Training Midwives in Tanzania

I have been in Tanzania for the past week teaching midwives. This time I and a fellow colleague are delivering the Intermediate course to 16 participants who have already successfully completed the Foundation course which was facilitated in June- July. I started writing on the plane…

I’m on a plane to Dares Salaam. Another hour and we’ll be there. I’m amazed at how calm I feel. This is highly unusual for me. Usually I’m full of tension and anticipation, but this time I feel quite relaxed, unperturbed and remarkably at ease. I believe this is as a result of the prayers of friends. A number of people sent me messages of prayer support. I’ve really needed it. The last few months have been full, a bit hectic and challenging. I’ve had to prioritise my responsibilities, building boundaries around myself to ease the waves of deadlines overwhelming me. For me personally I draw great strength from my faith in Jesus to help me cope with life. Recently in the daily ‘Every day with Jesus’ I’ve been meditating on how Jesus coped with the stresses and strains of life during his ministry on earth. There are some startling truths, especially in regards to looking after one self. I love the fact that he often withdrew from the crowds to pray and meditate. He also spent dedicated time with his disciples to teach them and go deeper. Jesus also never allowed time to run his life, feeling pressured. Rather he showed great peace and calm as he went day to day, teaching, responding to people, healing the sick, engaging in conversation. He never overlooked the poor, needy, sick, vulnerable or outcast despite the stresses and strains crowding in on his life.

There are a number of lessons that I have learned from this series of studies lately which I’ve been trying to apply to my life:
1. Be willing to forgive all injuries and offences
2. Have a servant heart
3. Maintain inner strength and peace
4. Look for good in difficult circumstances- find God’s perspective
5. Maintain focused determination
6. Have good time management
7. Don’t get bogged down in self pity

It’s challenging, but achievable with God’s help.

Oncall Midwife

I have always wanted to be a private midwife, providing individualised care to women. Being oncall is part of that role. I’ve been that midwife twice before in Perth, supporting friends when giving birth. But now I find I’m providing this service on the end of the phone. Supporting women in remote villages of Papua New Guinea! And I’m in Perth, one of the most isolated cities in the world because of its geographical isolation from other cities.
Last year I had the most amazing experience to give guidance to Vivien, a village birth attendant from the village of Kambaramba, who was supporting a woman who had been in labour for 2 days and was having difficulty. After a few phone calls and lots of praying, the woman spontaneously gave birth and both mother and baby were safe because of the actions of Vivien.
Well, last month I had another experience of being the oncall midwife and this time it was to Vivien herself. She was expecting her 7th baby, not by choice but by chance, due to the lack of family planning available to women in this remote area. When I was in PNG last month with the charity, Living Child Inc. which I founded last March, Vivien was meant to come to our training in Bunam. Sadly, the boat she was meant to come on broke down and her husband also said she was feeling ‘heavy’ and unwell as she was due her baby very soon.
I spoke to Vivien on the phone a couple of times and she reassured me she was going to go to Wewak to deliver. We discussed the fact it was her 7th baby and so she was at high risk of bleeding after the birth. This birth would also be just 13 months after her last baby was born.
Prior to travelling to PNG on this most recent trip, Vivien’s husband had sent me a text message asking for a carton of condoms because he didn’t want his wife to die because she was pregnant. Sadly this is a common fact for many couples in PNG: if you have sex, there’s a very high chance the woman will fall pregnant, and there’s a very high chance she’ll die. Every day 4 women die in PNG from pregnancy related problems. And from the stories I’ve heard from the people along the Keram River villages, the rate is much higher.
So, on this particular evening, as I was settling down to have dinner with my family in Perth, Western Australia, I had a call from Vivien. “Sara,” she said, “Please help me. I’m in labour for 3 days and am very weak”. I could hear in her voice that she was weak and I was thinking, “why is she not in good labour with her 7th baby. There must be a problem”.
“Where are you Vivien?” I asked, hoping to hear that she was near the Boram hospital.
“I’m at home. Sara, please pray for me”
My mind was racing. This is not good. 3 days of spurious labour. The baby must be in an unfavourable position. I knew it would be dark and it was too late to call Samaritan Aviation as I presumed that Mark, the pilot, would not fly at night.
‘Are the contractions strong Vivien?”
“Not too strong. They come every 30 minutes”. This did not sound like active labour. She was showing signs of a very long latent phase of labour which is not a good sign for a woman who has had 6 previous babies.
Vivien was showing two signs of high risk for birth: more than 5 pregnancies and a long pre labour.
Silently I was praying to God to give me wisdom and the right instructions. It’s actually quite hard talking on the phone to someone who speaks another language. It’s much easier when you can see their face and use signals and actions to emphasise your message!
“Vivien, have some tea or water to keep strong and have some rest. Can you have some kaikai (food)?”
“I’m too weak for kaikai, but I’m taking tea”
“Ok, good. Now you must rest and in the morning travel down to Angoram so that you can get the Saman Balus to Boram hospital. I will call Mark and let him know”
“Ok. Thank you Sara”
“”Can you feel the head low in your pelvis?”
“Yes, the head is down”, she said.
I’m praying for you Vivien.”
I said a prayer over the phone for her.
I came off the phone feeling helpless. I knew as a midwife that it’s not a good sign when a women is in labour for a few days without having strong regular contractions. Something was stopping her from getting into good labour. I was thinking perhaps the baby was lying across the cervix or that there was some placenta in the way. I felt angry too that she had not followed my advice to travel to Wewak, but I also knew that is was always complicated. I was learning fast and from bitter experience that life in remote PNG is hard. They make decisions based on a whole different set of rules and values and I had to respect that.
‘Lord,” I prayed, “How many times have you brought me to this place where I feel totally helpless. And how many times have you shown me that you are an amazing almighty God who can do the impossible. I’m going to have to just trust you completely.”
I decided to send a facebook message to Mark to warn him that there may be a callout in the morning.
I put my phone next to my bed that night, half expecting a call from Vivien, but hoping that all would be fine and in the morning we’d be able to organise for her to get to Wewak for review.
At 2.30am I woke up from deep sleep to the sound of my phone vibrating on the bedside table.
I could see that there were 3 missed calls from Vivien since 1am.
“Oh no”, I thought, “The spirit is willing but the flesh is weak”. I was angry with myself for not hearing the earlier calls. I jumped out of bed and tiptoed through to the kitchen where my laptop computer is. I closed the door so as not to disturb my sleeping family and rang Vivien via Skype.
Isaac her husband answered.
“Vivien no good”, he said, “She lusim blood”.
My heart sank. Isaac passed the phone on to Vivien and she spoke in a very weak voice.
“Sara, please help me. Me lusim plenty blood”
Immediately I knew there must be a problem with the placenta and that’s why she was losing blood now. It was making sense. She needs to get to the hospital for a c section as soon as possible.
“Vivien, you must get in the boat and get to Angoram where the Saman Balus can pick you up.”
“No,” she said, “Saman balus land behind the school”. She could hardly string the words together. She was very weak and I knew she was in a life or death situation. If the placenta was covering the cervix both her and the baby would die as the cervix tried to open. In these situations the placenta bleeds as it is pulled away from the wall of the uterus and the blood supply to the baby is cut off. The baby dies from lack of oxygen and the mother dies from massive blood loss.
I was now feeling desperate and prayed to God as I spoke to Vivien, to help me give the right instructions.
I told her to tell her husband to call Mark and tell him the situation. I then prayed for her over the phone and sent a text to her with Mark Palm’s number.
There was a part of me that doubted the whole story. Maybe she was stringing me along to get a free flight to Wewak? Maybe I just didn’t know my stuff and was jumping to conclusions about her situation? Maybe I was getting it all wrong and how could I really diagnose a problem over the phone anyway?
I sent a skype message to Mark’s phone telling him that Vivien was now bleeding and needed to be picked up.
An hour later I had another call from Vivien and I could tell she was scared and very weak. She managed to tell me that Isaac was walking somewhere to call Saman Balus. She was asking me to help her and I felt so helpless. Eventually I told her, “God is bigger than me Vivien. Trust in the Lord. Saman Balus will come and get you soon.” And again I prayed for her over the phone.
I then prayed to God as I fell into bed feeling so useless because I wasn’t there to provide hands on care. I told God how helpless I felt and how confused I was about what the problem was for Vivien. I also felt frustrated that I couldn’t get into direct contact with Mark because it was still so early in the morning in Wewak and I wondered whether he would think I was crazy and overreacting in this situation. I told God I trusted that He is sovereign and that he knew exactly how Vivien was. I asked that Mark would get the message at the right time and be able to make a decision about retrieving her.
All of a sudden there was a message from Mark on facebook saying that he hadn’t heard from them yet. I felt deflated. Do I tell him to just get in the plane and go get them or do I trust that God will prompt the right decision at the right time. I chose to trust God and prayed like crazy.
I fell into a deep sleep.
At about 6am my time I woke up suddenly and looked directly out of my bedroom window to a magnificent reflection of sunrise on a tree. Immediately I felt God say to me “Vivien will be ok”. As soon as that thought hit me, my phone beeped to say there was a facebook message. It was from Mark to say, “I’m in the plane going to get her”.
My heart sang for joy as I realised what God was doing.
My family, who had followed this journey with me and felt such sorrow at what was happening, were now joining me in celebrating as we realised that the Saman Balus was on its way.
I prayed for Mark and the mission to rescue Vivien.
It was reassuring to hear that she was very weak and it was good that they picked her up. Then later that morning, I cried tears of thanks when I heard from the Obstetrician at Wewak hospital, that she had indeed had a major placenta praevia. That means that the placenta completely covered the opening of the cervix and there was no way the mother and baby would have survived without a c section.
I felt overwhelmed with thankfulness. Validated as a midwife and reassured of God’s amazing love and provision for his people. I also felt so thankful to God for His amazing gift of connecting Living Child to Samaritan Aviation. What team work!

Hope

Sara David
“Before Living Child came, I was feeling helpless and overwhelmed from all the people dying in my area. Now I have hope…” said Matthew Akimin who walked all night to attend the training Living Child conducted in Bunam (as spoken to Sara in August 2014).
“Before I met you, I was overwhelmed by the deaths of my mothers, sisters, daughters… I cried out to God for help. And then Living Child came” said local midwife, Rhondy Ktumusi, as spoken to Sara in February 2014.
“I have helped many women to give birth in the village. A baby was born dead, but I remembered what you taught me last year. I rubbed the baby and took the mucous out of his mouth, and he came alive” said Roslyn, a village birth attendant from Bunam, to Sara, August 2014 (Roslyn had a huge smile on her face and her whole body spoke of the pride she felt that she was able to assist this mother and baby).
From hopelessness and helplessness to hope. This was the theme that ran through our most recent visit to the remote village of Bunam along the Keram River in East Sepik Province. It marked exactly 2 years since I’d first visited PNG. During that visit, the feeling I got from the villagers, the women, the men was of hopelessness and helplessness. I remember writing down that they seemed so overwhelmed from the deaths of mothers and babies, that they were stuck in a deep place of sadness and sorrow that they couldn’t get out of themselves. And despite the fact that many times I have felt that we are not doing enough, a momentum of hope has been ignited within their own communities and so the people are starting to do things to help themselves.
For example, this time we noticed a different more positive vibe in Bunam, men had cut the grass on what was the airstrip, hoping to get it back to an acceptable condition to allow an airplane to land for emergency evacuations. Despite the Health Centre at Bunam being closed for over 8 years, Matthew, a volunteer paramedical, was making visits to assist the people. The forms that I had given out to the village birth attendants to record their use of birthing kits, were diligently completed. And there is an excitement amongst the health volunteers (Village Birth Attendants VBAs, Merisen Men/Meri) that what they are learning and then doing is making a difference in their villages.
Although it was very disappointing to have to leave the village earlier than planned due to some unrest,I feel we made the right decision. I certainly got a sense that the locals love Living Child, they want us to come back and that they are benefitting not only from the education, training & resources we are providing, but also from our physical presence: encouraging, supporting, showing love & kindness to them.
The highlights for me were the fact that Living Child in a very short space of time has become a well loved & respected non government organisation (NGO) in ESP! I see our role is to continue to support the locals who have taken LC on as their own, to be able to realise their full potential in providing quality, evidence based maternal & newborn care.
Another highlight was while teaching about the danger signs in pregnancy and when to get help. I divided the volunteers into smaller groups and they had to come up with a song with actions to teach their communities about the danger signs. After a while, they eventually overcame their shyness and presented their tunes. I had not heard them laugh so much! I know they will never forget that exercise because of the amount of fun and laughter experienced by everyone!
Fear of sorcery and evil spirits is the cause of much suffering, especially for women and babies. After teaching about pre eclampsia and eclampsia (a common disease in pregnant women that causes high blood pressure and eventually leads to catastrophic seizures and even death) the health volunteers told me that they now understood why some women had died in their villages. It wasn’t because of evil spirits, but due to eclampsia. I feel this is a huge breakthrough, because if they can then educate their people about the disease process and why it is important to get the woman to a health centre or hospital sooner rather than later, then lives will be saved.

Learning to be Flexible

I won’t even go into all the personal emotional challenges I had before leaving Perth! Needless to say, having only 3 weeks at home between arriving home after a month in Tanzania and then hopping on a plane to PNG, were rather fraught.

There were 4 of us in the team this time: me, Mike, Debbie and Nicci (a New Zealand trained midwife. Her first time to PNG).

Departure: The Virgin Blue checkin was soooo slow, we were the last people to be checked in and raced to get on the plane. I was glad to be seated on my own at the back of the plane where I could gather my thoughts and try shift my feelings to a place of relaxation. My luggage didn’t make it so I was left without fresh undies and pyjamas for our overnight stay in Brisbane. I did a good job containing myself at the airport. But…

Transit: when we arrived at the airport hotel in Brisbane I was horrified to learn that my online booking was just for 1 room with 2 double beds rather than the 2 rooms with twin singles as I had originally thought. Well I started to cry at the reception desk! Tears welled up in my eyes, but I remained calm… The hotel very graciously gave us their biggest room and provided 2 more fold away beds. They had no other rooms and were fully booked. We managed. We were all having to be flexible.

The next day we left for Port Moresby, me now with my luggage in tow. Our flight was slightly late and we had to get to The Gateway Hotel to pick up contraceptive implants left there for us by Spacim Pikinini project manager Wendy Stein. We got the implants then raced back to the airport only to be told our flights to Wewak were cancelled – rescheduled for 4 am the next morning… By now I was feeling quite calm about the changes. “Well done Sara, you’re learning to relax and go with the flow,” I thought.

So, back to Gateway Hotel where we had a lovely buffet dinner, but a rather early wake up call to fly out to Wewak! Not much sleep with very loud hotel guests laughing and shouting until all hours – reminded me of Soccer City in Tanzania.

I’ve not arrived in wewak at sunrise before. Usually it’s at sunset. It looked like tropical paradise although a bit brown due to a long dry season. It was great to be met by Susie who we know from previous trips and to be warmly welcomed back to the CBC guesthouse – we’re regulars there now!

After settling into our rooms we went shopping at the local supermarkets in wewak to buy food and supplies for the remote village. At one point another white person came up to me and asked if I was part of the team of midwives from Perth? He’d heard about us from a young student teacher who visited my church earlier in the year. She had stayed with this family in Wewak teaching his kids for 3 months. He said we must catch up before we leave – his wife is Australian and would love to meet some Aussies and have a chat.

Later in the afternoon Rhondy arrived. It was so good to see her again. We both hugged each other for a long time and shed tears of gladness. We have had many many conversations over the last 5 months, supporting each other, wrestling with struggles and opposition together, praying together. At one point I didn’t even know if Rhondy would be able to travel with us because of difficulties within the bureaucracy. Amazingly because of her courage, perseverance and tenacity, she managed to arrange time off work to join us. She is such a blessing.

That night we had a very nice meal with strategic people in East Sepik Province. We had robust discussion about all the problems in delivering health care to people in remote areas. At one stage I felt very depressed at the overwhelming problems. But then we started talking about the opportunities… I came away knowing that there are opportunities, it just takes perseverance to see those become a reality. That’s what I want to do. Help people see the opportunities and then support them to realise those.

After a massive dose of chocolate ice cream for dessert we went our separate ways and prepared for the long journey ahead the next morning. Rhondy had us awake at 3.30 am. I could tell she was excited. So was I…

The Challenge Begins

Labour Pains

Women who have experienced labour will identify with what I’m going to describe. You’re expecting the birth of your second baby. Very excited and can’t wait to experience the warm gushy feelings of love when you lay your eyes on the baby for the first time. You remember that well. The labour starts and the pain is a gentle reminder that it is time. You arrange for the babysitter to come look after your older child and you and your partner head off to the hospital excitedly. When you arrive the contractions are coming strongly now and it’s then that‘the memory of the last labour’ floods your thoughts. You remember how tough it was, you feel a little bit of despair that you’re going to have to dig really deep to manage the pain. You know it’s going to be hard work. You want it to stop and just go home. You allow yourself to have a little cry as you realise the enormity of the task before you, but then with the love and support of your husband and your midwife you regain your focus and get on with giving birth to your precious baby.

This was my experience during the labour of my second son, Matthew. It was also my experience as I travelled to remote PNG again. With each discomfort and challenge I faced in the early part of the trip, I kept thinking, “this is just like giving birth! Its tough and I have to dig deep”. For me personally, I drew on my Christian faith for strength. During my labour I remembered had a mantra, “breathe in Jesus, blow away fear” and the biblical story was when Peter was in the boat and he then walked on water towards Jesus. As soon as he realised what he was doing and felt afraid, he sank, but when he looked at Jesus and kept his focus on him, he was able to walk on the water. Interestingly a friend of mine reminded me of this verse a day before I left for PNG. I have to say, as you read, you will see we had many challenges and this verse really did help me stay focused and feel at peace despite the circumstances.

The challenges began right at the start of our trip.

God Bless Soccer City

God Bless Soccer City

About 8km from the town of Kisarawe in rural Tanzania is a place called Soccer City. It is a motel with 4 sets of buildings with 4 rooms with ensuite bathrooms in each. It is also a pub with a small television set high above the chairs and tables on the balcony overlooking some lovely trees. There’s a well worn billiard table too. Thatched huts are scattered around where you can sit sipping milky tea at the end of a hard day. The motel is set at the top end of a valley. Above it is the local cement factory owned by the Indians. Apparently Soccer City is also owned by Indians.

The driveway to Soccer City from the dusty main road is steep and very bumpy. I imagine it’s tricky to traverse in the wet season. It is now the dry season and so there are no problems except for dealing with puffs of powdery dust.

I’d been intrigued by Soccer City ever since I’d been told by GHAWA that we’d be staying there while located on our rural placement. I can’t quite pinpoint the image I had in my head but it certainly did not match the reality! A silver building, multi-story perhaps, glistening high above the local homes and buildings? Not so…

Last week when we were here, so was the World Cup. The whole of Kisarawe I imagine, came to drink and enjoy the soccer. Each night we’d be woken by screams of delight. Drunken shouts echoed down the valley. Our rooms were close to the pub. The first time I heard it I was startled because I thought perhaps there was a riot! It took a few minutes as I woke properly to work out what was happening. This happened every night.

This week we were hoping that because the soccer was finished it would be quieter. Wishful thinking… Again each night the party cranks up. We have chosen rooms furthest from the pub this time and that has made a difference.

The other day I noticed that there was a lot more white paint than I remembered last week. Concrete walls now a crisp white colour. Then I saw the World Cup soccer fountain also painted white. I felt a little sad because it was a tarnished golden colour before. When I saw the fountain for the first time, the penny dropped. I now knew why it was called Soccer City! Anyway, yesterday we suddenly noticed two men spray painting the precious fountain – golden!! I have a photo but unfortunately there is not enough internet to load the picture but I promise I will when I get back to Perth. It’s worth a picture.

This morning when we arrived for breakfast (every morning we are served a boiled egg, 2 slices bread with butter and a cup of milky tea) nothing was ready on the tables. The place was a mess with dishes piled high. We’d heard quite a shindig last night including dogs fighting. All the pub staff looked a little worse for wear! Eventually at 7.45 we got some hot water to make a cup of tea (something we hang out for each morning). As the waitress returned to the kitchen she switched the thumping music on again. All three of us just about leapt out of our chairs shouting “no!!” And making the no signal with our hands. She quickly got the message and the thumping stopped. The birds began to sing again and it was music to our ears.

My room is quite spacious and I have a little routine now. Leave shoes at door so as not to bring dust and mud in. Spray with insect repellent before heading up for dinner. Have fan running until just before bed then switch off – there is only one speed although the dial says otherwise. Shower before bed. Don’t stand over the squat toilet because you’ll lose your soap (been there, done that!). Remember the shower is cold so ease in slowly.

Last week we ate dinner every night at the pub. It really was quite awful. Sadly the chicken was as tough as nails and a few times we just about broke teeth on grit in the greens. This week we are feeling rather smug because we have brought some supplements. Our routine is to order rice from the pub. Then we add a precooked/prepared meal. Monday was leftover Thai chicken curry and rice, last night was Alloo paneer from a packet and rice and tonight we had, you guessed it, rice with tinned tuna. It was delicious. The staff are intrigued by these three mzungu who are eating strange things. The kitchen staff have been very helpful in boiling water for us and heating up the meals.

When it’s time for sleep, I set out my mosquito net and snuggle down to sleep. The foam mattress sinks in after a while and so I find I have to dig myself out of the trench to get comfy again. Each morning I wake to the sounds of the many birds and sweeping. The sweeping starts at about 6am and hasn’t stopped by the time we leave which is about 8.15am. It reminds me of staying at my grandparents house in Scottburgh, South Africa…the sounds of sweeping the leaves every morning. p>

Despite all the noise and other discomforts, I’ll be sad to say goodbye to Soccer City. It has been a safe place to retreat to and we have felt well looked after. Every day we have gone for a brisk walk along the main road. It is busy at times and so we have to step off the side to let a heavy laden truck or bus pass. Of course we are intriguing to the locals. 3 white women walking along the road so we get lots of hoots and waves. We’ve got to know some of the women who sell oranges, coal, passion fruit on the side of the road. Today a couple of them greeted Mary and Beth by name! We’re feeling rather like locals here now!

We’ve seen some vervet monkeys, a bright green snake today, some interesting birds and of course some gorgeous children. It has been good to go for a walk and breathe in the fresh air (choose the timing carefully so as not to inhale a lungful of dust).

Soccer city , you have been good to us. Thank you God for a clean safe place to stay.

A Little Bit of Western

I’ve hooked my iPad mini to the speakers and am listening to Boy and Bear. It makes me feel a little less homesick for my family. I remember the journey from Perth to Albany that we took as a family to wish my Dad a Happy 70th birthday in April. The whole family humming along. That was a long trip but it was such fun being in the car together and chatting, singing and playing ‘I spy’. Funny how at the time I found ‘I spy’ so boring (again??!!) and yet they form fond memories for me now. I’ve coped well the first 2 weeks away, but this last week has been so hard. Most days I’ve shed a tear. The boys have written to me on Skype which has been great (me thinking, “that will help their writing skills”). Forever a mother!! Lovely to read their thoughts and feelings. I look forward to seeing them again.

It’s such a tightrope to walk. Being a mother, working. And not just down the road but in another country. I’ve had the conversation with my husband and children that they must tell me if I’m so busy helping mothers in developing nations, but I’m forgetting about their needs. They will always be my priority and I’m so thankful that I have a family that these open conversations can occur. I never want my boys to say to me that their mother was so busy helping others that their needs for love and time were not met. I think I’m reaching the limit of their tolerance. They’re having a wonderful time in South Africa: hiking in the drakensburg mountains, mountain biking, tree rope swinging, visiting places of cultural significance in Pretoria. Richard says they have been very good and all of them have had a wonderful time although missed me. It’s good to be missed.

Today I have focused on complete relaxation. I read in bed for a long while, then we went to the Hilton Hotel down the road for a leisurely breakfast. Funny how we always retreat to something Western to be comforted. Last night we treated ourselves to The Cape Town Fish Market for an absolutely delicious dinner. We caught a Bajaja for the short trip to the iconic expat (and anyone who wants to be seen) hang out. Beautiful view across the Oyster Bay, funky music playing in the background and a choice of mouthwatering dishes. I chose the surf and turf which was a melt in your mouth steak cooked to perfection and silky calamari that dissolved in my mouth. I will admit though, my tummy was a bit overwhelmed with so many flavours and richness of the food!