Learning and Teaching

Andrey's coming back tonight. Yay! He's been in Manila all week for meetings. I really prefer having that guy around and I'll be happy to pick him up from the airport later.

I worked last night and was delighted to get to rest for half the night because Tuesday night I was up till 5 a.m. with an 18-year-old first-time mama whose baby's father is considered 'unknown.' I find it sad on so many levels. The good things about this birth included a beautiful, precious little baby girl named Allyson and the fact that I felt really confident managing her labor and delivery. I'm starting to arrive at this place I couldn't imagine before. A place where I feel like I might actually know what I'm doing. There are still many-a-births when I don't feel this way but the number in which I do feel confident is increasing. I'm starting to feel like a real team member who contributes nearly as much as the nurses and midwives I work with that already have many years of experience.

The past few days I have been looking through tons of charts at the clinic of past births trying to find births that I either observed or managed and needed to be transported to hospital. I haven't kept of record of these because I didn't think I'd need to but turns out the North American Registry of Midwives (NARM) wants to know these in addition to the births I attended - delivered or assisted - as part of my application for the licensing exam. So I've been looking through charts. I found a few things that surprised me. In the past 5 months or so I have had the opportunity to instruct a couple of our newer staff-members (nurses getting trained in midwifery). There was a day when we had several births and Hilary was busy in the other room when a patient progressed faster than we expected and it was just me and one of the newer nurses in the room. Next thing we knew the baby's head was out and it's cord was wrapped around it's neck loosely. She panicked a little and I got to talk the her through what to do and I was surprisingly calm and relaxed (probably because cord wrap isn't that big of a deal, I may have reacted differently if it were an emergency or something serious) and was able to talk her through it instead of just taking over.

Then there was another birth I had forgotten about when a different nurse was handling the birth and she had trouble facilitating the birth of the baby's body after the head was out. I was able to instruct her and then stepped in to get it done after being instructed to do so by the supervisor on duty.

The reason I am mentioning these things is that I realize that I LOVE teaching! I love it! Who doesn't like to feel like they know what they are talking about? It's a good feeling and I'd love to do more of it. This is perfect as far as midwifery goes because there is a saying in midwifery (actually it's Midwifery Today's motto) - "Each one teach one." I have often thought about what it would be like to work as a midwife in another developing country on my own and how that would likely include training local midwives. There is a part of me that thinks it would be hard to not do births myself but I think I could really enjoy teaching.

One thing that has come out of becoming a midwife that I didn't expect is coming to understand and appreciate the significance of my father's two-decade career as a paramedic. When I took the Pediatric Advanced Life Support (PALS) class recently it occurred to me that this was the kind of stuff my Dad did knew how to do and did for so many years when I was a kid - handled trauma cases and managed a rescue car in a busy city, worked on a CareFlight helicopter. And then my Dad told me that he used to teach the PALS class. Wow! I had no idea how amazing my Dad was! I mean, I knew he was pretty great but I had no idea how skilled he was medically.

When I was a kid and somebody in my family got a bad cut or gash (usually one of my brothers), my mom and I immediately knew they needed stitches and always felt quite disappointed when my dad would say something like, "Na, it's fine. Just throw a butterfly bandage on it and it will be fine." My mom and I would usually think he was crazy and that he just didn't understand the seriousness of the laceration or we felt that the accident required more pity and babying (because that's what we would have wanted). Well, now I understand! It really wasn't a big deal and if it really were, it would have been handled appropriately. And even if there was a lot of blood, of course it wasn't a big deal considering the things my Dad saw and handled all the time at work. Sorry I underestimated you, Dad!

It's been so fun lately chatting with him about emergencies and trauma cases and growing as a care provider faced with these things or the possibility of these things. I love hearing his stories about starting out as a rookie and then growing into a confident paramedic that was able to sleep in the rescue car because by that time he had seen just about everything and was able to confidently slip in a few zzzz's on the way to a call. I learned also that he did quite a lot of teaching after he became an expert in his field. My Dad is extremely patient, kind and encouraging and I can clearly imagine him teaching a younger paramedic on the job. I feel like I may have some of these same skills. My mom is pretty great with these things, too. She teaches nurses to do ultrasound in pregnancy crisis centers around the US. I have seen her in action (she trained the GRC staff last year) and she's a great teacher, too - very patient and encouraging - so I've had great models.

My dad retired from the City of Tampa Fire Rescue department after he herniated two discs in his back from all the lifting over the years. I think these kind of jobs have a shorter life span than other careers and from what I can tell, most paramedics don't work as long as my dad did. I still don't know how he did it. I have a lot of respect for paramedics (like my friend, Melissa!), but I know I'm not called to that career. I am quite satisfied with the possibility of the rare, serious emergencies that midwifery brings and needing to be ready to handle them effectively should one arise. I never saw it before but given the careers of my parents, this midwifery thing seems quite appropriate. I never knew I'd get such enjoyment out of medical stuff but as it turns out some of my favorite things are poking people with needles to hook an IV or spending an hour suturing!!! Ha ha! The immediate, tangible result is so satisfying!

Exercise and Iron Deficiency

This week has flown by and it hasn't included even one occurrence of exercise. Hmph. I was doing so well for a while there but I have yet, once again, fallen off the wagon. I feel pudgy and weak just thinking about it. I know my body can't change that quickly after a week of no exercise and a few weeks of sporadic exercise but it's amazing how powerful the mind is.

I had nothing but night shifts in October - usually two a week. I'm not complaining because that isn't that much work but it's been busy lately and nearly every night shift has been demanding physically. My night shifts have been spaced close together - for example, Wed and Fri or Tues and Thurs. When they are close together like this I just don't get that rested after the first shift before I have to do it again, which pretty much leaves me extremely unproductive for about 3 days. I try to sleep for a few hours after being up for all or most of a night but I can't always fall asleep. Usually my head is aching from the delay in caffeine intake. I'm forced to wait till after I try to sleep. Even with a little sleep I just feel like a zombie on those days (is this what having children is gonna be like??)

Anyway, that's my excuse for the poor exercise this month. Lame excuse but most excuses ARE lame. Oh well. November is a new month and I'm working about three shifts a week with many of those day shifts plus a few half days just to help out during prenatal exams. I must try to get back at it. I feel so great when I do and now that I'm not as anemic as I used to be, exercise isn't as much of a chore or as painful (for years I always gasped for air and my heart raced even with mild exercise). I had no idea that was due to iron-deficiency anemia all those years (some nutritionist, huh?). Now I feel "normal" for the first time in years. I can exercise and not feel like I'm gonna die the whole time. I used to have to DRAG myself to do anything active before but I don't feel like that anymore. It's a new day. That, in addition to watching the Biggest Loser. That has seriously motivated me. I just keep thinking, "If they can do that then I really have no excuse!" And because I see them pushing themselves beyond their own perceived limitations, when I do get to the gym I try to really push myself beyond what I would normally do. Man, I really gotta get back at it. This is only going to get worse when I have kids. If it's this hard to stick with it now I'm really going to be in trouble later.

On a quick side note - I've tried numerous iron supplements but none made me notice immediate improvement as much as Floradix Liquid Iron + Herbs did. I felt so much energy when I was taking it and my CBC saw a greater increase in hemoglobin than when I tried other supplements containing the more absorbable forms of iron (Fumarate and Gluconate). This supplement has no synthetic iron - only iron-rich herbs. So awesome. I just wish I could get more! Can't buy it here in the Phils unfortunately and it's not the easiest (or cheapest) thing to ship.

And just so you know, I'm not wanting to exercise to lose weight as I'm at a healthy weight and have no need to lose. I've stayed at this weight (+/- 3 pounds) since I got married 7 years ago. My body likes this weight. My thyroid has been balanced for years now and weight stabilization is a benefit of that. I haven't had to change my thyroid medication dose for over 5 years. I am exercising because it is essential to being healthy and essential to retain the muscle mass that increasingly wastes away as you get older and to keep metabolism working the way it should. Plus, it is essential for decreasing the risk of cancer (and many more diseases!) - especially estrogen-related cancers. I have a higher risk of breast cancer because of the radiation therapy to my chest in 1995 so I want to counteract this as much as possible and diet and exercise are things within my control. I do pretty well on the diet end but I've always struggled to keep a regular exercise routine.

I really like the gym I go to. I just don't like having to drive 15-20 minutes each way to get there. But seriously, no excuse. Must get back at it.

War on Mice

For the past couple of months we have gone from never seeing any mice or mice poop, to seeing mice poop in increasing amounts all over our kitchen as well as half-eaten food, to seeing actual mice scurry away when we enter the kitchen. My scalp itches just thinking about it.

My scalp always itches when I think about rodents or roaches or maggots. And no, I don't have dandruff. I just feel like I want to barf when I think of these things, much less see them taking over my kitchen! So I bought some traps and strategically placed some peanut butter on them.

The result? Three mice in three days. I got photos of the last two. Oh so proud. First I hunted, then I killed. Oh and I forgot to mention that Gerald caught and ate one last week. Andrey and I were so proud of him! It's like all our wildest hopes and dreams for him were realized the day he ate that mouse. We just wished he would have done it a long time ago and would have been smart enough to catch the other three!

Oh don't think I don't see you! It's ON little buddy!

Ah ha! Gotcha! (insert evil laugh)

Oh the delight when I heard yet another loud snap in the pantry. I was giddy with excitement.

Gerald's hunt last week. Sorry the photo is blurry but you can see how Gerald has him trapped. I wasn't home but apparently Gerald played with the mouse for a while before he finally chomped him up for dinner. Crunch crunch crunch.

Cute photo of Gerald in my closet just to get the icky mice thoughts out of your head so it will stop itching - a bit of a cleanser for the mind.

And since I'm on the topic of Gerald... He was "castrated" this week. When I called to make the appointment with the vet I couldn't think of the word for getting a male cat fixed and didn't know what word was commonly used here so when the woman on the other end of the line asked for clarification I fumbled around unsuccessfully for the right word and said, "Uhh... Umm... I want to get his balls cut off!" "Ahhh, you want your cat castrated?" she said. "Yes. Yes. Castrated. Right. When can I bring him in?"

The surgery was a success and little Gerald was gingerly walking around for the first day at home. It was hilarious watching him stumble around as the anesthesia wore off. So entertaining. I even tried to get it on video and then I caught myself from being so ridiculous. Let this further confirm our readiness for children. This cat is getting way too much air time and attention. You should see how Andrey holds him like a baby and even bounces him in his arms. He's worse than I am!

Day Trip in Search of Nature: Photos

I said I'd post the photos in the movie I recently published. I just wasn't happy with the quality of the video and I wanted you to see the shots. Not that they are all that great but they give a little snapshot of Cebu and of some of the scenes we see as we drive around town. The latter shots are from our latest attempt to discover some nature near the city.

Cebu City streets not far from home...

Would you buy one of those "minute burgers"? Buy 1 take 1! (Buy 1 get 1 free) I love the phrases here. Another favorite is the Filipino equivalent of "all you can eat," which is "eat all you can." It really does mean the same thing but I find it interesting how the latter has a slightly different meaning that conjures up pictures of competitive gorging, as in "eat all you possibly can before somebody else eats more than you."

The ubiquitous rice shop (and other necessities in single-use portions - shampoo, laundry soap, etc...) Who knew there were so many different varieties of white rice?

"Wanted Boy"
Translation: handyman wanted

Scenes on our way out of the city and driving up the mountain....
Nothing says Philippines like a Jeepney!


Cow on a hill (I wish there were more than one so I could say Cattle on a hill)

Chapel

Kan-Iring Nature Park: after our drive up the mountain we noticed slightly cooler air but unfortunately there's only one trail, a 1-km loop. Most of the following shots we got because we ventured off said trail to do some exploring. The park staff were not pleased with us for that.

The beginning of the forbidden trail
We see some pretty farmland in the distance

A bit closer

Some small, pretty things along the trail

Once we reached the big tree and with the help of our zoom, we got these shots of a flower farm...

Day Trip Movie

Last Friday Andrey took the day off and we took a drive a little ways out of town to go to a nature park in the mountains. I took some video of the drive up and took some photos of the day. I decided to mess around with iMovie and put what I got into a little movie. The song is what we happened to be listening to on our way up (U2 is always great road music). It's a totally low quality movie (sorry for the poor video footage) thrown together without the usual obsession with trying to get every detail right but I thought you might like to see some everyday-looking scenes of Cebu streets as well as some nature not-so-far outside of the city. I realize now, after I uploaded the video that the photos don't come up very clear so you can't really see some of the pretty scenes. I think I'll post the photos separate later for you.

As for the nature park - it was nice but it's not all we'd hoped for. It only had a 1 km loop. We were told not to venture off of it but we did anyway and found a nice little path that led to some pretty farming scenes. I don't think we'll go back though because as we returned to the park a ranger was waiting for us and I heard him on his walkie talkie tell someone that he had found us. Oh well. We were hoping for some trails to explore but there just isn't the same public rights to open space as you find elsewhere.

A New Approach to Blogging and Likely Much More than you Bargained For!

I have recently been inspired by fellow bloggers to post more. I have a few friends who are so good at blogging. They blog almost every day and they include a lot of day to day stuff, which I really enjoy reading. I realize I could do more of this and not limit my blogging to what I consider to be the most significant things. I can include the details of the week or day - even if it doesn't seem that interesting to me. After all, people can choose read it or skim it or skip it! (although every blogger hopes her posts are read and commented on!). The fact is, when I sit down to write I realize there is some noteworthy stuff going on and I'd like to remember more of it. Time goes by fast and when asked I can't always say what I did in a week but I know I was busy. So I'm gonna try to take better note of what goes on in a week - even if it's just for me. Take or leave it friends. Here are a few things from this past week.

Midwife?
I started referring to myself as a midwife this week. On Monday I received this (long awaited) email from the National College of Midwifery:

You have completed all your clinical and academic requirements for your NCM program. We have issued your Certificate in Midwifery. I have reviewed your file for eligibility to take the NARM exam. You are eligible and we will be happy to grant permission to take the exam.When you send us verification that you have passed the NARM Exam we will issue your Associate of Science in Midwifery Degree.

I shared this with Hilary before our weekly clinic meeting and she immediately said, "You're a midwife now!" It hadn't occurred to me. She then announced to the staff, "Hey everybody! Jen's a midwife!" Everyone cheered and congratulated me and it felt really good. On my student record I noticed a little something - "Graduation date: October 19, 2009." So sure, I'm not licensed yet but I have apparently graduated and am going to start calling myself a midwife.

On a side note. One thing I find funny is when patients at Glory Reborn call me or another staff member "Doc." It happened this past week while I was stitching up a patient. I used to say 'No, no, I'm not a doctor. I'm a just student midwife.' And then I realized there is no reason to say 'just a student midwife' because I do value my profession - student or not - so it's value shouldn't be minimized. So then I started saying, 'I'm a student midwife.' Now I say 'No, no, I'm not a doctor. I'm a midwife' (smiling on the inside). I still can't believe it. I wonder when I'll start feeling like I'm a real midwife. I don't feel it yet but I think it will come.

I started prepping the application for my licensing exam. I plan to take it February 17 in Eugene, Oregon. Now that I got the "go ahead" from NCM, I can now apply and get registered to take the exam. That also means I have to start studying. I plan to officially start once November arrives - so I have a week left of post-midwifery-program, pre-NARM exam, time to do what I want. FYI: NARM stands for North American Registry of Midwives. They grant the Certified Professional Midwife credential.

Still a Nutritionist
The past few weeks have been fun as I've taken on a few nutrition projects. I realize once again how much I enjoy nutrition work. It's nice to remember the work I have put into become a nutritionist (not so nice to remember that student loan every month though!) and that I can help inspire people to take better care of themselves. It occurred to me recently that I should take the opportunity to do more with nutrition now that I'm finished with my midwifery degree. Several opportunities have come up at the right time.

Hilary wanted some brochures made for the clinic so I made a 'Nutrition in Pregnancy' brochure specifically geared toward our clients. I put a lot of emphasis on the importance of nutrition during pregnany and less on the specific dos and don'ts (although it did include basic nurition principles and the components of complete meals). Our women need to understand why it's imporant before they will put effort into improving their diet during pregnancy. I find many have yet to see the value in it.

As I made the brochure I was further convinced of how important it is! The main points of the brochure are 1. Nutrition may save your life (2 of the top 3 causes of maternal death in the Philippines are nutrition-related!) and your baby's life (low birth weight babies have higher risk of death and poor growth and development and a whole host of other negative things) and 2. Nutrition saves money in the long run by preventing expensive complications and need for hospital delivery. I felt good about it and hope it inspires and compels women to do what they can to improve their diets during pregnancy. It's going to be translated into the local language. I also made a newborn care brochure and I would like to make a breastfeeding one as well. These are all topics that are covered in our health teachings during prenatal check ups but what is taught is not firmly established and really just depends on which nurse or midwife does the teaching. Also, it is good to have something in writing that our women can take with them.

I'm also creating a meal plan for my neighbor who is battling cancer and needs help gaining weight. It's a really tough situation for our her and her family so it feels good to be able to help in a practical way.

Other projects in the works include creating a meal plan for an American guy we know who is in a boxing training program and is training for a fight in December. He needs to gain weight, which is not easy since he exercises intensely 6 days a week, and wants to do it without having to rely on fast food all the time (good on him).

Also, recently I was asked by our church leaders to teach a nutrition class to the families in our community. Most of the children (and many parents) are quite underweight and I see a lot of packaged junk food going around all the time. I love teaching and I have tons of fun ideas for the class, which will probably take place sometime next month.

What fun to have two careers that I absolutely enjoy. I was quite happy and content to work in nutrition - especially if it included working with moms and babies and getting to do some doula and breastfeeding education work. Midwifery is the icing on the cake. How did this happen? I feel so blessed to not be limited to only doing jobs that pay. What freedom to be able take on whatever I have the desire and time for. It's really a joy to be doing such practical, useful work. Years ago I could have never guessed I'd be living in Asia doing what I do. The longer I am in Asia, the more thankful I am for this opportunity to live overseas and learn so many new things.

Our Weekend So Far
Yesterday (Saturday) Andrey and I (along with many other IJM staff members) took part in an anti-human-trafficking awareness walk and concert put on by MTV EXIT (End exploitation and human trafficking). Three very popular Filipino bands played and they were so good! It's great that MTV is taking a stand against trafficking and using their popularity among young people to do something about it. I wish I could post a few photos but I forgot our camera.

I also wish I could share in some detail about Andrey's work on this blog but I can't. What I can say though is that in the past two weeks, there has been some exciting work that has gone on that has resulted in arrests and rescue. We are thankful for the success that has occurred on behalf of the oppressed and pray for the work of healing and transformation for those involved.

It's Sunday morning and Andrey left for church a little while ago. I'm so tired this morning. I pulled an all-nighter Friday night at the clinic, then yesterday was busy all day and this morning I'm just not feeling so great so I decided to stay back. I'm gonna have some quiet time and do some journaling and reading and resting. So nice.

The Coming Week
Andrey will be in Manila all next week. He leaves early Monday morning. I've decided I'm going to eat vegetarian all week. I've pulled out some old Bastyr University recipes from my whole foods cooking classes. Some very Fall recipes as that was the season I took the class but hey - it's Fall in many places in the world right now. This week's menu will hopefully include:

• Curried lentils with cauliflower and sweet potatoes with spicy raita (yogurt sauce) and brown rice
• Rosemary red soup (beets, carrots, red lentils), green salad and whole wheat buns
• Mexican bean/corn casserole
• Sweet squash corn muffins
• Honey-glazed tofu

Well, at least the first two meals are sure to be made as I've already bought the ingredients for them. If any of these sound good to you and you want the recipe let me know and I'll send it to you. They are generally pretty easy and very perfect for Fall weather. I'm not going to let the lack of Fall weather stop me from enjoying these foods. I'm working Tuesday and Thursday night shifts this week so we'll see if I have the energy to cook later on but at least I'll get the week started out right and then have leftovers all to myself.

I've really been enjoying meal planning and lately I've been challenging myself to plan meals utilizing stuff I already have in stock instead of always buying more. This month, I have successfully began clearing out our pantry and refrigerator/freezer. Meal planning results in healthier meals and less waste. I buy the produce I plan to use, not hope to use. I only have to shop every 3 to 4 days - sometimes I'll make the meal plan for a whole week with two different shopping lists of what to buy now and what produce I will need to pick up mid-week. I love cooking and the satisfaction it brings knowing I am eating well and using less.

I have uncharacteristically started planning already for Thanksgiving and Christmas. What's wrong with me? I'm slowly conforming to Filipino culture as I plan to put up Christmas decorations BEFORE Thanksgiving this year. Gasp! Our family never did this but Christmas in the Philippines started almost two months ago so the idea of mid-November Christmas decorating is growing on me. I'm so excited about Thanksgiving this year (after all, it IS my FAVORITE holiday of all!). I can't wait to roast a large bird after it sits in brine for about a day. I have learned (from my skilled mother with little credit to Martha Stewart), that this produces the most juicy and flavorful turkey of all. I have been tweaking my recipe the past few years to include some dark beer and brown sugar. Oh Lordy it is good. Maybe in a few weeks I'll post a few of my favorite Thanksgiving recipes. The others that I must make and just can not delegate to others is apple pie (adapted from my Mom's famous recipe!) and a new addition whole wheat butterhorns (thanks Lonna and Mennonite bakers from Intercourse, Pennsylvania - yes that is a real town and yes, that is it's real name. Isn't that awesome?).

Well now that I've gotten started I'm just rambling now so I'll stop here for fear that no one will read or comment on this extremely long post. Hope you all are having a great weekend!

Inching Closer... we think.

On my online Philippines adoption group yesterday I read that a couple that was approved in October 2008 just got matched with a 10-month-old. This is exciting for two reasons.

1. It tells me it is possible to get matched with a child under age 1.

2. Since we were approved in December last year, it makes me wonder if our file has been released already. Or will we be in the next group of files released? Last I heard those approved up to June last year were being matched. With this couple having been approved in October and getting a match already, shows us that they have moved on to other applicants that were approved later than June last year (and closer to when we were approved!).

This couple only waited a year for their match. It gives us hope and shows us that it is possible to get a match by early next year (or late this year!). Yikes! As soon as I start to relax and get settled in for a longer period of waiting, I hear something like this that pinches me into sober anticipation that it could be anytime. I just don't know which attitude to take on! I guess I should prepare as if it's going to happen soon - because it is possible! Oh my goodness!!

Adorable Christmas Cards Available

About a month ago we had a photo shoot during one of the baby parties at Glory Reborn in order to get photos for this year's Christmas cards.

I would just like to tell everyone that these cards are now available and they are SO CUTE! Please take a look at them and buy some to give to your family and friends this year. Go to http://shop.gloryreborn.com/collections/holiday-cards.

They are a bit pricey if you think of the cost per card but if you keep in mind that the purpose of making and selling these cards is to raise much-needed funds for the ever expanding programs at Glory Reborn. For example, two social workers were recently hired. They will be assessing the financial situation of our patients in order to determine those who need more assistance than what Glory Reborn usually provides. This will come in the form of free lab work and medicine. Currently, patients have to pay for these themselves but for some even these basic costs are too much. The new program is exciting as it will help us to determine who really needs the extra help so that they are not prevented from accessing the care they deserve.

The proceeds from the Christmas cards go directly into the programs at Glory Reborn that serve the women of Cebu, Philippines.

Gardening Success! (so far...)

Ah, the garden. I have always dreamed of some day being successful in gardening, or at least trying my hand at it. I've always felt that as a nutritionist, it is ridiculous that I have such little knowledge about and experience with growing food. My very first attempts only began last year. Without initial success I gave up for a while but decided to try again a few months ago. Thanks to my mom stocking me up with some (non-expired!) seeds and some attempts to keep the slugs away, I am happy to report that my garden is thriving. I imagine this is strange for you all in the West as you are heading into Fall and Winter and I'm just getting tomatoes growing. Oh well, that's the benefit of getting to sweat year round. I have many more seeds I plan to plant as soon as the tomato harvest takes place and I have some more space. Next skill to learn: canning.

On a side note, I started knitting again and I've been really into baking these days, on top of the usual cooking I do for dinner almost every night. I had a realization the other day. I'm really domestic! I really, really enjoy being domestic. I love working with my hands and having something to show for it immediately or soon after. I've always been one for instant gratification. Lately there have been opportunities to cook/bake for friends and neighbors who are going through various tough times in life (cancer, miscarriage...) and I realize that cooking and baking is one of my love languages. I feel I can really love people when I cook or bake for them. I take joy in it. Andrey is a blessed man and he knows it. Here are some shots showing the gardening progress...

Our circular bed and the newly cleared bed now full of tomato plants

Close up of the circular bed with many transplanted tomato plants

The new bed is also full of tomato plants

The potted plants in the side-yard. Most of what you see are tomatoes (can you believe all of our tomato plants got started in that one large white pot?), plus there is a chili plant, some thriving basil, some not-so-thriving cilantro, and some gulay (or "guy" for short), a native green veggie that our helper planted

Chili plant. If you look close you'll find one, white chili ("sili" in Visayan). Next to it are a couple of sprouts I found in the compost. I think they might be watermelon.

More tomato plants - this pot's still a bit crowded

The basil (so fragrant!) and cilantro (go baby go! I want to make salsa.)

Where the tomatoes got their start. I've cleared out and transplanted all but a few so they'd have room to grow big. We just added the stakes today to keep them upright.

Bonus picture of Gerald. Enjoy those balls little buddy because you're getting castrated soon. If he only knew what was coming. When I said I believe in family planning, I meant I believe in family planning. There are too many orphaned kitties around here! I don't want to perpetuate the cycle.

Our Near Distant Future in Cebu

I'm not sure how many of you we told about this but wanted to make sure I got an update out to everyone. It looks like we'll be in Cebu at least through the end of 2010! Yay! This is great news.

For the past several months we weren't sure how long we'd get to stay in Cebu because of the end of the grant funding for the office here. Andrey traveled to Seattle in July to see about getting a renewal in the grant but no go. Since then our near distant future has been a little uncertain meaning we couldn't guarantee that we'd be here past the end of this year (with the current job at least.)

We prayed and prayed as we both do not feel ready or that it's the right time to leave Cebu. There is much work to be done here, we love and appreciate life here, and we really really really want the opportunity to receive and live with our adopted Filipino child(ren) here.

Two weeks ago we got final word that headquarters was able to find enough room in the budget (assuming fundraising goes as planned) to keep things going without having to cut any major programs in Cebu through 2010.

Andrey and the office will work all year at getting a bigger grant for 2011 and beyond. The thought of being here for several more years is a happy one. I just can not give up on the fact that I believe in my gut that receiving and living here with our Filipino kid(s) during the initial adjustment will be the absolute best thing for them. What a blessing for them to not have to adjust to a new country on top of adjusting to a new family, language & culture while they navigate the other common adoption-related challenges like grief, attachment & development issues, etc... While here in Cebu, they won't have to give up their language so quickly or the food they like and I figure there must be something comforting in having some of the same or similar sights/smells/sounds of their home country.

So that's our good news. We are so incredibly blessed and thankful for each day here. Life is good. Come and visit us!!!

Busy Baby Season & the Making of a Midwife

September and October are the most busy months at Glory Reborn clinic. Last night was a good example of this. When I arrived we had six inpatients plus a woman in labor. Three patients had delivered the day before and two had delivered earlier in the day. The woman in labor was already active and lying on her left side since her blood pressure was borderline high. While we were doing endorsements (explaining of charts from one shift to the next), the woman in labor exclaimed that she was ready to push. I quickly checked her and determined that she was fully dilated. We transferred her upstairs and within 15 minutes her baby was born. Our postpartum room was full, which has three beds. Our delivery room was full (two beds) and our prenatal area was full (three beds). Thankfully, after the delivery we were able to send one of the postpartum patients home, giving us one free bed. That turned out to be exactly what we needed because at 9:30pm another woman in labor arrived and she too was fully dilated! I ran upstairs to tell my coworkers to hurry and transfer the last patient off of the OB table so we could bring the next one upstairs. They moved her and the bed was cleaned just in time.

I got to deliver the second baby, "Baby Jane," at 9:54pm. Whew! Both deliveries were so fast! After that, we ended up with 9 patients for the night. We had to transfer two to the annex in the back of the clinic so that our delivery room would have two free beds.

I feel like I am becoming better equipped to serve the women we see at GRC. For a long time I resisted the active management of our patients in labor as I believed that most births should be normal and would not need intervention except in a minority of cases. Because of this I have missed some key interventions/preventative actions that resulted in a few of my patients losing a bit more blood than they needed to. A few weeks ago I had a patient that hemorrhaged and it sobered me to the very real danger of excessive blood loss. It can happen so fast!

Hemorrhage is one of the top three causes of maternal death in the Philippines as is the case in most developing countries with poor maternal mortality rates. I have become aware of the necessity in changing the way in which I view my patients at Glory Reborn. By far the majority of our patients are high-risk and my management should reflect that.

I have written about this in the past - my need to reconcile the birth stories I read about in the West and my experience in midwifery in the Philippines. I have come to the following conclusions:

• I still believe that birth is a physiological process that should not be interfered with as long as it continues within the realm of normal. Expected management should be implored in known low-risk women.
• Most women will have normal pregnancies and deliveries if they enter pregnancy with a certain level of health, which sadly and in the majority of women, corresponds with socioeconomic status and level of education.
• Impoverished women, who have lower levels of education, less access to health care and family planning services, and know less about health and nutrition, tend to enter pregnancies malnourished with iron-deficiency anemia, and as is the case in the Philippines, higher parity (having had a greater number of pregnancies).
  
• These women end up with very poor nutrition - with numerous states of deficiency in the least including deficiencies of protein, iron, vitamins A & C, calcium, folic acid, zinc...
• The impact of poor nutrition is understated and is often overlooked.
  
• When compared to women in developing countries, the women in the Philippines have a MUCH greater risk of dying from infection, hemorrhage or pre-eclampsia.
  
• This warrants a different approach by me as a midwife as long as I am working among the poor in a developing country. (Numerous resources put forth by the World Health Organization further confirms the appropriateness of this.)
  
• Doing this will not ruin my ability to appropriately support healthier women in pregnancy and childbirth but will better equip me to handle life-threatening emergencies when they do occur.
  
• It is very appropriate and possible to "be on the safe side" for the women we serve at Glory Reborn while remaining in the realm of evidence-based practice.
• I must continually challenge myself to further improve my skills and judgment so that I can better discern the line where interventions become unnecessary and harmful.
  

So, the birth I handled last night confirmed to me that this approach is an appropriate one. Even though the patient's hemoglobin was normal (so was the last patient I delivered who hemorrhaged), I decided to hook her to IV fluids before she delivered just in case she hemorrhaged. This was only her second baby, but her labor was precipitous, which increased the risk of hemorrhage. I delivered her placenta actively (within several minutes) and sure enough her uterus did not contract well and she had a steady trickle of blood until the pitocin that we immediately infused into her IV took effect. She lost at about 400 cc of blood in those few short minutes. I believe it would have been worse had I not hooked IV and had to give pitocin intramuscularly, which takes longer to take effect and is less effective than pitocin administered via IV infusion.

Her placenta showed signs of poor nutrition. It was small with a very thin cord. Come to find out her husband is a smoker which further reduces the health of the placenta. In the end, her baby transitioned well to extra-uterine life with a birth weight of 2800 grams (only 300 grams away from being considered low birth weight. Babies who weigh less than 2,500 grams at birth have significantly increased risks of mental retardation, learning disabilities, stunted growth/development, and death when compared to babies in a normal weight range. Babies in the 2,500 - 3,000 gram category have lower risks of the above but are three times more likely to experience one or more of those things than babies who weigh more than 3,000 grams.

So, I am practicing a different kind of midwifery than I initially envisioned, but I am choosing to embrace it, learn as much as I can and do the best that I can. Who knows where this experience and will lead me? For now I am quite content and thankful for the opportunity to volunteer at Glory Reborn to grow in my skills as a midwife.

A Right to Personal Information?

How often do you get asked about whether you use birth control from a perfect stranger? Is it common? It's happened to me at least three times since living in the Philippines with one of those times including getting warned by a taxi driver about the difficulty of getting pregnant after I turn 35 and how I'd better hurry.

The most recent occurrence was during the training I attended in Manila last week. Here's how the conversation went with a guy that I had just met and had had a few bits of small talk with that morning about where I live and why I was in the Philippines. Naturally, the conversation by that afternoon had moved to more personal stuff. This is normal, right?

Guy: So are you married?
Me: Yes.
Guy: Do you have kids?
Me: No.
Guy: How old are you?
Me: 34
Guy: How many years have you been married?
Me: 2 (Okay so we've been married for 7 years but I started lying about this recently because I've learned that telling the truth makes conversations like this even worse)
Guy: Hmmm... (I can hear the wheels turning as he searches for the reason for this)... So are you using family planning?
Me: That's a little personal, don't you think?
Guy: Sorry.

End of conversation.

Yes. I know it's weird. A married woman in the Philippines who doesn't have kids. I can understand why this guy and numerous taxi drivers have found this strange, given the fertility rates in the Philippines. But frick! None of them ever seem to consider infertility. None of them seem to consider that this may be a sensitive topic (less so now than before but still!). That's why I've started lying. Perhaps I'll start really lying and just say I have kids already so we can have a cordial conversation about the joys and challenges of being a parent.

The last person who asked me the same line of questions was a salesman in a hardware store after I asked him where I could find a new toilet seat. I told him that's none of his business and proceeded to immediately walk away abandoning my purchase. Two words. Unexpected and Inappropriate.

I'm a pretty open person and I usually don't mind entertaining the common array of questioning from curious Filipinos. I choose to be flattered by the fact that they are just genuinely interested in my story - why I'm here and what I'm doing. I'm okay with that but being questioned about my use of birth control is clearly a line that should not be crossed.

Oh Happy Tired Day

I am just so happy to report that I have successfully completed the Pediatric Advanced Life Support (PALS) course AND the LAST requirement of my midwifery degree. Ha-Le-Lu-Ya!!!

It wasn't easy. And there were a few people who didn't pass. I have to say it was one of the most challenging trainings I've ever participated in. I was the only non-Nurse/MD/EMT there. I've had no previous training in heart rate tracings (ECG) and know very little about emergency meds and indications for their use, oxygen doses and methods of administration, etc.... Since I wasn't able to find the exact course that I was required to take, which would have been limited to neonatal resuscitation, I had to take the PALS course, which teaches you how to manage a wide variety of respiratory and cardiac emergencies, including every form of possible shock, in infants and children through adolescence. Very, very interesting. It kind of makes me want to be an ER doc. But only kind of.

The class was fun in that very little of it was lecture. Most of it was playing out case studies. We had dummies and cardiac monitors/defibrillators and all sorts of oxygen delivery systems to play with. We even got to practice inserting a needle into bone marrow of a chicken leg. Who knew that you could administer fluids and meds via the bone marrow!? So cool. Apparently it's quite useful in children and infants during an emergency when establishing an IV line is difficult or impossible due to shock or cardiac arrest. The class was taught by a team of about 8 pediatric cardiologists. They were very kind and cordial and clearly knew what the heck they were talking about.

For the tests today we had to perform as a team leader in a cardiac case and also in either a case of respiratory failure or shock. I'm so glad I passed! I really had to cram a ton of new information into my brain in a short amount of time. I am feeling quite tired.

At the end of the class today they presented us with our certificates. They put on some graduation music and then just before they called my name the doc said, "And now... All the way... from the United States...of America... Jenifer Sawchenko!" As I walked up front, she said, "So, tell me, what is the biggest problem you see facing the Philippines? And what is its solution?" I just smiled and acted shy and took my certificate back to my seat. It was a mock Ms. America pageant so as I walked away I said, "World peace." This is why I love the Philippines! They make ordinary, stuffy, boring things fun. Silly, immature and unprofessional at times - but fun!

So here I am, sitting in the terminal at the airport in Manila having just had dinner. I also had a beer to celebrate all by myself while I wait for my flight. I'll be happy to see Andrey when I arrive in Cebu tonight.

The 'Ber Months in the Philippines

With the arrival of Septem'ber' and Octo'ber' so begin the 'Ber' months (some go so far as to say the "Burrr months," I figure someone's saying "burrr" somewhere in the world as I sit here in a tank top and shorts). In the Philippines, this means Christmas season has ensued. Since I haven't been to the mall lately I could have easily forgotten this if it weren't for the Christmas music coming from the house next door in the variety of the Chipmunks' rendition of the 12 days of Christmas. Oh my.

For some, having four long months of Christmas commercialism is a joy. I know a few Americans here that love it. For others, who have a low tolerance for even a month's-worth of Christmas music, the 'ber' months are just an annoyance. I'm trying to have a good attitude. (Okay, I realize I'm not or else I wouldn't be posting this.) Classic Christmas music is one thing - Nat King Cole and contemporaries heard in the month of December - but the Chipmunks? On October 1st? You've got to be kidding. There are just a few too many annoying things about America that have made it to Filipino culture for my liking.