essentialmidwifery

Birthy Thoughts by Jane E. Drichta and Jodilyn Owen

Winding Down…–Jodilyn July 25, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 12:03 am
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Thursday was humid and sweaty.  I felt like I was  moving through Jello and time was going soooo sloooow.  One of the midwives asked me, “Will today ever end?”  I don’t know what was going on unless they all felt the effects of the humidity as well or this is just one of those common workplace occurrences where everyone has slow-days.

We had several moms in early labor and lots of paper work to catch-up on.  We attacked the paper work, the tidying that never ends, making empty beds, mopping up…on and on.  I did a bunch of newborn exams and spent a lot of time hanging out with the twin’s family.  The dad was there to help get mom and the girls home and we chatted about their older son’s reaction to the babies and seeing mom and dad holding them.  Parenting is a universal challenge—we talked about Touchpoints (thank you Dr. Brazelton) and I shared some stories from when the kids were little.  Dad owns a tour company and they invited me to come and see “their little island” which reminded me of MamaMia : )

Of course everyone decided to have their baby at the same time—we had four mamas going within ten minutes of each other and they threw me into one to work with a student.  I had assessed this mother throughout the day and she would only let me touch her, telling the student and the other senior midwife who came in that she would have none of their fingers in her body.  Ok.  I actually wanted to support this student through it as she needs the hands-on.  At this point, strangely, I am feeling like I have done a lot of births and don’t need to do more.  (time to come home?!)  But I understood her position and respected it.  To make a very long story short she had a super tight fit and pushed for an hour and half, which is like 4 hours of pushing at home—it is unheard of.  She was bleeding ahead of the baby and complaining of acute pain.  We kept tabs on the mother in the bed across from her and they were having parallel experiences.  We prepared for both of them to have some serious bleeds and just asked the doctors to come hang out.  All the other babies were born first—3 girls.  This mother was insisting that she wanted a boy.  I slipped in once, “ok, it might be a girl too” and then held my peace—she would have to make hers or not make hers when the baby was born and I just decided I am wrong to interfere with her hopes and push reality on her when she is clearly a)not ready for that idea and b)in possession of 50% chance of getting what she wants.  The other mother had a high tear that required suturing by a physician and after baby was born so did this mom.  Baby was indeed a boy (!) and she asked me to go out and tell dad.  I went to tell him—he was a young 20 years old.  I asked him to come and see the babe but he wanted to know first what it was.  I told him it was a boy and he told me he actually knew that already so it was no surprise to him—he had had a very strong dream and had no doubts.  He made the transition from playing it cool to being uber excited quite rapidly and jumped up and snapped my finger—a trick the locals do which he later gave me detailed instructions in so I can show Jeffrey.  He wooted and hollered and danced around and clapped me on the back and kept saying, “alright!  alright!”

Friday I filled out and folded dozens of “blue cards” which are health records that parents use keep to track immunizations, well-child visits and any notes a provider would like to make mention of.  I also filled out and folded dozens of birth certificates.  So the next many many babies born in this hospital will have my signature on their birth certificate.  Which is kind of funny, considering I am not even a citizen here.  I am doing a lot of newborn exams as I have to pass my exam in the fall and have to match my scoring to the examiner’s scoring in order to be certified.

The weekend was all atwitter with building booths around the perimeter of the park for a week of celebration.  The booths are made by stripping the bark off of branches and then notching them at the ends so they fit together.  A whole frame is made in this way.  Ceilings and walls are made of woven leaves.  Each booth is about 10×5 or 10×7, depending on the use and they all share a wall with the one next to them.  Everyone was busy preparing, either with the weaving or the framing and then the moving.  That’s right, the moving.  Families move into these booths and use the front to sell goods—mostly food–and the rear to sleep in.  It is like a week-long Seafair from the old days when peons like us could pitch tents and actually enjoy themselves without spending a fortune.  All Sunday afternoon people were hauling pots, pans, sleeping mats and household goods down to the park.  Many of the houses are empty.  Chicken road is well represented with a few booths that are triple-wides in a row.  So now it is easy to visit my friends, I just go to their corner of the park and hang out.

Sunday at 3:00 began the festivities of Children’s Day with a parade led by the Big Chiefs from several islands, the minister of finance of Vanuatu, and several other dignitaries.  Behind them came the band and then the children and then the stragglers.  This parade does not work like our parades where everyone starts at the start and ends at the end.  This one started with the Chiefs and the band and a few children and they parade around the neighborhood and people wait on the street to see them and then join in at the end of the line so that by the end of the parade, when the procession marched onto the field there was a hodge-podge of people of all ages tagging along.  The prize has to go to my father-in-law’s counterpart here who ran around the corner from his house, got a big hat and stuck a Vanuatu flag in it and then waited for his grandkids to come down the street.  They clearly thought they had lost him and laughed and laughed at his prank.  He swooped up one of them and joined in the parade.  I happened to have been on the corner he ran to and he told me his joke while he got his hat situated.  Grandpa’s are da bomb.  I have been listening to so many stories lately and a lot of them are about grandfathers.  I will share one in a later post.

The parade entered the field and the Big Chiefs were called to do an opening ceremony, which is actually a ceremony once reserved for the start of wars between villages, and the singing sounded much  more war-like than happy-Children’s-Day-like.  They went to the middle of the field and exchanged Kava.  There were several chiefs present and they started to dance in a circle.  After a moment a group of grandmothers (I kid you not, some of them are great-grandmothers) ran to the center of the field and started dancing around the chiefs, much to the delight of the onlookers.  The chief from Pentecost saw them and stepped out of the chief’s circle and danced with the grandmothers instead.  This was extremely popular and there were loud cat-calls from the audience, who stood around the perimeter of the field.

Then came the speeches.  I had been warned.  But I’ll just say that I listened to about 6 of them over an hour and a half and then headed back to my room to call home and say happy birthday to Jeffrey and drink water.  I could hear them talking for another 2 hours so it was a good decision.  I had the chance to skype with Jane and I’m not sure what exactly happened but there was an extremely high rate of laughter and accusations leveled at each other regarding something to do with acting like 12-year olds.  Looking back, I’m not sure if 12 isn’t too mature.  Either way, just one more thing making me feel ready to come home.  I talked a long time with the kids and Benjy as well which was so great–also, making me feel ready to come home.  I am really happy to have these feelings.  I was kind of worried when I got here about how I would manage to get on a plane and leave.  Ever.

The partying went into the wee hours of the morning and this morning was the only morning since I have been here that the neighborhood was not awake with the sun.  I walked to the pool and it was still pretty quiet with the exception of a few toddlers who rose at the usual hour and teenagers who hadn’t gone to bed yet.  This will continue on for a week—even now there is a huge game of soccer going on the field and a live band playing music.  And it’s only 10:00am.

I am winding down my work hours as I want to see some more sights here before returning home and am frankly wanting fresh air.  All of the weeks in the hospital and the fumes from the cleaning agent still make my eyes water and set my gagger off.  I have caught a lot of babies.  I have delivered quite a few.  I feel confident about suturing, dystocias, breeches, twins, internal exams, and mothers with friable tissue.  But not so confident that I will ever approach birth without knowing that regardless of what I know, the mother knows more and the baby knows more and as a team they know best about how to birth and be born.

And not so confident that I would ever assume I could midwife better, just because I midwife differently than my colleagues, mentors, or peers.  This place has knocked the judgment out of me.  I hope that I can go on to support those in my profession with an open heart and genuine curiosity about who they are and how they arrive at decision points.

And certainly not so confident that I will ever stop learning or wanting to know more about why things unfold in the way that they do.  I am so lucky that the people I work with are information seekers and that they not only put up with my endless energy for getting to the bottom of things but they one-up me or encourage me or sit patiently with me as we talk these things out again and again so that we can all be better for the families we serve.

 

The Star of the Show (almost)–Jodilyn July 6, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 9:43 am
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quick post just to track the mayhem, and it’s mostly birthy updates for my non-birthy friends reading, skip to the end if you’d like where you will read a bit about after work…

Today I caught the 40th baby born in 6 days.

I had a first time mother who looked very healthy.  Baby was coming down OP but rotated and either he had a hand up and shredded the mother on his way around or she had absolutely no tissue integrity…either way plenty of bleeding before baby was born.  I actually asked one of the med students to whistle down a doctor because it looked like the placenta may have begun to separate ahead of the birth.  I put the Doppler part of the CTG on mom’s belly and got good heart tones.  I left it sitting on her belly for the duration of labor.  Forgive me please, I know the dangers of Doppler but felt at that moment that I had to decide which was the greater worry and I chose  monitoring baby’s immediate well being as my priority.  Blood oozed forth and the doctor was poised to move.  I had to get bossy with this mom who I had worked with all morning and had developed a connection with so she took my shift from gentle quiet talking midwife to bossy lady seriously.  Baby’s head was born and blood was pouring over his face.  After the body came I held him in a good drainage position for about 5-10 seconds and watched the fluid run from his mouth.  He was vigorous and well but I did not want him to drink in mom’s blood if at all possible.  When he seemed to have cleared the fluids I put him skin to skin on mom.  I won’t get into it entirely but clearly there was something not right.  Her tissue was so friable that even as the doctor sutured the many many tears new ones were opening up.  After an hour and half she settled on packing her with gauze and waiting for a couple of hours to see if it would get easier.  I left her for all of two minutes to go sit down and do the paperwork and have a drink of water.  I forgot my pen so went back into the delivery room and there was mom, standing up wanting to walk to the bathroom.  I had already mopped up the quite bloody floor and it was now coated again as she clearly had open tears that bled when she was walking.  I slung her arm over my back and half carried her back to bed, got her a bed pan and gave a good finger wagging about staying in bed until we moved her out to the postpartum area.  I mopped again and cleaned her off again.  A second doctor came in to do the second repair as the first doc was worn down.  I was worn down and I had only been holding the speculum and watching the progress (or lack thereof) and mopping!

One of the moments I love at homebirths is that dreamy time after mom has her baby and she is all settled in and the midwives have some time to rest and decompress or fall asleep in a heap all tangled up together on a too-small couch or some corner on the floor.  Even when births go perfectly this time is still so valuable.  So this birth, which  had loaded me with adreniline, left me in need of collapsing in a heap to recover but alas (or awae as they say here…) I never did get that moment and left two hours after the shift was over.  The second doc actually removed all of the stitches the first doc had placed and restitched the mom.  We finally got to move her to a postpartum bed 6 hours after the birth.  We had a big review of the birth after and I told them the only time I have seen this kind of tissue shredding was a mother who refused proper treatment for diabetes.  They were testing her blood sugars when I left tonight.

The other birth I did today was in a supervisory role as a nursing student was finishing his last required birth.  We had the Aussie med students in with us and it was a nice learning atmosphere.  The mother was plagued by muscle cramps in her feet, calves, and arms.  I tried unsuccessfully to get her sister to go and buy some bananas for her.  So barring potassium all we had was our hands and all of us were rubbing her down.  I kept my hand on her belly and she was skipping the contractions—not even able to think about pushing because of the pain of the other cramps.  I taught the nursing student how to perch  at the end of the bed and let her stretch her foot and leg by bracing her foot on his shoulder.  It was a second time mom who was pushing with good contractions and not making any progress.  I started to talk out loud about the things I was worried about and as it became clear that the baby was hung up on something and they had finished another delivery on the other side of the room, we wound up with several midwives in the room.  I asked “how many midwives to deliver a baby?”…they started laughing and tossing out numbers and we decided it was less than were needed to figure out how to run the microwave and more than were needed for changing a light bulb.  I was happy they were there as I knew we would need an extra hand and if the baby had a rough time then several extra hands seemed just fine to me.  They loaded synto (what we call pitocin, they call syntocin—synthetic oxytocin) in via an IV and soon the baby was being ejected.  Something was still clearly wrong as the baby was so slow to come forward.  He turned out to have a tight nuchal cord which had no give at all.  There was hardly room to clamp and cut on the perineum but we did it and he came right out.  His cord was exceptionally short.  He needed a bit of help to get going but came round quickly—a great big baby boy.  I did half the suture job and another midwife finished it up as there was a lot of bleeding and I was worn down to the bone and couldn’t even see straight, and was frankly a bit traumatized by the other suturing job of the day.

I bathed some babies and got them into their nappies, got the moms settled in and finally looked up to see how late it was.

Now here’s the not birthy part of the day.  I hustled over to the pool for a swim and was about half way through when I heard a loud horn of some sort.  It was dark around the pool and in the pool and I am half blind so I had to stop and put my glasses on to see what the continuing blast was about.  I looked up and there was a native Vanuatu man in kustom garb blowing a conch shell.  I took a look around and it seems I was swimming in the middle of what was about to be some kind of show of kustom dancing and kava drinking for the hotel guests.  There were a dozen dancers waiting behind the tree to come out and start the show.  I jumped out of the pool, wrapped my lava-lava (sarong) around me and hustled back into the trees behind the dancers.  I put a tshirt and skirt on over my swimsuit and watched the start of their show and then walked home, dripping wet, my flip-flops squeaking the whole way.  I think, for the record, how amazing it is that I am not too embarrassed to relate this small story…  : )

 

Hemi One Midwife from America–Jodilyn July 5, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 9:18 am
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Today started early, up at 5:30 to get to the pool before work.  When I arrived there were two inductions underway.  I continued with part two of yesterday’s project in which they turned the big cabinet in the midwive’s lounge over to my organizational savvy.  It was a veritable field of gold—I found a lot of donated supplies hidden away.  There is a fear here about using these things, that someone will borrow them.  But leaving 6 new stethoscopes in their boxes in the cupboard for two years is not a much more effective use for them.   I refreshed the equipment and supplies in the delivery and exam rooms, filled a cabinet with donated baby clothes in the room where we bathe and examine the babies, and ran a bunch of toys and larger clothes down the pediatric wing where they were promptly given away for use.  I stacked up all of the pictures that have been taken of visiting midwives and students that were sent here as gifts and made them easier to browse through.  I compiled all of the stats books by order of which kind of stats are gathered within and gave a book on how to perform vasectomies to a urologist doctor who asked me why we didn’t want it.  I stared at him for a moment and then he burst into laughter…

I actually want to take a break in the orderliness I was imposing to talk about laughing here.  The laughter here stretches across the street and down entire blocks.  I know some of my neighbors by their laughs—long cackles and high pitched “hooeeeyys”, the stuttered giggles of small children and those huge open-mouthed-head-thrown-back deep laughs some of the men have. Laughter here is unmodulated, joy thrown forth from bodies that are aligned in ways that would make ballerinas in America green with envy.  The chest is thrown forward in a physical sharing of happiness.  It is not tempered or adjusted or toned-down in fear of being seen as flaunting or whatever it is that keeps us Americans from going the distance when it comes to joy.  There is clapping and hopping and quite often, shoulder shimmies.  Teenagers tend towards knee slapping and grandmothers do the same.  There is a culture of acceptance when it comes to joy.  No one tries to take it away or diminish it.  No one accuses the joyful party of being too joyful.  Here, joy is shared and bold and independent.

Which is how I got to talking about laughter…this doctor, so enjoying his joke.  I laughed and laughed with him until we were all laughed out.  I finished the distribution of supplies and complete organization of the cupboard and went to observe the med students doing their newborn exams.  They seem to have been taught by the resident here who does not seem to know why he is doing what he is doing and has thusly modified some of the elements of the exam and now they don’t make any sense.  I observed and helped answer their questions and then talked about some of the items.  Tomorrow we are going to go through a complete exam together so they can see an American Style exam, where I will talk through each item–what we are looking for and what the absence or over abundance of can mean.

I spent a few hours doing assessments on babies and scoring them, part of my certification requirements for the second certificate I am getting through the Brazelton Institute.  It is so stunning to do this assessment and talk through it with the parents and watch their eyes light up as they see the unique behaviors of their babies.  It feels in many ways like I am providing a deeper introduction to their child and that I get to be a witness to the discovering of baby as a unique and individual person that these mothers make.  One of the grandmothers wanted to sit in on the assessment with the mom—this was the grandmother of the new mother and she was elderly and half blind and mostly toothless and had one of those dispositions that makes me want to sit next to her all day long.  She exudes grandmotherliness.  I’m pretty sure that is not a word but you will all know what I mean.  As I worked through each item on the assessment the grandmother got so excited and starting say “whoop!whoop!” and slapping her knees every time the baby responded to me or I elicited a reflex from him.  The baby, as they tend to do with this assessment, became more and more engaged and interested the further we proceeded.  He stared at me constantly waiting to see what was next and performed like a champ for his great grandmother.  It feels magical in the moment, to see how capable and what depth there is to their personalities, even when they are only hours old.  The grandmother dissolved into fits of joy.  She was thrilled with his clear miracle-like abilities and proceeded to walk around the ward and tell all of the other grandmothers what her baby was doing.  Oh, the baby’s name?  Owen  : )

I spent the day doing these assessments between births and got a good number in.  There was another set of sticky shoulders on a beautiful tall baby girl, 4th girl to a mom who wanted a boy but promptly fell in love with this little one.  The local midwife had called me in to catch this baby and the mother had an absolute panic attack.  She was terrified of me.  I asked the local midwife to do it as I have no desire to be terrifying to a mother with a baby on the way out.  The midwife told her, “you no be fright, hemi one midwife from America” (don’t be afraid, she is an American midwife) and then she started to leave.  I said, “wait!  come back here, she is afraid and that is not good for her or baby”.  I talked gently to the mother and the other midwife stayed, and it was all good.  I took care of her and baby during her postpartum hours and I definitely grew on her as she got to know me better.  As for continuity of care from the start, there just wasn’t time.  She walked in pushing—something the women from her island are known to do.  They have super fast labors, don’t tend to need any suturing and get up and walk about shortly after the birth like nothing ever happened.  Now I know to try to get these women when they come in!!

I walked flip-flop time down Chicken Road on my way home.   I played my way through two dozen kids, giving high fives and watching different displays of childhood.  Like little peacocks they are eager to show me what they have done with their day and their creations and inventions are a pleasure to behold.  I did remove a sharp metal edge off of a little plastic pipe some of the boys were using as a trumpet, but other than that, it was all good.

 

Kustom Dancing and Pranks on the Ward–Jodilyn June 30, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 11:14 am
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I rearranged my day today so that I could participate in a conference call via skype for a board I’m on at home…I only had to redial 6 times so I have to consider that a success all things considered!  I forced myself to take a nap in the afternoon which was nearly impossible considering the ruckus that is this neighborhood at almost any given hour…usually not a problem since I am collapsing at the end of a long day.  I went in for the night shift and things were oddly tidy.  It turns out there was just one birth today so they spent the day cleaning and straightening up.  A few of the midwives were headed up to practice their Kustom Dance performance and I tagged along, wanting to see it.  I wound up jumping in and learning the dances with them, it was quite fun and involved the use of brooms (which are thin twigs tied together), a 2 foot tall speaker, and a few doctors as well.

I headed back to the ward after dance lessons were over and showed off my newfound skills to the night crew, who were either quite impressed or quite entertained.  Hard to say.  I helped out with some of the babies in the nursery, removed an IV from a postpartum mom, talked nice with the new mothers and their families and then sat at the desk with the midwives for a chat.

Suddenly there were noises of groaning and pushing coming from down the corridor.  Everyone stood up but I was closest so I did a trot around the doors to see what was going on and there was one of the senior midwives from the day shift in mock-labor.  She started jumping and clapping and laughing.  I found out later that she regularly pulls pranks after the night shift gets settled in.  Apparently she is quite skilled as the midwives told me they fall for it every time.

With everyone settled in we retreated to the lounge to watch TBV (Television Blong Vanuatu aka the local station).  We got the news, the sports, and the weather reports punctuated by public service announcements on a variety of topics.  Then came on a drama by the local kids community center for the arts, the troubled, the youthful masses yearning for direction and positive influences.  It was the perfect combination of Law and Order type mystery and action and sexually transmitted disease/domestic violence education.  That’s right, cops and robbers meet “use protection when you sleep with another woman instead of your girlfriend.”  I kid you not, that was the plot.  It was actually quite compelling television and very well acted.  So kudos to the kiddos who are involved in the performance arts instead of trouble!  There is the somewhat familiar character trait of yelling at the TV during the program here (familiar if you ever had the distinct privilege of watching TV with my grandmother).  I joined in the yammering and vociferously encouraged the teenage girl who had landed a job singing in the local bar to stay home like her parents were begging her to, because all that is out there waiting for her is “Chlamydia Chlamydia, Chlamydia!”  This got me approving looks and a slap on the back from the doc.

With only one baby arriving today, in a place that averages 16 per day, tomorrow is bound to be busy busy…and if not, I will grab a broom and practice my kustom dancing : )

 

Snorkel, Snorkel, Snorkel…–Jodilyn June 29, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 9:32 am
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Well, firstly, hooray!  Jane has made it to Uganda in one piece : )  And just a reminder–we will put our names after the title of the post so you know if you are in the south pacific or uganda before you start to read…

Very little makes me as happy as when I am Under Water…chlorinated, fresh, ocean, doesn’t really matter. I am covering for a midwife shortage coming up when two of the midwives head to a conference so am taking a couple of days before hand to relax and get ahead on work. Today I headed to Hideaway Island…just a mini-bus and skiff ride away. This tiny island boasts a resort that is open for day-use for the cost of about $10 which is then credited back to you for purchasing a drink at the snack bar. It’s something out of a dream really, with white lounge chairs in a single row across the ocean front and picnic table under the shade behind them. The island seems to be made of millions of pieces of washed up coral. Hideaway is the proud home of the only underwater post office and I bit it and paid $4.00 to send one home. It’s kind of a dive down and there were several folks who purchased them and wrote their notes but couldn’t make the dive down so I played post-lady (or so the aussie’s call it) and dove repeatedly under to get the cards posted. It is kind of funny as at 2pm every day a man dressed in scuba gear waddles into the ocean, empties the box and then puts the postcards in the skiff where they are delivered to the main post office in Vila, where they may or may not make it out to their destinations. But it is just so cool, I couldn’t resist. The coral here is full of color and life, with purples of all hues, deep reds, bright yellows, endless endless color everywhere I looked under the ocean. I saw giant purple clams and swam in a school fish that was hundreds and hundreds of fish big. I tried to herd them and got a big circle going but realized I was in the middle of it and suddenly surrounded by yellow-striped fish all staring at me with one eye was a bit creepy and I swam over the top of the pack. Little black and white fish are curious fellows and if you stay still for two long they will converge on you to investigate. And luminescent rainbow fish like to be warm and will hover near your body if you stand on the ocean floor. Giant fish disguised as coral show themselves if you keep very still and wait for them to move. The water is in a protected bay and quite a lot calmer than the snorkeling Benjy I did all over Kauai. I met a woman from New Zealand who was also playing hookie and we lounged and read and chatted the afternoon away. The sun felt great after the week-plus of rain and cold. I took the skiff back to the main island (a 4 minute nauseating ride), then took a walk down a long spit which turns into black sand at the end. It was incredibly beautiful and quiet. I would love to go back there at night for a bon fire. On the way back I saw the pack of med students and they invited me to come out with them tonight but I am beat from the day in the sun and surf and hope to get a good sleep tonight without the noise of the squalls waking me up every 15 minutes or the noise of the Aussie rugby team that was here last night hooting and hollering in a drunken roar at 2am (urrrrgggghhh). I have made my most important connection so far when I struck up conversation with a loud happy local woman at the NumbaWan Café. I was wondering what approach to take when it comes to independence day here and heard her speaking English so I asked. Should I diverge and tell you the contents of the conversation I overheard? Probably, at least a snippet of it. She and her girlfriend were looking at pictures of some of the dancers that are performing on independence night here. They pulled up a photo and her girlfriend said “there is a G-d!” to which she replied, without missing a beat, “or a devil, but either way, I’m in!!” This was followed by huge infectious laughs. But back to the story…there are clearly parties being planned all over every neighborhood. It turns out that she is in charge of the events in my ‘hood. She actually seems like she might be in charge of the neighborhood in general. She has a week-long program and was detailing all of the night’s activities. There are competitions for everything—kid’s competitions, men’s, women’s, beauty, dancing, kustom dancers, foreign dancers, food, on and on and on…It kind of sounds like 7 nights of the Camp Talent Show. But the important part of this story is that now I get to go and hang out with Ciska—Queen of Seaside Neighborhood. Hooray! A word about Aussie TV: It’s Horrible. (ok , that was two words but now I’m done) A word about morals on Vanuatu: As long as one is honest about their immorality, it is moral. Steal? Cheat? Play around on your spouse? Just own up to it without skipping a beat when asked and it’s all good. A word about bugs in Vanuatu: If they have left their home and entered yours, and Dirty Harry is not doing his little lizard job and eating them, close your eyes and smack with a shoe. Gross, but better than bug bites.

 

Pigs and Bats June 27, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 12:27 am
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Just a quick note to tell you that Sunday morning started out with me getting chased by a pig on the way to the pool (enter the usual rescue heroes an old lady with no teeth and an umbrella to beat him back and masses of small boys under six with pebbles and pig-wrestling skills).  For the record it was a Giant Pig and not the cute pink kind with the curly tail.  We looked eye-to-eye and after he added some snorting and grunting to the posturing I decided he could win and bolted.

The midwife here from New Zealand and her husband took us American girls on a round-the-island tour where we sampled coffee from Tanna, saw black sand beaches, and stood in the roaring wind with our feet in the warm turquoise waters of the south pacific.  The weather was stormy but we had a great day.  I shouldn’t forget to mention the one beach we stopped at where some locals had trapped some bats (which I think they call flying foxes) and were prepping them for a good ole fashion BBQ.  The other American midwife and I were making gagging gestures—I believe at one point she said she would rather eat a locust than one of those bats—while they explained how they grill ‘em up.  Apparantly the armpit is quite succulent we were told, while he spread the wings out to show us.  These creatures look like squirrels with bad-ass teeth and leather wings.  They should be the mascot for a biker gang.   I really can’t go on about it, it is making me a bit queasy.  We ended the day with an outdoor movie down at the NumbaWan Café where they string up a screen just in front of the ocean and use a projector with DVD to show the movie.  It was quite fun and I discovered that they do have ice cream here but it doesn’t taste at all like ours.  There is finally sun again after a week of squalls and rain, though it is entirely blustery, which I am just trying to enjoy as the humidity has been blown away for now.

And for the record, when I went this morning to swim the pig had been thoroughly detained in the back of the property again so I called him a name and walked slowly by.

 

Twins, Breech, A Baby who is Here to Stay–Jodilyn June 25, 2011

After six days of 8-12 hour shifts I happily collapsed Friday night, falling asleep to a light but steady rain.  Squalls woke me up and kept me up most of the night and I finally gave up and decided to walk up to the hospital to say goodbye to several mothers and babies who were checking out today.

The family who named their baby after me told me they will be having a party in a couple of weeks and will send someone to collect me for it : )

The next bed down was a first time mother who had no one with her for her labor or delivery except for me as her aunty and her husband were at work and she hadn’t thought to call them until she was already pushing.  I gave her lots and lots of good back rubs and managed to hold her hand right until the baby was born and then she held my arm while I caught her baby, who I somersaulted gently out of the cord that was around her neck and straight up to her mother’s chest.  Next in the row was a first time mother who was so tiny I had asked for a second pair of hands from the midwives who were eating lunch and watching French soap operas.  She had the body of a 10 year old and I just didn’t have a lot of confidence about the whole thing…of course she proved me wrong and delivered a 2700 kg baby over an intact perineum.  She was 20 years old and was clearly madly in love with her little baby when I saw her this morning.  Her young girlfriend had been with her and was cowering in a corner when mom started to push so I encouraged her to come and hold her friends hand and sit by her.  She had never been to a birth before, something I figured out when she nearly fainted as the baby was born.  She caught herself and rested her head on the pillow next to the new mother’s.  As soon as baby was settled on mom’s chest and I was sure the mother wasn’t going to do any excessive bleeding I went around the bed and kicked a chair under the friend.  She looked up at me and said “OH WOW” and then laughed and laughed.  The Tutu (grandmother) came in and started clapping and kissing her granddaughter who had just delivered and then kissing and hugging me in a great show of affection.  It is hard to argue with an octogenarian who wants to shower you with love, even while waiting for a placenta to deliver!

Next in row in the postpartum area was a second time mother who was up and looking like a beauty queen—as if she hadn’t ever given birth.  Aha!  So they have those mothers here as well!  Across from her were our most recently delivered twins.  The mother came in having had no prenatal care and in active labor.  The head midwife wanted the doctor I’ve been working a lot with to be primary on this delivery.  The other American midwife and I talked over what to expect with her extensively as the mother labored.  Since we had no idea about these babies and how they were situated inside—one sac or two, one placenta or two, we planned on taking preventive measures and doing the best we could.  It was clear that twin b was sitting breech so as we waited on the birth we reviewed the mechanics of breech birth with this doc who had never seen a breech birth before.  It was a great collaborative spirit and the other American midwife and I were happy that the doc was asking for instruction.  As the first baby came she asked if she should cut an episiotomy to which we both cried “no!”…so she waited.  She kept asking if we were sure about that but before she could finish the sentence twice the whole head was born.  Then she went to reach in and pull the baby out and we both cried “no!”  I told her, “the baby will come to you.  Just keep your hands there and let it come to you”  the other midwife was speaking in the calm soothing tones to the doctor I had seen her use with mothers so many times now and I smiled at what we were doing there…retraining her, talking about the baby’s ability to restitute on its own.  Sure enough the baby turned to one side and one shoulder slipped free, then the next, and the body quickly followed.  We clamped and cut the cord pretty quickly since we did not know if the twins had any of their vessels crossed so we wanted to keep the blood supply even between them.  The doc looked up at us, “boy you ladies are patient!!”  We provided some guidance for twin B and felt from the outside as it settled into a nice breech deep in the pelvis and after several minutes the mother felt like pushing again.  10 toes appeared first and they were so darn cute as they wiggled their way into the world.  We lifted mom way to the edge of the bed so that the baby would just hang on its own with no disturbance from any of us or a table which might block its way out.  I had repeated several times to the doctor the mantra “hands off the breech” and as the feet were fully born she went in to support them and we both said “no!  hands off the breech”.  I said “Dr. X, I know this is the hardest thing to do but you cannot touch that baby!”  The other midwife showed her the sweeping motion she could do once the head was born to bring the baby to mom.  Dr. X did a little dance to keep from touching the baby which I have subsequently showcased for her over and over again : )  Breech baby twin B arrived without drama after a proper hang and maneuvers,  all self-directed.  Dr X was quite thrilled with the whole event and I let her in on the little secret that most of what midwives do is wait and paperwork.

So I said goodbye to those moms as they were on their way out today and it was nice to be in there just in my “civies” which is what they call clothing that is not scrubs and to sit and relax with the moms.

One other case this week that I don’t think I wrote about was a couple who were in having their second child.  Their first had died on day two due to some very tragic circumstances and they were extremely traumatized.  They were terrified their baby that was just born this week was not doing well and he would die too.  I spent about an hour with them doing a whole newborn exam and assessment.  The father was so upset because the mother was refusing to sleep and the baby was already 20 hours old so she was into day two + of not sleeping.  He spoke great English which was wonderful as I could really talk him through everything.  I reassured him it was normal for mothers not to sleep and to be primally obsessed with their newborns under these circumstances and that it would take baby proving his intent to stay on day 3, 4, 5, and so on for her to start to buy-in to releasing the fear she has now.   The baby looked like a normal 1 day old but was very smooth in some ways that I didn’t love, although nothing tangible enough to really complain about.  I told her since she was awake she should provide kangaroo care for the baby since that will give him the best shot at regulating his heart and respiratory rates and give her the feeling that she is getting to know him and get a sense of who he is.  She loved this idea and immediately put the baby skin-to-skin under her lava-lava (sarong).  I modeled for them talking to the baby and I asked them to express their fears and then I retold them to the baby and asked him to understand how loved and wanted he is and to know that the fear they have is not because they believe he will not stay but because this is all they have known.  There is something really amazing about telling their stories to babies, as they tend to perk up and listen.  He did this and I encouraged her to talk and sing to him that night plenty.  I told them I would be back first thing in the morning to check on them all.  I spoke that night with the other American midwife about this baby and she agreed there was something not quite great about him. Even though we know that babies on day one will sleep the bulk of the hours of the day, it was hard not share the fear with the parents, and I’m not sure if that wasn’t what was causing us to see him in this way.   I skipped swimming in the morning to get there early and went straight to them.  He was nursing vigorously and showing off great muscle tone.  I asked her if I could bring the medical students by and share her story with them and talk to them about the assessment I was going to do again.  She agreed.  As I did the exam he was clearly totally present and accounted for and although he started out fussy (which frankly I was happy to see!), he slowly got interested in what we were doing and he landed in that wonderful state where he was primed to learn and play.  He showed off by tracking further than the average baby does and regulating his states beautifully.  The mother finally smiled as she watched the incredible language of her newborn and when I was done I passed him to her but he had seen her from the middle of the bed and was all-eyes for her, and she was taken in by him entirely.  It was incredible to see him win her confidence over and although she was exhausted she looked fresh and eager to be with him as we left them alone to discover each other.

 

Continuity of Care–Jodilyn June 22, 2011

Being cared for by a provider who a woman gets to know and develop a trusting relationship with matters.  Having that same provider care for that woman throughout her labor and birth matters.  I had started to wonder if these truths, which seemed so fundamentally true in my little world, were true at all in the great big world I have come to.  I have seen over the past two weeks women laboring alone in the hallway as providers buzz past them without a kind word, or any word at all for that matter.  I have seen only two husbands present for the laboring and birthing.  I have seen soon-to-be-grandmothers doing the hard work of massaging, nourishing, encouraging a mama—their daughters–in labor.  I have seen everyone a mother knows scramble out of the room just after the birth as they have been taught that this is what they should do.  I have seen babies parked in corners in bassinets.  I have seen women wanting to stay upright or on their sides while providers bark at them to lay down flat and open their legs.  I have seen mothers whose bodies were instructing them to perfection in the slow art of pushing out a baby told to push for sustained periods of time and I have watched them lose their breath trying to do so.  I have seen providers trained without the understanding that after a baby’s head is born, the body will restitute to one side for the birth of the shoulders and body, reach inside and pull babies from their not-quite finished process.  I have seen mothers whose eyes go flat as the providers are giving a series of cold harsh commands that deny the truth of what the woman and baby in front of them are doing in that moment.  I have wondered:  why do these loving connected people turn into the essence of 1950’s medical model when it comes to birth?  How do these women accept what is done?  Do they gather and tell their stories to each other or is this just parked away as one of the many things women here experience as part of their lives?  Am I projecting all of this onto the women and it does not bother them at all?

Today I went in early and stayed late.  I learned so much today about so many aspects of birth and this culture and the women here.  Last week I did a day of prenatal clinic as you’ll recall if you’ve been reading.  It was very insightful and helped me understand the charting and what kind of care is received before we see them during labor down on the maternity ward.  That day I was shown how one visit typically goes and then thrown into a room by myself.  One of the women came in and stopped me in my struggle with Bislama by telling me she speaks English.  We had quite a long visit with her as she had some things going on and it took a while for me to find out what kind of tests (if any) I could order for her as well as for me to interpret the previous results from another test she had done (we measure differently to start with but I could not read the doctor’s writing at all—another thing that seems to be the same in any language!  And for the LD fans out there, I thought right away to go to a pharmacist to have it interpreted but the pharmacy is three buildings away!)  She is a very tall woman by American standards, but here, where I am tall, she is several heads above most of the people here.  She is a calm, centered, and strong woman.  Long and short of it, I just really enjoyed her and hoped very much I would be on duty for her birth.  When I came in this morning she was there, in very early labor with her fourth child.  She was unhappy with what she felt was prodromal labor (a long early labor that didn’t seem to be picking up in intensity).  She asked me what I thought about her going outside for some exercise and I agreed that sounded like a good idea.  I showed her the stomping I had been taught by some Kenyan woman many years ago and she headed out the door to “go find a hill to stomp down”.  She came in a bit later looking more active and indeed when she was checked she had made quite a lot of progress.  I understand her frustration as all around her women here have their babies after only a few short but intense hours of labor (we had one deliver in the car on the way to the hospital today btw) and woman after woman came through delivering while she walked the corridor with her mom.  I checked in on her often and between other deliveries gave her mom a break and rubbed her back.  I did manage something fun today with a dad who had missed the birth of his first baby and was adamant that he would not miss this one.  He was so involved and loving with his wife.  I had him discover the sex of the baby by picking up the legs and making eyes at him to look—he sang out as he announced “one smol boy!!” and then I had him cut the cord.  Something very few men here have done.  He loved it.  It was a very celebratory moment and he kept checking on me the rest of the day and smiling proudly.

There are a handful of Australian medical students here and they are full of questions and eager to learn so I spent a lot of the day talking to them about what we do and why, and what they will see here and why not to do it.  One student attached himself to me and he was blown away by simple things like comfort measures and acupressure points.  He took his learning quite seriously and it was something else to see this 6’3 Australian doctor rubbing a mother’s back and asking if he was getting it right.   There is the most amazing midwife here from New Zealand—she is here on a two year contract and is a wonderful teacher and mentor for the staff here, and for myself and the other volunteer midwives.  I have learned from her to stake my claim to a birthing woman and I have learned that I would rather be alone, knowing I can call out for help at any time if I need it, and manage the birth the way I want to then to have some of the local midwives come in and start barking at the mothers.  We can be having a gentle lovely birthing with an actively engaged mother and it can all get shut down in a second when the local midwives come in and tell the women to lay flat and stop talking and push until they are purple in the face.  I have learned to speak up for what I want here in all new ways as I talk over them, coaxing the mother back to what is hers:  her birthing.

Late in the afternoon around 2:30 this mother got into active busy labor.  I stayed with her, as did the Australian doc.  We massaged her and gave her water and told her how wonderful she was.  She labored silently, smiling or grimacing when a contraction hit and then resting in between them.  She sat upright on the bed for a while, then asked if it was ok if she took a walk-about (which means, as it suggests, that she wanted to be able to walk around).  I encouraged her to do so, to follow her body and was so happy as the local providers all got busy elsewhere and left us alone.  Her mother stayed with her and she had a lot of attention from the three of us.  She became very hot and I used one of the gauze cuttings as a washcloth, wetting it with cold water and wiping her down.  She made such happy moans and told me it felt sooo good.  Around 3:30 she told us her other birth stories.  We listened to her.  We asked her questions.  She said this number 4 baby was acting like her number 2 baby—taking a long long time to come.  Around 3:50 she told me her husband is a sea-man, out on a ship due back tonight at 8pm.  I said, “oh, now I see what is happening here—do you miss him?”  She looked at me and smiled.  Her contractions picked up and became very long.  The Aussie doc had to leave and the other American midwife came on duty and offered to assist which I was so happy for.  At 4:02 mom leaned back and arched her back and her waters burst forth like those from a damn, suddenly shattered.  I felt the wetness seep into my scrubs and saw how far it reached across the room.  I love that power—it shows us how strong those membranes are and how strong the contractions are!  A local midwife wandered in and sure enough started barking at her.  I spoke right over her and said the mother’s name.  She looked up at me and I told her, “gently, gently, you keep doing what you are doing, you are perfect.  Do not be afraid and do not rush, we are right here and your baby is fine.”  The other American midwife spoke in such soothing low tones to her, talking slowly and never relenting until the other midwife stopped talking and just stood back and listened and watched.  Slowly, slowly the baby crowned showing us a bit more of herself each minute.  At 4:08 the baby was born with hardly a cry and I put her right on mom’s chest, skin to skin.  The mother said, “she is happy here on my belly, she is not crying.”  Smart mama.  After we had her all cleaned up and resting and nursing her baby she told me she felt  so fortunate to have come when I was there, to have had this birth where no one was commanding her to do this or that, to feel she could come up onto her elbows to birth the baby instead of laying flat.  I finally got to ask my questions to a woman who could answer them fully and we talked about the treatment here and the perception of the treatment in great detail.

I told her that we believe babies are conceived in love and should come into this world surrounded by love to which she and her mother fully agreed.  The midwife from New Zealand told her she needs to go and tell her women friends that this is what it should be like and this is what they should demand…to be respected and encouraged and trusted, that change comes best from the consumers.  We talked about our families and she told me she had been a basketball player.  I told her about Julia and that she loves basketball so much that in all of her school pictures she has her basketball with her.  She replied a simple, “of course they do.  A girl who loves basketball is all about basketball.”  Fabulous.  And in a delightful surprise I now have a very tall 4200 kilogram (9.3 lbs) baby named after me : )  .  Tomorrow I am bringing in my camera as I must have a picture with this family!

Today I learned that it is not just about one birth or one mother and me doing the best I can for that woman and that baby.  It is all about one birth and one mother and me doing the best I can for that woman and that baby.  We don’t know when we are interacting with someone where that interaction will take them.  And we certainly don’t know where it will take us.  Her birth has taken me places.  It was transformative for my understanding of who I can be, here and at home.

I have seen many wonderful things from the midwives here.  I have seen them stop a postpartum hemorrhage with finesse.  I have seen them mop and scrub and set up a bed for a mother with great concern for the details of cleanliness and infection prevention.  I have seen them wrestling with what care plan to lay out for a complicated case.  I have seen lights turn on in their minds when a new plan was introduced to try to understand why the babies who die here are dying.  I have seen them attend to families as if they were their own.  They have so much they do so well and I know they have the capacity for the rest.  They were trained in this very specific way and I think with the work that this New Zealand midwife is doing they will continue to improve and grow as providers.

On a side note, the Aussie med students came in today with loads of boxes full of brand new and used hospital equipment, including a new pump for the Nursery/NICU, resuscitation equipment and so much more.  It was very thrilling.  For anyone planning on coming here, if you take Air Pacific you can bring as many bags as you’d like if they are under 50lbs.  Please let me know if you are coming and I will email you a list of much needed supplies.  It is worth the lug to get them here!

 

Today I… –Jodilyn June 19, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 7:37 am
Tags: , , , , , , , , ,

Today I…

  • caught a million babies.  (ok, maybe not that many but all four beds in one room were full the whole shift)
  • got pis pis’d on–the women today decided to empty their bladders just before pushing,  while laying supine, so it actually squirts up in an arc.  Surprise to me!  And a Quick Learning Curve—I only got tagged once.
  • I had a MAJOR postpartum hemorrhage from one first time mom.  And I managed it.  I had to order people around as I don’t have six hands but i did that effectively.  It really sucks when there is a river of blood pouring out of a woman.
  • I got pooped on by two babies who decided to show me just what they thought of the way their days went down.  I would probably crap on someone if I had to do what they did too…at least they are cute.
  • I calmly replaced the needles on two shots a nurse was prepping to give a newborn to baby size instead of man size needles. (yikes)  And then I explained to the babies my plan and gave them their shots (every baby gets hep B and vit k here)
  • I gave first baths to several babies who were all alert and interested in me.  I sang them silly songs.
  • I taught a young aunt how to bathe her niece and dress her.   I just pretend I know what I’m doing when it comes to these nappies—they are not like our diapers at home.  So now the aunt will always put them on wrong until one day, one of her family members points it out to her and she realizes what a ignoramus I really am when it come to under garments for newborns : )
  • I helped a nervous new dad to sit down while his wife was asleep and I put the baby in his arms and it was magical
  • I almost passed out (somewhere in the middle of the babies and heat I realized the weekend people don’t use the AC in the delivery rooms OR the fans…and I had been so busy I hadn’t had time to drink.  I had the mute nurse (who is so sweet) stand where I was standing and pretend to be me while I went into the midwive’s “lounge” and lay down and drank 40 oz of water straight.  It really, really helped.  Then I got up and got back to it.  I made a comment about it being hot and one of the other midwives said “it’s hot sistah, you said it!” and I looked around and everyone was drenched in sweat running down their bodies.  I made eyes at the AC and one of them flipped the on switch.  Too little too late, 4 women, their moms or sisters or both, 2 midwives, 2 nursing students, one doctor…too much heat for one rickety old window AC.  At least I had 40 more oz to sweat out.
  • After my shift I went to visit the kids down the hill and I made wheelchair races for siblings in the childrens ortho ward.  There are no Rules here for kids.  It is a dream come true.  They get to play and keep score and fight it out if there is a disagreement.  It is like Childhood Unleashed and it is such a relief!  Kids learning to think and problem solve without adults telling them every little step they should take.  It’s Fabu!   Anyway, we went outside where there are long sort of empty pathways with hills and raced around in a giant rectangle.  I ran behind them urging them ever faster.  One of the boys had a little sister jump on his lap who was about my nieces size and she held on for dear life as he plummeted down the hill.  I should mention that the wheelchairs are old wooden things that don’t resemble what we know about wheel chairs at all.  It was FUN!  The old people laughed and clapped for the kids.  I visited my little friend whose mom was sleeping yesterday.  He had his whole family with him today and had the run of his dad’s cell phone which was playing music.  We showed off our mad peek-a-boo skills.
  • I got to skype with Jeffrey and Benjy and wish B a happy Father’s day and say goodbye to Jeffrey as he gets ready for camp tomorrow!

It was a great, great day.  And now I will collapse.  Goodnight to all!

 

Walls of Heat, Walls of Rain–Jodilyn June 18, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 8:34 am
Tags: , , , , , , , ,

A note about the weather here:  it has decided to act up.  I got trapped in my room when sheets of, or rather buckets of rain were dumped down upon the island by fast moving clouds plowing their way across the Pacific.  When it finally seemed to let up I headed out to do some errands, carefully placing things that matter to me in ziplocks, just in case.  The roads are slippery here when coated with an inch of rain and silt and the going was slow.  I finished a few of my errands, including one to purchase an umbrella, when the skies opened up again.  I decided to wait it out over a book and a glass of apple juice, which oddly enough hit the spot–likely replenishing some much needed sugars that had been sucked out of my body on the river of sweat which poured forth.  I sat in the back of this ice cream shop which is open to a view of the ocean.  It was so strange watching 60+ year old Australian men drinking milk shakes, which is what was happening in multitudes.  There were only two children in the entire shop.  Actually, let me diverge for a moment and say these Australians really have me baffled.  There are many (and I mean many) women well into their 50s, 60s, and 70s who walk around town wearing corn-rows braided from their foreheads back by the local women who charge a few hundred Vatu for the service.  At first I found myself wondering but now when I see them I just think happy thoughts of women who are no longer 17 years old feeling just good enough in the sun and the surf to try things like this.  So oi oi oi Aussie women, I give it to you for the braids and the male companions 20 years your junior and all the rest of the unmentionables as well!!  And hooray for giant chocolate milkshakes—of all the things a man who wants to venture out and go crazy at the age of 60 might do, a chocolate milkshake seems like a safe foray into pleasure (and it’s decidedly Chlamydia-free)!

By the time I got back to my room I was caked in mud up to my knees…and not Seattle mud.  This was the kind of mud fancy French people use for facials and it requires scrubbing to remove.  I was soaked from head to knee in water from walking in the heat and rain so I took a cold shower and scrubbed my shins, calves, and feet for a very long time.

Ok, back to the weather and the ice cream shop as I seemed to have skipped that part.  I became engrossed in my book when I felt I was being rained on.  I looked up and saw that indeed, the rain was so strong outside it was spraying 8 feet into the non-window windows and I was getting a cool shower.  I could hardly complain as just minutes prior the air had become heavy with heat.  I waited a good 20 minutes for it to let up and then walked back to my room.  The rest of the day was spent in this vicious cycle:  heat builds, pressure builds, it feels like you are sitting in a hot cloud.  Then it sounds like you are about to be run over by a train—this is the only way I can think to describe it:  you are tied to a railroad track with your ear on the rail and you feel and hear the train bearing down on you at the same time.  Then there is water.  Everywhere.  Then it gets louder (an island of tin roofs adds to the noise factor).  And louder still.  Heart rate increases.  Are we *SURE* this complex has not slid down the hill into the ocean before?  Where’s my flashlight?t (oh, in my hand)  Maybe I should listen to some music? (nope, can’t hear it even when the ihome is on full volume!)  What kind of bugs are being unearthed right now?  What kind of snakes are slithering and where will they land?  I hope the dog that charged me earlier today drowns.  Remember Seattle?!!!  It was so calm there…….Then it’s over.  Then there are three blissful minutes of cool breezes and relief from the barometric pressure.  Then you notice it feels funny to draw a full breath again as you are sitting in a hot cloud.

This went on for the better part of the afternoon and all the way into the early morning.  So when it is not stunning here—sunny and wonderful and breezy if a bit humid, it is kind of stunning—a mighty show from Mother Nature I have never seen the likes of before.

 

 
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