Here’s the thing about swimming in the morning. I swim a gazillion laps and then I put on my glasses and kick a gazillion laps with the kickboard I toted here from home. And every morning there is some Australian or French or Chinese man sitting in his shorts outside of one of the rooms that has a door that looks out onto the pool. And every morning that man, whichever man is staying in the room apparently reserved for men in Vanuatu who smoke in their shorts in the morning, sucks away on his cigarette as if it was the last cigarette in the South Pacific. He is partially obstructed by a small palm tree and about 20 feet away from the end of the pool. He blows his smoke up and it puffs around him before the wind catches it and takes it away. And he continues on and on with this morning ritual while collecting his thoughts for the day. And I swim back and forth and kick back and forth dozens of times, trying to dump my thoughts from yesterday. And we stare each other down from time to time, until he has to go get ready for his meetings, and this is our little dance. I’m the only one of us that knows I have been doing this for almost 8 weeks with other men who have the same morning routine as he does. This morning there was a new man with new shorts and new cigarettes and new thoughts. And this morning there was me, back and forth and back and forth, unable to banish the thoughts in my head from yesterday so trying to let them just melt in to the ones that stay around for a while.
Yesterday was my last full day shift. Two midwives and a student came from New Zealand and we had a new crop of nursing students in and they were all integrating themselves into the schedule and the workings of the place. From 7:30am until 5:30 pm we had eight laboring mothers, eight births, eight postpartum routines, two of which were anything but routine at all. I was with two women who had lovely births and I taught some new nursing students through them. They have to observe 5 before they can participate and I had much teaching to do as the male student was abrupt and harsh with the moms and I had to beat it out of him. Which I kind of did. OK I totally did. I figure I am leaving before long and would rather give it to him straight than wonder if I should I have been more direct with him about respecting these women and their process and their babies.
The female student was seeing stars by the end of the first birth and just wanted to talk and talk about it. I had her deliver the placenta with me and then I gave her The Big Placenta Tour and told her to stand there and play with it and get to know it, fold it, open it, turn the membranes inside out and back again. She followed me all day long asking questions and translating for me when mothers had no English. She was a lot of fun but I missed my old students who know my ways already and who I have developed friendships with. I saw one of them later and we hugged and chatted.
I went to help out at a premature birth. I will have locked in my mind forever walking in and meeting the mom and the aunties and watching them smile and laugh and rub her belly. She had just been to have an ultrasound to determine dates—she was already almost fully dilated when she came in to the hospital. By records she was just 24 weeks, by scan 25, with the baby estimated at 870 Kilos. Very tiny. Too early. We had a quiet consult in the corner, reading the scan (which is not an ultrasound report as we know them but just notes on a blank page from the doc who did the scan) and staring at each other. We had a sentence exchange. “I hope it is more like 26 or 28 weeks.” “Me too.”
Even here where the death of premies is what normally happens with premies, I was relieved to be with the midwife from New Zealand who has been such a mentor to me and to see her working it out in her mind what our options might be for saving baby. We planned…if baby looked like it had a chance we would take one path and if not then straight to the mother so that she could hold the baby while it died. We were prepared to protect them and keep them together, something that is not automatically considered as an option here. The baby was breech. We called in a doctor to come do the delivery as is protocol for premies here. I don’t want to go into the details which feel private for the mother and baby and are frankly horrific in many aspects. I watched the aunties faces as they realized what was happening. We did our best to prepare them but the truth is, a person just can’t face it until it is upon them, and until there is death, there is life. It was an agonizing birth. The baby was stillborn, it’s little body not able to withstand the birth or life unsupported by the unique environment of the womb. We carefully wrapped the baby up, leaving his hands and face exposed for the mother, leaving the blanket loosely wrapped so that if she wanted to she could explore the curves and limbs of the child she had felt moving within her for all of the those weeks. I heard the NZ midwife behind me whisper, “We are all mothers here.” I gave a brief nod and felt a tear slide down my cheek.
The mother’s mom came in, having left work to come and be with her daughter as she birthed. She was paralyzed in the doorway and I gently placed a hand on her back and helped her in the room and eventually over to her daughter and grandchild. As I got her to the bed I heard screaming from the other half of the room and walked calmly but quickly to see what was going on. I saw a mother in there alone, she was obviously going to push her baby out. I took a breath and shook out my body and went in. I was instantly surrounded by students and more importantly the utter life-force pouring out of this mother. She was power incarnate as she leaned back on her elbows, arched her back and pushed. My heart was still with the mother on the other side of the room. I needed my whole self there with this mother. I was responsible for her and the baby and these students. The newly arrived midwives came in and observed. The birth was beautiful; the baby was perfection and acted just like we hope babies will through birth. It found its way out and I swooped it up to mom as it let out a screaming opinion of the whole experience and then quickly quieted as the thump of its mother’s heart was felt and heard beneath her ear. This was baby number three—the first girl after two brothers, and she was welcomed mightily. The mother held on to that girl with gusto. I was lost in the joy with this mother and the memories of my sister-in-law having her first girl and one of our clients having her first girl and all of the girls we have welcomed and celebrated. And there was my experience here in a nutshell. Whatever is happening in one moment, life will pull you forward into the next without a thought for whether or not you are ready. At home we pause and gather energy for the next big thing. Here we are whisked in whirpools of loss and sorrow, joy and triumph, shaky knees and power. And it just keeps going and going until the whistle blows and someone else comes and stands in your place to give you some reprieve for a few hours.
We had 10 minutes before we had to move one of the moms and babies and it looked like the laboring ones would wait that long so we all ran to the lounge to get some food in. The NZ midwife said to me, “Lunch. Now.” I have learned to trust her sense of timing and bolted to the fridge where I put my lunch. I didn’t think, I just fueled up and hustled out to get the mom and her baby settled in. The mother who lost her baby was given a bed near the midwives’ desk where higher risk mothers go. There are only 4 beds in that room so it is a little easier. She was alone in the bed staring at the mother across the way who was nursing her baby. I went in and sat on the bed next her and held her hand and she cried and cried. I told her what a strong good mama she is and rubbed her forehead softly while she closed her eyes. I stayed with her until she fell asleep and then quietly took my leave. The other mother was crying and smiling at me.
I went to check on the delivery room to see what kind of activity was going on. I sutured a mom while next to us another was birthing. She was attended by the newly arrived New Zealand team. I heard pushing for a while. Too long by Vanuatu standards, too short by American. I peeked. Bleeding ahead of the baby—she would have some deep tears. I went to the front desk and told them I just want them to see that it is not me in there to which they chuckled because they know I am paranoid about this whole issue, even though I have seen it happen to mothers when I am not the midwife with them. I went back to check. Still pushing. I caught my favorite doctor and told her I felt something was not quite right and that maybe one of the hospital employees should be in there with the visitors. She came in with me, took one look and lifted her eyebrows in her way that means, “you are right, Jodilyn.” She left the room and I stayed in the back, watching.
Baby was born quite floppy and they started mild “hey, wake up baby!” activities that were unsuccessful. I had already put together the bag and mask and set them out for them—I have had long discussions with a variety of people about this kind of thing. Am I intuitive? What does that mean? I might just be putting together bunches of tiny bits of information and compiling them all like symptoms into a syndrome, or I had a funny feeling, or whatever we are going to call it. I just knew this was going where it went—although I can’t say I imagined the final outcome, I did think they would need to resuscitate. They brought the baby to the table and I told the student how to place the baby as she put the baby backwards, which is exactly how a person would place the baby when we put babies down, but this was one to work on and not to admire and coo with. She turned her around and they got the resuscitation working. The baby had a good heart beat. I have learned here to palpate the heart beat instead of listen for it as it is faster. So I felt then listened. I left them to it and went and got the NZ midwife who came in and called the shots thereafter. After 15 minutes of bag and mask the baby started to breathe on her own but it looked reflexive in nature and she had no tone in her muscles, did not open her eyes, and continued off and on to stop breathing. I ran around the ward finding the doctors we needed and they came in and tried to get IVs going. She was finally stable enough to move—although still had shown no sign of life beyond heart and lungs. In the nursery I watched her—clearly having seizure after seizure for quite a long time, longer than I care to say, until the medicine came which stopped them. One of the mothers who has been in the Nursery with her baby for 5 weeks now is the most amazing peer-mentor. She did not let a second pass before she placed her own baby in his incubator and went to show the dad how to open the arm slot and hold the baby’s hand and stroke the baby gently and talk to the baby. She was amazing. I have seen her doing this with parent after parent. She is stunning, so full of compassion and gentle, easy companionship with the other parents in there. Their babies come and go, some live and others do not. She never waivers in her steady and soothing presence.
I spent the rest of the day doing births, getting moms and babies settled and running back and forth between the nursery and the mother to give her updates. I happened to have my camera there and took some pictures of the baby with the dad holding its hand to show her. This seemed to really soothe her. I assisted with her suturing which was extensive and I learned a new technique that was very cool. I will probably never need it at home as our women just don’t tear like that but I am glad to know it. At the end of the shift there were three babies who needed shots and to be put on the scale and all of the baby things we do. I happily busied myself with them, feeling their good weight and tone and enjoying the way they stared at me as I talked and sang to them.
I sat at the desk and talked and laughed with a midwife and my OB friend. I am very good with punch lines here. Probably because the things they talk about are so funny. There was discussion about the men in the Mobile Force here. They tend to wander. They tend to have many women in love with them. My friend said, “ah, it’s the uniforms, hmmm?” “Oh the uniforms!” said the other midwife, laughing and with a dreamy look on her face. “They are too Mobile in the Mobile Forces.” I stated. “Oh GAWD Jodilyn!!” Laughter and laughter rang out as the midwife held her head in her hands, shaking it and staring at me. The thing is that things I say have stronger nuances in Bislama than in English and I am always phrasing them wrong so it is easy to keep them entertained, which we have all decided is my actual purpose here. We stayed past our shift unwinding together. It was good.
Meanwhile in my neighborhood the party rages on…the trash is piling up under the trees where it will be burned when the piles get too high. The dogs are hardly able to move as they are clearly the beneficiaries of all of the fair food that is dropped in part or in whole around the field as people walk and eat or sit on the ground and leave leftovers. Even the dog I have a tenuous understanding with gives me happy eyes and rolls over to show me his full belly when I walk by in the mornings. If I come here again I am going to bring a box of MilkBones so I can keep some in my pocket for growling dogs and grunting beady eyed pigs…maybe they aren’t mean, maybe they just have low blood sugar.
And now I am sitting outside on a windy day, the palm trees making a racket, the clouds fighting their way in, my laundry rippling on the line. I am headed back to the hospital to check on the baby and to take pictures as I told them I would make a web page for students or midwives coming here so the learning curve might be a little less steep. There is nothing that can really prepare a person coming from the modern westernized world which I think is a really great thing—getting knocked out of the comfort zone and into this reality or any reality outside of ours affords opportunities I am so grateful to have had a tiny slice of. But a few pictures and some words about some of the nuances might help a few future visitors a little bit…