Imperfect but Still Perfect: My Second African Birth Story

As any pregnant mom going past her due date, I was starting to feel impatient for labor to start. Unlike most, though, I hadn’t been wishing for labor every day for the last few weeks. Quite the contrary, I was anxious that I would go into labor because the doctor and midwife I preferred were both out of the country for the two weeks leading up to my due date. So now, just a day past my due date, I felt a bit guilty for being impatient. I was genuinely just excited to meet her. My OB stripped my membranes at my appointment, and I was hoping I’d be one of the 1 in 8 that go into labor within 48hrs. I planned a game night that evening for distraction. We played games until almost midnight, and though I was feeling crampy most of the afternoon and evening, I didn’t feel like labor was imminent.

Around 1am, a strong contraction woke me. I let Ryan know that I felt we would have a baby in the morning, but I was really hoping for a normal time of the morning instead of at night. I was planning to walk to the hospital, and in addition to waking people up, I would probably have to call the security at the school to find out where the patrol dogs were, as my path to the hospital was on the guard’s trail that is patrolled during the night by huge dogs. 

Guard's trail

I slept fitfully, but made it through the night. The kids woke one by one, and I tried to keep our normal routine despite my contractions becoming more frequent. At 6:30am, I woke Ryan and sent a text to a staff member, also named Shannon, that I had previously asked to help me. I wanted to avoid trying to treat myself and trusted her years of experience as a labor and delivery nurse. She asked if we could wait until 8am as she was making her daughter’s birthday breakfast. I took a shower and got ready, putting some last minute supplies into our hospital bags. Ryan gave the kids breakfast and Nancy Rice, visiting us just for this birthing occasion, then took over watching them. Just after 8, Shannon M arrived, and we told the kids we were going to the hospital to have their baby sister and headed out the door.

Waiting for the stork

We walked out of our apartment, through the hedge, and out onto the guard’s trail. Thankfully, the walk to the hospital was all downhill. When I say downhill, let me help you picture our walk. We live on the side of a mountain along the Rift Valley. It’s steep- think stairs. And it’s a forest, at over 5000 feet of elevation. June is the rainy season. We live in Africa but it’s not hot nor dusty. So we walked in the cool of the morning, along the fence of the guard trail, out the gate of the school, down a road, down some stairs through the forest, and finally down a narrow sidewalk leading to the hospital gate. Along the way, I had to stop frequently for contractions, but it was peaceful otherwise. In my opinion, walking is so much better than driving in a car, especially on a bumpy road during active labor. Shannon M looked at me asking, “Is this how bad it gets for you?” I nodded, not able to speak. When the contraction was over and we had resumed our walk, I said that I thought I was in transition. Shannon M turned to Ryan and advised, “You need to listen to what she is saying and not how she is acting. And in case you were wondering, this isn’t typical.”

Mountainside forest- peaceful

I had texted the midwife and doctor that we would be heading down around 8am. We arrived around 8:30am and headed for the private ward. It was renovated in the last year, and the room was very nicely arranged with a bed, infant warmer, fridge, microwave, heater, private bathroom with shower and Western toilet, a couch/bed, and even a flat screen TV. As we entered, the midwife was busy preparing the room… by getting rid of grasshoppers! She straightened up as we came through the door, exclaiming, “Ewww.” A grasshopper leg had broken off into her hand. “I’m so sorry. That’s already the 7^th one I’ve tried to remove!” Ryan set our bags down and took over the grasshopper hunt. 8, 9, 10…. Shannon M got heart tones, the midwife brought the birthing ball over. 14, 15… Ryan was hunting successfully on the bathroom ceiling. The OB came in and greeted me. Sure enough, I was 8cm. It was such a relief to have the people I was hoping for at my side. “I tried to make it to the morning so I didn’t have to wake you up,” I said smiling. The midwife said, “I’m supposed to leave at 9:30am for Nairobi though.” Challenge accepted. 18, 19… Ryan was throwing grasshoppers out the window.

We called the pediatrician, Dr. Arianna Shirk, our good friend since orientation with Samaritan’s Purse in 2014. She was just down the hall. She assured me that it was a good day as her formal responsibilities were minimal. 20, 21, 22. “I think that’s all for now.” Ryan announced. I was only on the birthing ball for a few contractions. I could feel the baby’s head descending. We raised the head of the bed and Ryan put my pillow up on the top so I could kneel and rest my head. After a few more contractions, I told the waiting crowd that I thought I would need to push in the next 5 contractions. Although it had only been 45 minutes since we had arrived, it felt like a long time. With my other two, I waited on my doctors because I had to push when I got there. 30 min for Sydney in the US and 15 min for Zack in Congo.

Sure enough, I needed to push with my 3^rd contraction. I felt her head descend with the bulging amniotic sac in front. I waited until the contraction was at its peak and the work partly done, then with all the uncontrollable power of a reverse vomit, my water broke and I pushed her head out and then her body. Just like that, the excruciating pain is gone, and I just had to turn around and meet my baby girl. But I couldn’t move. I needed a few more seconds to recover. “Turn around,” they encouraged me a couple of times, and finally they gently nudged her underneath my body so that I could get a glimpse of her face for the first time. Will she look like me? I thought as I recalled my first excited words when I saw Zack for the first time. I looked down, and my breath caught. “Oh. She has a cleft lip.”

Time stopped. A thousand questions went through my head. I voiced one to Dr. Shirk, hoping she wouldn’t immediately need to take her away from me for evaluation. “Will I still be able to breastfeed her?” I finally turned around and rested my head back against the bed, holding her to my chest as my mind continued to churn. She had had prenatal care in SIX countries, but I’d done most of the ultrasounds and I hadn’t been looking for this. Our anatomy ultrasound was done in the US with a high-quality ultrasound and hadn’t picked it up, although it was done a few weeks earlier than normal because of our inability to travel later. What would knowing have done except made me worry? Then again, I’ve always argued for prenatal screening and testing so that the parents are prepared and the delivery brings an expected gift (a beautiful child with Downs Syndrome or a heart defect etc) rather than the potential for disappointment. Disappointment. I quickly pushed that sentiment away.

My mind scrolled through emotions like an old-fashioned Rolodex, but I had no reference for how I was supposed to feel. I’d had three relatively easy pregnancies, three quick deliveries with no stitches despite big babies, and two out of three kids with no medical problems at all. Now I had a beautiful baby girl who happened to have a defect. How could I possibly be ungrateful or anything but happy? So I reverted to my tried and true defense mechanism, stuffed any negative aspect and focused on the positives. Keep this in mind as I recount the next moments and days.

Our baby girl was screaming. Really pink and screaming. She wasn’t so happy to be out of the dark and warm womb and into the world. So I got my wish and was able to hold onto her while we eventually clamped the cord, I delivered the placenta, and got cleaned up. Whitney was still loudly making her presence known. Ryan and I looked at each other, each of us thinking how loud her cry was compared to our other two. Buckle up. “What’s her name?” the four in the room looked intently at us. “Whitney Celeste.” Born at exactly 9:30am. We took a moment to stop and pray, thanking God for a quick delivery and a healthy mom and screaming baby. The midwife excused herself shortly after, only slightly delayed in her planned trip to Nairobi. We had successfully met that challenge.

“Should I call David?” Dr. Shirk broke into my thoughts. I thought she meant her husband. Sure. I heard her talking to someone in a more impersonal, medical way. She saw my quizzical look and quickly explained, “Oh, David Nolen, the facial plastic surgeon, not my husband…. But I can call my husband too. He can bring his camera.” So confusing. We already had a few times where an instruction was given and addressed to Shannon and I wasn’t sure if they meant me or Shannon M. Now we had two very different Davids, both our friends from our medical orientation with Samaritan’s Purse, but Arianna’s husband is a professional photographer and runs a foundation and the other David is a surgeon. It was comic relief. But it was fun to have a professional photographer capture truly some of the first moments we had just with Whitney. She even cooperated and decided crying wasn’t the only option in the outside world. Silence. And peace.

Next came a parade of medical evaluations. Dr. Nolen came to assess the extent of her cleft lip. It was good news. There is no cleft palate and thus very little risk that her speech or feeding will be affected. Whitney will need a surgery mainly to address the cosmetic aspect of the defect and she can have it at 3-4 months and 10lbs. She may need another revision later in life and will likely need braces when most of her friends are probably getting theirs. Then, an audiologist came in to test her hearing, and both ears failed the test. “We’ll check again later. It’s probably fluid or wax.” I was struggling to stay upbeat. Dr. Shirk did a bedside heart ultrasound (echocardiogram) to check for a heart defect. I recorded the screen on her iPhone, trying hard not to move the phone when I wanted a different view. I’m so used to doing the ultrasounds myself! She then sent the recording by email to a doctor in the US who officially reads them for her. We’d have the results later that day, she promised.

Dr. Arianna Shirk

It was family time. Nancy Rice brought two very excited kids to meet their baby sister. They each brought a homemade card. Nancy had introduced them to Daniel Tiger (thank you, YouTube, and a good internet connection) and specifically the one where Daniel goes to see his baby sister in the hospital, so they were prepared. Zack came in and got an intense look on his face, saying “Baby!!” with clenched fists and a grin on his face. He quickly got up on the couch and gave her a kiss. His attention to the baby, although sweet, was short lived, and soon he was trying to play with the birthing ball (eww!) and climbing up the infant warmer. Sydney wanted to hold her sister, and lovingly bent over her. She was also very excited, but Whitney held her attention for much longer than her brother’s.

Homemade card

Watching the exam intently

Nancy took the kids back home for lunch, and we settled into watching our traditional movie: Pride and Prejudice. (With Sydney, this was the notorious movie that had made us go to the hospital nearly too late.) We hoped to go home in the late afternoon, after the results of the echo were back, but Whitney had other ideas. The audiologist came back and this time only one of her ears failed. “We can check in a couple of days. It could very well still be fluid from birth.” Sigh. Whitney didn’t pee, and the echo wasn’t back yet, so we resigned ourselves to staying in the hospital overnight. We had a few special visitors, and a few friends that brought flowers or food or just good company. Ryan was able to watch some of the opening of the World Cup, so that felt very similar to us staying for two days in St. Louis after Sydney’s birth so that we could watch the World Series :)

Whitney finally peed late that night, an occupational therapist came in to evaluate her nursing ability, and the echo result came back good. Things were looking up. In the morning, however, we got a blood test result showing elevated thyroid stimulating hormone, giving her a 24% chance of having congenital hypothyroidism. Sigh. As we were preparing to leave, we had another scare which seemed to indicate that she could have an infection based on her temperatures. Sigh. I just wanted to have a normal baby that I could take home and cuddle. Thankfully, after further review, the temperatures had simply not been recorded correctly and she was cleared for discharge.

We were home finally, but not without some lingering concerns. How will I tell people this? So many of my acquaintances are on Facebook, and how do I tell them she isn’t perfect? What will people do when they see her face? Students, staff, are all excited to see her and I can’t bear the thought that they will look at her differently. So I struggled with posting much on Facebook or even walking around with her. We repeated the thyroid test after a couple of days. I was so worried about it, but I tried to push down my fears. We’ll just deal with it as it comes, I thought. Thankfully, it has decreased significantly so it is most likely going to normalize with a final lab draw. We retested her hearing and she passed.

Proud brother who knows he is not the baby anymore. "No, baby. I BOY."

Our househelp made a birthday cake for Whitney. So sweet. We sang Happy Birthday when we got home.

First morning at home as a family of five.

With the number of unknowns and scary false positives decreasing, I feel my defenses going down. I finally allowed myself to feel sad and cry for her. I’d rather be sick and need surgery than have a child that needs surgery. I am still nervous about how people will react to the news or react to seeing her. In many ways, I feel like my birth story is not nearly as impactful as her story will be. I’m learning to embrace her physical defect. I do love her little nose. Her eyes look like Zack and her chin looks like Sydney. She has smiled at me, which I didn’t know was possible with a cleft lip. I’m incredibly thankful that she was born in a hospital that is set up as a center for cleft lip/palate with 4 surgeons and speech and audiology and occupational therapies available. I doubt we would have gotten a facial plastic surgery consult within 2 hours of her birth even in America. God provides for our needs before we even know we have them!

I have a bible app on my phone, and do you know what the verse of the day was for Thursday, her birthday?

Every good gift and perfect gift is from above, 

coming down from the Father of the heavenly lights, 

who does not change like shifting shadows. -James 1:17 NIV

She is perfect, through her imperfection.

Travel Missed Adventures

A lighthearted look at what ALMOST went wrong during our travels this year. My family would call much of this Toews luck (my maiden name for those many times when we, on my dad’s side, don’t plan well and just happen to have good things still happen).

Nairobi

Traveling, with and without littles, is usually an adventure. Flights connecting Nairobi and Europe are not always, or usually, catering to people living in Kenya. Our flight to Greece left at 4:20am. I have made many trips to the airport this year, so I calculated accordingly. Early in the morning, there is usually very little traffic and the trip takes about an hour. At that time of the morning there is usually not much of a line at the airport. No sense in leaving super early with small kids just to wait with the cranky kids a long time before getting on the plane. Ideally, it is best to arrive just as we can get through the last bit of security with 10-30min left to spare and not hours.

I asked our usual taxi driver when to leave, suggesting 1am. He agreed 1:30am,would also be fine. BUT, he was sending someone else to drive his car as he personally was out of town. Well, we left a bit late around 1:45 because...kids. Though we rarely get stopped at police checks here in Kenya, we did that morning. I was trying to keep the kids asleep in the backseat, and I mostly ignored the rapid conversation going on in Swahili. Clearly something was amiss, but I wasn’t concerned until the police said in English, obviously to shame the driver, “I could have you thrown in jail for driving without a license!” What?!? At this point we did start worrying about time, but after a few more intense looks, the policeman indignantly waved us on.

We were looking at the time, but hopefully we could still make it to the airport a little after 3am. We did need to check baggage, so it was cutting it close for the hour before mark, but we’d probably make it. We always carry extra clothes in our carry-ons anyway. At the security checkpoint before the airport, again we were delayed for some time. I assume this was continuing to be the lack of license issue. Who drives a taxi without a license?? It’s like playing baseball without a glove or running in a marathon without a number. We were getting anxious, and really I just wanted to ask the security personnel, who had every right to detain us, to just let him drop us off a few minutes later and then they could arrest him. I contemplated how long it would take for use to walk/run to the airport from the security area. Nope, not with the kids and luggage.

They finally let us go, and I don’t know why. We arrived at the terminal only to see a HUGE line outside the door to go inside. As I wrangled the kids and Ryan put our luggage on a cart in the dark, Ryan immediately said, “We’re going to miss our flight. There is no way. This line is at least an hour long.” It was nearing 3:30am. I felt adrenaline surge. “No we’re not. We have little kids! Let’s just go up to the front of the line.” So we did. We totally cut the line, and when we got to the front, I asked one of the passengers when their flight left. 5am. 6am. I said that ours leaves at 4:20am. They looked at our full hands, sleepy kids, and gestured for us to get in front of them, saying, “You’re late!”

We raced through security to get to the check-in counter. It looked closed. My heart sank for a minute, but then I realized that there was still someone behind the desk. Whew! And then not 5 minutes later another passenger on the same flight came with his baggage. Ryan pointed out to me that he probably arrived at the airport an hour before we did. Gulp. But, we made it. Just in time to walk through immigration, find our gate, go through more security lines, and finally get in the boarding area and sit, even if just for a few minutes.

Greece Missed-Adventure

I was standing near a message board at our conference, reading through the bus schedules so that I could know which one to sign up for in order to catch our flight back to Africa. It was a couple of days before we were to leave. Providentially, I overheard another couple talking about how their flight to Egypt had been canceled and that they were now on an earlier flight. Curious, I asked them which flight it was. Same one we were on. I checked my email. Nothing. Hmmm. I asked Ryan if he had heard anything from our travel agent. Nope. For once, I was thinking ahead and planning. We emailed our travel agent, and they assured us there had been no notifications. However, it was too much of a coincidence to overhear a conversation about that flight and I wanted to make absolutely sure. I decided to ask the concierge service at the conference center to verify our flight details. They called the airline directly. Sure enough, our evening flight had been canceled and we were now booked on the afternoon flight. Had we gone the three hours ahead of time as recommended, we would still have missed our flight by an hour. Whew!

Wanting to take advantage of as much of the conference as possible even though we were leaving on an earlier bus, Ryan and I divvied up the tasks we needed to do before leaving, agreeing to meet at the bus before it left promptly at 11am from the front of the conference center. I took some luggage to the waiting area and went to a session while Ryan finalized packing. Then we swapped and he took some luggage and went to say some goodbyes and pick up a flash-drive while I got the last of the luggage and picked up the kids from their kids sessions. Being over 30 wks pregnant, I decided to drag the luggage to the kids and then haul it all together back to the meeting point. Problem was, the kids were busy having fun. Sydney was getting her face painted so I went and picked up Zack first instead. When I came back, Sydney was still finishing up, but I finally tore her away and we said goodbye. Then we headed with the luggage to the meeting point. It was a good distance away but along the road the bus was going to travel at least. Of course the kids did not walk in a straight line nor did I have enough hands to carry them both and drag the luggage. It took a bit, but even so I did not realize how close we had cut it until we reached the bus. 

There were two buses already loaded but no Ryan in sight. I sent Sydney onto the first bus and held onto Zack while looking for Ryan. The buses were ready to pull out. Finally I saw Ryan who had been frantically running, trying to find out where to come help me. He had been back to our room and again to the conference center at least twice but I’d come a different way. He had our other luggage on the second bus. He grabbed the bags from my hands and I started coming with Zack. “Where’s Sydney?” Right! Sydney was on the first bus which was about to pull away. I ran up those steps and snatched her :) and we ran together to the second bus. Ryan was sweating despite the cold weather and put his head forward on the seat as we started the first part of our journey. I felt horrible for causing the stress I’m sure he had felt for the last 15 minutes. I should have been way more anxious. But it didn’t do much good for me to get worked up about what could have happened.

Our heart rates had returned to normal when we got to the airport. We were there a lot earlier than we normally are (see above). As we usually do in airports, we took turns and scouted out the kids’ area first. We waited for a bit to check in our luggage as it would have been impossible to lug it all over. Finally, our hands lighter, we headed first to McDonalds to satiate tummies. We still had a smaller cart with carry-ons along with the two kids. Both are so active. Ryan held onto Zack and went to put our trash away and I maneuvered the cart through the very large McDonalds, thinking Sydney was in front of me. She wasn’t. Ryan and I met outside with Zack and luggage but minus Sydney. Great. Our very independent child was now lost in McDonalds or somewhere in the airport. Ryan headed back into the McDonalds. Not anywhere where we had been. I tried to look but I couldn’t go up and down stairs with the cart and Zack. Ryan quickly scoured the area, looking downstairs and I looked in a second restaurant closeby. Finally, Ryan went back into McDonalds and located her on the opposite side, trying to order from an electronic menu. Whew!

Our beautiful, independent girl

We headed, finally, to the kids’ area. We didn’t have a lot of time anymore, but we had promised the kids that they could have some time to play. As we sank back into the parents’ chairs for a respite, Ryan looked at our tickets and saw that it said we needed to be at our gate over an hour before. Weird. We reluctantly left the kids’ area after less than 15 minutes. It was better than nothing. The security line was pretty normal, although longer than it had looked initially. As we walked up to our gate, we noticed that the sign said, “Final boarding call.” What?!? We walked up and gave them our boarding passes and they directed us out to a bus. In a few minutes, the bus took off and bused us a ways to our waiting plane. We weren’t late at all, but why were we cutting it so close? Whew!

Immigration Missed Adventure

We had taken a bit of a risk when we left for Greece and then Egypt. Due to the extensive traveling we have had, both Ryan and Sydney’s passports had no free pages left. We realized this without enough time for Ryan to take off time from teaching and to get new ones. We had been thinking that the last two pages of the passport would suffice, but they are apparently endorsement pages and not visa pages. We knew we would get stamps and perhaps a big visa in Egypt. Would they use the endorsement pages or would we have to spend our days in Egypt going to get an emergency passport at the embassy? Turns out that Egypt just put their big visa over a previous page, ignoring whatever was already on that page. Ha! So Ryan and Sydney were both allowed into Egypt and back to Kenya.

Egypt Missed-Adventure and Misadventure

Our layover in Egypt was a bit more than 48 hours. We wanted to have a little adventure with our kids, see the pyramids, and have some family time. We organized an AirBnB that would pick us up from the airport. I notified them that our flight had been moved up many hours (see above), but I hadn’t gotten a reply. We waited in baggage claim and noticed a few people that had been at the conference and on our flight with us. They lived in Egypt. We decided to Uber our way to our destination using their local phones if our AirBnB wasn’t waiting outside. They weren’t, so we caught an Uber along with our new friends who were going to their homes. We got in the first car and they got the next. On our way! To the pyramids and camels etc. Little did we know that our friends were detained with their Uber driver for over 45 minutes after we left because he did not have permission to enter the airport for customers. We would not have had the language nor a cell phone to help get ourselves out of that or to know what exactly we should do. Whew!

Our AirBnB was as advertised—right across from the Great Sphinx. The window right above Sydney’s bed looked straight out on the pyramids and Sphinx “Look mom! They are in order!” and straight down 4 stories to the street below where the street was crowded with camels and buses and horse-drawn chariots and taxis. What an odd mix! Thankfully, I inspected the room carefully and when I got to those windows, I noticed that they easily opened without a screen or a window lock. They were large, and did I mention we were 4 stories up? I was just imagining my kids trying to get a better look at the camels by sticking their heads out of the window and then falling 4 stories. Gives me shivers. We soon had jury-rigged a sort of lock using the end of a broom handle to ensure that the windows only opened a crack big enough for an arm. Whew!

Sydney looking out at the pyramids from our AirBnB window.

Because of our early flight, we were able to plan a bit for what we would do the next two days of being tourists. Turns out we had chosen a day to explore the pyramids when nearly everyone in Egypt was not working. Good Friday meant Christians had a holiday. Friday is the Muslim weekend. And it was also the day before Jewish Passover. All of the regular tour guides were already taken (ahh, lack of planning). We had few expectations, but we wanted a camel ride, a chariot ride, to explore the inside of at least one pyramid, and see things that were generally climbable and not breakable.

Our chariot driver ended up being our tour guide of sorts, though he mainly just took us to the different sites so that we didn’t have to walk. Ryan rode a camel alongside us, usually with Zack or Sydney. Most of the others visiting the sites seemed to be Egyptian. We got as many pictures taken of us as we took of the pyramids, especially of Zack with his white hair. We explored. The kids really wanted to climb the pyramids but at least we got to explore the tombs underground. Nearing the end of our journey, we were looking forward to finally going inside a pyramid. This was the smallest one of the three, but at least it was something. We waited around, not sure why we weren’t going in. Finally, after at least 20 minutes of stalling, we found out. Our guide had neglected to get us tickets. What?!? That was the one thing I asked for other than the camel and chariot rides. Ryan and the guide took the chariot to an office close to the main gate to buy the tickets because as Sydney said, “I don’t want to ride the slow camel. The chariot goes fast!” I tried to keep the kids from climbing the pyramid or going inside, etc for an uncomfortable and frustrating 30 extra minutes, but we finally got to go inside. :) Long day but good memories, even with the misadventure.

Ryan and Sydney on the "slow camel"

Enjoying the chariot ride

The second day we went to the oldest of the pyramids, from around 2600BC! There was a lot of fine smooth sand for the kids to play in. We joked that it was the oldest sandbox in history and that they liked the sand more than the amazing architecture that had withstood the test of time. Imagine that Jesus may have seen these pyramids when he lived in Egypt and they would have been old—over 2000 years old at that time! As we were walking to one that we were able to go into, our kids were running and falling and having a grand old time. We had no idea that there were many many open tombs scattered around. They were over 40 ft deep with stone bottoms leading to a burial chamber or perhaps a fake one to discourage tomb thieves. BUT, these tombs were surrounded by only a thin railing. I realized that Sydney or especially Zack could easily have walked, stumbled and certainly crawled through the sand and fallen into one of these pits. We kept a closer eye out for these and our kids closer after that. Whew! Missed adventure.

The oldest  sandbox

Sand filled with hidden tombs and treasures from ancient Egypt

Pregnancy Travel Missed Adventure

I’ve been co-coaching volleyball this term of school, which has been an absolute blast. Our last game of the season was over an hour away and my fellow coach was not able to come due to a previous commitment. At over 36wks and with my history of fast labors, traveling without an extra adult wasn’t smart, so I recruited a good friend to come with us. You know, just in case I need to go to the hospital instead of the game. Would be quite awkward for me to just leave a group of high school players and then be alone myself somewhere in labor. I brought my medical records, gloves and a towel. :) No labor. Whew! And I thought I was done traveling.

BUT, immigration officials here in Kenya decided to have all foreign workers come in to get fingerprinting and to validate their work permits during the next two months. (Imagine the backlash if the US did this.) Faced with possibly standing in line very pregnant or standing in line with a newborn, I chose to take the chance and go early. I mean, it wasn’t very early, but as early as I could. I went with a group from the school. The driver joked that he knew he was leaving with 5 and coming back with 6. "If anything will put her into labor, it’s standing in line for a long time in the sun." Again, I brought stuff to be prepared. I even found out there was an L&D nurse and a pediatrician in line with us. The line was shorter and the process way faster than we thought it would be. I was prepared but it wasn't needed. Whew!

The OB I’ve been seeing as well as a midwife I’d really like to be present at my delivery are currently both out of the country. Such bad timing! They have been gone for almost 2 wks and will get back tomorrow night, just before my due date. I’m really praying for our little girl to come on her due date but not before, and this is why. It will probably all go fine in any case, but birth is sacred and memorable and having people there that I really love is important to me. 

If I deliver in the next two days, it will be ok, but last weekend was a missed adventure for sure! Imagine... my doc and my midwife are gone. I have an L&D nurse who has agreed to help, a nurse practitioner with a lot of delivery experience, and a back up family practice doc. BUT, last weekend was midterm so many of those on campus were gone as well on (mostly) day trips. Monday of this week, it was still midterm. Ryan had to go to Nairobi to do his fingerprinting and I volunteered to keep a couple of extra kids for another couple who were going to stand in line. So I was at home (thankfully with househelp!) with 4 kids at 38w6d, the very day that my water broke with Zack. I was at home with those 4 kids but without Ryan. And all of those people I mentioned had agreed to help if needed? Gone as well for the day. Really, every single person I was hoping to help me was not there. I am so thankful we missed that adventure.

Nancy (Nounou) is here!

Nancy Rice arrived the next morning, as planned, to be around to care for the kids when I’m in labor. I’ve felt much more at peace. If I go into labor now, I have a lot of people around to help and Nancy will handle the kids, just as she did for Sydney when Zack was born. Still, I’d really like to start labor on Monday or Tuesday when the doc and midwife are also back. That would just be wonderful. We will only be missing Dr. Jennifer Goldkamp who delivered my other two. I know she would rather be here than taking another (final!) board exam, but I’ve heard those are important. Hopefully my next blog will be another African birth story. :)

Raw

After sitting on the sidelines here in Kenya, so to speak, for the first term (Sept-Dec), I was eager to have my board exam behind me and looking forward to the chance to be on the team down at the hospital. Just before we left for the US at the end of November, we had a very difficult meeting with several people in leadership at the hospital, wherein I was told that they aren’t going to offer a position to me: surgical, clinical, or educational. Nothing part-time or full-time. And yes, this felt like death. Death of yet another dream for us as a couple on this journey in missions.

It still is raw, and part of why I haven’t blogged about it or written much in our newsletter is that I simply don’t want to bring up the feelings that it created within me, over and over and over. The questions are inevitable, and I’m struggling to find a concise way to answer and stop further questions when people ask me, “How do you like working in Kenya?” and “How are things at the hospital?” and “When do you start?” and “Have you decided whether you and Ryan are extending your time past a year?” I have also found that I am re-dealing with the sorrow of leaving our dream in Vanga, DR Congo. A counselor reassured me that although we have gotten a great deal of debriefing about that and felt emotionally stabilized, when something new comes along that is similar, it can reopen a healing place in our hearts. And that is certainly what I feel like: raw. Tears come easily, and I don’t think it is just the pregnancy.

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I know you may be thinking, but I have so many questions! How can this be? Isn’t she volunteering to work as a physician in a hospital for free? Isn’t the hospital busy? I’ve never heard of this. Aren’t missionary doctors always overworked? Is this just a temporary ‘no?’ Why would they not invite her? What is wrong? Where is the misunderstanding? And I assure you I’ve been asking myself the same questions. When I get really down and allow the Enemy to whisper to me, it is usually, “You aren’t good enough. They didn’t like you. You haven’t been able to stay in one location longer than 14 months so you aren’t showing perseverance or being patient enough. You aren’t a good doctor. You aren’t a good teammate. You didn’t ask enough questions on your visit to Kenya last May and made a mistake.” And I have to fight it. Every. Day.

A rainstorm in the Rift Valley

The truth is, I don’t resent the hospital leadership, or our organization, or those who are working there right now. I am frustrated by a situation that I don’t fully understand. I’m upset that when Ryan is finally thriving in his role on the mission field that I’m not fulfilled. I’m worried our supporters won’t like to hear that I’m not doing medical work here and stop supporting us. And I’m sad to not be a part of a medical team, to not see on a regular basis our friends who also did the post-residency program with us and are now permanently here. But… I don’t think I’m supposed to understand. God was not surprised by this. I can look back at our Ebenezers and clearly see that we were supposed to come here. I’ve prayed and prayed for clarity and this ‘no’ is about as clear as they come. For some reason, I’m not supposed to be working. I’m supposed to be at home with my kids and have the freedom to come and go when need be.

Before I start in with some of the good news, I need to be forthright that January was a low point for me. We had just come back from spending time with family after I finished—and passed—my oral board exam for the final step to becoming board-certified in OB/GYN. So there was a natural post-holiday slump. But we brought the dreaded flu back on our flight home, so about a week after getting back, we were sick, one after the other, for most of the month. I wasn’t working, but I had set up our household so that I could have been working, so I felt like I was simply not needed around the house. Then I was cooped up with one kid sick and the other stir-crazy, then I was dog-tired and pregnant with my own flu, and then the other kid was sick and the former one stir-crazy. Needless to say, it was a tough start. Ryan was very busy with a full class load and coaching basketball—and thriving.

Ryan enjoying his roles as basketball coach and math teacher

Continuing to teach at home

When we were on the upswing of sickness, but I was feeling quite depressed by the situation, we were contacted by Samaritan’s Purse to see if I could go and fill an urgent need back in Togo where we just left in June. Ryan encouraged me to pursue it. I looked at the calendar and considered what activities were going on at the school and what I’d already committed to as far as volunteering for things like nursery duty and hosting students. I decided that even though the need was for the entire month of February, I thought, I could only commit until Feb 14. I sent an email, not realizing that the Togo team had already sent me a message saying that my end date should be…. you guessed it, February 14. It was a confirmation to me that the Lord was behind this. “Whether you turn to the right or to the left, your ears will hear a voice behind you, saying, ‘This is the way; walk in it.’” Isaiah 30:21 NIV

Less than a week after booking tickets, Sydney and I were landing in Togo. It was a bit of déjà-vu. We had also booked our tickets less than a week in advance when we moved from Congo to Togo last time. As we left the baggage claims, went through customs, and exited the airport in Togo, the first person that I saw was an airport employee who sort of ran up to me saying, “Oh Doctor, you are back! I need to come see you.” To me, this was like getting a big hug from God Himself as I was dealing with self-doubt. There were lots of happy reunions over the next few days. The maternity was significantly less busy than when I had left, a purposeful scaling back of services due to the shortage of doctors. I had heard that the numbers of deliveries were down to about 20/month. Even so, the moment I walked into the labor room I was able to assist in a delivery. Another hug from God.

Part of the maternity team in Togo

I’m trying to settle into a new expectation for this season. I have a group of students I meet with on Sunday mornings, I am starting to see formal and informal consults for students and other staff who want help with medical issues, and I am working on editing a medical book meant for health workers in developing countries. In the near future, I’m hoping to help out with menstrual issues and eating disorders at student health. I’ve even just recently been chosen to help with a resolution by this year’s Model United Nations regarding menstrual health hygiene. Of course, I help out with preschool and run around with my kids. It’s a beautiful climate to live in, and there are lots of things to be thankful for. But, for now, the issue of our future and work in the hospital is raw. God knows and I feel His love in the midst.

Fistula Surgery on the Africa Mercy

AFRICA MERCY
If you are unfamiliar with MercyShips, they are an organization that uses a completely volunteer workforce to do life-changing surgeries off the coast of Africa using a hospital ship. The advantage of this approach is that even in a war-torn country with minimal infrastructure, they bring all of their equipment and personnel right to the shore, dock for 10 months, and then move on to another country. I had the privilege of working alongside an experienced fistula surgeon (former Vanderbilt faculty) named Andy Norman. As he mentored me, I was able to mentor a Cameroonian GYN who is part of the medical capacity building program that MercyShips provides. Being fluent in French, I was able to translate for her as Dr. Norman explained various aspects of the surgery in English. We did 30 operations in the three weeks. Over half were fistula cases, and the rest were hysterectomies and prolapse cases that really affected the quality of life for these women.

THE PROCESS
MercyShips provides all surgeries for free, and they focus on surgeries that are not usually done in the country due to requirements for multidisciplinary teams or special imaging like CTs or due to lack of resources. If the surgeries are done in-country, MercyShips provides training so that local surgeons can improve their skills or perhaps learn a different way of doing things. In this way, there is a concerted effort to avoid competing with local doctors and their source of income. Because the surgeries are free, there is quite a demand for the services, and lines are long at screening sites. Some of our ladies came from 3 days journey, sent by the government of Cameroon in buses. I believe they went from village to village and asked anyone with problem of leaking urine or stool to join them on the journey. As a doctor coming to work, the process is very streamlined. The patients have already been interviewed by the screening team. The surgeons then have one or two days of their scheduled time on board to screen the patients. We would see as many as possible, diagnose the problem, decide if surgery was needed, and then put a priority on them. The rest of our days were entirely surgical.

Part of our surgical team. Dr. Andy Norman is center.

A DAY
We made our postoperative rounds to see patients just after breakfast and headed to the OR. The hospital is all on one deck of the ship with wards and beds on one side, and the 5 operating rooms, lab, CT and Xray, and pharmacy on the other side. As you can imagine, there are no windows in this part of the ship and patients and nurses alike enjoy their afternoon time to go up on one of the upper decks for fresh air. There are places for children to swing and ride trikes, but most of the time the women would walk around and sing. We surgeons typically finished surgeries just before an early dinnertime. After dinner, we would go back down to the ward to check on the patients and to consent the patients who were scheduled for surgery the following day.

Beautiful! Patient waiting for her turn to be introduced at the dress ceremony

A PATIENT

One particular patient had been having problems of leaking urine for 10 years. This was not uncommon, as the range was from a few months to 27 years. The sad part of her story was that she had been going from hospital to hospital looking for a solution without result, for 10 years! Indeed, when we filled her bladder with the blue dye, there was none that came out into the vagina that would have indicated a fistula connecting the bladder to the vagina. Although these are the most common type of obstetric fistula--even our name tags said VVF surgeon for vesico(bladder)-vaginal(vagina) fistula surgeon-- they are not the only fistulas we see. There are also connections between the ureter (the tube coming from the kidney before it goes into the bladder) directly to the vagina or the rectum to the vagina. For our patient in screening that day, after further questioning she mentioned that she has blood in her urine once a month, just like her period, but she doesn't have any vaginal bleeding. Bingo! We diagnosed Yousseff's syndrome by injecting contrast into the bladder and looking on CT to see that there was a connection between the uterus and the bladder. So every month, she would have a period but all of the blood would flow into the bladder because it was easier than going through the thick muscle of the cervix. And conversely, only if her bladder were extremely full, the urine would flow into the uterus and then have enough pressure to come out of the thick muscle of the cervix. So she would leak urine intermittently from the cervix and into the vagina, but she would always have her period through her bladder. During a long abdominal surgery, we were able to separate the uterus from the bladder, remove the uterus, and close the bladder.

Putting on makeup prior to the dress ceremony

THE DRESS CEREMONY
The patient is one of many who are so grateful to finally have resolution to a problem that has significantly affected their life. Each woman who has found a cure (or at least a significant improvement in their condition), has an opportunity to be involved in a dress ceremony. They get dressed up in a new dress, their makeup done, and they then dance together down the hall of the hospital deck in their bright new clothes and enter a room of cheering MercyShips crew. It is a highlight. They sing and dance and then (usually tearfully) share their stories, praising God that they were healed. Comically, they usually have to get up one by one to use the bathroom during the ceremony. And I always smile. Imagine needing to go to the bathroom after all those years!

Dancing through the hallway during the dress ceremony