We've been busy!

July 12th (Thursday) 
I started this day with a double shift, doing a vaccine clinic and then swing shift. The clinic offers BCG (tuberculosis vaccine) for babies every two weeks. It is a pretty hectic day as all of the babies that have been born in the last two weeks return with their mamas for this vaccine and many of them have baby checks afterwards, and busy it was!
http://tuberculosis.emedtv.com/bcg-vaccine/bcg-vaccine.html This link offers information about the vaccine, and why it is important in the Philippines and not so much in the States.

I was pretty nervous going to the clinic because I had heard that giving this vaccine is particularly tricky for a lot of the girls here.  Unlike a standard intramuscular injection (ie needle jabbed in at 90 degrees, tetanus, flu shot, etc) this vaccine is subdermal. This means that the needle is positioned at a 5 degree angle to the skin and is slid just under the skin and the injection is placed in that layer of skin. It creates a bleb or bubble on the skin if done correctly (think TB testing on your forearm). This is a skill we learn during our sophomore skills class so I felt comfortable with it, but was worried because of all of the talk I had heard.

This is how the BCG vaccine is given. It leave a scar as well.

Once the clinic started, the supervisor instructed all of the mamas how it would work, and that when they were called to help us by holding their babies still while we worked. I watched a few times and then it was my turn to show my supervisor that I was ready. I called my first patient (who was actually one of the babies I have caught) and prepared. The vaccine goes just below the baby's shoulder on their arm. I did my best to sooth the baby as I poked and injected the solution. I got it on the first try, despite a fussy baby (I can't blame him, can you?). My supervisor was satisfied with my work and allowed me to return to my spot and continue to give injections. I don't know how many babies I gave it to but I know we did about 50 or more as a group of four of us.

Three week old Hyacent Mae

After the BCG clinic, I got to do a three week check on the first baby that I caught! Hyacent Mae is getting SO big! This is such a good thing and I was so very happy to get to see her and her mama again. I talked with her mama for quite some time and changed the day of her six week check so that I will be able to do it before I leave. Mama was pretty sad to hear that I will be leaving and let me hold Hyacent for quite some time. She said that she will miss me and kept telling Hyacent that they will miss Aunt Casey. This made me sad and miss Xander, Landon, and even more anxious to meet Eli of course!

Shift went well, I was able to labor with a patient for quite some time and deliver baby girl Princess Joy at 9:03pm. I am always bummed when I catch near shift change and am unable to do their postpartum care, but I endorsed mama Gie-Gie to Tilly and knew that they were in good hands. This was her first baby and she was EXTREMELY excited! Her aunt and cousin were outside waiting for news and were excited to meet the new baby in their lives. Her labor was a bit difficult, she kept asking me for pain medications and telling me that she couldn't do it any more. We worked together to help her cope by changing positions, breathing and using her bana as support. He really was good with her.
God thank you for showing me your beauty in the growth of Hyacent Mae! Thank you for bringing four of my patients to the BCG clinic today and thank you for helping me to form relationships with my patients! 

Hyacent Mae is getting big!

Friday the 13th oh boy!!!
Friday morning I woke up feeling a bit crummy, hoping it wasn't a tropical bug or anything. I took some ibuprofen and Kelsey and I headed out to figure out our visa renewal process. We will be here three days past our visa from home so we had to extend it. We took a jeep downtown to the Office of Immigration but were early so we grabbed some pastries from a bakery. We made our way to what we thought was the office but found out it was next door. When we walked in, we had 8:15am and the office had 8:40ish! Turns out they run on a different time! We had arrived early per suggestion of other girls here, wearing our long pants and closed toe shoes, as required. We applied for our extensions and then went to make copies. We waited patiently and read until they called our names. We had a bit of a hang up when they informed us we needed to get I-Cards  (identification cards) because we were staying longer than 59 days. This would be an additional 2000ish pesos ($40USD). We paid and then waited a bit more. The visa process was fast but we are still waiting to hear about the I-Cards, they said they would text us sometime this week.
After our Immigration adventure, we returned home where I had a small lunch and then slept all afternoon- still feeling crummy. Tilly and I went with Eva, another midwife here, for hot chocolate at a local market. They use pure cocoa grounds (think coffee grounds but BETTER) and make delicious hot chocolate, served with sticky rice to dip it in and you add your own sugar. Translation: YUM!!! Tilly and I believe we will make a trip there again.

I had night shift on the 13th... dun dun dun! It started out fairly busy with everyone having a labor patient of their own or immediate postpartum patient. I began checking in two or three patients while there was a pushing patient in another cubicle so everyone else was busy and the power went out! Our generator kicked in and out but fortunately it didn't take long for us to get power back up. It was storming to beat the band- lightening, thunder, and downpour!
  Both patients that I checked in were interesting. One of them I had sent home on a previous shift as she was not very far along. She had a very big UTI and we sent her to the hospital for management but the doctor didn't giver her anything because she was pregnant despite our recommendation for an antibiotic. It is very dangerous to deliver a baby when the mama has a UTI because it can increase risks for baby and mama. This patient, I knew from experience spoke no English but my supervisor took her because she knew the UIT history as well.
I continued to check in another labor as my supervisor worked with the UTI patient.  She was pretty far along and when my supervisor did an IE (internal exam) to check dilation she felt fingers! The patient was 8cm dilated with intact bag of water. We promptly transported this patient because it is a malpresentation and dangerous for us to manage her. While in the ambulance ride, we prayed together for a healthy baby and mama. We prayed for wisdom of the doctors managing her case.
We arrived at the hospital to a line of ambulances dropping women off at the OB-ER. When we got to the hospital, they still had no power! They were using candles in the waiting room and flashlights on their phones! I guess they either don't have a generator or it doesn't work. The nurses took the patient promptly but her bana got hung up trying to check in. On the ride back to the clinic, I asked Kuya Felix (our guard) if Filipinos believe that Friday the 13th is a crazy day or not, the way that we do. He said no and asked how I meant. I told him that back home people believe that crazy things happen (ie power outages, crazy patients, unfortunate events, etc). He laughed and said well I guess you got it huh?
Back at shift I worked with a post partum patient to breast feed. She was having a bit of difficulty and seemed ready to give up. I worked with her for about an hour and began to feel crummy again. I left the cubicle and laid on the floor for a while to avoid falling to the floor involuntarily. The other midwives took good care of me, ensuring I ate and rested. The rest of the shift I delegated my patient care from the couch to a new missionary and hopped in on a birth near endorsements.
I left the clinic at shift change and endorsed my baby checks to the shift, sad to miss the opportunity to see three the babies I have caught but I needed to rest.
God thank you for the gift of caring women in my life. Thank you for their compassion and kindness they have shown me thoughout my stay and the love they showed me when I felt crummy. 

Saturday the 14th
A day of rest for me. I slept most of the day, had a light supper, and hopped into bed around 6:30pm to watch a movie. Our whole house was pretty ambitious either sleeping, watching a movie, or reading. It was nice to have a relaxing day and recover from feeling crummy.

Sunday the 15th
Sunday was a day shift of firsts for me! I had my first patient who spoke ZERO English, put in an IV in the same patient for elevated blood pressure (my first), and it was the first time that I have been sprayed by SROM (spontaneous rupture of membranes- aka her water broke on me, sorry for the detail but I thought it was something important about my life here). She delivered a healthy baby girl shortly thereafter! Because of the area she lives in, a poorer area, an outreach did a home visit for her baby check on the 19th to ensure follow up. God thank you for the challenge of patient communication, I know that you placed Villma into my life for a reason and I am so very grateful for all I learned from her both spiritually and medically!
After shift, I ran to the market and grocery store with Brenda, my roommate. We got the supplies to make granola and some snacks for the house. When we returned, I helped tally the week's receipts for the office at the clinic and then spent my evening making some granola for the house. It was a relaxing and therapeutic activity! God thank you for rest and quite time!

Monday the 16th
Monday I had double shift day with clinic and then swing shift. Mondays are initial prenatal visits so that is always very exciting to me to be able to share the baby's heart beat with the mama's for the first time. It is such a special moment to see their smiles spread across their faces. I saw one patient who had been trying to get pregnant for three years. My heart immediately went out to her. She was so very excited and happy to be pregnant. She had told me she tried 5 different pregnancy test brands to make sure they were right and then went for an ultrasound at 4 weeks  (pretty early). She has also been seeing an OB. She had so many questions about how to take care of herself for her baby and exhibited so much joy that it was contagious! After interviewing her, I got to do the best part- let her hear the baby. If she was happy about being pregnant before, her happiness increased exponentially once she got to hear her baby. She got tears in her eyes and was so excited that I kept the doppler going for a few minutes so she could enjoy the moment. If only I were here in October, I would have taken her as a continuity patient to catch her baby.
This patient was such an amazing reminder and testimony to the work and services we provide at the clinic. Our devotion prior to prenatal checks was about watching for God in our days and this my friends was the PERFECT reminder! God thank you so much for the reminder of the precious lives we are touching in our work here! Thank you for allowing us to serve you and these women! 

Swing was pretty chill, which I was grateful for, I got the opportunity to talk with other midwives here and relax a bit.


Tuesday the 17th-
Happy Birthday Mom and Carly!!
Tilly and I went on an adventure on the 17th! We went SCUBA DIVING! We found a place that offers introductory instruction and a 15-30foot dive and we were so very excited to try it out! We practiced a bit where we could touch and then moved to deeper water where we saw many fish, coral, and got to feed fish (an exciting experience for sure as they picked at my arms a bit).


I worked night shift and labor watched some patients and transported another for elevated blood pressure and then monitored a few other patients. I left shift pretty quick to go home and sleep because I had switched to work swing for another midwife to go on a little trip out of town.

Clearing my mask of water. check out the fish! 

Wednesday the 18th

DEAD COCKROACH!

Another pretty calm shift, with a few baby checks and helping with other patients. After shift as  we waited for the guard to bring us home, I was resting my eyes a COCKROACH FLEW ONTO MY BACK! I woke up promptly and had a mini freak out. Another midwife killed it after I shed my backpack where it was dwelling. Once home I went to bed to ready myself for day shift.












Thursday the 19th
Day shift included labor watching, hopping from patient to patient to check them in and I coached my labor patient who was pretty set in her ways. I endorsed her to Kelsey at 1:45pm as she was on swing shift. Baby was out at 1:49pm, and Kelsey did very well! It was the first time that I have seen her handle and I have to say that she did a very good job! The mama was pretty tense so they needed to use a bit of extra force to get baby out but she was excellent. I was so grateful to her for taking my patient as I was pretty wiped out from my last few shifts.

I did a quick baby check after shift and headed home to have lunch, do laundry, and NAP! I woke up from my nap to have dinner prepared by Heidi (a roommate) and then Tilly and I tried Durian, the fruit of Davao. Very interesting taste indeed. I don't think I enjoyed it but Tilly ate it up!


We cleaned up dinner quick and headed out to the mall to see Ice Age 4! I would see that again!


We came home from the movie and I have been blogging away.

Midnight snack will be arriving soon from McDo Delivery!!! Coke Float!!!