A day on the Maternity Ward

So I've been asked lately by a few friends what my days are like now that I'm not teaching in the classroom but working on the Maternity ward. Today might not have been a typical day but it wasn't completely out of the ordinary either. Woke up at 5:30 prior to the pig in the garden behind my house, had some Bible time and then a quick shower, breakfast and started a load of laundry before leaving at 7:25 to go to Monday morning Hospital chapel service.
8:00 attempt to listen to change of shift report (spoken in Tok Pisin. English and PNG nurse acronyms) while counting heads to see if all 17 of the assigned students are present.
8:20 assign each 2nd year student on postpartum 4-5 patients and have them work with 1-2 of the 1st year students, assign two students to work in nursery, make sure the 2 students in the delivery room aren't doing a delivery by themselves, and make sure the 3rd year student charge nurse knows what he is doing for the day.
8:30 supervise the students beginning their daily care for the moms and babies, while Doctor rounds on patients. Begin signing procedure books for all 17 students for procedures done on Friday afternoon when it was too busy to sign then books.
8:45 check on students in delivery room, no one in active labor, one student starting an admission on a multipara.
9:00 continue working on procedure books- sign Sr. Staci approximately 150's times throughout said books, wonder where my coworker that is suppose to be working on postpartum is, so I can fully supervise in the delivery room.
9:20 continue to go back and forth between labor and postpartum, watching one procedure after another, point out some things in the chart for students to pay attention to, chat with a few patients
9:45 coworker arrives, inform him of students task on postpartum and then concentrate on patient in deliver room with 2nd year student Joshua. Time contractions (using hands and wrist watch and patient reports) review labor process, assist with filling out paperwork.
10:15. John now is beginning to admit his patient in the next delivery bay, go back and forth between both bays assisting both students.
10:30 remember I need more latex free sterile gloves to do these deliveries and go to central supply and find my stash. Place gloves in both rooms so I can quickly put on when needed.
10:45 while helping John, hear Joshua's patient make a noise that basically only means one thing on a delivery ward in PNG and run back over to them (10 ft away) and put the gloves on while making sure Joshua is ready for this delivery.
10:49 help Joshua delivery baby boy, try to prevent tearing, not quite successful, big baby
11:00 bleeding controlled, give assistance with suturing but realize this is over my head as American RN's don't suture and I'm still learning, so trade places with my coworker on postpartum
11:05 begin supervising 2nd year students giving scheduled meds after the medication prayer time, avoid 3 medication errors
11:35 switch places with coworker again and assist with breast feeding on Joshua's patient and them do assessment on John's patient. Now she is 7 cm dilated, amniotic sac still intact, and its her 5th baby in 7 years. Fully get her history, it's her first time ever to come to a hospital. Has not had prenatal care, last two babies died at 11 months and 4 months. Wants to avoid another baby dying (why she came to hospital this time) but also has husbands permission to get a tubal after this delivery. Has only had girls. Last baby born 13 months ago. Not the best history, not the most common, but I've seen many similar stories here before.
12:05 let hospital staff know of our patients status, tell John to run and get some lunch fast and head home to get a quick lunch and hang up my laundry! (We are allowed to take a one hour lunch, haven't done it recently!)
12:40 back at labor ward, John is already there and monitoring contractions and fetal heart tones as needed. Amniotic sac still intact. Talk with Joshua about things we could have done better in his delivery.
1:50 Joshua begins to admit another patient, help with assessment and paperwork. Check on John and his patient periodically.
2:45 John's patient remains unchanged. Contractions are not very close together, 7-8 minutes. Decide to break her water. John performs procedure. All is looking good. Contractions pick up.
3:10 Assist with Joshua's patient. All admission done, waiting for more orders as she had prior c-section is now post-dates, not active labor
3:45 John's patient is getting closer to delivery, 9 cm, but wants to keep walking around the bed, of course, right at change of shift. All midwives on ward are at a staff meeting (not located on ward) and all CHW (community health workers, somewhat like an LPN) are in change of shift report out in the postpartum area. We remain with John's patient.
4:15 John's patient suddenly makes the same noise that Joshua's patient made earlier, except she is still walking around the bed and isn't on the side that has the step to get up into the bed. She squats before I can get out any Tok Pisin that would have gotten her to get up into the bed and that motion was enough that we know have a baby coming and no way to get the mom up to our sterile field. Quick instructions to John and we have the field under mom and I have a baby head in my gloved hands (thankful I had them ready to go a few hours ago). I've never delivered a baby this way before and John was suppose to do the delivery but no way it could happen with where we were each located in the room. Baby boy safely delivered and placed on our clean field at 4:20, followed quickly by the placenta. John gets to help at this point, cord clamps and cutting, and we then get them both up into the bed to do continued assessment. I'm still amazed nothing bad has happened but that this lady came to the hospital to deliver safely and we end up delivering on the floor!!! She is smiling though, very thankful we were there to help and loving that she got a baby boy! Some more assessment and we control bleeding and discover a prolapsed cervix to add to all our fun. John and I keep on praying!
4:30 All the nurses return from their meeting in time to help us finish putting mom together and then get her and the baby cleaned up and assessed.
5:15 All paperwork completed, patients successfully moved to postpartum ward. We informed them we would see them in the morning and to keep a close eye on her bleeding. I head home to get my laundry off the line before it really starts to rain.
5:25 Second shower of the day with my lovely heated rain water!

So just another Monday on the Maternity Ward, Kudjip Nazarene Hospital. Love it and this life God has called me to.

The Three P's

So it's been a while since I posted last. I've had computer issues and still do but I'm putting my other technology to use and writing this on the iPad. I'd been wanting to write about my obstetrics class for awhile. Classes finished 5 weeks ago but now we are working on applying those lessons in clinical. I mainly taught about the normal labor process this semester. One of the big lessons was on the three P's, power, passenger and passageway. These terms are referring to what is needed for labor to progress normally; sufficient contractions and then pushing effort from mom, a baby that is positioned correctly and isn't too large, and a passageway that allows that baby to move through it. The students did well learning the lessons and what is good and bad for each of these categories. We have a obstetric model that has helped me to demonstrate some of these lessons. I've found it quite Interesting that the model is Caucasian while the plastic baby doll that is always our "passenger" is the darkest skinned doll I've ever seen (and darker than any Melanesian baby around here). We use what's available! I've used a cloth book bag and towels to hide the baby in to help with identifying baby's position in the uterus and I've used a plastic bag coiled up to represent an umbilical cord and show cord prolapse. It's been fun and challenging to find hands on ways to engage the students, because hands on is a preferred learning method for many of them. I've also gotten to see how those lessons worked now that we are on the labor ward and are delivery babies. The Army way of "see one, do one, teach one" comes in a lot here. We try to get the students to see plenty of deliveries prior to doing a delivery and then they have to do 25 deliveries prior to graduating, but often the guys are so anxious to try their skills and teach them to the other students, that after one delivery they are feeling pretty confident and want to teach those who haven't been assigned to labor ward yet! Controlling this enthusiasm has been my struggle over that past 5 weeks. Constant reminders that two lives are in our hands works of a time! (I say guys because I've only had male students on the labor ward so far, missing my girls a lot but the guys are really doing quite well).
I've been thinking about three other P's recently as well. Presence, Prayer and Passion. Daily presence with my Heavenly Father, a lot of that being prayer and a continued passion to be here in Papua New Guinean despite all the continued challenges.
Also, over the past month our station power situation has been drastically improved because our hydroelectric power is up and running for the most part. A few kinks are still being worked out but it's amazing what having reliable power allows you to do! Like the dishes at 7:30pm, or a shower whenever it's needed, or reading a good book at night using a lamp and not a flashlight, things that rarely could happen before. That daily presence of power has really improved my overall outlook at times. Daily power outages are no longer the reality. It's also a great reminder of what the daily presence and power of God can do in our lives. Who knows what this continued passion will lead to, but I'm praying about the next few years and would also appreciate your prayers in this area.
Seven more weeks on the Maternity ward, then back for more lessons in the classroom, but never ending lessons continue with the Three P's here in Papua New Guinea.

Now a bit of my prayer recently, for my fellow coworkers here, all who are under that great commission and for myself-

But I do more than thank. I ask—ask the God of our Master, Jesus Christ, the God of glory—to make you intelligent and discerning in knowing him personally, your eyes focused and clear, so that you can see exactly what it is he is calling you to do, grasp the immensity of this glorious way of life he has for his followers, oh, the utter extravagance of his work in us who trust him—endless energy, boundless strength! (Ephesians 1:16-19 MSG)