When I walked into the labor ward this morning, hunting for the primary midwife for the day, I noted a tiny green bundle lying on the resuscitaire, a worn hexagonal plastic box with a tube snaking from the O2 tank beside it through a hole in the top. I figured someone had left it there from the evening shift and I wandered out. I found the midwife, asked what had gone on in the night: three women delivered babies, a fourth delivered at 23 weeks and was then transferred to the surgical wing. She gestured toward the labor ward:
"850g. Too little. He's still in there, gasping." She said simply.
I realized the tiny green bundle on the resuscitaire contained a tiny baby. One about the same size as the one in my belly. I went back in, opened the green, surgical bundle. I was expecting honestly, to find a baby who was dead. Instead, he opened his tiny eyes and began to cry. His tiny mewing sounds caught the attention of the morning midwife, who summoned one of the peds who was in for rounds and somehow the decision was made to support his impossibly slim chances for as long as he was up for the struggle. Support here for such a tiny preterm baby is minimal, but for those babies who take up the fight, they are helped as much as they can. I watched the ped start an IV line, begin him on fluids, and he was tenderly carried to an isolette in the nursery by the male midwife, easily the tallest bloke in the vicinity, where he lay, tiny arms waving occasionally. The contrast of 1lb-something baby in the hands of 6.7ft midwife was striking.
I asked when his mama would be told that her baby was still alive (she was evidently told he was dead). "The pediatrician might tell her sometime today" was the response. He clearly did, because a 1/2 hour later and then every hour after, baby boy's grandpa came up to peer at his tiny grandson through the crackled plastic of the O2 hood in the isolette.
At about 2pm I stepped in to see him. "Him give up" the male midwife reported from across the hall. I went in anyway. His tiny birdlike chest was indeed still, his hands and arms the slightly darker purplish shade which comes with death. I stood there for a while, said a little prayer for him, and his mother (who I never met) and his grandpa. His chest rose and then fell again: an agonal breath. In truth it may not have been his last breath, but in any case his short (almost 8 hours!), brave little life began, and ended today, and I spent some of it with him.
I don't think he was ever held by his mother. His whole family came to collect his body. I think they were to take him to the morgue. It may have been them I heard keening as I walked home.
****
Today though, about 11 am I admitted a G2P1 in active labor. Was pleased to find her a stretchy 6cm and lovely low head. I broke her bag (protocol) into a bedpan, and 15 minutes later she reported she wanted to push.
To the labor ward we went and about 10 minutes later her son felt my hands first. Wonder of wonders (doesn't happen here a lot) she welcomed him up onto her chest as soon as his cord was cut, and she cuddled him for a few precious seconds before he was whisked away. Don't fret, got him back to mama soon after, latched and nursing.
"How many babies you deliver in Vanuatu?" she asked.
"Yours is the first!" I said. She didn't seem too bothered.
****
Today was notable also for two misoprostol inductions (also known as cytotec, it's a very inexpensive prostaglandin medication which is placed in tablet form beside the cervix in the vagina to induce labor and treat postpartum hemorrhage). One for a woman whose chart was covered with highlighted instructions. Notes that she was high-risk. of 6 term pregnancies, she's delivered 1 living baby. Two of her babies were stillborn, and two had died within hours of birth. None of these deaths had ever been explained, no autopsies ever done. She presented for induction at 38 weeks, in the hope that we could help her have this baby be ok - her living child was born after induction at 35weeks. for this, her 7th pregnancy, 6 hours after the miso was placed, her baby - who to my eye had had really weird CTG tracings from the word go - began to decel into the 90's (should be between 110 and 160 or thereabouts. Given her history, the decision was made immediately to proceed with cesarean section.
Immediately here translates to the time it takes to call the doc, draw blood, send it to the lab for type and crossmatch, The time the lab takes to type and cross match and then send over the requested two units of blood, place urinary catheter then wheel mama over to the OR, prep for surgery. Scenic detour for me and fresh UK med student as Doc took the time to instruct us on proper hand-washing technique (I wish I was kidding). Then instruction on how to place spinal anesthesia (I KNOW I'm never gonna do that). All with no fetal monitoring going on... I have to tell you my skin was crawling just a little as he talked and 'taught' us through dissecting into the peritoneal cavity, and then the uterus, all the while saying cheerfully "with no indication of fetal distress, there is no need to hurry - I could do this much faster if necessary". I was looking around the room thinking "Dude! We're doing this CS because we had signs of fetal distress and we're not actually monitoring baby presently so we have no idea if this baby is tanking as we speak - not to mention the fact that this woman's lost 4 babies already!!"*
Anyway baby was born alive (good start) and was transitioning poorly. I wasn't actually supposed to be doing anything at this birth, aside from observing, but the baby was looking funky, very blue, low tone, not opening his eyes and I was kinda anxious that he be ok. The ped did an initial suction, but not a whole helluva lot of much else. I was itching to rub on that baby - he just looked too flat. I pulled out my stethoscope from my pocket and gestured to the ped if I could listen. He gestured to me to go ahead. I listened and his HR was 90ish. I busted into full resus mode: rubbed on him, flicked his feet. Bagged him till I got chest rise - he seemed completely disinterested in breathing and his color just sucked. He just wasn't transitioning right at all. But at least with the PPV and stim he started crying a bit and his HR got up over 100. Ultimately he went back to the nursery with blowby keeping him (almost)pink. I popped in to see him on my way home (only 2hrs after my shift was supposed to have ended) and he was still needing 4L O2 but his eyes were open. The word which keeps popping into my head is syndromic, not sure why, but something about the way he looks struck me as a bit 'off'. I hope like hell he's still with us tomorrow morning, and that he continues to do Ok. 1 dead baby is too much for any mama, 5 dead babies (term babies at that) is inconceivable to me.
BBQ for everyone tonight at the place I'm staying. Ate well, but really didn't feel at all like socializing, can hardly walk, my feet are so sore from running around all day, then standing in the OR for a couple of hours. I'm so finishing this post and going to bed.
Oh yeah. Was so tired, my entrance to the BBQ involved me walking through the screen door to my room. In a seriously elegant maneuver (I'm occasionally famous for them) I tore off the screen door completely, and the door and I landed in the bush in front of my room.
A member of my audience: smart arse South African bloke, three beers down, called out: "You're supposed to slide that one, love."
You don't say.
* I should note that I am very grateful for the cool stuff this wonderful doc is teaching me. I mean no disrespect at all to him when I relay my anxiety in this post. It was just stuff that was going through my head. It's just different is all. Cytotec inductions for a grand multip with a history of multiple term stillbirths and neonatal deaths, and lengthy decision to incision times just kinda freak out this student midwife who's used to lovely low risk, healthy gravidas!
Monday, January 5, 2009
Sunday, January 4, 2009
First Shift
6.50am Stroll up to the hospital, bags of supplies in hand.
Maternity ward found at the end of rutted dirt driveway, front door surrounded by discarded hospital beds and other miscellaneous furniture. Postpartum ward is PACKED. All 12 or so beds occupied by women, their babies in giant nappies and swaddled in LAYERS of blankets - for the love of GOD women, it's 95degrees in here! Assorted family members lying about on woven mats or up preparing food for the women - no food service here!
7.10ish meet three midwives (including tall, handsome and clearly quite shy, male midwife), 4 docs (2 OB's, one Ped, one Gyn).
7.30 Rounds. Gyn doc snaps me up and begins quizzing me enthusiastically(socratic method, anyone?) on postpartum visits - "History, examination, investigation and don't forget to wash your hands!!", then begins quizzing the other docs (felt a little weird). Discharge 10 women. Hospital has seen some 32 babies in the last 5 days including two preterm babies, a set of twins and breech baby. Round on surgical Gyn patient transferred emergently from another Island two nights ago. Poor lass had been bleeding for three weeks (!), ultimately her ruptured tubal ectopic pregnancy evulsed into her uterus (ack) and she bled three liters into her peritoneum before emergency surgery saved her life. Her Hgb this morning was 3.2. Holy shit. Needless to say, she was a) lucky to be alive, and b) feeling pretty crummy this morning.
9ish. back to the maternity ward where three women were in various stages of labor. hung out with midwives, helped a 4day pp woman learn to hand express milk, then cupfeed her pretty awesomely lethargic and dehydrated baby who hadn't nursed effectively um, EVER. NB Weightloss central. She and her baby were readmitted.
11ish. Mama #1 G1P0, complete, not having fun. Assisted MW with birth. Hope like crazy that my probably not well understood gentle words and back rubbing made up somewhat for the *slap* and sharp instructions to "yu no cry out" from my colleague during the end of her labor. 25 minute-ish 2nd stage. Vigorous baby, tiny by our American standards (~6lbs). Seriously actively managed third stage. MW proudly displays intact primiparous perineum - no sutures needed at all. I admit I'm impressed.
2ish. G2P1 stalled at 8cm for ~3hrs (I guess this counts as stalled here). Complaining of crushing back pain, I'm suspicious of malpresentation. Suggest she gets on hands and knees on the bed for a few contractions. I'm amazed, she tries it, then tries wall swaying! She pushes out large 4.6kilo babe a short while later. Baby girl met with auntie's exclamation of dismay: "Shit." When we peek between her legs. Mama starts sobbing. I spend the next 5 minutes telling baby girl and everyone else in the room how beautiful she is and how lucky we are she's here.
3.00pm. I'm supposed to go home. But the third admission, another G1P0 is "fully". I can't help myself. I poke my head in to the labor ward, and ask the MW if I may assist. We spend the next hour speaking gently and encouragingly to her (I think this particular midwife may be one of my favorites) as she slooooowly (by ni-van standards) brings her baby down to her very looooong perineum. An hour later an inch long midline episiotomy is performed, and minutes later another vigorous babe slides into the world. I take care of the babe (they are weighed and their vaccinations - HepB and BCG - and vit K given as mama delivers her placenta) and then swiftly return her to her mama. I hold her so baby and mother may look at each other as MW completes a stunning repair of the episiotomy with 1.0 vicryl.
Then baby to breast, opens wide, latches.
4.30ish. Head home. Smile on face.
Other things. Three women, three births, almost 10 hours. Heart tones were taken once on admission (a CTG strip) for each, then perhaps once more at the onset of second stage. In the case of the woman pushing for an hour, I think I was instructed to take heart tones once again. Placentas are deposited immediately into the trashcan on the right. Sheets are washed, by hand, by me. I have a new love and respect for chux pads. We have no idea just how lucky we are.
**Paul - you want to bring some stuff, and you can get your hands on disposable underpads, then bring as many of those as you want!! **
Can't figure out though, how to get gloves onto my sticky, sweaty hands.
So. Short version: day one, no drama. Lovely women, good midwives, beautiful babies.
Oh yeah. And 1970's squat hospital architecture. 95 degrees today. 1 fan in the whole place. Blessedly someone put two struggling air conditioners into the delivery rooms which helps. Anywhere except (ironically) in front of the resucitaire where we put babies immediately after they're born (the whole dry off/look over/listen/wrap up thing) it's hotter than hades.
Too much fun, peeps. Too much fun. Oh, and Emily - everyone sends you their love and best wishes for your baby!!
Maternity ward found at the end of rutted dirt driveway, front door surrounded by discarded hospital beds and other miscellaneous furniture. Postpartum ward is PACKED. All 12 or so beds occupied by women, their babies in giant nappies and swaddled in LAYERS of blankets - for the love of GOD women, it's 95degrees in here! Assorted family members lying about on woven mats or up preparing food for the women - no food service here!
7.10ish meet three midwives (including tall, handsome and clearly quite shy, male midwife), 4 docs (2 OB's, one Ped, one Gyn).
7.30 Rounds. Gyn doc snaps me up and begins quizzing me enthusiastically(socratic method, anyone?) on postpartum visits - "History, examination, investigation and don't forget to wash your hands!!", then begins quizzing the other docs (felt a little weird). Discharge 10 women. Hospital has seen some 32 babies in the last 5 days including two preterm babies, a set of twins and breech baby. Round on surgical Gyn patient transferred emergently from another Island two nights ago. Poor lass had been bleeding for three weeks (!), ultimately her ruptured tubal ectopic pregnancy evulsed into her uterus (ack) and she bled three liters into her peritoneum before emergency surgery saved her life. Her Hgb this morning was 3.2. Holy shit. Needless to say, she was a) lucky to be alive, and b) feeling pretty crummy this morning.
9ish. back to the maternity ward where three women were in various stages of labor. hung out with midwives, helped a 4day pp woman learn to hand express milk, then cupfeed her pretty awesomely lethargic and dehydrated baby who hadn't nursed effectively um, EVER. NB Weightloss central. She and her baby were readmitted.
11ish. Mama #1 G1P0, complete, not having fun. Assisted MW with birth. Hope like crazy that my probably not well understood gentle words and back rubbing made up somewhat for the *slap* and sharp instructions to "yu no cry out" from my colleague during the end of her labor. 25 minute-ish 2nd stage. Vigorous baby, tiny by our American standards (~6lbs). Seriously actively managed third stage. MW proudly displays intact primiparous perineum - no sutures needed at all. I admit I'm impressed.
2ish. G2P1 stalled at 8cm for ~3hrs (I guess this counts as stalled here). Complaining of crushing back pain, I'm suspicious of malpresentation. Suggest she gets on hands and knees on the bed for a few contractions. I'm amazed, she tries it, then tries wall swaying! She pushes out large 4.6kilo babe a short while later. Baby girl met with auntie's exclamation of dismay: "Shit." When we peek between her legs. Mama starts sobbing. I spend the next 5 minutes telling baby girl and everyone else in the room how beautiful she is and how lucky we are she's here.
3.00pm. I'm supposed to go home. But the third admission, another G1P0 is "fully". I can't help myself. I poke my head in to the labor ward, and ask the MW if I may assist. We spend the next hour speaking gently and encouragingly to her (I think this particular midwife may be one of my favorites) as she slooooowly (by ni-van standards) brings her baby down to her very looooong perineum. An hour later an inch long midline episiotomy is performed, and minutes later another vigorous babe slides into the world. I take care of the babe (they are weighed and their vaccinations - HepB and BCG - and vit K given as mama delivers her placenta) and then swiftly return her to her mama. I hold her so baby and mother may look at each other as MW completes a stunning repair of the episiotomy with 1.0 vicryl.
Then baby to breast, opens wide, latches.
4.30ish. Head home. Smile on face.
Other things. Three women, three births, almost 10 hours. Heart tones were taken once on admission (a CTG strip) for each, then perhaps once more at the onset of second stage. In the case of the woman pushing for an hour, I think I was instructed to take heart tones once again. Placentas are deposited immediately into the trashcan on the right. Sheets are washed, by hand, by me. I have a new love and respect for chux pads. We have no idea just how lucky we are.
**Paul - you want to bring some stuff, and you can get your hands on disposable underpads, then bring as many of those as you want!! **
Can't figure out though, how to get gloves onto my sticky, sweaty hands.
So. Short version: day one, no drama. Lovely women, good midwives, beautiful babies.
Oh yeah. And 1970's squat hospital architecture. 95 degrees today. 1 fan in the whole place. Blessedly someone put two struggling air conditioners into the delivery rooms which helps. Anywhere except (ironically) in front of the resucitaire where we put babies immediately after they're born (the whole dry off/look over/listen/wrap up thing) it's hotter than hades.
Too much fun, peeps. Too much fun. Oh, and Emily - everyone sends you their love and best wishes for your baby!!
Friday, January 2, 2009
Sounds of a Saturday Morning
I think I mentioned that the ubiquitous crows of the neighborhood's countless free-ranging roosters kick off at about 4am. They continue at intervals of two minutes or so until about 9am. This would be less irritating if there was one or who roosters, but it amounts to a veritable dawn chorus of domestic foul in the numbers I'm talking about. Three mornings into this, and I find I'm almost used to it. The roads are largely unused by vehicles aside from buses (wee, rickety minibuses) which speed by periodically accompanied by noises which my non-mechanical ear diagnose as "sans muffler". These sounds start at about 6.30, I assume when everyone heads off to work.
One of the little kids next door begins screaming and crying. Sounds somewhat like my (almost) 4 year old pitching a whopper tantrum, but it's somehow a slightly more distressing sound to me, like perhaps he's hurt. Trips my "Mum nerve", makes me anxious. I listened to him wail, and couldn't hear anyone respond to him. He stopped eventually.
Dogs bark a lot, and fight. Small yappy sounds punctuated with larger sounding growls and scuffles. I passed a vet's office the other day, wonder if any of my neighborhood dogs are ever seen. Frankly I doubt it.
I'm writing at this moment to the sound of a piglet squealing loudly. I wonder if the kids are playing with (or pestering) it, or if they're getting ready to kill and eat him. Given the marked crecendo to his squeals, and their subsequent abrupt end I suspect the latter. Hmm. Neighborhood pig prepared for eating. Why hadn't I factored that one in? Interesting to contemplate that as I munch on my weetbix and bananas.
It's a hot one today. The sky is bright and almost an unbroken blue. I've come to rather wish for the cool promise of cloud cover which brings with it the sudden, intense 20-30 minute downpours. The rain cools the air for about as much time again before the humidity replaces the heat and I wait again for the cycle to repeat.
I promise I'll stop talking about the heat soon. Really.
I'm doing a whole lot of nothing for a few days. After a pretty manic couple of weeks traveling with Husband and boys, and then a week of extended family and the benign but nevertheless quite exhausting dances which go along with that, I'm talking three days to just sit.
I venture out to the town periodically. Walked for a couple of hours yesterday in the relative cool of the morning. It was still bloody hot though, within a half hour my fingers and wrists were swelling. I found the sunscreen I was looking for - should have bought that in NZ (1495VT - ~$15.00 for 100mls!), bought an enormous hand (I think about 25) of tiny perfectly ripe bananas at the market for the equivalent of a dollar. I also bought a couple of postcards and stood in front of the display for a while thinking that it seems fraudulent to focus so much on the pristine beaches and impossibly blue water of this place, strategically placed starfish in the shallows, when the reality of this place for most of the people who actually live here is to my inexperienced, western eye, a good deal bleaker, and certainly uglier than the beautiful images on sale for 110vt each. I suppose though, that the world isn't really all that interested in the grubby bits. In the States we buy postcards of the beautiful tall buildings of the NY skyline and central park, but there are no postcards of the housing projects, or the homeless people. Perhaps the desire to focus on the perfect, and ignore the less-than-perfect is universal?
I walked by the hospital in the morning, watched the occasional parent/child pair wander hand in hand past the piles of rotting rubbish piled by the gates and up the dirt driveway to the very modest mother child health building where I will present myself early on Monday morning.
I'm keen to get started, but I'm enjoying this little bit of time to myself, with no greater problems to sort out than what I'll make for dinner tonight (smuggled quinoa?) and totally uninterrupted knitting and reading time for at least another day or so.
One of the little kids next door begins screaming and crying. Sounds somewhat like my (almost) 4 year old pitching a whopper tantrum, but it's somehow a slightly more distressing sound to me, like perhaps he's hurt. Trips my "Mum nerve", makes me anxious. I listened to him wail, and couldn't hear anyone respond to him. He stopped eventually.
Dogs bark a lot, and fight. Small yappy sounds punctuated with larger sounding growls and scuffles. I passed a vet's office the other day, wonder if any of my neighborhood dogs are ever seen. Frankly I doubt it.
I'm writing at this moment to the sound of a piglet squealing loudly. I wonder if the kids are playing with (or pestering) it, or if they're getting ready to kill and eat him. Given the marked crecendo to his squeals, and their subsequent abrupt end I suspect the latter. Hmm. Neighborhood pig prepared for eating. Why hadn't I factored that one in? Interesting to contemplate that as I munch on my weetbix and bananas.
It's a hot one today. The sky is bright and almost an unbroken blue. I've come to rather wish for the cool promise of cloud cover which brings with it the sudden, intense 20-30 minute downpours. The rain cools the air for about as much time again before the humidity replaces the heat and I wait again for the cycle to repeat.
I promise I'll stop talking about the heat soon. Really.
I'm doing a whole lot of nothing for a few days. After a pretty manic couple of weeks traveling with Husband and boys, and then a week of extended family and the benign but nevertheless quite exhausting dances which go along with that, I'm talking three days to just sit.
I venture out to the town periodically. Walked for a couple of hours yesterday in the relative cool of the morning. It was still bloody hot though, within a half hour my fingers and wrists were swelling. I found the sunscreen I was looking for - should have bought that in NZ (1495VT - ~$15.00 for 100mls!), bought an enormous hand (I think about 25) of tiny perfectly ripe bananas at the market for the equivalent of a dollar. I also bought a couple of postcards and stood in front of the display for a while thinking that it seems fraudulent to focus so much on the pristine beaches and impossibly blue water of this place, strategically placed starfish in the shallows, when the reality of this place for most of the people who actually live here is to my inexperienced, western eye, a good deal bleaker, and certainly uglier than the beautiful images on sale for 110vt each. I suppose though, that the world isn't really all that interested in the grubby bits. In the States we buy postcards of the beautiful tall buildings of the NY skyline and central park, but there are no postcards of the housing projects, or the homeless people. Perhaps the desire to focus on the perfect, and ignore the less-than-perfect is universal?
I walked by the hospital in the morning, watched the occasional parent/child pair wander hand in hand past the piles of rotting rubbish piled by the gates and up the dirt driveway to the very modest mother child health building where I will present myself early on Monday morning.
I'm keen to get started, but I'm enjoying this little bit of time to myself, with no greater problems to sort out than what I'll make for dinner tonight (smuggled quinoa?) and totally uninterrupted knitting and reading time for at least another day or so.
Wednesday, December 31, 2008
Just when you think it can't possibly get hotter...
it starts raining, and the mercury drops a good couple of degrees. Today I immediately threw on my swimsuit and almost ran (as much as you can in 90 degree/100% humidity) outside where I alternately sat in torrential tropical downpour and then in the pool. The downside of the rain is the oppressive humidity which follows it.
I’m not sure what I expected from the way Vanuatu looks. It appeared idyllic from the air. Seriously green, palm trees, impossibly blue water, all the tourist brochure stuff, unsealed dirt roads skirting the coast but the drive from the airport revealed dwellings which could be described as shanties. Little huts constructed of corrugated iron and palm leaves which are often clustered around other little huts with long crowded washing lines strung about. Scrawny looking dogs who stand around looking tired in a few places, and the men here seem to either stand around in small groups on the side of the street or wander about. All the women seem to work in long impossibly flowery tropical print dresses and flip flops - they have quick smiles and seem to (correctly) assume I speak English. I discovered that not everyone does though, after a funny encounter with a little girl in the supermarket when I spied an unoccupied basket on the floor. I asked her immediately, unthinking, if it was taken. I may as well have descended from another planet for the look she gave me. I realized very quickly that no, the kids don’t speak English. I asked another man who looked on chuckling, and he kindly translated for me. I was expecting bislama to be the predominant language spoken here, but I’m surprised to find that I hear French spoken just as often, it’s helpful as I really know no bislama, but my French is passable. I hear many of the midwives are francophone so, that should be helpful.Next time I think I'll just ask in french.
The trip to the market was memorable for being 4.00pm on New Years Eve. The place was packed with people, imagine Black Friday sales at Walmart, but at a Safeway, buying supplies for parties. The lines at all 4 checkouts were 10 to 30 people long. The party item of choice seemed to be cans of air with a (very loud) horn attached, but more about that later. There truly is almost everything you could need in there, lots of familiar foods with outrageous prices and local stuff which was more reasonable. The French influence here translates to insanely good French bread (50vt for a batard/baguette). I’m informed that there is a tiny corner shop across the road which sells fresh bread daily and assorted canned goods. Which I’ll have to check out. It was nice to see lots of local tropical fruit and veg. Masses of bananas, and my all time favorite fresh passionfruit (5 for about $1) and the hugest avocadoes I’ve ever seen. Some were bigger I swear than my head. I spied a few avocado trees on my walk home which were heavy with fruit as well so I expect that they will feature prominently in my diet while I’m here.
Ni-Van’s celebrate NYE as much as New Yorkers. I was warned when I checked in that it would be “noisy” and boy was she not wrong. My little cabin seemed too be surrounded by parties, loud island music (kinda a cross between reggaeton and low budget electronica), screams (yeah, real screams - not a nice sound, really), whoops resembling those of howler monkeys, incessant canned air horn honks (the children I assume?), and then later (towards dawn) the dulcet tones of dogs fighting and myriad cock crows. I think one area off to the left of my house still hasn’t stopped its party and as I write it’s 7.00am. Update: the party seems to have moved to a series of car/trucks which are driving about – or more careening, really – past, yelling, honking those damn air horns and generally encouraging everyone to continue the party at all costs. It’s now 4pm. These folks have serious party stamina!
I’m staying at a small "resort" hotel just by the hospital. It’s a cluster of 6 studio apartments and 4 or so of larger apartments. It has a nice pool and a BBQ area. It’s comfy, but my apartment isn’t air conditioned. I suspect it will take me quite a while to get used to the heat. I’m torn by my desire to seek out some air conditioning especially at night. I know though that I’ll be more reluctant to venture out by myself if I have a cool refuge. I confess I find it pretty intimidating to wander about as a solo (visibly pregnant) female foreigner, in a country which is so clearly socially dominated by men, but I notice that there are local women about on their own. I’m conscious also that women are modest with their dress, I’ve not seen any pants worn by women at all, and skirts and dresses fall at least to past the knee. Good thing I’ve never been a short shorts kinda gal. I suspect also that my pregnant belly may deflect some unwanted attention.
Hopefully some of these nights we’ll get some more rain and some cool breezes both of which were absent last night) and in the meantime I’ll throw myself into the pool periodically, and continue to drink loads of cold water. Today (Friday) is New Years Day, and everything is closed, I plan on sticking close to home, recovering a bit from yesterday’s travel, and reviewing some midwifery material. I think I’ll go up to the hospital on Monday morning for my first shift. That leaves Saturday for a good trip to the market for some food shopping and Sunday for some wandering around and finding my feet.
Seems I have excellent internet access though, which only occasionally necessitates a wander out to the pool area where the modem is nailed to the wall. The breeze is nice out here tonight though, off Erekor lagoon.
I'm here.
I’m not sure what I expected from the way Vanuatu looks. It appeared idyllic from the air. Seriously green, palm trees, impossibly blue water, all the tourist brochure stuff, unsealed dirt roads skirting the coast but the drive from the airport revealed dwellings which could be described as shanties. Little huts constructed of corrugated iron and palm leaves which are often clustered around other little huts with long crowded washing lines strung about. Scrawny looking dogs who stand around looking tired in a few places, and the men here seem to either stand around in small groups on the side of the street or wander about. All the women seem to work in long impossibly flowery tropical print dresses and flip flops - they have quick smiles and seem to (correctly) assume I speak English. I discovered that not everyone does though, after a funny encounter with a little girl in the supermarket when I spied an unoccupied basket on the floor. I asked her immediately, unthinking, if it was taken. I may as well have descended from another planet for the look she gave me. I realized very quickly that no, the kids don’t speak English. I asked another man who looked on chuckling, and he kindly translated for me. I was expecting bislama to be the predominant language spoken here, but I’m surprised to find that I hear French spoken just as often, it’s helpful as I really know no bislama, but my French is passable. I hear many of the midwives are francophone so, that should be helpful.Next time I think I'll just ask in french.
The trip to the market was memorable for being 4.00pm on New Years Eve. The place was packed with people, imagine Black Friday sales at Walmart, but at a Safeway, buying supplies for parties. The lines at all 4 checkouts were 10 to 30 people long. The party item of choice seemed to be cans of air with a (very loud) horn attached, but more about that later. There truly is almost everything you could need in there, lots of familiar foods with outrageous prices and local stuff which was more reasonable. The French influence here translates to insanely good French bread (50vt for a batard/baguette). I’m informed that there is a tiny corner shop across the road which sells fresh bread daily and assorted canned goods. Which I’ll have to check out. It was nice to see lots of local tropical fruit and veg. Masses of bananas, and my all time favorite fresh passionfruit (5 for about $1) and the hugest avocadoes I’ve ever seen. Some were bigger I swear than my head. I spied a few avocado trees on my walk home which were heavy with fruit as well so I expect that they will feature prominently in my diet while I’m here.
Ni-Van’s celebrate NYE as much as New Yorkers. I was warned when I checked in that it would be “noisy” and boy was she not wrong. My little cabin seemed too be surrounded by parties, loud island music (kinda a cross between reggaeton and low budget electronica), screams (yeah, real screams - not a nice sound, really), whoops resembling those of howler monkeys, incessant canned air horn honks (the children I assume?), and then later (towards dawn) the dulcet tones of dogs fighting and myriad cock crows. I think one area off to the left of my house still hasn’t stopped its party and as I write it’s 7.00am. Update: the party seems to have moved to a series of car/trucks which are driving about – or more careening, really – past, yelling, honking those damn air horns and generally encouraging everyone to continue the party at all costs. It’s now 4pm. These folks have serious party stamina!
I’m staying at a small "resort" hotel just by the hospital. It’s a cluster of 6 studio apartments and 4 or so of larger apartments. It has a nice pool and a BBQ area. It’s comfy, but my apartment isn’t air conditioned. I suspect it will take me quite a while to get used to the heat. I’m torn by my desire to seek out some air conditioning especially at night. I know though that I’ll be more reluctant to venture out by myself if I have a cool refuge. I confess I find it pretty intimidating to wander about as a solo (visibly pregnant) female foreigner, in a country which is so clearly socially dominated by men, but I notice that there are local women about on their own. I’m conscious also that women are modest with their dress, I’ve not seen any pants worn by women at all, and skirts and dresses fall at least to past the knee. Good thing I’ve never been a short shorts kinda gal. I suspect also that my pregnant belly may deflect some unwanted attention.
Hopefully some of these nights we’ll get some more rain and some cool breezes both of which were absent last night) and in the meantime I’ll throw myself into the pool periodically, and continue to drink loads of cold water. Today (Friday) is New Years Day, and everything is closed, I plan on sticking close to home, recovering a bit from yesterday’s travel, and reviewing some midwifery material. I think I’ll go up to the hospital on Monday morning for my first shift. That leaves Saturday for a good trip to the market for some food shopping and Sunday for some wandering around and finding my feet.
Seems I have excellent internet access though, which only occasionally necessitates a wander out to the pool area where the modem is nailed to the wall. The breeze is nice out here tonight though, off Erekor lagoon.
I'm here.
Friday, December 19, 2008
Updates...
Turns out the counter agents at United are a bunch of idiots, well one in particular actually. He managed to put my bags on the correct plane initially, but then saw fit to assume which airlines I'd be flying onward from LA. Fortunately I had that agonizingly long layover during which I had to extricate baggage from Air Nui (New Caledonian Air), and get it to Air Pacific (Fiji). No small task, but accomplished with about 45 minutes to spare.
The layover in Fiji gave me a lovely taste of what I'm in for in Vanuatu weather-wise. It was about 5 am when we landed there and it was about 30 degrees c and humidity like I haven't felt since living in Townsville. NZ by comparison is cool. Weather in the 20's, chilly at night, but the sun is Southern Hemisphere HOT. The boys are toasting up to a lovely shade of brown, Ryan persists in getting RED every day and complaining bitterly about it at night. Lots of swimming, playing on wild NZ playground equipment which would be deemed MUCH too dangerous in the States, and yesterday we wandered around the Sea Lion colonies here at Kaikoura - Miles of stunning blue water beaches on one side and towering mountains (complete with a touch of snow) only a few short miles away on the other. It's lovely.
Earlier this week we enjoyed the hospitality of lovely M, her partner T and baby Noemi and midwife/preceptor Sue. It was so nice to finally meet her (will update blog roll accordingly - terrible omission). They were kind enough to hook me up with my 2nd trimester ultrasound which was, suffice to say, considerably less expensive here than it would have been in the States ($65ish versus $300-odd). I'm not sure if it was a combination also of NZ's less litigious attitude, or excellent scanners which seemed so much better than any I've had before, but we scored a rockin' ultrasonographer who was happy to talk me through the whole scan, pointing out the findings I was most interested in (4 chamber heart, all outflow tracts lovely, kidneys, diaphragm, etc. etc.). It was fun watching her chase this new little person around. While we hadn't quite decided to discover the gender, it was all rendered moot within about 2 minutes when he decided to point his bum right at the transducer beam and well, all mystery was swiftly lost. I should note that this scan also served to determine that there is but one fetus in residence which makes me very happy indeed.
So with that sorted I give you the obligatory creepy ultrasound pic of wee baby #3. It seems I am destined to be mother to legion sons.
Internet access sufficient to update blog is spotty here in NZ, and quite expensive... You may not hear from me again till I land in Vanuatu. Happy Christmas, Hanukkah, Solstice, Kwanzaa - hope you and your families are warm and safe, and your tables full of delicious things this holiday. Here comes 2009!
Catch you on the flipside.
Xx L
The layover in Fiji gave me a lovely taste of what I'm in for in Vanuatu weather-wise. It was about 5 am when we landed there and it was about 30 degrees c and humidity like I haven't felt since living in Townsville. NZ by comparison is cool. Weather in the 20's, chilly at night, but the sun is Southern Hemisphere HOT. The boys are toasting up to a lovely shade of brown, Ryan persists in getting RED every day and complaining bitterly about it at night. Lots of swimming, playing on wild NZ playground equipment which would be deemed MUCH too dangerous in the States, and yesterday we wandered around the Sea Lion colonies here at Kaikoura - Miles of stunning blue water beaches on one side and towering mountains (complete with a touch of snow) only a few short miles away on the other. It's lovely.
Earlier this week we enjoyed the hospitality of lovely M, her partner T and baby Noemi and midwife/preceptor Sue. It was so nice to finally meet her (will update blog roll accordingly - terrible omission). They were kind enough to hook me up with my 2nd trimester ultrasound which was, suffice to say, considerably less expensive here than it would have been in the States ($65ish versus $300-odd). I'm not sure if it was a combination also of NZ's less litigious attitude, or excellent scanners which seemed so much better than any I've had before, but we scored a rockin' ultrasonographer who was happy to talk me through the whole scan, pointing out the findings I was most interested in (4 chamber heart, all outflow tracts lovely, kidneys, diaphragm, etc. etc.). It was fun watching her chase this new little person around. While we hadn't quite decided to discover the gender, it was all rendered moot within about 2 minutes when he decided to point his bum right at the transducer beam and well, all mystery was swiftly lost. I should note that this scan also served to determine that there is but one fetus in residence which makes me very happy indeed.
So with that sorted I give you the obligatory creepy ultrasound pic of wee baby #3. It seems I am destined to be mother to legion sons.
Internet access sufficient to update blog is spotty here in NZ, and quite expensive... You may not hear from me again till I land in Vanuatu. Happy Christmas, Hanukkah, Solstice, Kwanzaa - hope you and your families are warm and safe, and your tables full of delicious things this holiday. Here comes 2009!Catch you on the flipside.
Xx L
Wednesday, December 10, 2008
Give me your tired and huddled masses...
I gotta say, that LAX is about the weirdest place on the face of the earth. I can remember the first time I ever visited the States on a family holiday - I was about 13, my parents bribed my younger brother and I with a trip to Disneyland so they could then subject us to every major church and art gallery in western Europe... I can remember stumbling off the plane here in LA, staggered both by the thick smoggy air (I'd never actually seen smog prior) and the sheer size of everything and the throngs of people. Back then (1991?) LAX was a good deal grubbier, and seemed to be inhabited by hordes of aggressive Hare Krishna devotees all determined to "gift" me - and I assume everyone else with copies of a large book. I'd never encountered the "here's a present, now you must give me a donation" technique of fundraising. How good a target I appeared as an incredibly naive Australian tween, still rather eludes me, but they tried anyway.
Every time I'm back in LA I'm struck by just what an extraordinary place the Tom Bradley International terminal is. It's massive, it's packed with every possible nationality of traveller in every manner of national dress. I've been sitting here (I can't check in for another 2 hrs) watching people, and it continues to be just a kaleidoscope of people. Interestingly the first man who spoke to me this afternoon after I arrived was a south asian Indian?) guy thrusting yet another text at me, and, with nothing to identify me as such asking urgently "Are you an Australian or New Zealander?" I'm really not sure what it was that tipped him off. I rather thought that after almost 9 years living here that I'd have less Australian-ness about me - especially when you consider that I didn't actually open my mouth (an almost immediate give-away). I didn't stick around to find out which group he was recruiting for...
Anyhoo. After two days of what is quite honestly, a pretty grueling exam, I'm now headed south. In something like 20hrs I'll get back to my family who are currently enjoying NZ's beautiful Bay of Islands and then we'll head south for three weeks of R and R. Before the real adventure begins.
Fingers crossed my bag tranfers as it should from Seattle, all the way to Auckland else I'll be royally screwed.
Every time I'm back in LA I'm struck by just what an extraordinary place the Tom Bradley International terminal is. It's massive, it's packed with every possible nationality of traveller in every manner of national dress. I've been sitting here (I can't check in for another 2 hrs) watching people, and it continues to be just a kaleidoscope of people. Interestingly the first man who spoke to me this afternoon after I arrived was a south asian Indian?) guy thrusting yet another text at me, and, with nothing to identify me as such asking urgently "Are you an Australian or New Zealander?" I'm really not sure what it was that tipped him off. I rather thought that after almost 9 years living here that I'd have less Australian-ness about me - especially when you consider that I didn't actually open my mouth (an almost immediate give-away). I didn't stick around to find out which group he was recruiting for...
Anyhoo. After two days of what is quite honestly, a pretty grueling exam, I'm now headed south. In something like 20hrs I'll get back to my family who are currently enjoying NZ's beautiful Bay of Islands and then we'll head south for three weeks of R and R. Before the real adventure begins.
Fingers crossed my bag tranfers as it should from Seattle, all the way to Auckland else I'll be royally screwed.
Wednesday, December 3, 2008
Countdown
Have been (blessedly) off call for some three days now, and have been a perpetual motion machine ever since. Have finally accumulated some 20kg (~40lbs) of supplies to take with me thanks in large part to the gracious donations of assorted Seattle midwifery practices, friends and preceptors. Vila Hospital has the following coming their way, assuming I don't slip a disc in the process...
I'm frantically preparing for my final practical exam - the dreaded ACE (Advanced Clinical Examination) as well as completing the rough draft of my Senior Paper which, inexplicably is due NOW. Husband and boys leave for NZ tomorrow morning, as I head to school for a couple of days.
I'll be on a 10.30 ish flight to LAX/FIJI/AUK on Wednesday next.
Thanks all for your support and encouragement. Stay tuned!
- 200 disposable chux pads (we get to use 1/2 a chux for each birth - I'm used to using between 10 and 20 per birth so I expect I will get to love those rationed items dearly...)
- 12 boxes (1800) non sterile nitrile gloves. Always in short supply I'm told.
- 200 pairs of sterile gloves
- About a gallon of alcohol based hand sanitizer.
- A big pile of hand towels (all now permanently marked with "Property of VGH" on the advice of former pacific midwife-adventurer Emily. I guess they have a tendency to "walk" otherwise)
- About a dozen bars of antibacterial soap (more to be purchased in NZ)
- Several large bottles of lidocaine - students have found at various times that there wasn't enough lido for all the repairs that are reported to go on. I tend to think that you can never have too much, so I've brought a bunch with me.
- A bag of tubes of Erythromycin eye ointment - I've since been informed that they don't use it, but perhaps it'll come in handy anyway to some baby somewhere!
- A handful of (slightly out of date) amnihooks thanks to a lovely nurse at a hospital which shall remain nameless.
- A handful of digital thermometers (which read in celcius - note to self, must brush up on conversions...)
- Oh yeah and a small fortune in suture material, mostly 3.0 and 4.0 synthetic. I'm reliably informed that every lac, no matter how small is routinely sutured with 0.0 (aka what I imagine looks and feels like heavy gauge fishing line). Besides the fact that I'm not sure I could adequately knot that sort of suture, I hope that the 3.0 and 4.0 will make more women a bit more comfortable.
I'm frantically preparing for my final practical exam - the dreaded ACE (Advanced Clinical Examination) as well as completing the rough draft of my Senior Paper which, inexplicably is due NOW. Husband and boys leave for NZ tomorrow morning, as I head to school for a couple of days.
I'll be on a 10.30 ish flight to LAX/FIJI/AUK on Wednesday next.
Thanks all for your support and encouragement. Stay tuned!
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