Postings.

Friday the 20th

At the Bureau of Immigration.

I woke up pretty early and headed to the Bureau of Immigration to pick up my I-Card. This is an identification card (ID) that Kelsey and I had to get because our stay is longer than 59 days (by 3 days). It was a quick in and out situation in which I just had to tell them my name and sign for it and I was the proud new owner of an I-Card! I was glad that it was a quick trip for sure!

I-Card!

I got home and Tilly and I decided to make the day an adventure and go to the island of Samal to find a waterfall we had heard about the week previous from our scuba instructor. We packed our bag and headed out, ready for a relaxing and exciting day. We took a jeepney to the wharf and waited for the ferry to take us across the bay. The boat ride was pretty quick and we hopped onto a motor to head up to the waterfall. It was Tilly's first ride on a motor and she hung on pretty tight! The island is so very different from where we live, so filled with jungle! There were banana trees, pineapple trees, and who knows what else as we wound up, down, and around a mountain or two. The houses were pretty spaced out, which was a welcome change to the city pace.

Motor ride! All three of us on this baby up the mountain!

The homes we saw were very similar to those that we have seen so far- either cement or woven bamboo for walls and either bamboo roofs or tin. Many yards had goats, dogs, or cats in them. We left the main road when we got close and drove on a narrow path to the entrance to the waterfall park. At the gate we were informed that because it had rained the night before and the water was murkey, admission would be half price. We were bummed about the murky water but happy for the half price! The man at the gate told us it would be about a 100meter hike to the falls and we set off. Hike it was! Down and then up again! It was pretty toasty while we were walking but pretty adventuresome. All of the foliage reminded me of the times we have gone to Pikes Peak in Prairie Du Chen. It made me feel a bit at home.
We ventured around near the falls and then hiked out of the valley to take a tricey back into town.

The hike

Overlooking the falls.

We walked through their market a bit and popped out at the shore. There we saw a low tide and some of the homes that are on the water. They are stilted and right on top of each other! They were pretty tiny and had tin roofs and walls. We also saw a dad at his market stall watching his sleeping baby in a homemade 'Pack and Play' out of wooden slats. Lord, thank you for showing me more of this country today! Thank you for continuing to open my eyes to the culture, need, and lifestyles here! Lord I pray for those who have entered my life and I theirs, may you continue to touch them.

Some of the homes near the water.

"Pack and Play"

We hopped onto a bus to take us the rest of the way across the island where I snoozed off and on. The bus even took us on the Ferry and dropped us off at the local hospital. From there we walked home.
Once home we hung out for a bit and I got ready to head to bed! It was a pretty crazy day but I had it all off because of some switching that another midwife and I did so she could go on a trip out of town. It was pretty nice to have a relaxing day after so many back to back shifts!

Saturday the 21st
This was another pretty relaxing day for me, since I was only scheduled for night shift. Tilly, Kelsey and I decided to go to Aldevinco (the touristy market place) to check out some more souvenirs. We left pretty satisfied with our purchases and walked to nearby mall to pick up flour and bananas for the house before we headed home.

I tried to nap before shift but wasn't really able to and headed to shift hoping to be first up. It turned out that I wasn't but that was okay with me. I was told that I had mail upstairs by my supervisor and rushed upstairs to see what was in store for me. I was SO very excited! It is a special treat to get mail here because I like to see how long it takes. It turned out that I got two letters (one from Bev and one from Grandma Gravel) and  PACKAGE!! Of course the package was just a packing slip and I had to go to the post office to claim it and wait until MONDAY! None the less I was pretty stoked!

Shift was pretty uneventful. I did end up being first up for about two hours while the first up midwife sutured a patient along with Heidi, one of my roomies. I didn't get any sound sleep while I rested my eyes, being ready at any minute for a labor to arrive. Once I heard them transfer the patient to postpartum I slept pretty well until 5:20AM when a patient came in via ambulance. This was the first time that I had seen a patient arrive via ambulance (lights and all). Typically they arrive via tricey, jeepney, or most commonly taxi. We checked to see if she had received prenatal care with us, a prerequisite for being admitted. She had and was brought in quickly. She didn't deliver on our shift but it was certainly a memorable moment, especially since the first up midwife had to be shaken awake!

Sunday the 22nd

Busy at work!

I left shift well rested and headed to the other house to call Grandma  to tell her I had gotten her letter. She was pretty tickled, I would say. I talked with her for a while as well as Mom. I left the house to shower and change at mine. I decided since it was pretty warm to head to the mall to write some long overdue postcards. I talked with some roommates about shift, showered, and then headed to the other house again to call Dad. We talked for a while and then I headed out for the mall.

I hulled myself up in a coffee shop and wrote some post cards, determined to send them out on Monday when I picked up my package. And write them I did! I also tried coffee jellies in my frozen mocha. Interesting. Its like coffee flavored knox blox that you put in your coffee. It is pretty trendy here. I think I might pass on it next time.

I got home from the mall and we headed out for a pre-arranged date to People's Park. This is a family friendly park with statues. It is pretty much a park that you walk around and they have performances there also. It was neat enough but not near as exciting as the website made it out to be. A very nice place to take kiddos for sure!

Kelsey, Tilly, and I went on a hunt for mozzarella cheese after the park to bring over to a friend's house for homemade pizza! Three of the midwives that live in the other house are house sitting in another neighborhood and invited over for dinner. We had a bit of difficulty finding cheese as it is fairly pricey here and the grocery store Tilly and Kelsey checked around 2:30 was expensive, the next we checked after the park didn't have any. We struck gold at a third grocery store and bought it! The next challenge was making it to our friend's house. We took a taxi because it was faster than a jeepney (which would have taken 45 minutes! versus 15-20 minutes).

some of the statues at People's Park of the tribes.

Dinner was SO SO GOOD! Plus the company was delightful and filled with great conversation and laughs. We took a taxi home and I went to bed pretty promptly(ish) since I had day shift the next day. Lord, thank you for such wonderful companions while I am here! I have learned so much from them about life, midwifery, myself, God, and compassion! Thank you for all of their gifts and talents they have to offer and share! Thank you for showing yourself through them to me!

The dinner gang! Pizza, Pringles, salad, and Coke! Cookies and ice cream to boot!

Love you!
Casey

Baby check! Healthy baby girl, AMEN!

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!!!

My girl Aizah Jane

Happy Birthday  Aizah!

This is a special post for Miss Aizah Jane, born July 7^th at 6:10AM. I arrived to shift and one of the night shift girls told me “Casey, there is a fully [dilated] for you.” I was still working on waking up but hurried and changed into my scrubs. I checked in on mama, Rizza before endorsements (shift report) and she was pushy with a  bit of head visible. She coped well with labor and was ready for baby to come out! She arrived at the clinic at 5:30AM but since she was a G1P0 (first pregnancy, none delivered), the supervisor advised me to have her rest while we did report. I was a bit leery because it seemed like baby was close but my supervisor was sure. I left the cubicle for a quick report and headed back in as soon as we talked about my patient. Per protocol, I began taking a new set of vitals but she was still very active and ready to push. I took a peak at 4-5 cm of head was visible with BOW (bag of water) intact! I hollered for my supervisor and she and another midwife came running! This baby was coming. I positioned myself at the foot of the bed, ready for the bag of water to break, guarding myself and others. (oh, PS this was during the weekend that we didn’t have water at the clinic so we were being conservative with the towels and blankets we were using).

Rizza continued to push well and before I could even think, baby was out at 6:10AM! A bit of nursing for you: since the BOW (bag of water) hadn’t broken, baby was out “in the caul” aka with the bag covering her face. This was the first time I had ever seen or heard that and honestly had no idea what to do. My supervisor stepped in quickly and wiped it from her face to allow her to breath. Baby’s APGARs were 7 and 9 so she did very well despite that little snaphoo.

I cleaned up and worked on their paper work and tried to help baby girl breast feed.

Unfortunately, this patient was a first time mom and was having difficulty breast feeding. I worked with her all shift and stressed the importance of feeding her baby with breast milk (breast is best, after all. Especially when the water supply isn't guaranteed for formula and it is premixed, where formula is expensive and mamas here dilute it which means less nutrition for baby). I never did see her breast feed for more than 5 minutes without giving up and was worried as I discharged her. My supervisor didn't seem worried but I was anxious all night. I talked with my roommates about it and they gave me some ideas.

I saw her the next day for her one day baby check and she reported that the baby hadn't been sucking well still. Another supervisor helped me establish a good latch and baby Aizah Jane went to town! Praise God! I had the patient's husband come in and help and his face was priceless as he stared in amazement at his baby and mother of his child. It was like a kid in a candy store. I was so close to tears as she switched sides and the baby latched on her own! It really is a matter of thriving or dying here if the baby cannot eat well.

The rest of the shift, I was on cloud nine. I realized that catching babies is only part of my journey here. The education and aid to women with this new life in their hands is another component of it. When I first arrived here I was anxious to catch babies or help them be born; now I am so overjoyed to be welcomed into their lives in such an intimate way!

Rizza came back for another check today and I got to see baby sucking well again and GAINING WEIGHT! Happy faces all around!

Heading home.

Day one baby check

He was so very careful with her!

This is after she breast fed so well! I think we were all relieved and happy!

PS- McDonald's delivers here. We got a little bored later on during shift and craved some ice cream! Sundaes for all!

A bit of fun

My last post eluded to the Fourth of July so I may as well start there.

Before prenatals on the 4th!

On the Fourth I got to sleep in until 6:20AM! I was scheduled for a long day with prenatals and clinic. As I made my breakfast and packed my lunch, I skyped the Riesberg family while they all ate dinner and got ready to watch the 3rd of July fireworks back home. I loved getting to chat with all of them, Landon was a bit confused as to my eating breakfast :).

I headed out for clinic where I saw 11 patients on my own (we had a lot that day, 76)! Thankfully, all of them seemed healthy. I did have to refer one patient to the doctor for inconsistent fundal heights (either her due date is wrong or baby is growing at a slightly different pace than expected). I wrote the referral and had my supervisor double check everything. It still catches me off guard that I am able to refer patients for labs, ultrasounds, and doctor visits even though my supervisors are always there and have confidence in me. I had one patient who was 19, first baby who was a doll! She had so many questions and wanted to make sure that she was doing everything right. She had brought in an ultrasound and we went over it together. Here they are given the print out results but aren't often explained what all of the medical lingo means (until I got the hang of it, it all looked like a foreign language to me). We make a copy of the ultrasound for their chart and they keep the original.

Happy Independence Day!

I enjoy prentals because it means a lot of one one one patient contact and tons of opportunities for education. We talk a lot about how important it is to eat healthy (that means cutting down on beloved sugar and soft drinks) and drink lots of water. We also do a lot of education on clean catch urine samples. Many of the labs here don't have soap so if the woman takes public transportation and then pees in a cup, she contaminates her sample. We stress that it is important to bring your own soap and wash your hands first. This can make all the difference in the results of the labs!

After prenatals, I went to a close barbeque place with one of my roomies. I had some great chicken and rice and then it was time for swing shift. Shift was pretty slow, but a nice relaxing one at that.

July 5th
WHITE WATER RAFTING AND ZIPLINING! Tilly looked into a package and we went on the 5th. It was quite a bit of fun! The rapids were Class III (out of six) so they were pretty mild. We did capsize once and we all got tossed out at least once but we had a good time. The drive to our drop spot was pretty rugged in the van/bus with many bumps. We all kicked ourselves for not having our cameras as we passed rice fields, banana fields, and little villages. It sure is a good thing that there are hand holds in vehicles here because we sure used them! We got a quick lesson in rafting and were off! Our guide was pretty funny and even tipped out when we capsized!
 We were all pretty tired as we drove home and when we made a pit stop at the zipline place we had vouchers for. This is the second longest zip in the Phils and we decided to do it! We got our harnesses on and climbed the tour  to our fate! The view was BEAUTIFUL!! (not to mention fun!)
We got home and I was pretty tired, so I took a bit of a nap before heading to night shift.

oops! there we go!

We are just too cool to handle ;) L to R: Eva, Jac, Tilly, Me, Kelsey

Our sack lunch- BBQ Chicken/Pork, rice- of course, hard boiled egg, and a juice bag.

so tired. Queens of the rock!

Drifting, another fun aspect of the trip! Me and Tilly

We survived!

Let's do this!

Check out the view!

WOOOOOOO!!!

On an unrelated note- Tilly, Kelsey, and I went out for pizza the other night. YUM!

Look moms! We match!! Kelsey is fresh for shift, I'm heading out.

Roadside diner Kelsey and I ate at on the 10th,

pork and rice. we are basically Filipino now!

this cake was huge but SOOOO good!

Kelsey, Tilly, Kara (another summer volunteer) and I got massages the night of the 10th downtown for 200peos, $4.67USD. I think I could get used to this....