Anniversary #7

Seven years. It feels significant. Every year is I suppose, so we do our best to celebrate well.

Andrey returned from Seattle late in the evening on Saturday after being there most of the week for work-related meetings. Sunday morning I made us a pancake breakfast and we enjoyed some delicious Stumptown coffee that Andrey brought back from Seattle. Before breakfast I prayed to bless the meal and began to thank God for giving us each other and the fulfilling relationship we enjoy. I asked for many more years together and for guidance for the future. I got a little emotional as I prayed, thinking about how good God is to have given me Andrey. What a gift! Even better than what I asked for.

God really is the best gift-giver. Since he created us he is the one who really knows us - way better than we know ourselves. Because this is true, it makes sense that the gifts he gives are much more appropriately suited and specially designed for us, who we are - who we truly are. We, not knowing ourselves the way our Creator knows us, many times lack the creativity, wisdom, and understanding to determine what it is that would really fulfill us. For this reason, in my experience, it is a much better deal to trust the Creator for his plans and his gifts, in his timing. This wouldn't work if the Creator wasn't loving and good or lacked power but since the Creator is good and loving and powerful, then it becomes exciting and entirely more fulfilling to let him take care of the details.

I realized this when I wanted so badly to be married years before Andrey and I started dating. I let go of how I wanted it to happen and with whom and waited for my Creator to set me up. I even had a list of what I wanted in a husband. But when God gave Andrey to me and after we got married, I began to realize how wonderfully perfect this guy was for me - in ways I didn't even consider before! God gave me everything on my list (except for the ability to dance well, which I had decided I didn't really care about) and much, much more.

This is what David was singing about when he said, Oh taste and see that the Lord is good! I have tasted and I have seen and I know the Lord is good. With this certainty I can relinquish and trust this good God to bring about our family the way that is best and in the right timing. I can lay down my ideas of where I want to live and what kind of work I want to do.

I am just amazed at God's gifts. It is said that every good and perfect gift comes from the Father of lights. Yesterday in church, there was a prophetic word spoken that went something like this: Through my death, you have been set free. Because I have taken care of all of your needs, you are free to receive and enjoy my gifts and free to give generously to others.

So we celebrated yesterday. We enjoyed the gifts we have been given. After church we went out for lunch at a nice Greek restaurant and had a delicious meal. Then we went home and relaxed for a few hours and in the evening I made us a simple dinner. Our appetizer was toasted whole grain bread with Danish cream and gruyere cheeses and ginger lime thyme jam from Nova Scotia. Our dinner was grilled steak and zucchini and red wine. It was great to have a whole day to spend with Andrey, just the two of us. We discussed how more than other years, this anniversary really is the most likely so far to be our last without kids. That perspective helps us enjoy and appreciate our time together even more.

I am so thankful for my husband, my best friend, who continues to make me laugh and love me well. I am excited for what the future holds.

(Thanks to Andrey's Mom for providing the attached photo)

What a week...

It has been a full week. Andrey left for Seattle Monday morning for a big meeting. He'll be back on Saturday. I worked all day Monday and we were busy. I got to attempt an external cephalic version (ECV) on a patient (with the help and guidance of a real midwife, of course). An ECV is a procedure done to manipulate a baby's position from breech to head down. It didn't work. I was disappointed, not only for our patient who really wanted it to work, but for myself as I've never done this before and it's one of the skills I'm supposed to know how to do in order to graduate.

We also saw one of our patients who is pregnant with twins. She's 36 weeks and both babies are head down and so we had been planning to deliver her at our clinic but then her last routine complete blood count revealed that she was severely anemic and would need blood transfusion. She would no longer be able to deliver at Glory. Again, disappointed for our patient, as she has delivered all of her babies at our clinic but also disappointed for me because I really want to see a twin delivery.

I texted our obstetrician who also happens to be the head OB at the city hospital and asked her if I could observe the delivery. She said she'd try to coordinate with the residents on duty and that she'd call me when the patient was in active labor.

She texted me at 4 on Tuesday morning. The patient was 5 cm and in active labor. It could go fast so she advised me to go right away but when I arrived at the city hospital she was resting and didn't seem to be in active labor. I waited until the next IE at 6 am and she was still 5 cm. I had lots to do that day so I left and asked the docs to kindly text me when she was closer.

Nobody ended up calling me when the patient delivered normally at around noon so unfortunately I missed it but that was for the best because I had appointments to see two patients at the clinic that morning that I couldn't skip out on. One was a postpartum check-up on my last continuity patient who delivered last month. The other was a prenatal check-up on an extra continuity patient I decided to take on just in case the National College of Midwifery wasn't satisfied with my first three. It's extra experience. I've been providing all of her prenatal care for the past 2 months.

Just as I was finished and getting ready to leave, the patient who's baby was in breech position returned. This time I got to attempt ECV again, with Hilary's help, and it worked! It was amazing! With lots of gooey gel and hand manipulations over this woman's belly and prayer. We'll see if baby stays in this position. If not, we are going to let her try and delivery vaginally since it's not her first baby. So that wouldn't be so bad because I'd love to see a breech delivery.

Just as I was about to leave, my last last continuity patient returned in labor - the one who had been in earlier that morning for a routine check-up. She had actually been in early labor when I saw her. When she came back a few hours later she was 5 cm and getting active very quickly. This was at noon. So I stayed and expected to be there for the rest of the day until she delivered.

Let's just say she had what is called a precipitous labor. I didn't even have to do another IE. One minute I was rubbing her back during a contraction and the next she was bearing down spontaneously (without warning!). Remember she just came in 2 hours ago and was 5 cm dilated. She was so quiet and calm that I didn't realize that her baby was quickly on it's way. I pleaded with her to quickly walk upstairs to the delivery room and to not push. Perhaps she was as shocked as I was that it was happening so fast. We got her on the bed and donned our gloves. We told her it was okay to push and in that very instant I was supporting her baby's head and shoulders as it made it's surprisingly forceful appearance. I was not expecting this because her water did not break. Right before she pushed I could feel the bag of water bulging under my hand as I lightly held an absorbent pad over the opening so I wouldn't get splashed. It never splashed or burst. I'm not sure what happened except that her baby was born with the bag practically still intact. Somehow it must of torn as it wasn't covering the head as I held him. His cord was wrapped around his body twice so I untangled him and placed him on his momma's belly as she sighed relief. Whew!

Patients with precipitous labor tend to bleed a lot after birth. Her placenta was delivered after 8 minutes and she had minimal bleeding up to this point and several minutes after. However, a few minutes after her placenta was out, it was as if her uterus sighed in relief as well and decided to stop contracting. So her uterus remained boggy and blood flowed intermittently. Nothing too scary or dangerous, but enough to warrant medication to help her uterus contract. The medication took several minutes to kick in but it did and the bleeding stopped.

These are the cases that it is scary to think about what would happen if they had delivered at home without a trained attendant and without necessary medication to stop bleeding.

Here are a few interesting statistics that I gathered while doing my community health assignment today.

• A woman's lifetime risk of maternal death is 1 in 7300 in developed countries versus 1 in 75 in developing countries.
  
• Among Filipino women, the lifetime risk of dying from maternal causes in one in 100.
• The four major killers are: severe bleeding (25%), infections (15%), hypertensive disorders (12%) and obstructed labor (8%). Complications after unsafe abortion cause 13% of maternal deaths. Globally, about 80% of maternal deaths are due to these causes. The other 20% are from indirect causes, which include diseases that are complicated or worsened by pregnancy, such as malaria, anemia and HIV. Women also die because of poor health at conception and a lack of necessary and adequate care essential for a healthy pregnancy and delivery.
• 40% of births in the Philippines do not have a trained attendant present.

The World Health Report 2005 - Make every mother and child count. Genva, World Health Organization, 2005 (www.who.int/whr/2005/en) and World Health Organization Philippines Health Situation and Trend (www.wpro.who.int/countries/2007/phl/health_situation.htm)

Back to Tuesday. I finally left the clinic around 5 pm, went home and relaxed for the rest of the evening. Wednesday I worked on the computer in the morning and ran errands in the afternoon then I worked the night shift. Our shift was busy with 2 postpartum patients, 2 prenatal patients sick with fever and a primigravida in labor. I helped a newer staff deliver the baby around 1 am with Hilary supervising us. It was fun to be teaching someone else. It made me feel like I knew a few things.

By 3 am we got to rest for a few hours. At 7 another patient arrived in labor. When Hilary checked her she was fully dilated with compound presentation. The baby's elbow was very close to making an exit. Not good. Hilary yelled to me to get the car ready. Thankfully our driver was there so I didn't have to drive. Within 5 minutes we were on our way to the hospital. Thank God our patient was from outside the city so we could take her to the provincial hospital and not have to go to the city hospital where we have seen babies die for lack of the necessary action to perform an emergency cesarean section.

At the provincial hospital they attended to the patient right away and the doctors were actually nice to us. What a welcome contrast to the city hospital! We heard later that she delivered a healthy baby by C-section.

I spent most of the day at home at Thursday getting stuff done. And today, Friday, I got two more midwifery assignments done. Yeah! Only 3 more to go and then I am DONE. Like really done. I'll be working all day on assignments again tomorrow.

I haven't cooked much this week. It's interesting how little motivation I have to cook just for myself. I get so much more joy out of cooking for the two of us.

Andrey will be back late tomorrow night and then Sunday is our 7th anniversary! We'll have the whole day to hang out and celebrate. Not sure how we'll spend the day yet but it will hopefully include champagne.

Noise update

The noise is gone. Just thought I'd update you. No more blaring radio. I went to the neighbor's house and only their (very young-looking) live-in helper was there. I think she was very afraid of me because she just stood behind the screen door and wouldn't come out as I approached. I was polite and smiley. I introduced myself and then asked her to turn it down (in my best Visayan) and she turned it right off and I haven't heard it since! I didn't expect them to never play their radio again but I can't help but enjoy the quiet. It's wonderful. That poor helper though. I must have really intimidated her. (I'm so intimidating, aren't I?)

NOISE

What is it about intruding noise that makes me want to scream! We live in a house with open windows in the main front living area. It's all very open. We have new neighbors. They live across from us. They have a radio in their front living area. They also have open windows. They turn it on at 7 am and turn it off at 10 pm. It's loud. When they turned it on this morning we couldn't hear CNN which was on our TV at a reasonable level 10 feet away from where we were sitting and had to turn it up.

I work on my midwifery assignments at our dining room table in our main living area. To get away from their radio I'd have to go into our room, turn on the aircon and shut the door. But I don't want to spend all day in there with fluorescent lighting. So I turn on my ipod even louder. I know that I will have to go over there soon, introduce myself, make small talk and then kindly and respectfully ask them to do something about the radio. Perhaps they're not aware of how well the noise carries over across our small street.

I love our home because it is an escape. A haven. It's in a relatively quiet neighborhood in a small private subdivision. When I'm at home I can forget that I live in the Philippines. I need this for my sanity - so that when I go out and into the world I can deal with all the other things that make it stressful to live here. Like the pollution, the traffic, the dense population of people EVERYWHERE, and the feeling that comes with being a minority. Sometimes the attention I get is like being a rare, circus animal that could perform a trick at any moment. With the neighbors and their radio and the commercials in the local language and the same annoying repeated marketing jingles blaring in my ears I can't escape! I don't even like listening to the radio in my own language. I can't stand commercials. When watching TV I always mute the commercials because I have little tolerance for unnecessary noise.

I miss the relative quiet we had in this neighborhood for the past year and a half. Sure, we have really annoying dogs on this street. They bark, loudly, sometimes for many many annoying minutes at a time but there are long breaks with no barking. Ahhh. I think it's the constant, unending nature of the radio that just grates on me. It's even beginning to bug Andrey. And he's not even here all day! That's how I know it is a valid disturbance and that it's not just me being sensitive. My sweet husband, who is as calm and collected as a gentle, flowing river - who by being so usually makes me look bad - is annoyed and agrees the radio is loud. I feel so validated.

Another Learning Experience to add to the list of Complicated Births

WARNING: Descriptive birth story with a photo of an abnormal placenta. Only read if you're really interested...

I delivered a baby last night. It happened to be my third of three required continuity patients necessary for the completion of my clinical requirements to become a midwife.

It was a tough delivery and I learned a lot. I want to share the details of my patient in order to illustrate why most of the births we see at Glory Reborn don't end up being considered normal. My patient is just one example of so many other like her that we see every day.

My patient is a 28-year-old G8 P6213, which means this is her 8th pregnancy. Of the previous 7, all but one fetus made it to a viable age. She had 2 premature deliveries, 1 miscarriage, and currently has 3 living children.

The two premature babies she had (one at 5 months, one at 6-7 months) died within a month after birth. Another child died at 18 months from an infection. Thus the 3 living children. Until last night. Now she has four living children, praise God.

Her first 5 deliveries took place at home with a traditional birth attendant (hilot). Hilots are not medically trained. They rely on traditional 'wisdom' and folklore. They don't have B/P cuffs or any method of listening to the heart rate of the baby. Therefore they don't monitor blood pressure in labor or the baby's heart beat. They don't carry pitocin (to prevent/treat a woman from bleeding to death). They don't do prenatal care. They don't suture tears and apparently don't refer women for suturing even when it is essential (as in the case of fourth degree tears). They basically are called in at the last minute to catch the baby and cut the cord. And they get paid for this. Sometimes more than what we charge at Glory. Crazy. I have a whole host of stories about hilots but I think you get the picture.

My patient's previous premature labors likely could have been prevented through routine prenatal care and treatment of common infections or dehydration.

Throughout this pregnancy, my patient was diagnosed with and treated for a severe UTI, and another common infection in pregnancy. She took good vitamins for her mild anemia. She had regular check ups.

The last baby my patient delivered had a midwife for an attendant. Apparently her labor lasted for seven days. When she finally went to the midwifery clinic (not Glory Reborn) they were able to artificially rupture her membranes (AROM) to get her to progress. It worked and within two hours, her baby was born.

This labor started out very similar to the last, according to my patient. She had been having mild to moderate contractions every 10 minutes for days. She came in to Glory Reborn yesterday at 11:00 am at 4 cm dilated, head -3 station (head high in pelvis). We gave her some herbs to help strengthen her contractions, which, for a while made them come every 5-6 minutes but they were still very mild. She progressed to 6 cm after 8 hours.

Thankfully the heart rate of the baby stayed normal enough for us to not need to hurry things up. We would have liked to do AROM but that is contraindicated when the head is not yet engaged in the pelvis because of the risk of cord prolapse.

When we did an IE at 7 pm we found a tiny little hand and fingers up towards the top of the head. This is risky because if her water were to break spontaneously the baby's arm could extend past the head and make vaginal delivery either extremely difficult or impossible. She was still only 6 cm dilated and the head not yet engaged. We called our obstetrician for advice. She said to wait two more hours and see what happens. We tried to move the hand back and out of the way but it didn't work. We let the patient rest and her contractions slowed to every 10 minutes again. Two hours later she was 7 cm dilated, head at -2 station (still not engaged) with compound presentation (still nuchal hand but at least now the hand was at the side of the head instead of the top). We called our Dr. again. She said we could try slow, controlled AROM with an assistant gently guiding the baby's head into the pelvis while the other held the baby's hand back.

This was risky but considering the alternative - hospital transport of a patient with no money and an almost useless public hospital with no such thing as a stat C-section even if it became necessary to save the baby's life - we explained the risks and options to the mother and she discussed it with her husband and they agreed to go ahead with it. We made a hospital transport plan in case we were unsuccessful and the hand slipped through the cervix before the head.

I was able to poke a tiny hole in the amniotic sac and then slipped one finger through it so I could control how fast the water drained, while at the same time pushed upward against the baby's hand with my other fingers, while the other staff gently held the baby low in the pelvis. The AROM immediately resulted in strong, frequent contractions. We also did nipple stimulation and gave her more herbs. After about 30 mins of slow leaking of her water the baby's head began to fill the pelvis and the hand was completely out of the way. Whew! During this time she showed signs of partial separation of the placenta as there was a big clot that came out and also the water was blood-stained. Thankfully the baby's heart rate stayed within normal limits but this had us on-guard.

The contractions were coming frequently and the baby's head started to descend and it was finally at 0 station (engaged, fully filling the pelvis). Then the baby's heart rate dipped down so slow to 60 beats per minute during a contraction. This was way too low! Normal head compression would cause the heart rate to dip down to 100 but not 60. This was a sign of either the beginning of placental separation or cord compression. We connected the mom to oxygen and stimulated the baby's head. After the contraction the heart rate went back to normal. She was still 9cm but she had to push that baby out! As with other women who have had so many of babies, the cervix is very soft and stretchy and usually will just move out of the way when the baby's head moves down. But our patient didn't push well during the contraction that caused the baby's heart to slow and so the baby's head stayed where it was. With the next contraction the heart rate dipped again. The last time I heard a heart rate that low was when we transported a patient with cord prolapse and the baby died because the public hospital would not do a stat C-section. So this was now a real emergency.

Hilary stepped in and put hard pressure on the posterior vaginal wall to stimulate the right kind of push from the mom and we all demanded that she Push. Now. Hard! Hilary alerted the staff to get ready for resuscitation. The patient did exactly what we demanded and the baby's head was suddenly visible, then crowning. We told her to keep pushing. Then the head was out. It rotated normally but the cord of the baby was wrapped tightly around it shoulders. I slipped my hands beneath the cord and slipped if over the shoulders and applied traction to deliver the baby immediately. Thank God the baby cried immediately and resuscitation was not necessary. Thank you God. We were all praying like crazy!

Also because our patient was G8 and anemic and had possible partial separation of her placenta, we prepared for hemorrhage. We infused her IV with pitocin after the baby was born (we usually always wait till after the placenta is delivered but this was a unique case). Thankfully the placenta was delivered within 5 minutes and it was intact. She didn't hemorrhage. And there was no tear. Praise God.

Her placenta had an abnormal shape. It was a circumvallate placenta, which is associated with prenatal bleeding especially during the 2nd trimester, placental abruption (separation of placenta in utero), multigravity (more than 4 pregnancies) and placental insufficiency, which can lead to intrauterine growth restriction (IUGR). IUGR is associated with malnutrition. My patient's husband is a smoker and has no job. She sells fruit when she can but mainly they depend on family for food and they commonly do not have enough to eat. She also had some bleeding in her second trimester. So interesting.

Here's a photo of a circumvallate placenta. My patient's looks so similar to this, expect smaller and with a very thin cord.


Within 20 minutes the baby was breast feeding and mom was smiling. Baby Lenzy weighed 2,550 grams (5 pounds 10 ounces). I'm so thankful everything turned out okay. Hilary was so fantastic at staying calm and instructing me and the rest of the team. I have to admit I started to panic at one point. Not majorly but I did say, "Oh God, Oh God" when I thought the placenta was separating. I'm embarrassed about that now but I'm thankful that Hilary was there to tell me, "Don't panic. Stay calm."

It's experiences like these that I wonder if I can do this. Be a midwife. I'm still not to the point where I am 100% managing the birth by myself (unless it's normal or a slight variation of normal). But that must come with time, right? I know I am getting great experience and I feel fairly confident in handling some complications, like hemorrhage but it's hard to know how I will react and handle other emergencies when they happen. It's a big, scary unknown. So far, I've always had someone with me, which of course is the way it should be as I am still a student, but in those times of emergencies there isn't time for my supervisor to ask me, "ok, what are you going to do or what do you think we should do." No, there is just only time for the supervisor to tell me directly what to do, so I have no idea what I would have done.

In fact, I meant to blog about a couple of other emergencies that I had last month during deliveries. I learned a lot from those too. I got to deliver a posterior shoulder because the baby's body wouldn't deliver spontaneously after the head was born and needed assistance (it was almost shoulder dystocia but not really a true case). Another time I attempted to manually remove a placenta as it was abnormally attached, possible due to previous uterine scarring and/or the abnormal shape of her uterus. It was scary because she was really bleeding. In both cases, my supervisor was excellent at calmly instructing me what to do and I was able to do it. Well, I wasn't successful at removing the placenta but I did get in there and try and now feel confident that I know what to do next time. It was my first time after all!

I just needed to process that birth, so thanks for reading if you made it to the end! When I read about these beautiful, natural, water births at home with midwives with healthy, empowered, educated women I feel I am living in a parallel universe. Then I remind myself that the maternal mortality ratio (MMR) and the infant mortalitie rate (IMR) in the Philippines, especially among the urban poor, are much worse than that of the U.S. and Canada. That has to count for something!

Hairy Baby

Did I get you to look because of the title of this post? As they say here, "So drama!" Yeah, it's really not that exciting. It's just that the director of Glory Reborn, who is also my friend, Hilary, sent me this picture of me holding a newborn with a ton of hair at one of our recent baby parties. She thought it was cute because the baby had so much hair. We have a baby party the first Tuesday of every month for all the babies born the previous month. We sing happy birthday, eat cake, give gifts and the staff get to hold lots of babies so the moms can eat cake. It's a highlight. Here I am with a baby with one luxuriously full head of hair.

Oh how I wish I had a picture of myself as a baby. My father used to call me Kojak, after the actor Telly Sevales who starred in the hit TV show in the 70s. That's because I was bald till I was nearly 2 years old. Quite the contrast to these Filipino babies who have an ample head of hair the day they are born.

Who loves ya, baby?

Another Burma Update

Thank you to those of you who have been praying for the recent attacks and subsequent displacement of thousands of Karen villages near the Thai-Burma border.

I read today that over 3,500 displaced people have fled across the Moei River, the natural border separating Thailand and Burma and are seeking refuge and shelter in Thailand. The Burma Army has continued shelling the small village of Ler Per Her throughout the week. Reports indicate Burma Army proxy forces have even sent mortar fire into Thailand.

Thankfully, there appears to either be minimal or no casualties reported among the Karen. Even though relief work has been made extra difficult by torrential rains, Partners Relief & Development and Free Burma Rangers (FBR) have been able to provide hundreds of pounds of food, medicine, mosquito nets, and clothing to the displaced citizens. Shelter is inadequate in the heavy winds and rain and many, especially babies and young children are suffering from malaria and diarrhea.

More supplies are needed such as blankets, sleeping mats, additional medicine, plastic sheeting, food, children's clothing, and boots. If you wish to donate, please go to the Partners website, www.partnersworld.org/donate.

For documentation and photos of the crisis, covered by BCC, go to: http://news.bbc.co.uk/2/hi/in_pictures/8093562.stm

Please continue to pray for peace.

Update on Burma Army Attack

I just received the following update from a representative of Partners Relief and Development, which is providing support to the displaced people from these attacks. Please keep praying. Also, if you would like to donate to help these people see the link in the update below:

6th June 2009

We have just been informed by our team that the Burma Army have begun an offensive against displaced villagers along the Thai-Burma border and early this morning heavy bombing has been heard.

There are an estimated 800 Burma Army troops, joined by 300 soldiers from their proxy forces spread along approximately 20 - 30km of border region.

Three days ago there was an ambush which reportedly left four Burma Army soldiers deceased and four wounded. This resulted in the Burma Army retreating a short distance. On Thursday there was a second ambush where one Burma soldier died and four were wounded. This has resulted in the Burma Army reinforcing their troops.

Innocent children and families are hungry and at risk. With their home villages destroyed or in peril, the options to escape to safety are limited.

Major evacuations are under way. Yesterday all women and children were evacuated, leaving the older people and men at the camp last night. They plan to move them today.

Since the 3rd of June, more than 3,295 villagers have left their villages inside Karen State Burma and travelled to towns inside Tak province in Thailand. The Thai authorities have been very helpful.

These villagers from eleven different internally displaced persons villages were being forced to be porters and human mine sweepers for the Burma Army in preparation of this attack.

Many of these families have already fled previous Burma Army attacks. As recently as last week, Partners' staff assisted 40 families with essential survival materials, such as mosquito nets, blankets, clothes, pots, pans, and bowls.

Partners' staff are rapidly working with ethnic leaders to provide critical assistance to the hundreds of families have arrived at the border seeking aid and refuge. Food and medicine are being distributed.

Yesterday, the Partners Mae Sot staff delivered aid and emergency supplies to these villagers. Three four-wheel drive trucks were fully loaded and supplies were delivered to the camp leader.

We were able to give:

Two trucks of clothing
Medicines for 200 cases of each of the following illnesses: malaria, diarrhoeal diseases, respiratory, wound care, analgesics etc
30 pots
25 large sized tarpaulins
100 bottles of mosquito repellent
15 boxes each containing 100 dried fish
10 boxes each containing 180 individual packs of Ma Ma noodles
5 boxes each containing 96 packs of small shrimp
72 bottles of cooking oil
Rolls of plastic sheeting

All of this was brought in torrential rain, which continued for 90% of the journey - usually this journey takes 1 hour 45 minutes, but yesterday took 5 hours. The team prayed with the camp leader and Isaiah 41:10 came to their minds "Don't be afraid for I am with you. Do not be dismayed, for I am your God. I will strengthen you. I will help you. I will uphold you with my victorious right hand"

YOU CAN DONATE TODAY TOWARDS THIS EMERGENCY CRISIS – WE NEED YOUR HELP. PLEASE VISIT : http://www.partnersworld.org.uk/donate.html

Thanks for your ongoing support and prayers. We will endeavour to update you as soon as we hear news.

Pray for Burma

Today I got word that the Burma Army and the Democratic Karen Buddhist Army (DKBA) are planning to attack Ler Per Her, a Karen village on the Thai-Burma border where many internally-displaced people have set up camp for years. Some have heard that armed troops of hundreds of soldiers are only 2 days walk away. The people in Ler Per Her have nowhere else to run and are in fear for their lives.

Some of you may know that while in Thailand, I worked on a small development project called Babies at Risk. I, along with a nurse from England and good friend of mine, Kelly, trained village health workers to provide breastfeeding and nutrition education to mothers and to prevent, assess and treat malnutrition in infants. We also regularly distributed vitamins and vegetables seeds and provided training on how to grow vegetables and reproduce small crops year after year.

Ler Per Her is one area that we did a lot of work in. I've made numerous trips there and we trained more than 30 regular health workers and provided them with a small salary for a while. In the process I got to know many of the health workers, who do what they can to serve their people. They are very dear to me. I want to post some photos from some of the time I spent there in 2006-2007. Please pray for these precious people.

The boat ride across the border


Walking into the village


A walk through the village to the middle school


The Health Center annex where trainings are held


Community Health Workers & Babies at Risk trainees

Teaching on how to use growth charts


Learning to use the infant weighing scale

Shwe Dah and children - a struggling family we got to know; Shwe Dah's malnourished 18-month-old son died from an upper respiratory infection 7 days after her baby (pictured here) was born

Shwe Dah and Kelly with the squash grown from seeds that were provided

Heading back to Thailand

Male health worker demonstrates proper breastfeeding position



Health workers take a training break to play a game

AI surprise ruined

I am SOOOO angry right now! Seriously shaking angry. I know I am overreacting but a friend from Andrey's office just texted me to tell me who won American Idol. I don't care who it was it's just that we are hosting a AI Finale watching party tonight and I wanted to BE SURPRISED!! She should know b/c she is also coming! Takes all the fun right out of it. I want to cry.

Sleep

What? I haven't posted in 9 days? Time is racing by lately. I was seriously surprised to see that May 5 was the last time I posted. Busy. BU-SY right now. May is a busy month because I am working ~40 hours a week at the clinic plus I am finishing one of my last major midwifery modules - all the about the newborn, which has 4 very long assignments. The two I just finished totaled 56 pages with 10-point type. Yesterday I took two of the four tests in this module and it felt great to be done with those. So today, I'm allowing myself to get caught up on a few things - like grocery shopping and blogging. I also met a friend for coffee this morning, which was nice.

Starting tonight I'll be working every other day until a week from Saturday - alternating 12 hrs on with 24 to 36 hrs off. This happens to be a very common schedule for most of the Glory Reborn staff and frankly I don't know how they sustain it for years and years. Granted, they're not working on a degree at the same time, but I think I would be nearly just as tired with or without the studies. It's just hard having inconsistent sleep patterns. It just feels harder on the body. In my lowest tired moments I wonder if midwifery is really worth it, I long to feel rested so bad but then I realize that this is probably quite similar to how parents of young children feel all the time too. So it's not like giving up on midwifery will make it all better, which I don't plan on doing anyway.

I have always been a good sleeper. Always. Until I started working night shifts two years ago. The frustrating thing is the fact that the pressure of really needing a good sleep when I have the opportunity to sleep makes me unable to SLEEP! How stupid is that? I seriously work myself up so much that I lie there feeling angry about still being awake. It's madness!

Andrey tells me I just need to not care about not getting sleep, that way I'll be able to sleep. Believe me, if it were that easy I wouldn't be struggling with this to begin with. Make myself not care? Fine. Maybe, if it were every once in a while. And I told him he is sweet for trying to help but I simply don't agree. Yes, I (now) agree a night with poor or little sleep isn't that bad (I used to be WAY worse!) but I'm talking about the importance of a night of sleep after a previous sleepless, work-filled, tiring night. Or a night of sleep after a previous night with only 3 hours of sleep. Humans need sleep. God created sleep. I am not crazy to feel like I REALLY just need to sleep sometimes. When I don't get sleep I don't make much progress on assignments! I sit there at the computer, spacing out, taking way too many breaks to pee or eat or check email... again... and then get sucked in to facebook (I know it's nobody else's fault but mine) for 20 minutes and then I check a blog and then another and then suddenly hours have gone by and oh shit, I still haven't gotten any assignment done! And then it's time to make dinnner. I could try to push through with lots of coffee. I'd probably get more done that way but then that is a recipe for an inability to go to sleep later.

I haven't exercised in weeks which I know would probably help me sleep better. I've tried herbs - skullcap, passionflower, sleepytime tea. These help sometimes. I've taken magnesium maleate, which helps sometimes. What really works are anti-anxiety sleeping pills but they are habit forming so I save those for only my most desperate times. I've also started a bed-time routine to help get me relaxed for sleep. I dim the lights, put on soft music, no computer or TV is allowed, do some reading, journaling or praying. That helps sometimes too. Maybe I do just have to find a way not to care about sleep. If so, how the heck do you do that???

I'm surprised Andrey suggested this. Ever since we've been married he has remarked at my silly habit at counting hours of sleep. He calls me the sleep-counter. This is how it goes...

Ok, let's see. What time is it? It's only 10. I have to get up at 7, so that's at least 8, almost 9 hours. Great! It's going to be a good day tomorrow. (My body's favorite number is 9)

-OR-

Oh crap it's late. And I have to get up 5. Five hours? Oh tomorrow is going to be awful.

And that was back when I got to sleep every night. No night shifts. No midwifery training.

Now it's even worse. I say to myself... I got 3 hrs last night and I'm exhausted. Damn I'd better get at LEAST 8 hours tonight! Oh no but it's already midnight and I've been lying here for more than two hours! I'm screwed! My hours are chewed down to almost 6! Oh God no! Help me, please! Why can't I sleep?! This is so ridiculou! I'm so tired! And this is when I either feel like punching the wall or crying.

So this whole thing isn't about the sleep lost when I'm working. It's about sleep lost when I theoretically can and should be sleeping. That is the frustrating part. I know it is all in my mind but that is a very tough battlefield. It also has to do with anxiety and the stress hormones that are released when I am lying there analyzing my day. I sometimes lie there and run through scenarios of things I said to people and realize things I didn't notice before or realize a mistake I made a work or that I forgot to do something and maybe so-and-so is mad about me or because I said the wrong thing...all the while I feel this surge of adrenaline going through my body. I'm going to have to get a handle on this because stress is very damaging to the body (knowing that doesn't help). At least I am eating well. I still make the time to prepare dinner almost every night and we eat pretty well when I do.

I also realize that this temporary. Once I finish this module things will slow down a little bit - not much, but a little. And hopefully we'll get more staff at the clinic (we're currenly short-handed and that's why i'm working a little more than usual) soon so I won't have to work quite so often. I just feel this is a common life challenge that I need to learn to overcome.

burdens, blessings and something about love

My blogging has been spotty. I feel compelled to write something so I'm just going to start and see what comes out. I think sometimes I don't blog because I feel I don't have anything "good enough" to share. It's as if it needs to be a polished thought or an impressive post. I wish this wasn't so because sometimes I just need to write. I do reserve my journal for times like that as it is a place I can write more freely but I'd like to get better at doing a bit more of that here. One reason for that is that my favorite blogs are the ones that are real, raw and unpolished. They're just about life. And life, in its truest sense, is that. Raw. Real. Unpolished. Ugly, even. And, as this post turned out, corny. So at the risk of not sounding as cool and smart as I wish I was, I will ramble a bit about what has been occupying my time and thoughts these days and not waste time trying to make it sound good...

Lately I've been burdened. Burdened in one of the few positive ways one can be burdened. Burdened and compelled to pray, and compelled to treasure the numerous, abundant blessings in my life.

I am burdened by the sufferings of friends I know, of people I don't know and of things that are far-removed such as what I read about online or in the news. I can vascillate between feeling numb or feeling too much in reaction to what's going on around me. Lately it's been the latter. Here are a few examples of the things a little closer to home that make me feel deeply sobered to the realities of life...

I have a friend in Oregon whose 22-month-old son fell through a screen from the third floor of their town home onto his head on the concrete. He's hanging on but the extent of the damage is unclear at this point. Everyday I read her blog to get the latest update and hear her pour out her heart that is grieving, struggling, angry, and so, so sad that her son may never be the same again.

I have a friend at church whose 10-year-old son had brain surgery a week ago for bleeding in his brain after symptoms of a concussion weren't attended to while he was boxing in a neighborhood gym. He was encouraged to keep boxing and ended up unconscious. 10-years-old. His mother is 28 and 7-months-pregnant. Her 8th pregnancy in 11 years. They are very, very poor. Neither parent has a job. Thankfully the gym is paying for all of their son's expenses because there is just no way they could afford any of the care he's received. He woke up from a coma two days ago, thank God but the damage in his brain is yet to be determined.

One of the long-term midwives at Glory Reborn desperately wanted to get pregnant after she married. A year went by, and then another. So many of us prayed with and for her that she'd be blessed with a baby. And then it happened! And there was much joy and rejoicing and hope and excitement - especially on the part of Tina and her husband Vincent. Tina delivered a baby girl last month, "Hannah Monique." After birth, baby Hannah was rushed into surgery for a severe diaphragmatic hernia (the contents of her abdomen were displaced up into her chest cavity, restricting adequate growth and development of her heart and lungs). Everything that could possibly have been done was done but she didn't make it. Tina and Vincent were and are devastated.

I am sorry to depress you. These are just a few things/people that I think about a lot lately. The good side of this has been some of the moments in the past week that I have felt urged to soak up, inhale, take note of, revel in, and enjoy. Most of which have involved being with Andrey. Definitely the best thing in my life these days (& the past 7 years), is my relationship with Andrey. I really enjoyed hanging out with him this past weekend. Not that we don't usually enjoy spending time together, because we do. Time with Andrey - talking, eating, laughing, being silly - is one of the most life-giving things in my life and for some reason this weekend, even though it was full of ordinary life, just felt extra special.

Andrey typically isn't comfortable with being affectionate in public. I'm not talking about making out here. Ick. Not in public. We've become part Asian in that sense as we find ourselves very uncomfortable with inappropriate public displays of affection such as groping and necking. No, I'm talking about holding hands or walking with arms around each other. I love that stuff. I realize it's one of my most favorite things in the whole wide world, for Andrey to put his arm around me in public or want to hold my hand - more so in public because for me it means SO much that Andrey is compelled to express his love, not only just for me but for others to see. It sends the message to me that I am loved, wanted, special and that he's not ashamed to show it that I am his. I love it so much. Last weekend Andrey was uncharacteristically "lovie" with me in public. Once or even twice in the mall he reached over and kissed me on the forehead and smiled at me affectionately. I was beaming. I could have just melted into a soppy puddle right then and there in the pet shop. Few things make me feel happier or more loved.

Perhaps it's the fact that we know these days of just the two of us are fleeting and should be taken advantage of. Or perhaps it's the Lord further strengthening our marriage because we're going to need to be strong and united for the imminent parenting challenge ahead. Perhaps it's the awareness of how tragedy could strike at any time. As others can attest, life is just moving along and then BAM! - it's changed, forever. So I sat in the middle bench seat the other night when Andrey was taking me to work so we could be close and I told him how thankful I was that he's alive and doesn't have an unknown extent of brain damage. Time lately has been extra sweet and I am thankful. So, so thankful for all that we have. So thankful for my best friend. The guy I will team up with in this parenting thing soon enough and for the rest of my life, should the Lord bless us with that.

Part of the fun lately is seeing each other scold our cat Gerald when he does something he's not supposed to - like pee in our plants or scratch up our furniture. I was so entertained seeing Andrey run after Gerald, yelling his name scornfully. I too must look ridiculous when I suddenly get up from my chair to grab the spray bottle of water to discipline a silly little cat, provoked by his latest offense. I mentioned to Andrey something like this, "Man it's gonna be entertaining seeing each other lose our cool with our kids someday. I'm sure I'm going to find it hard not to laugh!" These are the things we look forward to, I guess.

I realize this post has turned corny. But love is corny so I don't care. God has given me a gift greater than I could ever have dreamed up myself. I am savoring and relishing this relationship; this partnership; this friendship. I want to combat the lie that all marriages eventually dry up and aren't fun anymore at some point. What a lie! Marriage is wonderful! We're coming up on our 7th anniversary and I'm still crazy for my nerdy husband!

I realize that if God could give me such a wonderful gift in Andrey, that I expect I will think the same of our future children. I know there will be times when I realize how perfect our adopted children are for our family and how precious they are. Times when I will be filled with love for them and with joy for God's amazingly creative goodness to us - how they were specifically chosen for and meant for our family. I'm really looking forward to that but am also really enjoying today.

We can't expect or demand a life without tragedy or suffering. Not in this world. In fact, living in the developing world has made me baffled at how little suffering I have experienced and how unbelievable that is when the majority of people in the world seem to have so many, inexplicably more serious daily challenges. That's one of the most significant things I've learned since moving overseas - that my life, my experience of life actually represents life of the minority NOT the majority. The majority of humans in this world live with much more pain, suffering, and discomfort. To my surprise, many are full of joy and life, despite the awful tragedies they have had to endure. I am amazed at this. I know that I am to enjoy today, enjoy what God has for me today. Lately, that is a whole lot.