Saturday, December 7, 2013

in a week...and meanwhile



Hi all.  At the airport now shaking from too much coffee and not enough sleep.  He he.  I’m awaiting my flight to Tacloban.  No time for pictures, but you can check out Mercy in Action’s facebook page for updates.
  Much love to all!
Meg

Storms and things...



A small Christmas tree stands on top of our filing cabinet now, its branches telling the story of creativity and a quiet evening in a buzzing clinic.  It reminds me of the thing that had been on my mind a lot lately; home. 
The Typhoon rocked the Philippines, but up here in Olongapo, we only experienced the gentle rocking.  Like a baby in a cradle, a kid in the back-seat of a car.  Something was going on out there, but it didn’t have much to do with us.   Not until the stories started showing up in the headlines.

"12,000 babies to be born in disaster areas next month"

"My mother was whispering to my baby, 'don't come out yet,'" Jaro said, recounting how storm surges flooded the shelter. "I was so scared and felt like all hope was lost."

"Haiyan's devastation is a further challenge to the nation's maternal and infant health targets.  About 230 out of 100,000 women giving birth in the Philippines die, compared with 110 in Thailand, 62 in Malaysia and 14 in Singapore..."

"Villarin's husband sought a midwife without success. "I think all midwives in our city died," she said."

"Life is coming to a land blanketed in death."

"We delivered the first baby that night, in the dark, with headlamps, on a desk."

"The plastic and cloth wrapped around the baby is their best attempt with the materials they have to maintain the warm environment the infant needs, she said." …….
The stories told us something.  They told us of the need for midwives trained in Kangaroo care, vacuum delivery, and hemorrhage management.  They told us of premature babies in dire straits, and birthing mothers with nowhere to go.
  Vicki, our director, who has been in the US teaching while we held-down the clinic wrote us all an e-mail.  She shared the headlines, she shared her vision, and she asked for our help. 
Mercy in Action is going down to the disaster zone, and brining a tent, some midwives trained with special emergency skills, all the supplies we can muster, and love. 
It took one day of silent reflection before that path rose up to meet me, and I knew what my part would be.  A small part, but a part none-the-less.
I have delayed my flight home until December 17th to help get the disaster relief operation off the ground.  My role is one of mustering supplies, organizing them, and making sure they all made it into our ambulance that will be driving our first team down.  I invested a lot in this.  The night before last I got up at midnight to pray over our three staff and ambulance full of supplies.  I cried when they left.  Over the course of packing, my heart got a little bit involved.
It was a marathon.  I slept little.  I had a clipboard full of lists, a note-book full of lists, and lists in my pockets. I walked around in circles trying to remember where I left off.  The night before the deadline, I spent the night weaving in and out of the mini typhoon that had hit our living room drowning in boxes, bins, medication packaging, and lists, lists, and more lists.  I took a nap on the couch, and got up to pack some more.  Trying to anticipate everything a disaster relief team will need to start on-the-ground operations for delivering babies with very little back-up in three days was a task that required endurance and focus.  Not to mention, there are the basic needs of the medical team to account for.  Food, water, propane, flashlights…
Day two, or was it three, I was texting important messages to important people when I ran out of load for my phone.  So I walked to the little mom-and-pop shop (called a “sari sari store”) up the street, and loaded my phone.  I was texting on the way back to organize the medication round, and I walked unknowingly directly into a man-hole.  There is a 5 foot deep by 5 foot wide cement gutter that runs along the street by the clinic, and my multi-tasking finally caught up with me! The neighbors flicked on their lights and looked out to inquire, and saw a white girl hoisting herself from the gutter.  One broken pelvis is enough for me, thanks, and gratefully the biggest casualty this time was a scraped knee and a broken flip-flop. 
I returned to the clinic, and not an hour later a mom came in with a birth emergency that required immediate transport to the hospital.  My shorts were still covered in dust from the man hole, my brain’s fog cleared in the emergency of the moment, and I managed to have someone help pull scrub pants over my dingy shorts on the way to the door to transport.  Both mother and baby had a happy ending though, so it was all worth the chaos. 
…Then, it was back to packing.
So the initial mission was accomplished.  I have a few more weeks here at the clinic, and then I will fly down to spend my last week here in the Philippines with the precious hurricane survivors in Mercy in Action’s little birthing tent. 

Thursday, October 31, 2013

Fire-flies


Her feet and legs were swollen to the size of rubber boots crammed into flip flops.  She needed more support, more medicine, more food.  They had been scrounging a living from jungle roots and river fish; barely enough to sustain a pregnancy particularly in a season of floods.
Her father, a tiny and ragamuffin mountain man with a graying beard, holey shirt, knitted brow, and gruffly concerned nature who hiked down to visit.  It took lots of love and gentle convincing her and her to agree that she should stay with us for a week.
We have some huts built specifically as "maternity waiting homes" to serve the rural Aeta population on the Mercy in Action property by the river now in the care-taking hands of a lovely Canadian family.
As living and working here warrants, I frequently feel out-of-place.  I'd had one such afternoon which after I walked the fifteen minutes to the Mercy in Action property with my co-wokers Cecille and Rosemarie to check on this mother and her little one.  As we crested the humming busyness of Benett Road to the soothing path by the river serenaded by the croaking of frogs, my soul responded.  Fire flies hovered in the bushes, creating a festive aura like the twinkling starts.
We squatted in the hut, palpating a tummy, seeing inspiring signs of improvement.  Delivering eggs and the nutritious herb Malungay.
On the way back on Bennet Road my co-workers, following their hungry noses, sniffed out a BBQ vendor selling delicacies on a stick.  They insisted on sharing, and so I found my self gnawing on the surprisingly tasty and nauseatingly awkward texture of a marinated roasted pig's ear.
Tonight I walked up their again, this time on my own.  Our Buntis little relative, and English speaking teenager was in the kitchen as I departed.
"Mangandang Gabi" (Good-night) I said, "Ingat, ha" (Take-care now)
And after a few minutes, as I walked away,  recognizing a motherly fondness for this single mother and her teenage companion whom we'd been caring for a week now.
"Mahal Kita"  (I love you)
The little voice emerged from the light bulb shining through the slats of the bamboo structure.
"Mahal Kita Rin" (We love you too)

Village

I got my walking legs back.
Last week two interns, myself and Janet packed a bag with a blood pressure cuff and pregnancy wheel, waded through the now manageable river, and walked to the closest Aeta village of Mampueng.  We hiked in to check and see if there were any Buntis (pregnant women) there, and to offer them a basic prenatal check.
Arriving, we parked ourselves on a wood-slat bench by the creek at the start of the village and Janet hiked up the stony path just a little more, bamboo hut to bamboo hut spreading the word of our arrival.  I thought we might do one check up, maybe two, in this village comprised of only a few dozen huts, a tethered water buffalo, and a roaming pig.
A young girl squats holding a six month old and a bottle half full of watery-looking milk.  The baby's eyes are hollow, her hair is as sparse as the food available at this time in the village.
There were five pregnant women, many Lola's wanting a blood pressure check, and one baby a week old with a concerning eye infection who had been born at home with her frizzy haired motherly Lola as the attendant.  I followed the Grandma of the baby back up to their house on stilts to check on the new mother.  Squatting on the bamboo slats, curious children gathered, dark starry eyes of a mother of but nineteen with gold rims on her front teeth.  I assess.  The mother is in good health, but the baby won't nurse which concerns me enough I began the very slow process of convincing the family they should walk back with us for treatment in the clinic.  Yes, the mother must come with the baby as she was the only one with the milk the baby needed.  No, we could not give formula for two days.  Yes, we would help her cross the river.  (There is a taboo in the indigenous culture about a woman getting her feet, or any part of her wet for several weeks post childbirth.)
Finally, all convinced and slowly progressing down the trail, we were stopped by the panicked local Hilot (traditional birth attendant) who was quite put out at us taking the new mother out.  She couldn't go, the elderly woman scolded.  If the baby must go, the grandma could go with it, she said, and we could forgoe breastfeeding for the course of treatment.  I set out explaining all over again how the baby was sick, and needed the milk that only the mother could provide and the treatment that we could provide, and that the mother was in fine health to complete the forty-five minute walk with us.
I met Aurora on the way down coming up to meet me.  There was another pregnant woman, she reported, with an astonishingly high blood pressure and puffiness from her toes to her noes.  And yet another, anemic and borderline hypertensive with a tummy measuring ten centimeters small.
Needless to say, we were a tired and concerned little company tromping the hot miles back to the clinic, carrying those who needed to be carried across the shin deep river. 

Thursday, October 24, 2013

One Birth

Maybe it was the light coming through the window just so, illuminating certain creases on the white sheets and wood-stained birth stool with transcendent glory, as if to defy the month past of rains and typhoons still predicted to impend upon us  

Maybe it was the child-like eyes of the curious father, not much more than a teenager himself, peering for the first time at the miracle of birth.  Maybe it was the innocence of his shocked look when his wife asked him to help her undress her shorts to have their baby.

Maybe it how she reached down to receive her.  Maybe it was the caressing of baby-cheeks; the round and contented suck of a hour-old child.  The smile.

Friday, October 4, 2013

Good Company



I started to attend births about a week past my injury.  At first I mostly could only chart, but slowly have been re-gaining my capabilities to assist as I find myself able to get around more and more.
 April was drying off the baby, assessing the mother, and multi-tasking as she said calmly to me from the corner of her concentration “You can do it Megan” as I took my first independent step across the birth-room to fetch a dry blanket and oxytocin. 
My second independent trip across the birth room was to retrieve the stethoscope to assess a baby that was slower to cry than appreciated.
We have an intern that arrived for two months from Switzerland.  Her name is Aurora and she is lovely.  She is also my room-mate. 
One time, after a busy day, she came into our room and broke into hysterics.  I didn’t realize quite what I looked like until that time.  Then I could see it from her perspective.  I had pulled the sheet over my eyes, and from beneath the old holey t-shirt that I wear to bed emerged two white legs elevated at ninety degrees with the toes hooked on the slats of the upper level of the bunk bed in an effort to reduce the swelling. 
Another time Shara caught our clinic mouse that had made himself a home on sticky paper.  As she threatened to come show it to me, I shrieked from the bathroom…."let me in peace!"
Aurora and I laugh mercilessly together.  Its smashing.  She found my walker particularly amusing.  It developed a goulish squeal.  That and the thump-limp-thump-limp pattern of my walk paired with the routine power outage and I think we decided I was the new clinic haunt.
So life is amusing, and we have good company to share the work and our midnight snacks with.

Typhoon Usagi



Super typhoon Usagi bore down, or shall I say poured down as we slept the unearthly hours of Monday morning September 23rd.  It was like being under a waterfall, but it wasn’t until the door-bell rang five times in a state of emergency and Shara opened our bed-room door at two-thirty AM to announce “there’s a flood!”that we realized that the rain was a true concern.

I was up faster than if Shara had said “there is a labour”, and began automatically throwing my belongings on the top bunk.  Computer.  Suitcase. Phone.  As I did so, I said to Aurora “A flood is coming, we must put everything up as high as possible.”  Next we tackled the living room, then the clinic.  Fetal dopplers.  Rapid lab tests. Book-shelf.  We spied out the front door.  Our front court-yard was a mud-puddle turned lake, and Tanno was frantically running around in an effort to control the flow of the water.  Our front gate has about a six inch gap at the bottom, and Tanno had shoved all our sand-bags to block the gap working by
the light of our ambulance idling with its headlights on.  All the while torrents of water poured down.  The water was at waist level outside the gate we were told!  We found the water-proof flash light purchased for the purpose of water birth came in handy as we started a rounds of the clinic, going door to door, monitoring the flow of water and the torrential rain, looking for even more valuables we could hoist out of the immediate danger zone. 

At first Vic was going to come to the clinic to help direct traffic in efforts to save the clinic from flood.  But it was not the clinic in the most danger, as the next texts from Vic revealed.  “Our house is flooding too…river at our gate now.” And then, “The flood is in our house now rising...I was up to my chest in water…water pouring through windows”  Vicki and her husband Scott, mother-in-law, and helper Medy retreated to their upstairs room, and watched the river greedily gulp up their yard and home.

And then there was that frightful moment of truth.  Tanno’s thus-far successful gate blockade gave away.  Water, big gushes of the angry muddy stuff began to spout through a hole in the middle, then over the top, until the sand-bags were just like rocks in a river.  The rush flowed on either side of our clinic, four to six inches deep.  It was this point I ditched my cane, we ran into the down-pour, wet t-shirts clinging to our backs.  Water was coming toward the back door.  We needed to block it.  Tanno was moving sand-bags to the doors now that our courtyard was a river in a last effort to stop it from running through
the clinic.  Our sand-bag blockade was failing on the small cement patio out our back prenatal door.  We needed to stack something.  I frantically looked around.  There was a pile of bricks that we had been using for construction of our back wall by the edge of the courtyard.  I grabbed one, Aurora followed, and we started an assembly line piling bricks around the sand-bags.  April made the rounds watching the other doors for entrance of water.  We opened the back door, and Tanno and Raquel hoisted our new washing machine into our labour room in an effort to save it from the damaging effects of the rising water. 

Then the water started to rise a centimeter below our front door.  Why wasn’t it flowing?  Tanno’s son William bailed it, Aurora ran around to see why it wasn’t flowing.  The drainage system running next to the clinic was blocked.  Then the neighbors court-yard wall collapsed, and the water started flowing again.
We’d focused, running around for a few hours now.  We were drenched.  We were worried.  The rain let up a little, and the first light of dawn yawned through the grey clouds.
Vic texted, I checked my phone wrapped in a plastic bag, “My sweet cozy little house is a disaster…all underwater…river higher than our gate.”  All I could say is “I’m so sorry…we will help”
In the easing rain, I limped around to the back yard to assess the current state of drainage.  Our back wall was intact.  However, behind our wall where we could usually see flora and a bank descending about twenty yards to the river we saw a churning, Mississippi coloured river with only the top of the trees and bamboo sticking awkwardly out.  It was a real flood scene.  Something a journalist would photograph.  And it was our back-yard. 


Our clinic was out of danger, but my forehead creased.  Bennet road would be under-water.  All the children who couldn’t swim…  All the people who would’ve lost their houses…  And our dear Vic and Scott and Grandma stranded in their attic room with all their material possessions drenched in mud….  I knew this was just the beginning of what we would face in the days ahead. 
The power went out for three days, the water for two.  We held the clinic down, despite muddy tracks from the door and dirty dishes by the sink.  We rotated our cold-chain meds to coolers with ice and back to the fridge with the generator running, and constantly kept an eye on a temperature.  We filled jugs from the water reservoir, and I sponge bathed with the water collected from the roof-top basin. 
Thank-goodness our propane held out, and I set about doing the one thing I felt useful for as going out to help the cleaning efforts in the slippery mud is more than my recently injured knee and pelvis could
handle.  I cooked.  I used the bag of black beans I had on the shelf, and the vegetables I could salvage from the Sari Sari store.  I made chili and chicken soup for the workers that were cleaning up Vic and Scotts house, for our staff, and for our midwife Analyn whose house had also flooded.  She came hungry that afternoon and thirsty the next.  No running water, no supplies.  I was longing to see what Olongapo looked like, but my pelvis and knee kept me house-bound, and slowly, slowly the chaos settled.
Our postpartum patient, after eating a bowl of chili, left for home with her newborn to her recently flooded house.  We were just glad she was here with us for the night, as running from the greedy river with a newborn is less than desirable.  Another patient come to be checked in early labour.  Her house was out of the danger zone, but her and her relative carried news of Santa Rita.  A woman stranded on a house-top since four AM with a two month old baby and no rescue.  After many hours someone was able to string a rope across and they put the baby in the basin and tied it to the rope to reel the baby over to safety…  Another woman swept down the torrent while her distraught and helpless husband clung to a bamboo tree….  A mudslide killing twenty-some people….  Many houses lost, and people displaced….
But as April said, “the people out there are still smiling!” The attitudes of those in crisis kept us going.
Scott, in an effort to lighten the mood of the Barangay Captain (village leader) asked If the 25th anniversary village celebration would still be underway the following days.  The street garlands were sopping, and the people working, but maybe there would be a little time for festivity?  The Barangay Captain, and this really makes me sad, the Barangay Captain started to cry!
It took a few days for groceries to be readily available again.  The downtown market area had been flooded more than neck deep.
So Olongapo recovered, slowly, from another disaster.  Life resumed.  A few days later electricity and water came back on, and life started to feel “normal” again.  Not that normal is in the vocabulary of Megan’s life this summer!   

Then they cried to the Lord in their trouble, And He brought them out of their distresses.  He caused the storm to be still, so that the waves of the sea were hushed.
Psalm 107: 28 & 29