You put hot water where??????

So recently I have noticed a lot of children screaming at the hospital. I was first thinking maybe because of IVs or Injections but no.......
Last week I heard the screaming and since it was a Sunday and I had just finished a delivery and did not have a million patients waiting to see me, I went to see what the commotion was about.
Well..........
There is a mother squatting on the ground with her child trapped between her legs and abdomen she is pulling her child's butt cheeks apart. Then HORROR....
She pours steaming hot water in her child's anus!!!!!!!
I screamed, "What is she doing? Please someone come and help."
The nurse came running she states, " Doctor this is a tradition in our culture when children are sick we pour hot water into their anus to clean them."
I told her, "That is not a tradition, that is child abuse"
Then I asked the midwife from Uganda about this. She states she gave up 2 years ago (she has been here 3). She states it is a Zande/ Azande custom and she used to scream at them but they never stop.
Also she told me that some families when they are wiping their children's butt they notice the pink of the anal tissue and get afraid and pour steaming hot water in it then also!!!
Every time now I hear a child screaming I try to go and save their anus. I do not make it all the time, in time.

Also speaking about culture, today a minister from Uganda who is working here asked me where were my husband and children?
I answered, I do not have a husband and children but I am very close with my own siblings and parents and extended family.
He asked me, "What happened to you?"
I answered, " Everything, I became a physician, completed 2 residencies, a Fellowship, have traveled to every continent except Antarctica as a tourist or a Medical Volunteer or Medical Missionary. I have saved many people's lives through God grace, and helped thousands. (I was trying hyperbole to get my point across).
I expected him to say, " Wow!!! Good for you."
But NO.....
He says, "That is all very nice but you are forgetting the most important mission, to have a husband and children. I hope you do that soon, before it is too late."
I asked him, "What if my mission is to be single or become a Religious, a nun?"
He said, "Impossible God wants us to reproduce. "
I said, " OK, God bless,"
Him, I can not change but I can try to save the children's anal canals.
God save us. God graciously save us.

On the other hand, last week was Pentecost and I had the BEST Pentecost ever!!!!! In my life!!!!
The mass was............
wait for it.....
4 hours long!!!!!!!
I felt like I was at a party, singing and dancing for 4 hours.
Not ONE second was I bored.
If you ever think religion, mass, church, God is boring, come to Ezo, South Sudan.
You will never think that again.
I love church here!!!!!
God is good, all the time. All the time God is good!!!!!

Doctor come, the baby's head is stuck...

Today is Wednesday.
We have Antenatal Clinic or ANC. People love acronyms here.
We had just finished seeing 40(!!!!!!!!!!!!!!) pregnant women when the nursing assistant from the Labor and Delivery came and very calmly states, "Doctor you come, Berna the midwife said you come. " So I ask, is it an emergency?
She answers very calmly, "A patient arrived from Nandi (a neighboring town) her baby's head is in the vagina."
What???
Is the shoulder stuck?
No. They can't get out the baby since yesterday.
What the HECK??????!!!!!!!!!
This conversation is happening while we are walking rapidly to the Maternity Ward.
A very dehydrated, lady is laying on a regular bed in Postpartum. Indeed a baby's head is coming out of her vagina.
So I immediately get the lady to the Delivery Room.
OK, the shoulders are not "stuck".
They are actually being pulled back if anything.
No fetal heart tones. (Dead baby of course).
But the women has severe abdominal pain., I can feel a leg very high up like right against the abdominal wall.
She must have a  Uterine rupture.
I say loudly and firmly, We need to go to the Operating Theater.
When we open the lady up, OMG!!!!!!
She has a huge uterine rupture. The uterus is exploded open.
Then WHAT????
CONJOINED TWINS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Thoracopegus. Joined at the chest.
This poor woman was trying to push out for 12 hours or more the impossible. They would have NEVER come out from below.
She would have eventually died.
Thank God she came. We can try to save her.
The infants delivered easily actually once we grabbed all 4 legs and arms.
Then we repaired the uterus.
I am shocked this lady did not die when she ruptured considering that her uterus exploded open through the side.
She just missed the vessels of the right side of her uterus.
We were able to save the uterus.
Now the strange part is that when the nurse brought the babies outside, the father ran off because he was scared. (So I am told, as I was still in the OR)
Then the aunt took the babies and placed them on a mat. Then everyone proceeded to call everyone they know and by the time I came out of the OR there were at least 150 people all around the babies. Looking, taking pictures. Calling more people.
I asked the "Theater Attendant" if we should bring the babies inside, and not let them be a "display". He said, No the family and the people want to see.
OK.
Then one of the Local midwives asked me if we have this type of "birth" in my "village". I told her that conjoined twins happen everywhere and in my "city" they also happen unfortunately. But usually we know about it early on because of early ultrasound.
So she asked me, "It is not satanic then?"
I responded, " NO of course not!!!! NEVER!!!!! It is just a simple issue of when the embryo separates. Pure science." "No Satan".
In fact we should thank God that this mother is alive.
PRAISE BE JESUS CHRIST NOW AND FOREVER!!!!!!!!!!!!!!!!!!!
What a day!!!!!

Butt rubs at Mass

Today I went to the Azande/ Zande mass.
Usually I go to the English mass early in the morning. But today I wanted to see all the excitement and what everyone is talking about.
It was spectacular!!!!!!!
Preteen girls in the middle aisle, dancing with every song. A full choir of about 50 singing with enthusiasm, swaying and clapping with each song.
All of us packed like sardines in this small church.
It was cooler today about 90 degrees Fahrenheit.
Everyone paying attention even the children. It is amazing.
I was sitting in the middle bench as I usually do for English mass and one of the Attendants (every one has a job) came up to me and told me to follow him. OK.
So I did and he had me sit up front near the altar. Which was fine because the big door is up front so more breeze.
Then the church became really full a few minutes before it started.
A little old lady about 90, bent over walking with a stick, weighing about 70 pounds wanted to sit behind me. She brought her own little chair which was maybe 12 inches off the ground. She sat right behind me.
When it was time to sit down for the first reading I feel something rubbing my buttocks. I thought could it be a bug?
No, it was not.
It was the old lady rubbing my behind. So I kind of pretended that it was a bug and brushed her hands away.
Nope. That did not do the trick. She continued to rub my butt.
Then when I stood up, I tried to move the 3 inches to the left that was empty space between me and the person standing next to me.
Nope. She keeps rubbing and now squeezing.
Nobody thinks this is strange.
Everyone is ignoring this.
OK.
I turn and smile at her and try hold her hands.
Why did I do that?
She then squeezes my breasts one at a time.
So when I ask the younger lady beside me what is the old lady saying?
She says, She is asking you how you became to big and beautiful?
OK So thanks for the beautiful part......
I think........
The rest of the mass I would feel an occasional buttock rub.
I guess when you are 90, you can rub someone's butt during mass.
It was an amazing mass and not just because someone was rubbing my butt the whole time.
These people really know how to celebrate the mystery of Christ.
Real community.
Real worship.
Real butt rubs.

Auto impregnation

Very interesting....

Today was the third time that a young patient comes to me asking to become pregnant.
The three of them are in their late twenties.
They come in, and ask can I help them become pregnant.
So naturally I say, well let us see what we can do.
Then I ask a full medical, surgical, obstetrical, gynecological history. Social history.
Every thing is normal.
Then I ask, how about your partner? Is he healthy? Does he have previous children?
They calmly tell me, I do not have a husband.
OK....
Do you have a boyfriend, male neighbor or someone to help you out with the other half of the genetic material?
Of course I do not say it like that but you get the point.
No, they thought maybe I had some medicine that could help women become pregnant on their own.
I think to myself, if I did then I would have received a Noble prize in medicine.
So then I explain that to have a baby, even in today's modern world. Even in the most modern medical situation. We need male genetic material (sperm) to create life.
Ohhh...... they say sadly.
Then I joke and ask them if they would like us to find them a husband.
They laugh and say No.

Sorry......

Eating Bugs

So now we are in rainy season. More or less every day it rains. At night after the rain on certain days that the local people know, but can't explain to me how they know, millions of "white ants" or termites gather under the light.
So we turn off all lamps and leave only one outside light. The neighborhood children gather and eat the flying white ants/termites alive.
I can't bring myself to do this.
But they dry them, remove the wings and cook them with onion and salt. Then the Azande people eat them by the handfuls.
Everyone who knows me, knows that I will eat anything and try anything. But I was able to take only a few bugs.
I could not do the fistfuls. And I absolutely could not eat them alive. Like the neighborhood kids eating them by the handfuls.
I do not know, Is it the little legs on my tongue, or the crunch when I chew?  I do not know. I have eaten in my life,  many things.
In Belize when I lived there for 2 months in the rain-forest with the Mayan people, I ate rat and armadillo.
I have eaten cow and sheep testicles.
I have eaten pig eyes, cow tongue, intestines, stomach, brain. Scorpion.
Not to offend anyone I ate a few of the bugs.
The people here say they are "sweet" I do not taste sweet but like a grass taste. Now maybe they do not know what sweet is.
They have no dessert here.
Can you stand it?
No cake, no pudding, no ice cream. NO DESSERT.
No brownies, no chocolate.
All of you already know there is NO ICE here. So water is lukewarm. Soda is lukewarm.
 No cold Coke. They have Juba Coke (named after the capitol city) which tastes like watered down fountain soda.
Any way I eat well every day.
BUT.......
I pass on the BUGS!!!!!!!!!!

Deaf Deliveries....... and miracles.......

Can I just say I have a soft spot in my heart for Deaf mothers who are delivering?
Last night we had a young lady who is deaf deliver a beautiful baby.
She was so focused on directions. She was strong and brave.
She immediately put the baby to breast and is a champion breast-feeder!
She already knew me because she came to look at her baby prior to delivery via the ultrasound.
God is so good to me.
I have had the privilege of delivering various deaf women in my career.
Actually at the North Shore Community Health Center, we were located next door to Deaf Inc. and we had quite a few of their clients. The beautiful midwife I had the honor of working with in Salem, Mary MT Collari CNM had a great relationship with them and shared this relationship with me.
So this was all preparation for last night, knowing what works and does not work with the Deaf Mothers.
What a miracle!
A mother, a beautiful woman who is sharing her body, her nutrients, her blood and oxygen with this little creature of God, has these contractions or "rushes" as Ina May Gaskin calls them. She uses all her energy to literally push out a 10 cm head through a barely more than 10 cm passage.
There is so much waiting during delivery usually.
Wait to be in active labor.
Wait to dilate.
Wait to push.
Then all of a sudden, after sooooooo much waiting there is an absolute and complete miracle happening so very quickly before your eyes.
There is another precious, complete human being with the potential for so much.
This new child could be the next Peace maker of this earth, then next scientist, teacher, physician, engineer that could change the world.
Wow!!
Am I lucky or what?
I get to witness this all day long.
It NEVER get old. NEVER get boring. NEVER is the same.
Women are so amazing.
Our bodies are so amazing.
God is Good. All the time.
All the time God is Good.

Promised Pictures.....

 I have the privilege of living on the richest man in town compound. He owns the local general store. He has 3 wives and 11 children. Two of the children are away at school.  I am the only one with an indoor toilet and shower in town. Also the only one with running water and a water tank. Above is my bathroom

 My living room. It is empty.

 The front of my house.

 My little neighbor Baquita. She is one of the owner's daughters

 This is Angelica the owner's wife's sister. She is peeling peanuts. A very common food ground in greens and cooked on top of rice with garlic and palm oil. And fried with salt also. Very good.

 This is the picture of my compound. My house is on your right.

 This is my back yard with 3 graves of family who died of HIV. All the adults in our compound have HIV.

 The community (Ezo) only public water supply. People come all day and fill buckets and jars and containers. People from 3 years old to 93 years old come. My tank is filled from this source. Sometimes it is stopped by the government. So we have no water.

 Our neighbor's compound.

 This is a "tukulo" on the CMMB compound. My house is on your right.

 My bathroom with the buckets of water in case of emergency.

My bed with my mosquito net. The bed came with the house.

Fridays......

We have great cases and happy deliveries all week.

Yesterday for some reason I just had the urge to drop by the "Safe Motherhood" Maternity Ward in the late afternoon. Everyone was like why did you come back?
I told them that I wanted to check on the lady who was sent from 75 kilometers away for "placenta previa" who turned out to be in labor.
She delivered a beautiful healthy baby.
Then as I was there talking with the midwife and nurses, a lady arrived. Everyone stated that she is an alcoholic or "drunkard" like they say. She is a G 10 which means she has been pregnant 10 times. Then they told me she was just released from jail and she is HIV +. Maybe compliant with treatment.  Wow!!
So I checked her as everyone is running around. She is 10 cm dilated, complete. She is cephalic (the baby is head down) but I said the baby's head feels small, her abdomen appears small. Well too late to worry.
As I step away to put on the protective apron that we wear, She yells out in pain and states the baby has moved abruptly. the midwife informs me that the baby is now breech.
What??????!!!!!!!!!!!!!!
Then she gives a huge push and 2 feet pop out of her vagina!!!!
What?????!!!!!!!
So I tell everyone, OK let us prepare the Operating Theater.
No, Doctor, this baby is coming fast and these feet are too small and we should not use the theater for this.
What?????!!!!!!!!!!!!!!!!!!!!!!
Then the lady starts pushing, Thank God I remembered breech face up can flip them on top of the mother to keep the head flexed.
So this is what  I do. Thank God it works and this lady delivers a double footling breech.
The kid is about 26 weeks, so very unlikely to make it here.
We suction the baby, warm him and let him stay with his mom, skin to skin. He died 12 hours later.
So this is why I felt called to go to the hospital.
Because if I was not there the head probably would have been entrapped and a big mess.

Then today a lady arrives and delivers a very abnormal baby.
The baby had gastroschisis (born with the intestines outside the body. Very low set ears, abnormal shaped head. Very pale. Very thick neck. I just realized this child even in the USA may not do well, so I suctioned the baby and let the Mom hold the baby. The baby was having occasional gasp for breath but not breathing.
She asked me to baptize the baby, So I did. She wanted to name him John.
"I baptize thee John, in the name of the Father, Son and Holy Spirit. I claim this soul for Jesus Christ".
That was very sacred to me, the parents were very pleased.
Now these are the stories that I want to get off my chest but every day we have beautiful deliveries, funny deliveries and great deliveries.
Blog coming soon....
All night parties for the dead........very interesting