I thought y'all might like a sample of my life. I'll try not to make it too lengthly. :) This week I did a little less studying than usual since I finished my assignment early. I maybe should have studied a little more for the test but I think I did ok.
Saturday night started a lovely relaxing weekend with the girls in my house playing games such as telephone pictionary and truth or dare. We then got to talking about anything and everything under the sun (we especially enjoyed girly topics such as our favorite style of wedding and what kind of wedding dress we want.) I decided that since I am no longer living at home and didn't have anything to do the next day I was going to stay up late (with the girls who were usually on night shift so they were used to being up late). I think I ended up going to bed at 2am like any normal college student. :)
Sunday I slept in, puttered around a little, read my Bible, and made myself lunch. Several of us decided to go to the same church together in the afternoon. We discovered that if we are all going somewhere at the same time we really need to talk about who is taking a shower when! Thankfully my room mate is a good sport and she handed out my soap so I could shower in the extra bathroom. Worship at church was quite refreshing. Afterwards we went to 'Serenitea' and drank tea and ate some chips and talked about midwifery things and what we want to do after we graduate. Sunday night I tried to sleep early since I knew Monday was a big day but I think staying up so late the night before had thrown off my pattern so I really slept off and on.
Monday I got up at 5:00am and left for the clinic at 5:30. We are just getting into the busy fall time at the clinic (about 9 months after last year's holidays!). A lady had given birth just before I got there and since I was last in line to catch that day I was put in charge of her. I sat and listened to the outgoing shift tell about all the patients, prayed with them, then got right to work because an immediate postpartum has a lot that needs done (paperwork, birth certificate, controlling bleeding, monitoring vitals, establishing breastfeeding, helping to the bathroom, newborn exam and meds, etc.). At this point I am doing most of the work, just notifying my supervisor of anything abnormal and asking permission before I do anything such as give the baby his vaccine. Of course, if another midwife is free they are usually great about helping anywhere they can. This patient had a little trouble at first getting the baby to suck but after several of us took turns patiently helping she did great. She also had a tear that needed to be sutured. I have not yet learned suturing so I held her hand and tried to distract her while another midwife sutured. She had local anesthetic but it still wasn't fun. Her poor mother couldn't stand to stay and watch so it was all on me.
Right about when I got her settled two of my other patients decided to show up at the same time for their check ups. I had caught both of their babies and scheduled them one hour apart for check ups but you never know if they will even come back at all let alone the time you said. I wish I had gotten a picture with both of them. One baby was three days old. Everything appeared normal for her. I gave her mom some tips on dealing with engorgement and made sure she knew the baby's cord has to be allowed to dry. A lot of ladies here like to use a 'binkis,' a piece of cloth wrapped around the baby's middle like a sort of bandage over the cord. This doesn't allow it to dry out and can lead to infection. The other baby was one week old. The only problem with her was that her mom's blood pressure was quite high. If we could get it to go down then we knew it was ok, she was probably just dehydrated or stressed or something, but if it wouldn't go down then it might be a hypertension problem. My supervisor told me to have her drink a glass of water and lye down for a while. The mother also said she hadn't had breakfast so I mixed some powdered milk and chocolate powder that we always keep on hand for patients.
The lady who had given birth just that morning was having trouble voiding. I felt her uterus. It was firm but high in her tummy and off to the side, probably displaced by the urine. This can be a problem because it can prevent the uterus from contracting properly which makes her bleed more. My supervisor and I had her sit up to put some pressure on her bladder and drink several glasses of water. She asked her husband to pass her the baby. He tried for several minutes but couldn't figure out how to pick up the baby. I think he was scared of hurting her. I tried to teach him but I think the high-blood-pressure-patient's husband helped him more. They were in the next bed over. He told the other dad,"Ayaw kahadlok" (don't be scared) and really encouraged him. It was kind of funny but I was glad he was helping.
I then ate the salad I had packed for lunch. It is very cultural for people to eat together here. If one is eating they always invite those around them to share the food. I'm often amazed how even on busy shifts the Filipinas usually manage to all sit down together for at least a few minutes. My check up patient still had high blood pressure so we gave her a big dose of calcium and some lunch. We were on the verge of referring her to a doctor when it normalized. My supervisor and I both think she was just hungry from skipping breakfast. The other girl was able to void and doing better. A couple of labors had come in but I was too busy to notice if they gave birth or were sent home. There was one in active labor right then. The midwife assigned to her and the supervisor were coaching her to push. When the baby's heart rate started dropping I and a couple others went to help chart and do anything needed. We gave her oxygen and an IV and had her pushing in positions that should make birth faster. When the heart tones would not get faster even with head stimulation and she wasn't making progress pushing we prepared to transport her to the ER. We put her on a stretcher with portable O2 and sent her in the ambulance with her midwife. I was ok until I heard the supervisor praying out loud for the baby. That particular supervisor is usually pretty calm in emergencies. I got one last round of vitals and we endorsed to the next shift and prayed with them.
I was hoping to have a little time to sit down and breathe between the end of shift and the start of class at 2:30 but they almost started without me. It was the practical class/test for IV insertion. I had inserted one successfully once before. This time it took me two tries. I also volunteered my veins for classmates to try on. I was poked three times but never successfully which made it much more painful. About 4:00 I went home and ate a cup of ice cream. I went down the street to the other dorm to plan a health teaching with my friend there for the next morning before prenatals since it was our turn. I went back home, slept from 5:30-7:00, ate some more ice cream and left overs, youtubed a little and went to bed around 9.
Tuesday I arrived at the clinic a little earlier than usual for prenatals, about 7:15am, because we wanted to get ready for the health teaching. The midwives and staff did a devotion together. All the pregnant ladies who had check ups that day were supposed to arrive by 8:00. We then sang with them and someone did a short devotion/Bible teaching. Then it was time for the health teaching. I was quite proud of myself that day. I used to get very nervous whenever it was my turn but this time wasn't so bad and I think we did pretty well. It was on labor and delivery. We had several activities where we asked for volunteers to keep people's attention. I tried not to get annoyed at our translators who kept adding things. They were quite true and good to say but they took up a lot of time and I wasn't able to say all I was supposed to.
On a prenatal day I usually get in 5-6 ladies and finish by noon. There are always one or two that stick in my mind. That day, I remember, there was a 17 year old girl who had her two year old daughter with her. She had had that little girl, one miscarriage, and now she was pregnant with this baby. I remember her mostly because she seamed to be a very very good mom. When we were done there wasn't time for me to go home to get food because I had a class at 1 so I walked down the street and got some siopao which is like a rice bun with meat in it. Back at the clinic, class was on family planning. We had already studied most of the methods so we finished the last few and then talked about how to counsel clients as to which one might be best for them. We also discussed our different beliefs about what the Bible says about family planning. After that a couple of the girls were going to print their family planning assignment and I went along to print mine too since it was due on Thursday. We had to go to the print shops across from the local high school and pay a few pesos to print from a USB drive. We decided to get fried bananas on the way home. Honestly I don't remember what I did the rest of the day. It was probably almost supper time by that time and I made myself supper. My friends and I might have also quizzed each other in preparation for the two tests coming up.
Wednesday in the morning I went to the store and got myself more soap and shampoo and other necessary things. I heard that my friend had been at the clinic since 2am with a continuity patient (just means she decided to be her midwife the whole way through), when she wasn't home at noon I texted asking if she needed food. She did. I prepared for swing shift, packing my scrubs, my supper, Doppler, thermometer, etc. and went over early to take her food. She was sleeping in the empty prenatal room and another friend was watching IV videos getting ready for the test so I watched them with her until shift started at 2. That day I had two postpartum patients. One was completely fine and one needed a lot more help breastfeeding than I knew how to give. Her baby was just super sleepy and didn't like to open his little mouth. Thankfully there was a senior midwife on shift who was able to spend a lot of time with her. I learned several things watching her. That patient had a white husband which is something I've only seen at the clinic a few times.
I assisted with my first shoulder dystocia that day. That's when the baby's shoulders get stuck behind the pubic bone and it is quite scary. It lasted 1minute and 40sec. I feel like I was actually useful for which I was glad but I was also very glad I was not in charge and able to just follow instructions. The baby was blue and a little bit floppy when he came out but it didn't take him long to come around. After that birth and another labor was given to another midwife I was next in line to catch. When my labor walked in she looked quite active. When we checked her chart she was only 35 weeks and 4 days. Five weeks early. We had to transfer her to the ER at the hospital. I took vitals and filled out papers as quickly as I could. She was in too much pain to lay down very long so I just measured her belly laying down and did the rest with her standing. She was handling it so well I really wished I could do labor watch for her. In the ambulance on the way over I read more of her chart. She was 20 years old, same as me. She had had two previous babies, both born at 7 months and both died within a few days. Her mother who was with her asked me if there was a medicine they would give at the hospital to make the labor stop. I had to truthfully answer that I didn't know. I asked if I could pray for them there in the ambulance and they said sure. At the ER I gave the doctor the referral form, she shortly asked where the paper was for her to sign and I handed it over. I felt like crying on the way back to the clinic. That government hospital is so understaffed and overworked and I knew her mom would not be allowed to go with her for anything. I could write a whole email about all the problems with the government hospital.
Thursday morning (yesterday) I decided to visit the girl I had transported. I walked to the clinic to get her a Visayan Bible and baby outfit, realized I had not written her in the correct book the night before and forgot her name. Thankfully I found it and fixed it. I took a taxi to the hospital. They said at the information desk that she was there but I couldn't visit until 9:00. After a while of waiting at the 7eleven across the street, I went back at 9 and they let me in. It took forever to find her. The first place told me several other places to try without even looking to see if she was in that room. The delivery room said she wasn't even on record. A couple other places had no idea either. For a while I wandered around trying to decide who to ask and where to go. I watched the doctor doing her "rounds." The way she did this was to call over the intercom the names of 25 or so babies and their mother and have them line up along the front of the room. She had six of them in front lay their babies lined up on a table in the corner and asked, "Kusog nagdidi tanan?" (Are they all breastfeeding well?) then she put her nose to the belly of each one to smell for infection of the cord. She flipped through each one's chart and said a couple of things to each parent and sent them back to the bed. It sounds cruel and maybe it was but if you could have seen how many babies were there with only one doctor you could see how stretched she was.
I decided it was really no use trying to find my girl and started back home. I didn't get too far though because I really felt like I should find her so I went back to the first room and politely insisted that they look. Sure enough, she was there. She had had her baby. She looked so tired. She said she had seen the baby for a few minutes and then they took him to the neonate room for observation. They hadn't told her anything about the likelihood of survival or any management they would give. She had not even been allowed to start breastfeeding. All around her were moms with babies, two to a bed. Her husband was allowed to be there and bring her food and things. There was no way she could sleep with all the noise and lights and not really enough room to stretch out. I gave her the Bible and signed it, she seamed to like that, and the baby onesie which I'm sure was way too big for her little girl. I prayed for her and cut my visit short because she had to go stand in line at the insurance desk. She walked over leaning on her husband and I could tell it was really painful. She told me she had been sutured. I know they almost always cut ladies there and it made me so mad because with proper technique she shouldn't even have torn naturally with such a small baby.
I walked the 30min home and maybe shouldn't have because my friend later noticed I got a little sun burnt. There were a few girls quizzing each other on IVs and family planning in the living room and I joined them for a while, then I fell asleep on the couch until someone woke me up saying it was time to go take the two tests. I grabbed a piece of bread with peanut butter for lunch and my assignment to hand in and walked with them to the clinic. I think I did ok on the tests but it will be a while before they are all graded. When we got home one of the girls declared that she was going to see "Jason Borne" in the theater and invited anyone else along. She said she wished she had seen the ones before it. I said I had them on my computer so we watched one. Three of us went over to the mall and got some McDonalds and some local food for supper to celebrate the finished test. Then we sat talking until the movie started. After the movie we walked home in a light rain. And we were very happy because Filipinos hate rain and we had all the roads to ourselves with no cat calls and no one staring at us.
Today was an around-the-house kind of day. I did my laundry, encouraged my friend that she CAN finish her assignment, washed dishes, made some rice pudding to try to use up all the rice that our Filippina cook likes to make for us and wrote Grandma a letter. About 3:00 I had a patient come for a check up with her baby so I walked to the clinic and did her check up. There was a baby there whose mother had been transported for too much bleeding. We don't keep bottles around the clinic though we do keep frozen breast milk to give by syringe(without the needle) but it's better for a baby to actually breastfeed. I asked my baby check patient if she would be willing to nurse the baby and she was quite happy to do it.
Tomorrow my friend said she would go over to Roxas street with me to get henna designs on our feet. I have seen they are really pretty and last several weeks. It's nice to do something fun at the end of an assignment and test. Maybe I can also print some pictures for Grandma since she doesn't have internet and go to the post office to mail my letter. Sunday I'll have to go to church in the morning since I have swing shift in the afternoon and evening. Then Monday I will start the next assignment and it's back to hitting the books hard again. So that's my week. I hope you all had a good week too!
