The Spaceship

 

This time last week I was preparing for my last full day in Wewak after what was an incredible visit to Papua New Guinea. I remember thinking that so much had happened, could there be anything else to happen that day. I woke up expectantly. I was gaining confidence to do this. When God is in something, expect great things to happen!

It all began at the end of last year while I was in Kenya providing a reproductive health training workshop to field workers with a humanitarian organisation called Medair. While spending time with these incredible people who were working in war zones in the toughest places on earth: South Sudan, Democratic Republic of Congo, Somalia, Iraq, Afghanistan (you get the picture), I had a real sense that I needed to return to PNG early in the year, on my own, to set up the program for 2016/7. I also felt that I needed to connect with the government and formally partner with them somehow.

So, I booked a plane ticket for a 2 week visit.

A week before I left I had a dream. God asked me to get into a space rocket with a man I did not know and fly out into space. I asked Him where I was going, but He said that I didn’t need to know the destination. I was then scrambling around trying to pack the right clothes and He said that He will provide for all my needs, all that I have to do is trust Him. So I said to Him, ‘you are sovereign father God and worthy of my trust’ and stepped into the spaceship…A bit weird, I know, but true.

On Feb 14 I flew out of Perth. The checkin lady made quite a few comments about how dangerous Port Moresby is. I reminded myself that I was meeting people I knew and wouldn’t be wandering around by myself.

Arriving in Port Moresby on my own was a little daunting, but the hotel pick up worked and I now knew exactly where to get my SIM card topped up and data connected so at least I could phone a friend. I went for a swim and noticed some women with bilums from the Sepik area so went up to them and had a chat. I was starting to relax.

In the morning I went down to breakfast and sat with the Sepik women. They were very interested in the work of Living Child and asked what I was planning to do when in Wewak. I mentioned that I was hoping to connect with the Angoram District Administrator to let them know what we’ve been doing for the past 3 years and find a way to work with them. One of the women turned to me and said, ‘the Angoram DA is here now’.

I looked at her in disbelief thinking I’d misheard her. ‘Here? At Comfort Inn?’.
‘Yes’, she said, ‘there he is over there in the red shirt’.
Her finger was pointing in the direction of the pool. She got up from the table and went over to him. The next minute I was sitting at the breakfast table with him sharing about the work of Living Child so far and our vision for the future!

‘Sara’, he said, ‘we are very interested to partner with you to bring health to our people in Angoram district. Can you come to Angoram for a meeting next week and we can discuss your plans further with the Member?’

I couldn’t believe what I was hearing. On my first morning in PNG the meetings that I was hoping would happen, but wondering how they’d come about, were being planned without me doing anything really!

I went back to my room literally jumping with joy. I had an incredible sense of God going before me. All I had to do was trust him.

The next morning I had a call from the DA requesting I come downstairs to meet the Member of Parliament for Angoram District. I couldn’t believe it! Finally I was meeting the man a friend of mine, Steve Combe (who died tragically in a helicopter crash exactly a year earlier) had advised me to meet. The member and the DA were very welcoming in a gentle way. They have a vision to get health and education back on track in their District and would like to partner with Living Child.

What a start to this spaceship ride. I knew I was serving and trusting an amazing Heavenly Father who was going before me and preparing the way…I also felt that it was significant that these events were happening over the first anniversary of Steve’s death. A man who had a vision to bring midwives into East Sepik Province to provide training to prevent deaths of mothers and babies, and who played a significant role in assisting Living Child become established and connected in PNG.

Midwifery Beyond Borders

 

P8250143.JPGI’m currently in Johannesburg waiting to travel home to Perth after spending a few days in Nairobi, Kenya providing Reproductive Health training to field workers from an emergency humanitarian relief organization. On my way to Kenya it suddenly dawned on me the significance of the name of my blog: Midwifery Beyond Borders. There is an incredible shortage of midwives with global experience who can support and encourage skilled birth attendants SBA in low to middle income countries where the maternal death rates are highest. I am certainly stepping beyond my borders and into areas I never thought I would, even could step into.

I’m also starting to see a pattern in the type of work I do. Throughout my life, even as a small child, there has always been a restlessness with the status quo: I can see how things can be done better or see a gap for a new program, new intervention, new idea, new way of doing something. I remember as a young adult struggling with this; as a woman in my thirties, wondering why I could never just be happy with how things were and accept them; and now in my forties starting to creatively accept that this just who I am. Inevitably my new way of thinking or doing something, rubs people the wrong way, especially people or authorities that are keen to maintain the status quo! I’ve always had a strong sense of social justice and speaking up for those who don’t have a voice, even when it means confronting those in authority. This has not been easy, and many times I have recoiled in fear and trembling! The driving force for me is the fact that God is sovereign, above rulers and authorities on Earth, and if He opens a door for me to move through, I know that I can trust Him to give me the courage and the boldness to speak truth and speak up for those vulnerable people. My favourite verse is Jeremiah 1:9, ‘Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go.”

The training that I do is not for people who are in settings where there is good governance, well-structured health services and well qualified health workers. I’m finding that I’m in areas where there is very little: poor leadership, few to no properly skilled birth attendants, hardly any resources in terms of simple equipment to provide a health service, environmental challenges, social inequalities and injustice. Those in authority quote the standard World Health Organisation WHO guideline mantra: “1. All women should give birth with a skilled birth attendant SBA at a health facility. 2. There is little benefit in training traditional birth attendants.”

So what do you do when there are no skilled birth attendants in the area? What do you do when there are no functioning health centres? What happens when there is a natural disaster or war and women don’t have access to health care or a SBA? What about the fact that women are not getting an education, so are not able to be trained as skilled nurses, midwives and doctors? And so the number of qualified health professionals is very low to be able to serve the needs of the community. What about women who have experienced terrible sexual abuse and violence at the hands of men, and then their only option for birth with a SBA is a male attendant? Is that fair? And what about the women who are from minority groups, displaced from their homelands and expected to birth with a SBA who treats them badly…verbally and physically abuses them? These situations are not unique, not unusual, in fact they are the norm for many women in low to middle income countries (and I have to sadly add that this happens in high income countries too!).

Many organisations and governments take a hard line approach to the WHO recommendations and I’ve heard stories where countries ban giving out clean birth kits to traditional birth attendants in remote areas because they don’t want to encourage women to birth at home. And yet there are no other options for them. Is it right that we take a hardline approach to women in trying to get them to birth in a health facility when there are so many obstacles and such poor services? Is it right that we marginalize village birth attendants or lay women attending to pregnant women and blame them for maternal deaths?

I don’t think so. I believe this is a top down approach that violates the rights of women, disregards their concerns and fears, and punishes them for circumstances that in many ways, are out of their control. It also further isolates them and promotes suspicion of modern healthcare. At the heart is the fact that I don’t believe that women want to die in childbirth; they want to survive, they want their babies to survive and thrive. The fact they don’t get to a health facility says more about the poor quality of the service and the attendants than it does about the behavior of the women. There are also many men who don’t want to see their wives die in childbirth and who live with the consequences of losing the mother of their children. Generalised statements about men I don’t believe is helpful either.

In my experience in remote villages of Papua New Guinea, women are desperate for better care in pregnancy and birth. Many men too want to know more so that they can help the women in their villages. When they have travelled to a Health Centre they have been let down: verbally abused, demeaned, sent home, made to wait…sometimes as long as they are close to death and then die (yes, this is true and I have heard many stories of this nature). Now this is not to say that there aren’t any caring health staff out there. There are and I have met them, but I have to say they seem to be in the minority. And, there are not many trained staff either. Many have had little training and little to none continuing professional education or support. Their health facilities are rundown and lack basic necessities such as clean water, soap, even a simple Blood Pressure cuff. I think we need to hear the voices of the caring health staff more…sadly I think they’re silenced.

I heard from a field worker who was in the midst of the Ebola crises in Sierra Leone earlier this year, that when people were in quarantine due to exposure to someone who was ebola positive, not even pregnant women were given care or support during childbirth. They birthed alone in their homes. Not even clean birth kits were distributed and explained. Many pregnant women suffered terribly during this crisis and died.

Women cannot be denied services just because they choose to birth at home (or are forced to birth at home) because there is inadequate healthcare. I believe it is important to start somewhere and that somewhere is building the trust of the women and community in the home. As skilled birth attendants we need to show women care and kindness so that trust and respect in the information we provide grows. We have an obligation to improve the quality of our care and services by improving cleanliness, working hard to improve our knowledge and skills and provide more outreach programs. Getting out amongst the people to increase their education about simple health messages can make a difference. The people feel that you haven’t forgotten them and do care about the state of their health. Myths and untruths can be gently refuted. Key health facts need to be communicated regularly over time. As their knowledge grows about how their bodies work, what is important for a healthy pregnancy and safe birth, when and how to get help, I’ve noticed that their confidence grows and so does trust.

So, caring midwives out there. Who is going to join me to be the voice of the women who have no voice and bring quality care to women of childbearing age in desperate situations?

 

Pictures

This morning, as I do most mornings, I woke up with pictures of Papua New Guinea in my mind. Visions of the villages, the river, the people, different faces, Rhondy, travelling up the river, teaching in the classroom, all the faces peering up at me, images of a hard life, sick children, grieving families because of the loss of a mother… There have been 2 known deaths of women during childbirth this week in the East Sepik Province. This is just the ones that we know about. What about the others that we don’t know about. The ones who have silently slipped away in the jungle, only their immediate family aware because the distances are so great and they are a forgotten people?

mother and baby pngYesterday, I saw a post on facebook which broke my heart. A PNG man was commenting on a PNG site and he posted a photo he had taken of a woman who had just given birth in a remote swampy area of Western Province. The photo struck me because when I looked at the woman, I could see the faces of other women I have met in East Sepik Province. Those in the lower Keram River areas where it is swampy and treacherous. The women have told me stories about what it’s like to give birth in these areas, but it is hard to imagine because I just don’t know how they do it. This photo now gives me a picture of what it’s like for these women. And it is not a nice picture.

There is a loving heavenly Father who has not forgotten these people. He has heard the cries of His people and is nudging people to be involved in providing support and assistance for some of the most vulnerable people on the planet at the moment: women and babies in East Sepik Province. I know for sure that I have been prompted by Him to help. Rhondy is a local PNG midwife who I have connected with in the most amazing way. God has placed a burden on her heart for her people. Her and I are working together through Living Child to provide a sustainable program of education and training, practical help and assistance for villages in some of the remotest places in PNG. Are you feeling prompted to help? With your help we can make a difference…

This Season of Life

Last night I read a blog post by Erika Marie who is working with Samaritan Aviation in Wewak. Her post was about the desperate attempt to save the life of a boy in the remote village of Samban after being mauled by a wild pig. As I read her blog and looked at the photos she posted on her facebook page I was teary and felt deeply sad for the suffering of the people there. Every word she wrote moved me as I have been there and seen similar suffering. I scoured over the photos to see if there were familiar faces from the training I’ve been involved in over the past 2 years and yes, there were. Erika’s account and her open sharing of her feelings hit a cord with me because I have felt those same feelings, done similar things, prayed similar prayers in the face of situations that I’ve never had to deal with before, with limited resources and in a very different culture. I also felt a deep sense of envy that Erika was there and I am not. That Erika has the freedom to stay and do something, but I do not.

It reminded me of the time I heard a woman speak about the Birthing Hut project in PNG, many years ago when my children were very young. Matthew was about 3 and Ryan was in pre-primary. When I heard her speak, I felt instantly drawn to the work and felt a deep sense that I wanted to be involved in that kind of work, but was restricted by the season of my life – wrapped up in parenting 2 young sons. I even told the speaker this and said one day I hoped to be doing something like the work she was involved in, in PNG. I remember being reminded that I need to make the most of every season in my life and be thankful for the moment, not wish my life away. I find I can do that for a while, but then will be distracted by something and then feel discontent and disgruntled about the restrictions and compromises I have to make to be a wife and a Mum. But then I return to that place of thankfulness again and trust that as I am meant to be involved in things, God will reveal it and enable me. As I thought about this a flash of clarity beamed across my mind that I am in fact living that dream of being involved in some midwifery work in remote PNG. Maybe it’s not exactly how I’d like it to be (I’d really like to be there full time devoted to the midwives and people in remote areas), but it is what I can do within the season of parenting teenage boys right now, and being a wife!

As the year draws to a close (and may I add, it has been an incredible year of challenges, but also beautiful blessings) and I ponder the work of Living Child for next year I’m starting to see more clearly my place and role, bearing in mind my responsibilities as a wife and a mother! As I reflect over Erika’s blog today and come to terms with my feelings of envy last night, I think I’m starting to come to a place where I feel comfortable with what I can do from afar. I’m sure this is a balance that all people have to find through their journey of faith and life. I know that my husband has made sacrifices in his career for me and the children so that we as a family ALL feel stable and secure and most of all loved.

The needs of people in the world are GREAT and never ending. The needs of the people in the East Sepik Province of PNG are HUGE (bigger than what you or I could ever deal with on our own). I know and believe that God has heard the cries of the people in the East Sepik and He is mobilising people with different skills and talents to help. I know that He has asked me to help, but I also know that He will guide and equip me as needed, within this season of life.

The Ripple Effect

Driving home from the hospital today we (my two midwifery colleagues and I) compared maternity care here and that available at the State tertiary referral hospital in Perth. We all agreed that if women who refuse treatment could see what happens when there is no treatment and found a balance between the two extremes, then perhaps they would have a different view of the service they can access so readily and at no cost in Australia.

We saw orphaned babies in the nursery because their mothers had died, we saw many women with eclampsia (seizures in pregnancy or after birth due to high blood pressure), a woman who was having continuous seizures due to a cerebral vascular accident 20 days after giving birth, 2 babies with Spina bifida, many preterm and small for gestational age babies, sick babies with infections, seizures, birth asphyxia. I saw 2 babies being wheeled out of the nursery because they had died. It really was overwhelming.

In a situation like this it is quite common to feel so overwhelmed that you become stuck in a state of inertia. The images are shocking to all your senses: sight, sound, smell. I’ve found that I need to focus on one thing that I know I can do. So for instance, in the nursery this morning, where the room is kept at 34 degrees centigrade because there is not enough room for incubators, I saw a mother struggling to express breast milk to feed her baby. So, I gathered up the course participants in my group and we proceeded to offer her some education and practical help. Soon other mothers sitting nearby (the room is so small and the mothers are crammed on a wooden bench down the middle) were asking questions and looking at us like sponges wanting to soak up information which may help them as they care for their sick, small and preterm babies. I was delighted to see the students teaching and sharing information with the mothers that they had learned in class. Needless to say they all achieved a pass in their breastfeeding and care for the small for gestational age or preterm baby!

I just want to add here that I have never sweated so much as I did in the neonatal room. There were rivers of water streaming down my face and body. If I had just given birth and was anaemic too, I would have fainted and been lying on the floor…

In the maternity ICU we went through the case histories of the eight women there. One after the other had been referred due to having seizures. A number of them had lost their babies (fresh stillbirths) and most had had very little antenatal care. I remember last time I was in Tanzania, I read the book “Call the Midwife” which gave me great insight into the state of maternal health in postwar Britain. I recall thinking at the time that the issues faced by those English women are what these African (and PNG) women that I have come across, deal with in 2014. Many deaths of mothers and babies can be prevented through quality antenatal care, family planning, birth with a skilled attendant, breastfeeding supposed and infection prevention and control.

The sister in charge of this ward gave us some great education about the cases she deals with on a daily basis: With very little medical support, few resources and hardly any equipment. There are no IV pumps so that the dangerous medications being given can be properly titrated. There is only one ventilator and cardiac monitor between 8 patients. And there are only 2 nurses between 8 acutely sick patients. I tried to encourage her and offer some support. I got the feeling she was moved by what I said.
So, to end this blog post, what shall I say? My senses are overwhelmed. My heart breaks for the suffering of the people. I feel for the staff. But I am also so encouraged by the improvement in the knowledge and skills of the course students. The level of care & kindness is delightful to see and they have told me that they feel more confident in their midwifery practice. They are also inspired to go back to their clinical areas to be good role models for others and provide quality education and support to the mothers in their care.

The pebble has been dropped and the ripples are spreading…one midwife at a time, one mother at a time.

Sadness

After a week in the classroom teaching theory, today was my first day in the clinical area. On arriving at the large hospital we saw a man holding a small baby wrapped in a kanga matching the one worn by his wife who was walking a few paces behind. It was obvious he was carrying a dead newborn. He was standing tall and carrying the child with dignity and grace. I felt a deep sorrow for this family.

Later this morning I cried with a mother whose baby had died in the night, 2 days after a planned caesarean. Her first baby had been stillborn at term. She looked at me with puffy eyes from all the tears she had shed and said, “I have no baby. I want my baby. I have deep deep pain in my heart.” This while mothers with their new babies were busy in the beds nearby. My heart broke for her. All I could offer was to pray for her and she immediately said, “yes please” and bowed her head.

Another woman was lucky to survive a ruptured uterus. Her baby was also alive, strong and desperate for a good feed of breastmilk. And another was cuddling a tiny baby weighing only 1.9kg but born at 40 weeks. She had severe pre eclampsia which causes growth restriction in babies during pregnancy. Together with the course student, we advised her about how to help this baby survive: 2-3 hourly feeding plus offering extra expressed milk ‘top ups’. Kangaroo mother also to keep the baby warm and assist with his growth and development. Kangaroo mothercare is a way of placing babies skin to skin with the mother, between her breasts. The baby stays in this position to keep warm, help stimulate and regulate breathing and heart rate as well as promote breastfeeding.

It was interesting that during a discussion with a midwife from the pre eclampsia ward, she mentioned that they are now very busy due to an outbreak of PE. For a moment I had to think through that comment because I immediately thought of outbreak in relation to something such as influenza, Ebola, or hepatitis. This, however, she was referring to the increase in numbers of women presenting or being referred to the hospital due to PE. Then there was lots of discussions about what was causing this outbreak: stress, poor diet and nutrition… I then said that perhaps the reason for the increased numbers of PE patients was due to improved quality of care: better understanding of the disease, better detection and referral for treatment and management. She quietly contemplated that theory as she walked away…

I came home feeling I had experienced and learned so much. I hope the course participants feel the same way too…

Teaching & Learning

I’m sitting in the Midwifery training centre at Muhimbhili Hospital, DaresSalaam. My midwifery colleague is teaching about Hypovolemic shock. Her voice echoes in the room which is tiled and closed while the air conditioner whirs in the background. There is a regular dripping of water from the aircon into a bucket below – yesterday it just dripped onto the floor and we had a slow flood in the room.

It has been lovely to meet up with the midwives who attended the Foundation unit with me last time. They have told me many stories of how they have found the training helpful and they’ve been able to use it in their areas of work. Two nurses told me how they had a woman who was having difficulty pushing the baby out. She was tired and the baby seemed to be staying in the birth canal. They then got her to change position and be more upright and immediately the shift caused the baby to descend and be born. They were very happy to see that this intervention worked.

Another told me that they were now feeling a lot more confident in teaching and advising about family planning. I think what has happened is that they feel encouraged and better equipped to provide quality care. It feels good to hear that positive feedback.

I happened to notice the office of the Tanzanian Midwifery Society so took the initiative to pop in and say ‘Hi’. It was wonderful to meet the project coordinator there and talk about all things midwifery.