Midwifery Advice Telephone Service

I take a short break from describing our visit to PNG last month to tell the story of events that happened this morning.

Just after 6am today, 13^th August 2013, Beverley gave birth to a healthy baby. She survived and so did the baby. I believe it was an answer to prayer.

I could hear my mobile ringing and vibrating on the kitchen bench on the other side of the house and thought it must be Vivien trying to call me at midnight again. I rolled over trying to get back to sleep. I don’t have a bedside clock so didn’t know what time it was. Phone went again. “I really should get up and answer it as she may be in labour herself and wanting some advice” I thought. It stopped. Then it started again and I heard my younger son get up and answer it. “Mum, Mum, wake up, it’s Vivien” he said shaking me gently. I looked at the time on the phone and it was 5.13am. “Sara, can you call me please” and the phone went dead.

Yesterday morning when I woke up there were 3 messages from Vivien and a text message asking me to call her. I had tried to call, but kept being put through to message bank. I even tried last night, but same again.

I called the number and it went through to her husband Isaac, “Please call Vivien as she is having pains and she wants to talk to you”. My first thought was, “Oh no, please not another death. I can’t deal with someone I know dying in childbirth”. I scribbled down the number as he read it out to me and dialled.

“Hello, Sara!” It was good to hear Vivien’s voice. You see, I haven’t told you this yet, but I didn’t get to see Vivien while in PNG last month. I was terribly disappointed. While shopping in Wewak for groceries we bumped into her husband and he said they’d be there in Bunam on the Monday. But Monday came and went, so did Tuesday, so did Wednesday and still no Vivien. On our way back we left some birthing kits and other things for the boat skipper to drop off for Vivien in Kambarumba. Nobody knows why they didn’t get to Bunam for Health training. There’ll be an explanation and it will probably be related to fuel and boats not getting out to collect them.

Vivien began telling me what the situation was. Initially I thought she was talking about herself and kept thinking she sounded quite good for someone who’d been in labour for a couple of days now! But then I tweaked that she was talking about a woman she was helping. She said the woman had been in labour for over a day now and the baby was stuck. “What must I do Sara?”. A million thoughts raced through my head. I prayed and asked God to help me think clearly and communicate simply with Vivien. I knew I needed to find out whether the head was down – if it was a shoulder presenting then that would definitely cause an obstruction. “Is the head coming first?” I asked. “Yes, I can feel head down and heart beat on left side”. I was amazed. So Vivien had taken on board what we’d taught last year about abdominal assessment and listening to the fetal sounds. I’d left a pinnard stethoscope for her too and wondered if it would be used. I asked her if the heart beat was strong and she said it was strong but it was now very slow.

Oh dear, not a good sign. This baby is getting tired and heading for death. She said the woman had been trying to push since yesterday and the baby would not come out. I had a picture in my head of an exhausted mother, on the floor of the haus, dehydrated and in need of some desperate help. And here I was sitting pretty in my comfy bed, on the other side of the world compared to her.

I told Vivien to give the woman some water to drink and some food (kai kai) for energy. To get her upright – squatting, kneeling, any position where she was up and had gravity helping her. She said she hadn’t done that at all and was lying flat on the ground. I also told her to get the men to get a boat ready to transfer her to the nearest Health Centre which was in Angoram. Vivien then told me that the Angoram Health Centre is closed and so they’d have to go to Wewak. I know that road to Wewak. I also know what the vehicle looks like that transports the sick to Wewak Hospital. I had a picture now of a half dead woman, with a dead fetus, bumping along in the back of a vehicle on the road to Wewak. “It’s no good,” I thought, “this situation is going to need a miracle for there to be a good outcome”.

Vivien then got to work and I sat bolt upright in my bed, searching my head for answers to this dilemma. “What can I do, Lord? I’m in Perth. Miles and miles away from where this woman is giving birth and where Vivien needs some help”. I remembered the name of the airline service in Wewak which is really trying to expand and provide emergency transport for women and babies in the East Sepik Province (another story still to tell). Samaritan Airlines…no, Samaritan Aviation. If only I knew their phone number I could give them a call and get them to try and rescue the woman. The village is not far from the Sepik River so they should be able to land their seaplane. I googled the name and came up with their facebook page, but no contact telephone number. I sent a facebook message: “This is a long shot, but I’ve just heard from Vivien, a VBA in the village of Kambaramba and she has a woman in obstructed labour. Any chance you could give her a call and give some assistance? I’m in Perth, Western Australia. Her number is…..” I pressed send and then prayed hard.

I said to God that I knew He was all knowing and all seeing, so he didn’t need me telling him what to do, but that I really hoped he’d be with Vivien and this woman. I prayed that She would have clear thinking and be able to remember all the positions we had demonstrated last year at training. I prayed that God would send his angels to minister to the woman, give her the strength she needed to push the baby out, and that the baby would be strong and be born alive.

The phone rang again. No one there. I rang Vivien’s number again and she answered: “The baby will be here in 3 minutes. What must I do?” I was so excited. I said, “God is answering our prayers Vivien.” Then I reminded her that she must watch for heavy bleeding because the labour had been long and the birth difficult. I reminded her to rub up the top of the uterus to keep it firm. To not pull on the placenta. Put the baby to the breast (if it’s alive, I thought). In the background I could then hear the sounds a woman makes when the head is crowning. “I have to go” she said. “I’m praying for you Vivien. What’s the woman’s name?” I asked. “Beverley”, she answered quickly and then the phone went dead.

I felt overcome with emotion. The baby was coming. “Lord, you have answered our prayers”. I turned to my side where my bible was laying open and my eyes fell on these verses in Psalm 34: My soul will boast in the Lord; let the afflicted hear and rejoice. Glorify the Lord with me; let us exalt his name together. I sought the Lord and he answered me; he delivered me from all my fears. Those who look to him are radiant; their faces are never covered with shame. This poor [woman] called, and the Lord heard [her]; he saved [her] out of all [her] troubles. The angel of the Lord encamps around those who fear him and he delivers them.

About 20 minutes later I rang again and Vivien told me the baby was born alive, the placenta came away immediately and there was little blood loss. The baby was suckling at the breast as we spoke. She was so thankful for the prayers.

This is a story of answered prayer.

Later this morning there was a message from Samaritan Aviation saying they’d give her a call. I messaged back telling the good news of the birth and a request for the phone number for future. So now, I have the phone number of the pilot and President of the Samaritan Airlines! I wonder what will happen next…

The Mystery of the Closed Health Centre

Cleaning the Health Centre that had been shut up for at least 18 months was quite a task. We hadn’t come prepared to do cleaning and were very remote. It’s not easy finding a bucket, cloths, let alone detergent. I asked one of the women if we could get a bucket, soon a large metal one appeared. I asked if there was a broom or something similar and shortly I saw a young woman sweeping the floors with a wad of straw tied together. In a cupboard I found some green theatre cloths and made an executive decision to use them to wipe surfaces. We also used some of the triangular bandages from the first aid kits we had. In terms of detergent, as I mentioned earlier, there was a bag of cleaning powder – I couldn’t see what ingredients they were but suspect it was bicarbonate soda. We added some to the bucket of water.

Anyone that was standing around and watching was shooed out! We said they had to be working or leave. Tough I know, but I wanted them to feel part of the whole process of getting the place up and running again.

The question was asked whether opening and cleaning the Health Centre was the right thing to do and was not going against the village councillors. I had to stop for a minute and run through the facts in my head:

• the men of the village had asked us to open the centre and run a clinic for the sick children
• I had spoken with Matthew one of the local men and he had reassured me that it was ok to do this – he was the go between with the village leaders
• The centre had been closed under dubious circumstances for such a long time and the village children had been without health care in that time: they were suffering.

Yes, I felt it was absolutely the right thing to do. I felt we had to show courage in the face of ‘unseen opposition’ for the sake of the women and children. Deep down I hoped that by our actions we could show the locals how to rise up against the fear and do the right thing.

Later that day we heard a bit more to the story about why the centre was closed. Apparently there were 2 qualified Health Workers paid by the Health Department. The young son of one of the men died and there were accusations of sorcery. As compensation for the loss of his son, the Health Worker took the ambulance boat with a 40hp engine (apparently the government had provided an ambulance boat to each village with a Health Centre to improve transport between the villages and the Centre), the radio and moved to the town. He is still being paid for his services, the Health Authorities still have Bunam Health Centre down on their books as being open and providing a service. The HW is receiving fuel and using it for his own use or on selling it. It appears that the other HW is afraid and as a result, no health services have been provided in all that time. We saw some Family Planning cards in the clinic, but they were dated late 2011 as the last time they were used. We were also told that there was a local man who had had some training and he would sometimes open the clinic and provide medicine but he’d charge 50 Kina pp!! That’s about $28 which is just prohibitive for these people, most of whom earn very little and are subsistence gardeners.

So, the situation was multi layered and hotly political. The story changed depending on who you spoke to and so it was difficult to find the truth. It was a mystery. And it was a mystery that the village leaders had allowed the situation to continue, depriving their people and the surrounding 22 villages of adequate health care. When I look back I am amazed at how unfazed we all were. We just had an amazing sense of peace and calm and desire to do the right thing for the people, especially the women and children.

We were gobsmacked at the variety of things we found in the boxes and dusty cupboards. There was a huge box of condoms, IV/IM Penicillin, Chloroquin, Chloramphenicol (A very strong antibiotic), Ampicillin for adults and kids, Augmentin Forte, water purifying tablets, Chloramphenicol eye ointment, and some iron tablets. We couldn’t find any guides for the medicine and I felt strongly about not practising outside of our area of comfort and knowledge! But, we had the amazing Docop. Docop had travelled in the boat with us and I remember him from Yamen too. A really humble man. While we were cleaning the Health Centre he said to me that he has been a volunteer Merisen Man for 18 yrs, for no money, but God Blesses him. He gave me a huge smile. What a precious man.

I asked him about the medicines and he knew the dosages and which medicines to use when, so I asked him to help us and do the prescribing. He was very happy to help.

Docop helping to clean the floor – notice the new paint on the walls!

Debbie sorting out the medicines

A great photo of Docop – one of my favourite men in PNG!

Reopening the Betesda Sik Haus

It was very quiet the first night in Bunam. Every now and again I’d hear a low bird sound, but other than that no barking dogs, crying kids, or snoring roommates. All good.

The sun started to rise at about 6.15 and so I lay there in the shelter of my mosquito net until it was lighter and then made a dash for the toilet. One thing I hate, is going to the outside toilet on my own in the dark. In fact, I just won’t do it. We had had a discussion about this earlier in the night and I’d reiterated to Deb and Debbie, that if anyone needs a wee in the night, they must wake someone up to go with. Poor Deb. Later on in the morning she told me that she had tried to wake me but I just wouldn’t budge and so she had braved the night on her own “to see a man about a dog”. Poor woman. I felt terrible. I hadn’t heard a thing!!

I really wished I had my own little camping stove to boil water and make a cuppa. “Make a note of that for next time”, I thought. It was quite cool. In fact, in the night I had really felt chilly and pulled not only the double folded sheet over me, but my silk liner too. It was nice to feel cool.

I went through to the kitchen and looked at it with fresh eyes now. What a blessing to actually have a kitchen, with sink and bench tops at my height. No water came through the tap, and the sink was quite grotty, but I had brought my special hiking ‘kitchen sink’ which is a fold up bag that holds water in it to wash dishes etc. It’s been used to soak sore and blistered feet once on a particularly harrowing hike along the Bibbulman Track too! I’ll keep that one to myself, I chuckled.

I found a couple of chux cloths and relegated one to wiping the filthy bench tops and sink. In a short space of time the kitchen was taking shape and looking rather dandy. Amazing what a bit of elbow grease can do, for the physical look of a place, but also for the soul. It was good to be cleaning – little did I know then how much more cleaning I was going to have to do that day.

There was a call from the steps and Wendy, from next door, had a kettle of boiling water for us. Bliss. A hot, steaming cup of coffee. I took some coffee bags with me and used powdered milk. We ate weetbix for breakfast with some dried fruit scattered over the top. We were able to wash our dishes in my kitchen sink. It was just like at home…

We were not sure what was going to happen this morning. I had in my mnd what I wanted to do, but was fast learning to be flexible, wait and be guided by the local people. We sat down on the floor and prayed for the events of the day.

By 8.30 we were sitting in the church haus singing songs in pidgin. The church building is just a big thatched shelter with a few benches. Most people sat on the ground, on banana leaves and other natural fibres. We sat on the bench at the front. Men on the right, women on the left.

Again we were warmly welcomed and Mike gave a short devotion. Then there was much discussion about the program for the day. When we first arrived at the church there was just a handful of people, now when I turned around I saw quite a few extras and even recognised a few of the women from Yamen: Suzanne, Doreen, Priscilla, Scilla, Jane. I was getting excited and couldn’t wait to greet them properly. The men asked that the Health Centre be opened that morning and that we run a clinic as they had many sick children. So we agreed that we would have a look at the Health Centre, see what was in it and then run a clinic in the afternoon. They were happy with that. We had to wait for the man with the key to open it for us. So after devotions we sat and waited for the man with the key. Bob.

I got up and went towards Doreen who gave me a big warm hug and welcome. It was really lovely to see her. She introduced me to her husband Steven who spoke really great English. They are from Bunam, but live in a haus along the river – where we initially arrived. Then I saw Suzanne standing in the background and went towards her. I felt incredibly emotional to see her again. Suzanne is very quiet, but such a respected woman in her community. She has an unwavering faith and a real heart to help her people. She is from Angisi, the next village on from Bunam. There was now quite a crowd of women around us and so I got Deb and Debbie to introduce themselves to the group and to explain a little bit of what we were hoping to do during the week. I asked those who had been to the training in Yamen whether they had used their birthing kits and there was a resounding ‘yes’. They said the kits had really made a difference – enabled them to teach the women about clean birth and to sometimes assist. They did say that because of the kits they were more likely to be called to the birth earlier on in the labour than before.

Eventually, after what seemed to be a long time, there was some commotion near the health centre and we were told that Bob had the key and was going to open up.

But then Bob disappeared again. A guy named Matthew came and saw us. He said he would make sure the centre was opened. We really didn’t know what was going on and couldn’t understand the issues yet. It seemed though that there was resistance to having the Health Centre open. But the men were onto it and so there were many discussions until eventually Matthew came with a key and a hammer (which came to be known as the ‘key’).

A crowd had gathered at the front of the health centre. The double doors were screwed shut and I saw a blue sign leaning up against the wall: Betesda Sik Haus. I remembered that John Bolton had said it was funded by Bethesda Private Hospital here in Claremont, Perth. Connection. Amazing. What a small world. We had to go round to the side door where the grass was really long and the path not clearly defined. I kept thinking about what John had said about death adders, “Bunam is full of them, just stay to the path and avoid walking through long grass”. I was breaking a snake safety rule already!!

The door was pushed open and we walked into a surprisingly cool building, freshly painted in bright sky blue, but with equipment looking like it had been untouched for years. The first room was obviously the labour room, complete with old bed with stirrups, shower and toilet (a bit worse for wear), neonatal cot, tray with metal duck bill speculums and draws full of IV giving sets. Through to the next room, there was a very old trolley with a mattress obviously the original one from the 60’s when the Centre was opened. There were a whole lot of boxes on the floor filled with medicines: cloroquine for malaria, Iron tablets, paediatric antibiotics and paracetemol etc. And there was a solar powered fridge that was open – hence the reason the place felt so cool. It had been donated by the Japanese government and was for storing vaccinations, it said. On the shelf were bottles of IV fluids and a couple of pinnard stethoscopes.

The next room was rather large and there were a couple of dressing trolleys, a space where the CB radio had once been, a delux looking sphygmomanometer (blood pressure machine) still in its cardboard box, metal jars for cottonwool, needles, syringes, cardboard sharps containers, plastering equipment, a stethoscope which looked a bit rusty, thermometers and alcohol swabs. There was a sink with a tap which was not connected and even a couple of bags of disinfecting powder for cleaning.

It was amazing. Everything there. Just really dirty. The place needed a jolly good clean and I felt we needed to show them how to begin.

You’re in the Village now

Once we’d set up our beds, the girls in one room, the boys in the other, the birthing kits in the third room, Yabru announced that there was a bucket of rainwater in the wash room for us to use. What a pleasure. Clean fresh rainwater to use as a shower. There was a shower head but the taps were not working. It was quite luxurious to be able to strip down in the privacy of a wash room and tip a bucket of cool water over me. “What a blessing,” I thought. Even though we’re on the edge of the village, we have no nice view of the river like we did in Yamen, we do have a lovely place to have a wash!

After showers, we walked up to the main ‘arena’ of the village where there was a ‘stage’ set up and a band playing music with an electric keyboard, guitars and even a drum set. It was loud. We were led to a bench at the side of the stage where we sat and took in the surroundings, music thumping loudly. The beat was in sync with my thumping headache! The sun was going down. The coconut palms were looming in the distance, a beautiful silhouette against the cloudless sky. All I could think of was, “what are we having for dinner tonight?” and “When can I go to sleep?”

The village/church leaders welcomed us to Bunam. We took to the stage and each had a chance to introduce ourselves, with Yabru interpreting for us. I took this opportunity to pass on greetings from John and Joyce Bolton, the first missionaries to this area (in fact, they helped establish this village in the early 60’s). I had met with them a few weeks earlier as they are now retired to the Southern suburb of Mandurah in Western Australia. There was an audible response to that message and I felt there was some connection with this village. That seems to be the way in PNG. I’ve mentioned it earlier as the wontok system. It stretches across a whole range of activities. If you can show you have some connection with someone from the area, the response is more welcoming.

I don’t know what was wrong with me, but I felt really heavy. Sad. Emotional. Missing my children. Wondering what I was doing back here. It was strange. I had to work really hard to cover my feelings as I did not want Deb and Debbie to be unsettled. They were fantastic actually! I remember thinking to myself, “why can’t you just relax like they are and be flexible”. I was tense and uneasy. The lovely people in the house next to us brought some food: rice with greens and coconut cream. They also brought a kettle with some boiled water – a cup of tea at last. Amazing what a lovely hot cup of tea does for the soul!

After dinner, we sat around with our torches on our heads and Mike reminded us of the things we could be thankful for: the vehicle and driver arrived eventually, the boat was there to meet us, it was a smooth journey on the boat with no breakdowns, we arrived safely – no danger. We had a nice house with a nice toilet and even a wash room! We prayed and went to bed.

After securing myself inside my mosquito net, sorting out what I was going to use as a pillow, I settled down to go to sleep. But instead of slumber, the tears flowed. I really felt alone. I felt like I was a princess and could not cope with this hardship for a whole week. I’m not sure whether it was just a reaction to everything that I had had to deal with and prepare for before coming to Bunam (house, kids, pets, money, travel arrangements, infections, sick kids, husband away etc) and now that I had finally reached the destination I was overcome with emotion.

At one stage I said to God, “I can’t do this Lord. I am weak, this is such a distant and remote place and I don’t like feeling uncomfortable. I feel overwhelmed by the needs of this area. I feel overwhelmed by the longstanding and ingrained problems and corruption. I don’t like Bunam, it’s not like Yamen. But, I’m here now, stuck for a week. There’s no turning back, so you’re going to have to help me, because I can’t do it on my own. I need help. Use me for your Glory”.

Once I’d prayed and put my true feelings out there to God, I felt a lot better. I took some deep slow breaths, stretched out and went into a deep sleep. I was dreaming about being back in Perth with my kids and whenever I turned over to the other side (read, other hip bone) I’d have to think about where I was. “Oh yes, I’m in the village now”.

Kitchen area – no, the taps did not work

 

Spare room with all the birthing kits

 

The girl’s room