Finding Joy in the Waiting: An Update

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Having been almost two years since my last blog post, it feels like a lot has happened. But in many ways I still feel like the girl who, back on American soil, got emotional about African dirt on her Chacos and wondered “what am I supposed to do now?”

I’m a few months away from finishing my education as a nurse-midwife. What a relief it will be – but terrifying almost at the same time! Almost like catching my first baby – you want so much for the experience to arrive and pass but you’re also terrified of doing something wrong or for something to go not quite as expected. For so long (really, it’s only 3 years) I have been working towards this goal of becoming a midwife. Now I’m faced with the question: “And then what?”

That question, of course, brings up all sorts of other questions. Where will I work? Will I actually go? …to Africa? Or some other continent? Or will my life end up looking completely different than I thought? For right now, these questions end with me taking a big sigh and resolving to have peace in the not knowing. For right now, I have peace that none of these questions need to be answered, and especially not by me, thank goodness.

Life lately seems like a lesson in patience, in taking the small and big things of life and releasing my grip on them, reminding myself that God is in control, and turning my palms open back to Him. The bigger challenge for me, though, is to not release these things like a child begrudgingly, wishing I could hold on instead and resenting that I cannot. There is joy in the giving over of all these things and I have been trying to find it and keep it!

Today I faced yet another delay in getting my Georgia nursing license, which will allow me to move to my next clinical site. After 4 and 1/2 months in Waynesboro, TN where I was blessed to learn under amazing midwives in a birth center, my next stop is Athens, GA. In Athens, I’m looking forward to helping catch lots of babies at a busy hospital midwifery practice. (Of course, I’m also a little terrified, too, to go to a big fancy hospital with a much faster pace than the birth center. Terrified seems to be a recurring theme… :))

I’ve basically been in a holding pattern here in Olive Branch, Mississippi thinking that each day is going to be the day I get this Georgia license and can pack my car up, move there, and get started. So, each day when that does not happen, I have to relearn patience and joy. But I am blessed to be able to be here with family and enjoy time with them. And I’m blessed to have a flexible job that has plenty of work for me to do to keep busy (and earn a living) while I’m in town!

I am also blessed to serve a God who has “unlimited patience” (1 Timothy 1:16) and continues to forgive, strengthen, and encourage. I would be so lost without Him. So, tomorrow, when I wake up and I’m still waiting, I’ll practice turning my palms back up towards Him, learn (again) that I’m not in control and trust that He knows best. And I’ll look for the joy that is in Him and through Him.

What now?

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Why is it that unpacking my Chacos with African dirt on them always makes me want to cry? Today I feel so far from the place where I spent three months of my life, but something about my sandals is such a tangible reminder that yes, I was actually there. And then suddenly all these memories of my time there comes back to me. And it’s hard to feel so far from the people and places of those memories.

I’ve been pretty distracted from what my life was like in Nigeria as I’ve been traveling around for the past two weeks visiting family and friends. I spent a total of 2 days in the car and my car has an added 3,000 miles after the trip! But I made it to Michigan, Minnesota, Mississippi, and back to DC and got to see lots of lovely people along the way! It was so nice to be able to talk to people face to face about my time in Benin City and to hear about what I missed during my 3 months away. And I got to spend Christmas with all my family, which hasn’t happened for several years – I am so grateful.

Everyone’s been asking if I’m having culture shock since being back. I don’t feel too “shocked” yet – but I think the worst of it will come once I’m back at work and in school, once real life starts to hit me. So far, I don’t think I’ve ever whined so much about being cold! The Minnesota winter cold was pretty brutal! And it’s also been weird as it’s been a little hard for me to adjust back to American food, which I never would have expected.

For right now, I feel thankful that the Lord gave me this opportunity to go to Benin City for 3 months of my life. I can’t wait to see how he’ll use my experiences there in the future. I definitely think I’ll be back in Africa – the where/when/how of that I have no idea about right now. But God has given me some measure of peace that He’ll help me figure that out when the time is right. For now, my first day back at work is tomorrow and I start school next week. I know there will be so much I’m grateful for at work and I hope that I’ll be even more enthusiastic about school now that I’ve seen how important it will be to remember everything I’m learning.

I’m praying that the Lord will continue to give me peace about where I’m at now and give His direction for each step I take in the future. Thanks so much for following this journey – can’t wait to see where else God will take me!

Almost…

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(Written 12-2-09 but because of technical difficulties, published today!)

This time next week I’ll be on a plane headed to DC. What – CRAZY!? Seems strange to know I’ll suddenly be on the other side of the world next week.

My plans at the hospital have all gone better than I expected which is such a blessing and an answer to prayer. I did surveys at the Newborn/Immunization Clinics and ended up with 50 completed surveys. I gave each woman a banana bread muffin after filling out the survey. (I think I’ve forgotten to mention that I make banana bread ALL THE TIME here. Nigerians don’t eat many sweet things so there’s nothing like banana bread around here. I am even selling it now to staff at the hospital and sometimes to the university cafeteria. Michael Higdon – Miss Butterscotch lives on in Nigeria!) The surveys asked about how the mothers felt about their prenatal care, prenatal teaching, care on the labor ward, understanding of care provided, and care of their baby. It also asked them how well they felt they handled their labor and delivery and gave them opportunities to say what they thought should be different about their care. I think the whole thing was really a new concept for the patients and the staff. But I think it really helped me make suggestions that took into account the culture and needs of the patients (as opposed to how I would change things from an American perspective). I also hope that it brought more validity to my suggestions in the eyes of the staff. It was so precious to be able to go to the clinics again and see all the mommas and babies! My heart felt so full at those clinics – so much of what brings me joy and drives me to do what I’m doing is right there. May I just say that the women and the babies here are beautiful!

Me and Itohan at Newborn Clinic

 

Itohan and her baby back at Newborn Clinic

I met with the Chief Matron and Labor Ward Matron (head nurses) last Wednesday concerning my suggestions for changes to practices on the labor ward. The three changes included: allowing women to move about as they like during first stage labor, delaying the clamping of the cord to allow for increased blood flow to the infant (and calm the now-hurried birth process), and give only light suctioning instead of deep suctioning to every infant after birth (again, to calm the now-hurried birth process). They were, for the most part, accepting of my suggestions although I don’t think they saw much benefit in delaying the clamping of the cord. But they were both really sweet and encouraging as they said they enjoyed my time here, felt like I blended well with the staff, and stayed busy while I was here. They also said they really hoped I would come back and that I should marry a Nigerian (everyone here is rooting for that one)!

Then I was given the opportunity to present my thoughts at a meeting for all the nurses at the hospital on Friday. I presented the results of my survey first. The results of the survey were actually pretty positive. Most patients knew that staff cared for them and felt they were “trying” (working hard) for them. Most of the suggestions for change were based on the fact that antenatal clinic should be shorter (right now it takes about 4 hours). The high point was on antenatal teaching – the women really love this part of clinic so I tried to use that to encourage staff to use every opportunity for education. The low point was on understanding what was happening on the labor ward so I again tried to encourage the staff to educate on the labor process in clinic and on the ward. Other things the women said included that staff should not be shouting at them and that husbands should be allowed back in the labor ward. I then presented my research on the three practices I suggested they change. I was able to find recent research articles online through my school library that helped me support my suggestions.

I felt like the presentation was well received by the staff. We had some time for discussion at the end and a few nurses had some concerns about husbands being allowed in the labor room and delaying the clamping of the cord and suctioning of the baby. But I felt like we were able to have a good discussion and come to good conclusions. Thankfully, I also felt like I was able to communicate clearly during my presentation. The last thing I wanted was for staff to struggle to understand me the entire time!

So, I feel like my experience at the hospital has been a really positive one. I know I have learned a lot and I am grateful to have been a part of the Faith Mediplex family and the lives of the patients. I’m not sure how I am going to say goodbye.

The Labor Ward staff on my last day

It’s going, going, going…

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Again, sorry it’s been so long since I updated. At some point life here just starts to feel like normal life and it’s harder to know what to write home about! Convention week has come and go.

Convention is a gathering of CGM (Church of God Ministries) leaders and members. Mama Margaret Idahosa (Feb’s mother) is the head of the ministry so convention is here in Benin City and she hosts a lot of people on the compound. So there were a ton of visitors here and every day was extremely long. I had work in the mornings and then convention in the evenings. I figured I was in church for about 15 hours over 5 days which I think is a new record for me!

Mama Idahosa was consecrated as an archbishop and Feb was consecrated as a bishop. ALL of the pastors, deacons, and deaconesses were anointed and prayed for – and there were A LOT of them! In some ways it was interesting to see history take place for CGM as Mama and Feb were consecrated. In other ways, the convention was exhausting; there was an overwhelming amount of protocol and ceremony. And then back at the compound there were bishops everywhere! So the protocol continued at home.

All dressed up!

I am enjoying feeling more proficient at the hospital and able to actually help with practical tasks. Last week at Antenatal Clinic I was able to be the third nurse to see patients. We were done earlier than we usually are and I had to ask the nurses only a few questions. It feels good to start to get the hang of things and to care for patients on my own terms!

Friday last week was crazy busy on the labor ward. We were full already and women were walking in left and right saying they thought they were in labor. I really enjoy being busy, though! Because it means I get to do more and see more.

I helped catch my fifth baby today. It was frustrating, though, because I still would have done things differently if I was on my own. The woman wasn’t allowed to stand at the end of her labor even though she kept asking. She was given an episiotomy automatically (since it was her first baby) before she had even pushed twice. Here they don’t like for the women to push for very long. Most of the women, with encouragement, are able to push out their baby in 5 minutes or less after starting to push. So, it can be really stressful because the women are pressured into pushing as hard as they can and are scolded if they don’t push well.

I feel like I have small victories on the labor ward that are quickly followed by feelings of defeat. Last week I encouraged a woman to keep pushing after staff had given up hope and were planning for a c-section delivery. Half and hour later when she delivered on the labor ward, I was so relieved and grateful. YES! This is what midwifery is about! Then five minutes later I watched her being yelled at by the midwife (for a totally inappropriate reason). And my heart just sunk. Some days I don’t have a problem accepting the reality of what happens at the hospital. Other days it just breaks my heart all over again.

I talked with the Medical Director at the hospital on Monday and he was completely supportive of all of my ideas for change. He gave me the thumbs up for doing patient satisfaction surveys in the Newborn/Immunization Clinics for mothers who have been through Antenatal Clinic and the labor ward. I started today and got somewhat confusing results. I don’t know if the women are afraid to be honest with me, don’t understand my survey, or really do feel satisfied with the care they receive and wouldn’t change anything. I hope to do two more days of surveys so we’ll see how the final results turn out. I also got the green light from the Director to bring up some suggestions I have for change. I’ve picked three specific practices on the labor ward and found research to support a change for each of them. The Chief Matron (head nurse) and I plan to meet later this week with the labor ward Matron to talk about them. Then, the Director asked me to bring them up in a meeting with all the staff nurses at the end of this month. I was REALLY encouraged to have his support so now I just have to DO what I’ve planned! Please pray for the staff at the hospital and for me to communicate well.

I have about 3 weeks left here. Some days I can’t wait to go back to DC and other days I can’t imagine leaving here. I know I will really miss everyone. I’m trying not to get anxious about leaving but just enjoy each day and the experiences that come with it.

Getting into a routine…

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Sorry it has been a bit since I posted. It feels like life is moving right along here and I hardly feel like I’ve been here for almost 7 weeks!

I am starting to feel less like an outside observer on the labor ward and more like I have a place and a job. I caught another baby this past Thursday and I felt a lot more trust from the labor ward staff. I think they were actually really excited and proud to see me catch another baby!

Staff on the Labor Ward

I have been trying to be more proactive in helping the midwives on the labor ward because, unless they are really stressed, they will do everything themselves without asking me for help. So now that I am understanding the process of care on the labor ward, it’s easier to step in and ask if I can help with specific things. Thursday looked like a busy day from the start as we had three laboring patients, one of whom was probably going for a c-section, and another patient already scheduled for a c-section. On morning shift, the labor ward matron is always on duty and then there is one other nurse who is doing most of the work. With c-sections, the nurse has to attend the delivery to see to take care of the baby afterwards, so with one (possibly two) c-sections that morning, I knew we were going to be plenty busy and that the nurse was going to need help watching the patients on the ward.

So I asked if I could do all the monitoring and charting for two of the labor ward patients and the nurse showed me what to check and how to chart it. I was excited to be busy! I checked the fetal heart rates, contractions, and blood pressures hourly and got more practice than I’ve ever had before at checking cervical dilation. It was such a great feeling to feel like I could do everything for the women that they needed. And it was nice to have more confidence and trust from the labor ward staff. I also empathized with the staff as I understood more of how when you’re caring for more than one patient it’s difficult to always be therapeutic. I wasn’t able to stay with every woman when I wanted and I had to check things even when the woman just wanted to be still and not be bothered. But I tried to explain as much of what I was doing as I could and wait until a woman was in between contractions before asking her to change position or let me check something.

I tried to stay mostly with a woman named Victoria who was having her third baby and was the patient farthest along in her labor. It’s funny to me how even when women have been through labor before, it’s sometimes no less overwhelming or unbearable for them. By the time Victoria was almost fully dilated and ready to push she was saying how she didn’t think she could bear her labor anymore and was ready to give up (not that she really could). I kept trying to encourage her, remind her that she had already done this twice before, and that she was almost done. She delivered a beautiful baby boy who cried right away and I got to catch him! I was able to do more than I ever have to take care of a woman and her baby and I really enjoyed it!

I definitely have an everyday routine here in Benin. I wake up early to have tea (I traded it for my usual 2 or 3 cups of coffee) and some quiet time with the Lord in the mornings. Then I eat something delicious for breakfast made by Auntie Tracy or Auntie Augustina (the two nanny/cook/housekeepers in the house) with Matthew, Laurie, and/or Feb who are usually headed to the university. Then I meet the driver, Umokaro, and police, Uncle Bassey or Isaac, and drive to the hospital. I love seeing all these familiar faces in the morning – I will definitely miss them when I leave.

I have been going in for the morning shift from 8 AM to 2 PM everyday. There are devotions in the main hall at the hospital for all the morning staff. Although I don’t usually know the worship songs, I enjoy watching everyone dance and listening to the voices. The worship is always acappella and everyone, staff and clinic patients, seems to really enjoy it. Then there’s a short message, which I can sometimes mostly understand and other times not really follow at all. Some accents are really hard for me to understand, especially when the speaker is really passionate and shouting the whole time. At the end of devotions, I usually greet the Chief Matron and then walk to the labor ward.

I like walking around the hospital because so many people greet me and ask how I am enjoying my time here. Since I’m obviously from out of town, a lot of people at the hospital have stopped to meet me so I feel like I know a lot of people there. Here people are usually very warm when greeting others, and people often squeeze my hand or my shoulders when saying hello.

After my shift is over then the driver and police pick me up again and take me back to the compound. Lunch is on the table when I get back and during lunch someone else is usually coming back to the house after school or work. There’s usually one, two, or ten visitors to the house during the evenings! So after work, I read, go online, meet the visitors, or just hang out with my “family” here (what I do the majority of the time). Feb and Laurie have an extensive movie collection so I’ve also watched a lot of movies since being here. There’s also a ¼ mile sidewalk around the compound so I try to make use of that and get some exercise.

That’s about it for my day-to-day happenings!

I still have not talked to the medical director (who’s currently out of town) about using a patient satisfaction survey at the hospital. Church of God Ministries is having a convention here in Benin City so the compound will be full of visitors this week and I expect things to be really busy!

Thank you…

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I want to say thank you to everyone who’s been praying for me and everyone who helped get me here. I sometimes still cannot believe I’m here and wonder how it all happened! It is such a comfort to know there are people thinking and praying for me. Knowing that not only encourages me but helps me feel a little less lonely. I am starting to REALLY miss everyone and wish I could share lunch or a cup of coffee with one of you!

I went to Abuja last week, a pretty developed city here in Nigeria, and visited DIFF Hospital. DIFF specializes in IVF (in-vitro fertilization) therapies and thus has lots of multiple pregnancies and preterm deliveries. So they also have a NICU with more equipment than the one here in Benin City. I went to see the hospital to have something to compare Faith Mediplex to and kind of as a way of seeing what’s possible in healthcare in Africa. I was impressed with what they had in the NICU at DIFF but also with what they were able to do without. They had incubators and bilirubin lights but no ventilators or monitors. They also had one nurse to 5-9 patients!

It was nice to see a new place and get a different perspective. I had a little bit of culture shock driving into Abuja, though, because there are large paved roads and highways with traffic lights and clear traffic lanes. I felt a little bit like I was back in the US and I was a little overwhelmed, to be honest.

I was glad to get back to Benin City on Saturday; back to some familiar people and places. Although I have been pretty discouraged this week at the hospital. There is so much about the way we care for patients there that I wish was different. I also wish I knew more about the normal labor process so that I could talk more with the midwives about how care could be different and the rationale behind potential changes. I’m still learning some basic skills specific to labor and delivery and still proving to the midwives the skills I feel confident in – like checking fetal heart tones and starting IV lines. I get really frustrated at the way I see the women treated and wish I could do more to change it.

One idea I have is to do a patient satisfaction survey for the women in antenatal and intrapartum care at Faith Mediplex. That way, it would be the voices of the women who could point out the strengths and weaknesses of the system instead of me or someone else coming in and pointing a finger. Please pray for me on this as I try to form a survey and figure out a way to introduce it to the hospital administration and staff.

Thanks again to everyone who is praying for me – I am so grateful!

A Second Birth

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It’s hard to believe it’s already been a month since I stepped on a plane to Nigeria. But I would say time is going by at just the right pace!

Yesterday I caught a baby for the second time and it was a much more positive experience than the first. When I came in the morning to the obstetrics ward, there was a first-time mother, 27 years old, who was 3 cm dilated. She shares my Benin name, Itohan, which means “mercies of God” and which some hospital staff here gave me. She seemed really nervous, kind of frightened of the contractions, and unsure of what was happening. I knew she needed someone to explain what was happening and to feel like she had help available when she needed it. I tried to encourage her to eat and move around as she felt comfortable because once she was back in the labor ward she wouldn’t really be able to do either.

I was excited to see someone go through labor from the beginning stages since women rarely come in before they are 4-5 cm. I was also excited to be able to be there for her from the beginning.

Now that I am more familiar with how they do things on the labor ward, I felt this time around I was better able to do things to care for Itohan and also to help her understand what was going on. I stayed with her almost the entire time and tried to help her keep a rhythm with her breathing while she had contractions, rubbing her back with every contraction. She was even falling asleep between contractions in the later stages! (Which means she felt pretty safe and relaxed – and pretty tired!)

It’s really exciting to see all the things that I am reading about what women need in labor ring true in my experiences. What I have seen so far is that women want to know that what they’re experiencing is normal and that they are doing well in coping with their labor. They want someone close by, close enough to hold their hand, and to feel they are not alone. I’ve found that once I come close to a woman in labor, especially late labor, she does not want to let go of me! A lot of them ask to be held and some of them even rub my shoulders or back while I rub theirs!

When it came time for me to leave yesterday before Itohan’s baby had been delivered, I just couldn’t leave her. And the midwives were all telling me I should catch her baby since I had been “trying” for her so long. (Trying here means you are working really hard and it’s how most of the mothers I help thank me here – “You tried for me, you really tried for me.”) So I was able to stay and catch her baby, with lots of direction from the midwife, and take care of the sweet baby girl after she was born! I told Itohan several times that she had done so well and celebrated her baby with her. It was such a blessing to get to be there for so much of the process and help a first-time mother go through it and, hopefully, help her feel confident in herself and excited for the birth of her baby.

Women are amazing! And the God who sees them through the amazing miracle of birth is so unbelievably amazing!

Itohan and her baby on the postpartum ward