I sewed the white hula skirts and the red tops!The Crew + Fia

Until next time,

Fia "keeping very busy" Merkeley

Into the Swing of Things

I love this school.

What do I love?
I love how the school was born, out of a pure love for God and the willingness of one lady to offer her skills as a nurse-midwife to train others.
I love that they value the integritous character of the midwife more than the skill of midwifery.
I love my fellow classmates! Each of their stories, where they come from, how they got here, each one is individually beautiful.

In one of our first lectures, we looked at what it means to be a midwife;
in its essence,
a midwife is someone who helps to bear,
who comes alongside others,
who is a delivery agent in the work of God.


“There is a desperate need for people who will nurture what is conceived by the Spirit of God,
and see it delivered.
So that we then, move into maturity.”

going from
Always needing to be delivered ---> to becoming the delivery agents
moving from self ---> to selflessness.

The Kingdom of God is fulfilled in our selflessness.



wow. That really impacted me.

This school is about LIFE, seeing the babies live. Defending the little ones, caring for them, and seeing them thrive.

The 2 main verses for this school are
Exodus 1:17:
“The midwives feared God... and let the little boys live.”

Ezekiel 16: 1-14.
God’s amazing grace extended to the Israelites, who were likened to a newborn that was despised, thrown out and left to die.
“ I said unto you, LIVE!”

This is all very exciting. I feel like so many things that I have felt strongly about are being fulfilled in this time. It’s not just about learning anatomy and the mechanisms of birth, but it is so much more than that. As children of God we have authority to speak life over the newly born. To bring the kingdom by doing all things with great love. To show a woman value, when she has been told she has no value by her culture, by her nation. To be the hands and feet of Jesus.
To be tenacious midwifes who advance the Kingdom, bind up the enemy, welcome in New Life.

“Speak up
for those who cannot speak for themselves,
for the rights of all who are destitute.
Speak up
and judge fairly;
defend the rights of the poor and needy.” Proverbs 31:8


This is us in our class,
studying,
and learning about testing urine.

Let's all raise our glass...
Just kidding.


We found out recently where we are going for our 8 month outreach:

Starting the end of September...
Tanzania, Africa for 3 1/2 months,
Back to Perth for 2 weeks, (YWAM 50th year anniversary, big celebrations)
South-central India for 2 months,
Phillipines for 2 months!!

When I found out we were going to India, I literally shrieked with excitement!
I’ve always wanted to go to India since forever,
and my desire was to be in India on the BAS, but I didn’t want to get my hopes up, so I was preparing myself for anywhere,
but here we go! India for 2 months, baby!
And I am so, so thankful to God that He honoured that dream I had in my heart.




yay!