Back in the Bay

Well after being in the states for a month I finally got around to unpacking! I think I kind of wasn’t ready to leave Uganda yet so I held on as long as I could. Life is getting back to usual here – babies and bellies although not nearly as busy as I was last month at this time ūüôā But I’m already trying to figure out how I can get back there sometime later this year!
The internet connection was too slow for me to upload any photos while I was there so I’m just going to post a bunch of photos for fun! Enjoy!

This is the whole crew celebrating Thomas’ birthday
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This is me learning an Acholi dance from the students at St. Monica’s (the school next to the birth center). They were super sweet but were all laughing at how bad I was – but it was fun and a great workout!
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This is a banana bunch in its early flowering state
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These are 2 of the kids we live with there – they LOVE bathing in the buckets! You can see the herb garden and the birth center. This was right outside my hut.
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The Traditional Midwives demonstrating the proper way to help a placenta to birth (no massage until after the placenta comes)

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All the Lacolos (Midwives)…I have no idea what was said but it sure looks funny!!
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Again, the whole crew
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Happy Mamas, Babies and Aunties
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Catching a baby by candlelight. I miss you Atiak! I’ll be back as soon as I can…
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Last Night!

In the past two months I have never slept as long as I wanted. At times I skipped at least one meal a day. I’m embarrassed to say that I often went days at a time without brushing my teeth! After being up with one or more laboring women I would drop into my bed in the dark hours before dawn only to wake up again an hour or so later with the morning sounds of Atiak: the “slashing” of the grass to keep it low to reduce fire and snake worry, the filling of the jerry cans with water for washing, the sounds of our children who wake up smiling with cries of “auntie, auntie, good morning!” Even with the exhaustion and stress I’m really going to miss our little birth center in Uganda!
The work that we’re doing there is really special! There really are few places in Africa where women are able to get the level of care we provide with the love and support that we give them. Women can birth at home where they’re treated kindly but their Traditional Midwife may have limited training on what to do in an emergency. Women can birth in the hospital where if something goes wrong they will be taken care of but they are often treated not well and it certainly is not a loving and supportive environment. Just like the American home birth midwives that we are, we give them love and support and even if we can’t treat every emergency we are able to recognize when something is up and know to transport if necessary.
I hope to return to Uganda and I really want to help MHI to figure out ways to make this midwifery model of care sustainable and available in more places! Right now I’m enjoying my last night in Uganda- at the beach! Already today I’ve been on a bus for 8 hours and will soon be on a plane for 24 hours then I’ll be in the winter wonderland that is Michigan! Love you all and see you soon!

Boda Bodas and Prenatal Outreach

Things have been so busy here I haven’t had time to brush my teeth, much less write anything down! But although there are two women in labor they are both first time mamas and are moving slowly. I’m sure I’ll be up all night but don’t feel like napping! Husbands don’t usually attend births here but we’ve had some sweet births with husbands present. Today one of the mothers is having bad back labor and her husband is providing good support to her, so sweet!

Before coming to Uganda I had happily managed to go my entire life without riding on a motorcycle. Here motorcycles or boda Bodas as they’re called are a veery common means of transport – you want to go somewhere t hat is a little too far to walk you just hop on the back, these are Ugandan taxis! My first few rides here I was terrified – super rough roads, no helmets, and all sorts of ‘obstacles’ to dodge! Now I’m still nervous but can comfortably ride ‘side-saddle’ like the women here do! When we don’t have a truck (the wheel & axel completely broke on our interim truck and the mechanic is not able to fix it) we take boda Bodas to do our prenatal outreach visits. The women that we serve come from all over, some close – many from far away. Since they usually are working in the fields all day it can be a real hardship to come to us for their check-ups. So twice a week we go to one of the parishes to do prenatal visits closer to where the women live. Sometimes outreach is in the Parish health center, sometimes it’s at the home of a Traditional Midwife. The Traditional Midwives mobilize the pregnant women in their areas to come. We do an individual appointment with everyone, give prenatal vitamins, and group education – usually on the importance of drinking water!

Northern Uganda is very beautiful. It’s a lush grassy savannah with distant mountains. There are many beautiful birds and supposedly there sometimes are hippos in the rivers. About 4 hours from here is a national park where you can find elephants, giraffes, hippos, lions, wart hogs, etc! I never thought I’d say this, but I’m starting to like to fly down the road looking off to the mountains at the edge of the vast savannah on the back of a boda! Like many things about being here, a little terrifying but amazing and beautiful!

HIV

Uganda has a very high percentage of the population that is infected with HIV (15% by most estimates) and where I am in Acholi Land in the north is one of the only places where the rates are still climbing. Most likely it is still a hold over from the war that ended only 8 years ago. The rebels and government soldiers both used rape and sexual violence as tactics of oppression (in addition to capturing child soldiers, capturing women as sex slaves – to give birth to more soldiers, burning villages, and killing anyone they suspected of opposing them).

The government has a big campaign to get every couple tested called “go together, know together”. In theory this is great as if a woman is neg and her husband is pos then without education and counseling she will probably also become positive. So it does make sense that they only want to test couples together. But this is often taken too far when women who either are not married or who’s husband is away will be turned away from the local health center and not tested.

We often have women coming to our clinic after they have been refused testing at the health center. We just had a woman 38 weeks pregnant in this situation. She became pregnant with a man who was going all across the country installing the electric poles (all the way up the country electric poles and wires are stretched but there is no electricity running through them, as with many things here it will happen someday). Anyway, since he was no longer with her they refused to test her. We gave her the test and it was positive. When we get a positive result we send the client with a referral letter to go to the health center for follow up testing, counseling, and medication. Because we wanted to make extra sure this happened, Christine, our amazing Ugandan student went to the health center with the mama to help advocate for her. She was able to get counseling and the medication that she’ll take for the remainder of her pregnancy. After the birth we’ll again take her to the health center where she’ll get more medicines. It is not fun to inform somebody that they have a disease which everyone knows is a death sentence. Even with medications which are available everyone knows somebody who has gotten sick and died a horrible death too early in her life. This mother took the news the way all women here take everything, completely stoic with no show of emotion. I expect that she’ll come in soon to have her baby.

Last week we had a lovely birth with an HIV pos mama. She was having her fourth baby. She has three healthy children at home and her husband is negative. Although the government wants all HIV pos women to birth at the hospitals many women choose to come to us where they know they will be treated with dignity and respect. Of course we take extra precautions to make sure we don’t get any fluids on ourselves, we really do a good job of that anyway. We also take them to the health center as soon as possible after the birth where they’ll receive more counseling and medications. It is a privilege to serve these women.

I promise to have a less depressing post next time! We just had a great meeting with all the Lacolos (Traditional Midwives) in the area and a fun multi cultural thanksgiving!

Baby Bonanza!

Uganda3Things have been super busy here and also super sweet! We have had 7 babies in the last day, 4 in 2 hours. It’s been all hands on deck and all rooms full! All healthy mamas and all healthy babies! There is an Acholi term “Yala Yala” which means something like everyone coming together in love, family and togetherness. When it gets really busy and all the women are birthing together the Traditional Midwives say it’s Yala Yala! There is a song that goes with it which is often sung at weddings or other family events, it’s always stuck in my head as we have a lot of Yala Yala moments here!

One of the unique aspects about this program is the ambulance we have. When a woman calls in labor the driver and a traditional midwife pick her up at her home and bring her to the birth center if she has no transport, which they usually don’t. After the birth we drive them home. Without this women would walk. Some live very far away and it would take them hours to get here, if they made it at all! Then they would walk home in the hot sun after the birth which is exhausting and puts them at risk for postpartum complications. We also use the ambulance to transport women and babies to the hospital 3 hours away. Without an ambulance if there was an emergency in the middle of the night we’d be in big trouble as there’s essentially no way to get there at night.

Currently we don’t have an ambulance because it broke down and can’t be fixed. Mother Health International is raising money to buy a new vehicle. In the meantime we have a local man who has a truck which is acting as an ambulance. The problem is that he lives 45 min away which is time lost in an emergency or if a mother is laboring quickly (we’ve had a few truck births and I just caught a baby on the path, she started pushing as she stepped out of the truck and only made it a few steps!) A midwife who volunteered here set up a website where people can donate to the ambulance fund. Checks can also be sent directly to Mother Health. The campaign page can be found at: http://startsomegood.com/Venture/mother_health_international/Campaigns/Show/mobile_midwives MHI website is http://www.motherhealthinternational.org/donate.html

Atiak Births!

The births here have been amazing and beautiful! I really feel so good about the work I’m doing here. The quality of care we give is of equal standard to the care i give in the US with the difference that here it’s very difficult to refer a client for testing or ultrasounds so there is often a lot of unclarity around dates. We often have women come in with active labor and theyre 30 weeks by dates. We always try to stop their labor by treating for dehydration or uti. If it works, great, if not we have the baby. With the exception of one the babies have come out looking term. The one baby that was truly preterm, 33 weeks by assessment was actually born in the truck on the way in! She had signs of an infection so we transported her to the hospital where she Was Treated very well.

last night we had our first set of twins and although twin births ar usually more complicated this one was super straight forward! Both babies were head down and came out screaming! The placentas had fused together and came out soon after baby b was born with very minimal blood loss! We keep twins here until they are both gaining weight and treat the mama like a queen. There are a lot of fears about twins in Uganda because often one or both dies so we work hard to make sure the mama has the support she needs from her family and the traditional midwife in her village. I’ll talk more later about our relationship with the traditional midwives but basically it’s amazing! We work so well together as a team each acknowledgeing the others strengths and weaknesses.

Grossness warning: The birth that brought me to the hospital was actually not complicated but the mother with her first or second birth had had a fourth degree tear which extends to the rectum, that was never repaired. For over 10 years she had an opening between her vagina and rectum and was pooping out of her yoni. After the birth we transported her to the hospital where I really had to advocate hard for her to get taken seriously. Once they saw what was going on they prepped her for surgery and I didn’t leave until they were wheeling her into the or. Appaarently it wasn’t a true fistula but the docs could see right away what was going on and said that they’d be able to put everything back together again! I don’t know what would have happened if she hadnt come in to the birth center to have her baby? She had nevertoldanyone about the problem and her mother who caught some of her babies didnt notice. Anyway we’ll be able to follow up with her and make sure she’s healing well.

Anyway, most of the births have been great and beautiful and amazing. We had a really sweet first time mama who came in, labored for about an hour, squatted down, and had a beautiful baby girl. We had a mama with a stubborn cervical lip that when I was finally able to push it up over the babies head she came flying out in the same contraction with no tearing! I’m excited for more babies tonight!

Atiak Hooray!

Hello everyone! I’m sorry this my first post but the day I arrived the internet stopped working in northern Uganda and it still is not back on in our small region. So I’m here in Gulu after transporting a woman to the hospital here (see birthy stuff below). ¬†The birth center and compound we live in is beautiful! ¬†it’s a very rural area and the town center is 2km away. We have some electricity from a solar panel but there is none in the rest of the area. ¬†We, and many members of the community use the well to get water to drink. ¬†The women here walk long distances to get water, carrying it on their heads in giant buckets. ¬†There is this one sweet elderly woman who always asks me to carry her water home for her. ¬†I ¬†keep telling her that if she doesnt mind the water all sloshing out by the time she gets home I’m happy to do it! That always cracks her up!

Our days are filled with prenatal and postpartum exams and caring for women in labor.  Our nights are filled with births, sometimes a movie that we all watch together, or going to bed super early.  Every morning I wake up with the roosters crowing and when it starts to get light.  It usually gets pretty hot in the afternoon and then very late afternoon a huge storm will come through with torrential rains and lots of thunder and lightning.  Then it cools down for the evening.  We eat a mostly local diet which consists of beans, greens, and either rice or posha which is a starchy white paste made from corn.  We have chapitis for breakfast which is tasty fried dough! There are banana trees all over thee compound so we have lots of fresh bananas

Have iPad, Will Travel!

Thanks to my dear friends in Tennessee I have the use of an iPad to blog while in Uganda!  So exciting!

Thank you so much to all the friends, family, clients, and midwives who donated so very much to this trip.¬† You are all amazing and very much appreciated.¬† Just to let folks know there are only 3 things left on the list from the Ugandan Midwives that I haven’t been able to get yet.¬† You all are amazing!!!¬† Only things I need now are some twin sheets, blankets and washcloths – seriously down to the nitty gritty!

Extra Special Thank Yous to:
Treesa McLean, Tenaya Jackman, Maria Iorillo, Sue Baelen, Pacifica Maternity Center, Esther Healey, Rebecca Plum, Mary Perez and the rest of the midwifery community for support and encouragement
Regina, The Pope’s, The Kane’s, Jimena, Meredith and Jason, Jennifer and Scott, Stefan and Christine, Pam, Denise and Bruce, Kathy and Bob, Michael and Nicole, and especially to Adam for putting up with the giant pile of supplies that I still have yet to pack and am adding to daily…I swear, packing it all up is the next thing on my list…IMG_2852

Here’s some of what I’m bringing:

Brand new Doppler for the Birth Center
28 Fetuscopes for Traditional Midwives
Herbs, Vitamins, Medications
Brand new surgical instruments for suturing
Brand new thermometer
Rechargeable Batteries and Charger to reduce battery waste and pollution
Tons of gloves and gauze, bulbs and deLees for suctioning babies lungs, and lots more!

Thank you all so much!¬† I can’t wait to get there and get working!!

 

To Blog or Not To Blog

That is the question!

This week has been busy with preparations for my upcoming trip to Uganda with Mother Health International.¬† So far I’ve been collecting donated supplies from midwives as well as money so that I may buy the supplies and equipment that are needed most at this moment.¬† Clients, friends and family have been incredibly generous and I’m feeling very blessed!¬† As soon as things get purchased and ready to pack I’ll post a photo here so that you can all see the amazing things I’m going to take with me.¬† And possibly once I’m there I’ll be able to post photos and continue this blog so that you can all see the Traditional Midwives, the cute babies, and amazing Birth House.

The Birth House is solar powered so although there is no electricity in the village there is power at the clinic. And there is cell service – Everywhere!¬† I was selfishly hoping to be able to ‘unplug’ while in Uganda.¬† To take time to not interact with the digital world, to be off-duty with regards to e-mails, phone calls, etc.¬† But, I want to be able to communicate with my loved ones while I’m in Uganda.¬† I also would love to be able to share my experience with my community – to share the stories, post photos, and really allow everyone to feel that they are a part of this journey (because you are!)

Most of the time when I travel I send very few e-mails home and although I may journal about my experience I don’t share it.¬† But this time feels different, it feels less about personal gain and enrichment (although of course there will be that as well) but more about giving something of myself to a community that has a desire for my skills and experience as a homebirth midwife, working in the US.¬† And I want to be able to give something of that experience back to you, my community in the US!¬† As midwives we love to tell stories and I’d love to be able to share some of those stories with you as I go.

So I will leave it up to the Universe and the kindness of others in my community to help me decide whether to blog or not!¬† If somebody will let me borrow (or wants to donate to Mother Health International) an unlocked iPad with 3G, I will blog!¬† Supposedly 3G iPads work the best in Uganda.¬† I think what it means is that a device that can get onto the cellular network as opposed to wifi, and it needs to be unlocked – so I can put a different sim card? inside.¬† I don’t really know anything about that stuff, but I’ve been told that’s the way to do it!¬† If not, then I’ll still try, but it’s less likely to happen as I may not have an ability to get online more than every few weeks.¬† I don’t want to buy a brand new device because, as many of you know, I’m against purchasing new things (especially electronics) if at all possible.¬† And I don’t really have the need for an iPad in my regular life!

But if you’d like to subscribe so that you can get an alert whenever I do make a post then you’ll know if I’m blogging or not and you won’t have to check!¬† Either way, I’m excited to share this experience with you, and hope that you’re excited to experience it with me!!