Rainy Season even in my heart.

So last Friday I was so happy. We did our first C-section. Mom and baby safe.
I was on top of the world........

 It is now 9:30pm on Friday night and I just got back to the Compound.
Rainy season has started. The people here in Ezo tell me that it will rain until November. The roads that are so bad to drive the 5 hours to the closest town Yambio are almost impassable now. But tonight even my spirit is raining, thundering and lightning.
What a sad evening......
So today was a typical day. Seeing Obstetrical and Gynecological patients all day. Everyone is enamored with the ultrasound machine. I happily and gladly show them their babies, their ovaries, their bodies inside.
I came home late in the afternoon. Took a shower. Was in the yard with the awesome midwife Annet (from Uganda) and then she received a call on her cellular phone that the other midwife who is at the hospital needs me to come stat as she has a baby who has "severe asphyxia" (trouble or not breathing). So Annet and I jump in the very old but thank God functioning Land Cruiser and I drove (as the official driver already went home) to the hospital over the terrible bumpy roads.
When I arrived people are looking at a grey baby. The midwife is giving the baby breaths through a ambu bag. She is alone doing her best. The nurse who was there was doing whatever she was told to do.
So I immediately started, neonatal resuscitation. We "worked" on the baby for almost 3 hours. Because I could just not let go. We would get a heart beat after epinephrine. So I would continue but the baby never spontaneously breathed and here we have no ventilator machines. I got an umbilical IV line going and was giving the baby medicine through there.
It was so hard for me to stop resuscitation. The entire family watched me for the nearly 3 hours. I kept praying to God to give me a clear idea of what I should do regarding "calling the code". The baby would become pink after epinephrine and heart rate would be strong. BUT no breathing.
Plus my goodness this is my first resuscitation. I wanted a living baby. I wanted to be the hero who gives the mother her baby and have every one happy that the Muzungo (white person) Doctor saved the baby.
But no........... that was not the plan.
It was hard to tell this 18 year old HIV positive mother that I could not bring her precious beautiful baby back.
She saw that I had worked my heart out for 3 hours. I had many times said, "Come on little one, come on baby, take a breath.". My shirt was soaking wet with sweat. My face was red.
She started to cry. I gave her the dead baby to hold. The interpreter told her everything. How we worked and no spontaneous breathing.
She looked at me and said, "Thank you for working so hard to try and save my baby."
I feel exhausted. The rain continues outside and in my heart.
Tomorrow will be a new day for me but the mother will live her entire life remembering her dead baby.
Pray for her.
God gives and God takes away. Blessed be the name of the Lord.

What HIV prevalence means

Here in Ezo county we have the highest HIV prevalence in South Sudan.
You do not understand what this means until you live somewhere where more than 80% of the population is HIV positive.
Wow!!!
CMMB, the group that I am volunteering with is doing an FREAKING AMAZING job with placing all these pregnant women on therapy, and the population in general. They are using the latest and greatest protocols. I am so very impressed.
We have a very low vertical transmission rate. In other words Moms to babies.
Just to give you an example, I live in the compound next door to the CMMB compound (where the midwives and CMMB staff live). I am the only person on my compound that is not HIV positive excluding the small children. The man and his 3 wives and his brothers and his relatives that live on "my" compound are all HIV+.
Just yesterday we were doing Prenatal Clinic which by the way after being in the Operating "Theater" is my new favorite activity, we had to tell a newly pregnant 19 year old young woman that she is HIV+. For me it was tough to do but it is so common that she was not really devastated. Perhaps she was being stoic. But the good news is CMMB has a great HIV clinic set up, giving medicines to everyone but of course our interest is pregnant women.

Polygamy is normal

OK....
So I did not know that among the Azende or Zende people polygamy is normal. One of the staff at CMMB had mentioned it during orientation but for real, it is a common way of life.
So of course it is the man who can have multiple wives. There is an obvious over population of women. Maybe through war, random chance, disease or most importantly HIV deaths, there are more women.
But of course polygamy here has been going on for millennium. Not even colonization, Catholicism or strict Protestant Evangelism has stopped it.
So like the guard here has 2 wives. The business man that owns the home where I live has 3 wives. Even men who attend Mass on Sunday have multiple wives.
It is not taboo to speak about it either. In fact the Ugandan Midwife that I work with Annet who is not from a polygamous culture teases the guard if he is going to acquire another wife.
We laugh. No one is offended.
When I was in Sudan last visit almost 12 years ago, I was with the Dinka tribe who are monogamous. So this is a really different culture.
The wives by the way all live on the same compound and get along. Also interesting is that the man has the women come to his hut/house. Not like we think where the man visits the women's home.

Curious cases.

So, Monday and Tuesday I had some very curious cases that I would like to share with you. 2 sad and 2 odd.
2 sad cases: a women comes to the Maternity Department with 2 pieces of paper for the Doctor (me). She is accompanied by 2 girls. One 9 years old and one 11 years old.
They are the daughters of her brother that were sent to her to care for.
The story is the 11 year old states while she was sleeping in her hut (no doors, no floors open in the bottom) a drunk man came in and fell on her body and grabbed her and raped her. The paper is from the police department and it is requesting an exam to see if the child has been raped. This happened at the end of March.
The sister is 9 years old, she states that while she went to carry water to her home a man that she knows called her into the woods and she states she thought he had something to give her so she went and he grabbed her and raped her. The paper from the police also requests an exam to verify and this happened at Easter.
So the 11 year old did indeed appear to have been sexually assaulted per anal route and the 9 year old did appear to have been assaulted vaginally. Per the exam, the foul odor.
So I did write the report for both of them.
Very sad.
Then a 14 year old came with a paper from the police to verify if she had been raped but this patient told us that she was not raped, she loves this boy who is like 15 and had sex with him for the first time. She states that he was arrested and she "made an arrangement" to "play sex" with him. This is through the interpreter.
Then Tuesday, yesterday, a girl come with a note from the principal of the school and accompanied by her father that she is disrespectful to her father, she is rebellious at school and this for them is an indication that she MUST have had sex with a boy causing this behavior and to perform and vaginal exam to verify if she was  "successful" being a virgin or she was "spoiled". To let them know either way. So at first I said bad behavior is not an indication for a vaginal exam. But the local nurse who trained in Italy with the Comboni nuns stated that we have to perform this exam or they will not let her back in school and her father may throw her out of the house.
So I did a very quick external exam and wrote a note verifying her virginity.
OMG!!!!!
Can you imagine if we examined vaginally every rebellious teenager?!
Obviously no photos........

Joy!!!!!!

 This is the woman who needed the surgical repair. She is happy with her baby!

 Interesting story. While she was pregnant there was a question regarding the paternity. Her male partner had said that if she had cheated on her, he put a curse on her that she would be pregnant for 15 months. Then when she was about 40 weeks (10 month aprox.) they went to him and asked to stop the curse. So he said if the baby was his she would go into labor that very day. He then took water in his mouth and sprayed it over her abdomen and then to the other side. She went into labor that night, so needless to say he was very happy that this was his baby.

 Post partum.

 Nurse Patricia on left rolling cotton balls. She is a very interesting person. She was with the Colomboni Nuns in Italy where she went to nursing school in Milan. She speaks Italian! So we were chatting in Italian. The Volunteer Justine is on the right, making Sanitary Napkin pads. Very innovative.

Mom in labor who we later took to the "Theater" (Operating Room) for C-section. Standing is the TBA (traditional birthing attendant) She received money for every mother she convinces to come to the hospital to deliver. This is the Delivery Room.
Also interesting story. As this women was in labor, pushing, her male partner doubted his paternity so they felt she was pushing for a long time as a punishment. Because her 5 previous deliveries had no problem. So he also took a mouthful of water and sprayed it over her private area and said if the baby was his it would deliver before night. Well we did the C-Section in the afternoon. So he also was happy the baby was his. The water spraying from the father's mouth works almost as well as DNA testing. .

Pictures!!!!!

 On our CMMB compound the staff, Juliana and Teresina where they wash the dishes, the wooden structure. The brick building is not finished, so it is full of trash.

 Annet the wonderful midwife and John the guard. In front of the dining area and Annet's bedroom.

 The CMMB Safe Motherhood ambulance and the outhouse.

 Annet in front of our dining room table.

 Our neighbors in front.

 Neighborhood children.

 The Theater (operating room) behind the non functioning water tanks and in front of the non functioning generator because no one has connected it yet. To the right is the HIV clinic.

 Delivery Room, One dark, hot room.

Antenatal clinic and postpartum.

Awesome Friday; first Cesarean Delivery in Ezo!!!!

Today was a great day!!!
Annet the midwife from Uganda (who is a joyful saint) and I went to the hospital early this morning and we just arrived home!
What an incredible day!!!!
When we arrived I was informed a mother who had just delivered had a tear that needed a surgical repair.
So right off the bat, I was sewing her. Then we had prenatal visits and I took care of the pregnant ladies who had sick visits today.
That was fun. It was through an interpreter as now I realize it is a privilege to speak English here as most women speak Zande or Azande (tribal language) or Arabic.
Then we had a women in labor who since this morning was pushing and had many hours of arrest of descent and I was asked to perform a Cesarean Section.
Wow!!!
This was amazing.
We went to the Theater (Operating Room). There is no electricity, no overhead lights so we used a head lamp run on batteries. Then there is no Anesthesiologist or nurse Anesthetists so we gave IV Ketamine (the only medicine available). There was only ONE vial left so we hoped and prayed that would be enough.
We only had a set amount of sutures so we had to be conservative on sutures yet quick on time to make it before the Ketamine wore off.
There is no Operating room nurse or tech so we pick our own instruments, set up the table, and choose what we need off the instrument table.
By God's grace and all of your prayers we succeeded and had a beautiful baby boy with a big (normal) head who just did not want to come out.
I felt so humbled and grateful to every one who assisted us. It is amazing how much you can do with so little.
I am so grateful to all those in CMMB in New York, who take the time and email me and are so wonderful.
When I think about other missionary physicians who even have less and do more, I take my hat off to them.
God is great! All over the world there are human beings working so hard to help others. Like all the nurses and midwives and TBAs (traditional birthing attendants) that I have the honor of meeting and working with in Ezo, Western Equatoria, South Sudan.

Late Entry

Today I left the capitol of South Sudan, Juba and took a United Nations flight to Yambio. This is my second stop in South Sudan. This is in the Western Equatoria state where there are no paved roads and beautiful red clay streets.

 Good Bye Juba Capitol City

 United nations flight. Really amazing pilots. Thank God for their skill

Hotel in Yambio where I am staying before taking the bus the Ezo.

This is the way it should be....

This morning I went to Mass here in Yambio, South Sudan, Africa.
At St. Mary's Catholic church.
I had to control myself from crying out of joy and happiness.
This is what church is all about. A celebration!!!!
Coming together to share our lives.
There were so many people at the Mass that they now conduct mass outdoors under a large tin roof mega structure. No walls, no doors, no floor. The red clay ground is under our feet.
A 60 voice choir up front. No formal training but hearts filled with love. 4 part harmonies. Perfectly tight. Emotion that is so real.
No one was looking at their watch. Everyone swaying with the music, clapping if desired.
The alter is full of people carrying out different roles.
Wow!!!! This is what Christ meant about community.
I did NOT take pictures as I did not want to be like a tourist.
What an event.......
I did not realize how much I missed exciting Masses.

View from hotel in Juba South Sudan.

Juba South Sudan

Very real goals

I just wanted to share:
"The first to apologize is the bravest,
the first to forgive is the strongest,
the first to forget is the happiest!".

My prayer is to be the bravest, strongest and happiest.
This reminds me of the story in the New Testament when the woman is caught in the act of adultery, and brought before Jesus. The crowd wants to stone her. You all know the story well. They are trying to "trick" Jesus, if he says, not to stone her, he is breaking the law of Moses. If he says to stone her, he is not being compassionate.
Jesus of course is not worried, he stays quiet, writing in the sand, then says, "Whoever is without sin, go ahead and throw the first stone."
Of course they walk away one by one. Then he asks her, "Woman where are your accusers." She states, "They are gone." Then Jesus says to her, " I do not condemn you either. Go and sin no more."
WOW!!!!!
This woman did not come to Jesus asking for forgiveness. She was "caught" in the act. Jesus forgives her WITH OUT conditions. In other words. He does not say. OK you are lucky today, but you must be careful. I do not know if I can help you in the future.
NO....
He just says, Go and sin no more.
Abba: please help me to forgive and love UNCONDITIONALLY.

Delay

Last night one of the CMMB coordinators Joel, informed me that the Humanitarian Flight is not leaving Juba for Yambio today. It has been delayed until Friday.
No problem. I am at a safe and clean hotel. I even have TV.
I purchased a local Nokia cell yesterday hoping to call my family but the SIM card does not work consistently, then it did work but the battery was not working.
So at least my time is occupied in the pursuit of a working cell phone.
I downloaded Skype last pm. Now I can communicate that way. At least now in Juba while I have internet access. That is funny the past 3 years in the USA I have NOT used Facebook or Skype because I felt it was occupying too much time. Also because of my job I wanted to be careful with social media. Now I am back using social media these few days until I am in the country side of Ezo where I am told there is internet access but not consistent. Also I will be working and will probably not have a lot of time on my hands.
Sorry that I am not giving you exciting medical news. I can give you exciting food news.
Breakfast is very interesting. Thin crepe like pancakes with sweet undertones, veggies chopped very fine and sauteed with garlic and olive oil.
This square biscuit like bread, very thick. Beans and eggs and hot dogs and chicken wings this am were at the breakfast buffet.
Many of the roads here in Juba are not paved. It has been raining and thundering and lightning.
Will inform you of any further news.....

Travel!!

So after a 12 hour plane ride from Boston to Dubai. I am here at the hotel in the airport in Dubai waiting for tomorrow morning to fly to Juba, South Sudan. Then I am told I will wait a day for the Humanitarian flight to Yambio. Then a 12-24 hour bus ride to Ezo depending on road conditions. Thank you to all the wonderful family and friends and co-workers who have given me so much strength and I was packing and preparing.
I keep repeating the words of Cinderella's biological mother before she dies, "Have courage and be kind.".
Will keep you updated.