Sick Babies

It was Tuesday morning when I walked into a small concrete/dirt, dark, hot home. This was the home of the twins James and Jasmine...and many other children. Sounds of a crying toddler in the back room separated by a dingy curtain filled my ears. I glanced to my left and noticed a small girl who looked about 4, but was probably 7yrs. old scrubbing dishes on the floor. There was a kettle on a hot coal fire cooking the family’s rice in the corner of the floor. Is that the only food they have? I left with Normi that morning with plans of doing a postpartum visit to Maribel, the mother who gave birth to James and Jasmine about 3 weeks ago, little did I know that this is where her, her husband and their 10 children lived. Pushed up against the right wall of the house was a small wooden bed where Maribel and her twin babies were laying. At first glance over the twins I noticed immediately that they were both very sick and desperately needed to be bathed. While I was doing vitals on the mother and babies all the other 8 children were staring at me wide eyed, isn’t it a school day? Unfortunately these kids don’t get to go to school, soley because they were born into this very poor family. Little James was just laying on the bed loosely wrapped in a dirty blanket with his head turned to the side, eyes open and mouth gaped open trying to breathe through his very snotty nose. When I picked him up he would not respond to my voice or touch, his goopy eyes had the look of suffering in them.  I could hear fluid in his lungs. He hadn’t even gained an ounce of weight since birth. Was he going to die? Jasmine didn’t seem as sick but had the same snotty nose, raspy sounding lungs and hadn’t gained any more weight than James did. I didn't realize that she wasn’t wearing a diaper under her dingy blanket, and could feel warm fluid running down my legs. She was peeing on me! Oh well... Is their mom to ignorant to realize her babies are very sick, why didn't she contact us at all or take them in to see the doctor? Upon talking to Maribel I realized that yeah, she knew her precious babies were sick, but what could she or her husband do about it? They have no money to take them to a doctor much less buy medicine. The contract the husband had where he worked had expired leaving him with no job. Their older children were providing the only income for this family. The mother was giving the babies some liquid vitamins hoping they would get better on their own, that’s all she knew to do... Upon also examining Maribel I noticed that she was just as sick as her babies! She had this horrible cough, was extremely stressed/tired, still bleeding from birth, and producing hardly any breast milk for the twins. Wow, all three of them needed to see a doctor ASAP. I left the home with a feeling of sorrow in my heart. In a country where using any form of birth control is looked down upon due to 95% of the population being catholic, where abortion is truly illegal, and there is absolutely no financial government help, this is the situations family get stuck into.

I walked back to the clinic and immediately told my preceptor Gerlene and midwife Eva about my findings. We prayed and thought about it, and came to the conclusion that we would take the mother and babies to the doctor the very next day and pay for everything, including the tricy ride...the doctor concluded that both the twins had severe infections, were malnourished, and the mother has severe pneumonia. We got them all the medicine that was prescribed to them and also bought some special substitute formula for the babies, meanwhile the mother will still breastfeed as much as possible. All that only cost about 1,000 pesos, which is equivalent to 25 US Dollars...It has been 3 days since and the family has been bringing the babies here every morning to get nebulised and checked on. The mother and babies seem to be slowly getting better, also the babies have both gained weight! We feel so much more at peace that we were able to help them. These twins will always stay in my heart and prayers.  

     

Tough Times

Wow, where do I even begin...the last couple of weeks have not been easy.  It is coming closer to the end of the month and we have only had one successful delivery here in the clinic this June. We have had to transport 4 patients and unexpectedly one of those patients baby boy died in the hospital for reasons we will never know.  That’s not the only death our  team of midwives experienced this last month, a family member of my preceptor passed away, and the father of Normi the other Filipina midwife who works here passed away as well. All of us have been in mourning, I have never been to so many funerals in my life. Now, you are probably wanting more information about the pt who’s baby didn’t make it... It was the mothers first baby and she was 22 yrs old. When we transported because of lack of progress during pushing stage, the baby and mom vitals were great, the bigggest problem was that this pt wasn’t able to push her baby out effectively. After trying all the midwife tricks to help this mom deliver, we decided to transport because no progress was being made. This pt and her baby had no complications during prenatal care or the entire time she was with us in labor, when we found out the next day that the baby had died in the hospital us midwives were shocked and angry. We were angry at the hospital/doctor because as far as we knew there was no reason that the baby boy should have died, it didnt make sense to us; but the hospitals here are still performing dangerous outdated procedures that are outlawed in developed countries like America, and neonatal resuscitation is something that they rarely do... Now, I cant sit here and say that it was the hospitals fault that the baby died, we really have no clue about what actually happened in the delivery room that night and there are no witnesses because when a laboring woman is admitted in a hospital here no one else is allowed to be in the room with her expect the nurses and doctors. We will never know if the baby died before or after being born, did all the baby need was a couple of breaths, but they automatically claimed the baby to be dead instead? These are questions that will be left unanswered. The family is blaming the hospital and the hospital is blaming the pt. The reality is a baby boy died and nothing is going to change that. I have had to rely on God in abundance during this month and I thank those who are praying for me and a turn around here at the clinic. The good news is the one actual delivery that we did have here went really well, she was a 17yr old first time mom and I was her primary midwife and so relieved that things went smoothly. I hope and pray that this challenging "season" here at the clinic is over and next month will be a good one. But, no matter what, I am learning so much from every situation good or bad here that is shaping me to be a better midwife in the end. 

my patient and her brand new baby boy in their home

When you don't see where you're going, when you don't think you can stand it one second more, if you only keep putting one foot in front of the other, chances are, you'll come out on the other side. Either that, or you come across a road sign that will point you in the direction that will get you out.

-unknown

Wait, there's two!

This last week has been a shall we say...interesting/crazy/unique week. We had a baby born almost every day. First off, I wanted to say how honoured I feel to actually have a family here name their little baby girl I delivered after me, and appoint me as the childs Godmother, they are a really sweet family who I had been doing most of the moms prenatal care before she gave birth, so we knew eachother well. Now let me tell you about the rest of this crazy week of mine... I think the most amazing part was delivering the twins that were both born breech(butt first)! It is so very rare for a Filipina woman to even become pregnant with twins, and also more rare (for a Filipina) that the babies would both be breech. It was 5:20am when she rang the clinic doorbell, she was a drop in pt who hadn’t had any prenatal care. Upon doing an internal exam I could feel not a baby’s head, but a knee, I also noticed her belly looked bigger than usual, but she was a tiny woman. The other midwives walked through the door only minutes after I txted them that the baby was breech, and once they started talking to the mom in her own language, the mom confessed that she believes that she is carrying twins. Sure enough, I found the other baby’s heartbeat . To tell you the truth, all of us midwives were a little nervous(but none of us dared to show it) Transporting this pt. was out of the question because her cervix was fully dialated, birth was eminent we were just waiting for her to get her “urge” to push, and it would be horrible if one or both of these babies were born in a tricy on the way to the hospital. The midwives and I agreed that midwife Eva who has been wanting to deliver a breech baby for so long would be the one to deliver the first twin, and I would be the one to deliver the 2^nd twin, whom we thought was in a head down position. Once that first twin (girl) was born without any problems, we were all so relieved. Upon doing an IE to confirm what position the second twin was, I thought that I was feeling a head, but I was actually feeling the baby’s little round butt through the tight bag of waters. 45 minutes later, the baby’s body was born all at once, but the cord was around his neck so it took my preceptors guidance and a little maneuvering to get his head born; he needed a couple breaths with the ambu bag to get him to start breathing, and he was smaller than his twin sister, but all in all, they were both healthy. They were named James and Jasmine; us midwives helped the family come up with the names. They were so very cute!! But, before these delivery of twins, we had another drop in pt who’s labor was so fast, and she hemorrhaged(which unfortunately is a common complication here due to the mothers being very malnourished and anemic) so I had to start an IV on her...and another pt. who’s baby had aspirated meconium at birth and had respitory distress syndrome ...ugh!! All these rare things we had happen in one week only. We ended the week with a little celebration that all of us midwives, moms and babies had made it through, we ate pizza and had some soda pop...unfortunately now all of us are taking turns one by one being sick with the fluL This is the 2^nd time since being in the Philippines I have gotten sick, and it really does suck...but I know I will make it through

P.S. Happy 4th of July!! I miss the celebration, no fireworks going off here:-(

On a homevisiting checking little Kian, the baby who had respitory distress after birth from aspirating meconium,
he recovered so well

The twins!

What a handful, I don't know how my parents did it with my twin sis and I

The boy, James is the one in camo, and the girl Jasmine is in yellow

My preceptor Gerlene on the left holding the baby girl

Eva and I holding the twins we were so blessed to be able to deliver

This is me on a home visit with the mom and the baby that the
family decided to name after me

There she is, Alyssa JoAnn, don't you see the resemblance? Hehe

baby Alyssa's daddy holding her, so cute!