Sunday, October 14, 2012

Going home and reflections


My journey home was long but good. Saying good-bye to the people at Ot Nwal Me Kuc was difficult and sad.  After a long and tiring day we made it to Entebbe and I had dinner with Charity, the woman I met within an hour of arriving – sick and pregnant.  This time she was healthy and full of life and it was a joy to see her and get to know her. She came with me to the airport and it felt I had come full circle.
Charity and me on the shores of Lake Victoria
The next day after an eternity of flying I was going through a long line in security at customs.   One more stop and I would be home.  I made a comment out loud about the number of security stations I had been through and the man in front of me agreed.  Come to find out he too had flown in from Entebbe the night before and after briefly saying where we were staying in Uganda we began to share what we were doing.  He is in the military part of the Special Forces that are there to train the police and government soldiers in Sudan, Congo and CAR – he spent most of his time in the CAR.  I looked him in the eye and asked when they were going to stop Kony and he replied “That’s what my job is and we are trying.”  I had discussions in Atiak with people about Kony and wanted their opinions and it is clear that stopping him, even though he is no longer in Uganda, would make people feel safe and offer some justice.  We spent the next 20 minutes discussing the limitations, the corruption, the stories I heard and the women I met and the scars I saw. The situation became more personal for both of us.  We left each other in gratitude for the work we are both doing and once again, I felt this was not an accidental meeting but one that was important, not only for myself but for he as well.




I've been home one full day now and tired as I am it feels good.  As I reflect on the last few weeks of my life I realize there are no words to adequately describe my experience.  Only those who have been there can relate and yet I need everyone to understand to validate what I have been through. It will take a long time to process it all and try to connect these two very different parts of my life.

It is easy to assume that the people in Northern Uganda are oppressed: limited healthcare and education opportunities, poor infrastructure to support modern technologies, limited food supply and income, high rates of maternal and infant mortality, lower life expectancy... And by our western standards the poverty seems overwhelming to a population as a whole.  Years of war and corruption within their government has left the people with only their own limited resources and those of the NGOs that come to help and offer some ease to the difficulties of their life.

Yet, the simplicity of this life, with all the joys and sorrows, far surpasses much of the quality of life we have here.  I do not pity the people I met and saw, I envy them in many ways. Yes, there were things that were difficult to see and I wish I could alter, but there were also lessons to me in resiliency and what defines a people and a culture and a good life.  My job was to serve the women and families the best I could and not change them.  In many ways I feel I have succeeded.  I tried not to judge but to observe, and give my compassion and my skills to aid these women and children when it was needed.  I feel good about my experience as a whole and as good as it is to be home with my family, it was hard to leave this beautiful and wondrous place.

Two moms and their sons with their attendants


Tuesday, October 9, 2012

Anyadwe - Daughter of the Moon


Lots of deliveries yesterday and today we drove women home.  I went to one village just a short distance from here almost on the South Sudan border.  One little girl, maybe 9 or 10, looked at me and could not keep staring.  She didn't smile or react or anything, just a look of shock on her face.  She warmed to me after a few minutes (she took my hand with caution as I said “Afoyo”) but was very hesitant.  I was told she had never seen a white person before and was a bit frightened and curious.  The children began to call me Anyadwe or Nyadwe (ah nya dway). It means “Daughter of the Moon”.  I am sure it what they call most white women but I am claiming it as my own.

Today is Uganda's Independence Day - but given their history even recently it seems a strange title.  Last night there was music ringing through the air and the children all running around yelling "Hoot! Hoot!"  They finally went to bed but then very late (or very early) a man started in which woke all the roosters and then that encouraged him more and then...uggh.  It was not a good night for sleep.  I am prepared for even more tonight.

October 8, 2012
As I write this there is a huge thunderstorm.  The air is finally fresh and the rain a blessing. I wish it would last all night. Sadly, it will probably only last a few minutes.  

Today we were very busy in the clinic – 2 births, 2 transports to Gulu, and a woman who is in labor still.  After a few days of quiet it feels good to have the activity and chatter here again.  I love how all the children who arrive with the attendants are cared for by everyone.  I love how when someone is in labor the other women peak in and offer their encouragement.  Alone as these women seem while laboring, they are still in a community.  Tonight the clinic is also full of dads who came to admire their new babies and have time with their families.  While encouraged it is not an everyday occurrence.  And, to top things off the mama who birthed this morning brought a sheet!  It was a relief to me to see her more comfortable and clean up was so easy.  She had the most beautiful baby boy. 

Last night we had a labor very late and all three of us midwives came over.  As she labored we all rested in the hammocks, the bats flying above in the room.  It felt good.  And today Corrina arrived, another of the traditional midwives who works here.  She, Carmella, Florence and I hung out in the dark of my hut snacking and chatting and having a wonderful time just being women together, even without the language.  Florence does speak English and could translate but mostly we just sat and laughed. 

Carmella, Corina, me,  Florence and Stewart (everyone's baby)



I heard some very disturbing news today and almost cried when I was told.  The woman who we brought home yesterday, the same woman who I mentioned 2 days ago as looking so worn down, the woman who walked 4 miles home 24 hours after given birth…This woman was not served breakfast yesterday.  There is no excuse and it was deliberate on the part of the server.  Had I known I could have easily brought her food and tea.  Instead, she went home hungry and expected to start on her daily chores and care for her other 4 children.  How can she even begin to believe in compassion if this is how she is treated here?  Yet she never spoke up – that is how beaten down she already is. I am so saddened and feel that as a midwife I have failed to honor and protect the women I am here to serve.  I heard this happened once before last week and I do not understand.  

Sunday, October 7, 2012

Road Trip


Today all the midwives and I went to Adjumani, a town in the neighboring district.  We dropped off the woman who gave birth yesterday and continued the journey there. It was amazing how different it was once your crossed the border – the Arua River.  The landscape was different, beautiful, maybe even more so than Atiak.  There were more hills and rocks – giant boulders.  The villages were right on the road and even the huts were different- many were square.  Pakelle a town on the way even had a mosque.  It was clear that this district had more wealth and support.  Adjumani itself was like a big town/city wannabe.  Only a few main roads with lots of shops and even a bank, a hotel, and 2 petrol stations; but the roads were still dirt and it only took a few minutes to get the full tour.

The woman we dropped off had given birth 24 hours before.  Her baby wrapped in a blanket and wearing one of the two outfits given (no diaper), her basin of supplies on her head – she left the truck and began her 4 mile hike on the paths to her home. 

Earlier in the day a woman arrived fully dilated.  We thought it would be a quick birth as this was her third baby but she seemed afraid to push.  She held back every step of the way until finally hours after she arrived her baby was born. Her second child died at birth two years ago – a breech at home who got stuck and no one was there to attend her.  We all felt maybe she was too overwhelmed with the memory of her last baby.  This woman, Irene, was a second wife.  Men here often take more than one wife, sometimes as many as four.  In general the first wife has all the power and each subsequent wife has less and less control over her situation and is often treated even badly.  The first wife attended to Irene with her own baby on her back and was very loving and helpful.  It was obvious she cared for Irene and after the birth lovingly took this child into her arms as we cleaned Irene.
This afternoon this mama and attendant were cooking dinner over the fire.  Irene approached me and asked for something – I thought a spoon by the signs she was making and pointing.  After I got her a spoon she laughed at me and had to walk to the kitchen hut herself.  She wanted salt.  I felt badly and a little embarrassed. .

Saturday, October 6, 2012

Return to Atiak


October 4, 2012
What a journey back from Nairobi.  After a long tiring morning, but with delightful company at the airport and on the plane I arrived in Entebbe. My driver Ali was there to pick me up and we began the long journey to Atiak.  We made a few stops along the way which put us smack in the middle of a riot in Kampala.  The president of Uganda who is not popular and considered corrupt by most of the people had arrested the main speaker for a strike/ rally that was to occur.  The strike continued and the people spoke out.  The police however, were there to stop it.

There we were, in the middle of the city center, in stop dead traffic with shouts and people in the streets, police were everywhere.  All of a sudden not too far in front of us we could hear tear gas canisters being thrown then screaming and crying and within seconds countless people running through the street crying and gasping and fleeing.  It was obviously very close to us and I was so worried that if it got closer to us I wouldn’t be able to breathe.  Ali, my driver, tried to turn around and was making headway going over the curb but everyone else was doing the same thing.  We were stuck.  Then, very very close – gunshots.  They kept going off and more screaming.  Somehow while we were all ducking Ali got us onto another street but it seemed the gunshots kept following us.  He called a friend and got us good directions out of there but it was 10-15 minutes of terror. I called John a couple times during the event, and while I didn’t want to worry him I didn’t want to be alone. I was actually more afraid of the tear gas than the bullets – whether that was reasonable or not. I do not know, but it was how it was.

On the way to Atiak we saw truckload after truckload full of police being sent down to Kampala. It was very sad.  So marks another eventful arrival to Uganda.

I met Paul in Gulu for the rest of the ride home. It was so good to get back and see everyone who I connected with in such a short time. There is a family from Kenya here having their baby here who are delightful.  After meeting them I walked into the clinic to see how everything was going and literally within 3 minutes caught a lovely baby girl.  Then off to bed for much needed sleep.


October 5, 2012
It was a very hot day. So hot I was dizzy every time I had to go into the sun, and the birthing center was stifling with lack of air movement.  We had a lovely baby boy this afternoon to a mother who didn't even speak Acholi which made it more complicated for everyone, not just myself.

I was speaking to Katherine, one of the TBAs and she was telling me of her children – 2 boys and 1 girl.  Then she mentioned she had 2 other sons, one who died very young and one who was taken from their village nearby by the LRA and killed in that terrible massacre.  I cried when she told me.  The history of this place is so easy to forget and yet it is so close it is palpable…


October 6, 2012
I rode out to the village today to pick up a woman in labor.  She met us on the side of the road with her family. I so wanted a photo but did not want to insult anyone – here I am the white girl gawking.  They probably would have been fine with it.  This family was literally in rags.  Herself, her 3 other children, her husband – and covered in dirt.  They seemed concerned and quiet and a bit taken aback by seeing me in the ambulance.  She also did not speak Acholi and there was no communication.  She gave birth within an hour of arriving - a beautiful little girl.  

I used to think women had a way of speaking to each other that transcends language, and that birth especially is universal. Not here.  At least not the way I am used to.   The women don’t make eye contact and seem so beaten down that they would never consider a bit of comfort. You have to be tough to survive here and maybe any comfort is a luxury that would cost more than it is worth. Yet I can still empathize and understand and try to send them my encouragement and reassurance even without language.  Sometimes I feel there is a connection and understanding, mostly I don’t.  At least not until the birth is over.

Let me share a bit about how birth is done here.  Women are often left alone.  I do not know if that is what they want or not, but their lack of eye contact makes me uncomfortable in stepping in and supporting.  Only once has a woman leaned on me and held me and had me rub her back, and I was told that was very unusual.  Not only am I not with them, but no one else either – not their attendant, not the TBAs. They are brought tea and food, but that is all.  They sometimes go and hang out with the other women in the center.  They are encouraged to move around and be in different positions which I suspect is quite unique to this center and is not done in the villages or anywhere else.  For the birth, however, they are expected to lie down.

In many ways it is disheartening to see these women give birth flat on their backs, naked, on a plastic sheet.  Just seeing them so hot and sweaty and lying on that plastic is difficult for me.  No cotton or polyester sheets as the birth center does not have enough and apparently cannot afford to dirty them.  They used to, but not any more. It would be so much more comfortable for them and make clean up that much easier.  Yet that is the culture here and I have decided that my role is to support these women as much as I can and offer the respect they deserve, regardless of how this seems to me. And really, this isn't about the women or culture but about the center itself and how it is run and what the needs are. I do believe that women are treated better here than in the villages and certainly in the hospitals. And they are treated well.   I actually love how the women are birthing and the attendants and midwives are chatting (not me, I just listen and feel very out of place).  It is clear birth is important, but just another part of daily life.  It is not sacred in the way I am used to, but it is not bad either. I often reflect on how we treat birth back in the states and am even more disheartened. At least here, plastic and all, women are endowed with a strength of knowledge that is not education but at the core of their being that is so lacking with the birthing culture in the US today.

After the birth we clean the woman up with whatever material is handy, usually a piece of cloth or clothing.  We wipe her and the plastic down as well as we can but birth is messy and it is not ever enough. Women are not cleaned with water.  Then she lies back on the plastic that is usually still damp and a piece of some sort of material is put next to her to lay the baby on. Sometimes it is large enough to put her body on as well; sometimes not.   The attendant washes all the laundry and makes her food.  She is left alone again for most of her stay, unless her attendant keeps her company.  Most women are staying overnight and leave as soon as they can in the morning after breakfast.  Their attendants sleep on a straw mat in the middle of the big room.  I was told that one night they had so many babies they had the women move to the mats and then had to have women and babies share mats.  Later the women washes from a basin and will bathe their babies as well.  When they leave they are given 2 outfits and a blanket and we ask them to come back for postpartum care.  Most women do not return - the journey is often too long and difficult.


Wednesday, October 3, 2012

Kilimanjaro

Today will probably be my last post for a while.  Internet in Atiak is too slow and to be honest, I actually never figured out how to get it when I was there anyway.  I will keep writing and saving my thoughts so when I do have access I can keep everyone up to date.

I went to Kilimanjaro today - a dream of mine since I was a little girl.  I saw her through the haze and clouds and admit I was disappointed I could not see her in her full glory.  I actually had the audacity to think I deserved to after these last 2 weeks.  But the truth is, I saw the snow caps before they are gone forever, ; I saw elephants and a lion and a hyena and a warthog and all the other animals I saw on my ride through Nairobi National Park.  I am ashamed I let such spectacular beauty be dimmed by petty disappointment. The truth is, I was truly blessed to be there and experience all I did and I am grateful now.  It was a dream come true. And only later, now, do I want to cry with joy at being able to behold her at all.

Ambesoli National Park is stunning.  It is 151 sq. miles of beauty and wonder on the Tanzania border.  Very dusty, in fact there were small funnels of dirt rising in the air everywhere.  It was also very hot and I was grateful I had my safari hat with me.  And did you know it is not Mount Kilimanjaro, but just plain Kilimanjaro (according to my trusty guide Peter who said the English mess everything up)?









I leave for Entebbe, Uganda very early in the morning and will have a long day of riding ahead of me. I hope to get to Atiak by late afternoon/early evening.  I am looking forward to being back there: working, learning, sharing, wondering, taking it all in...I wonder what adventures await, but to be honest, I will be happy with calm and peaceful and even a little boring would be good.

On another note and probably what everyone is following more closely than my silly adventures:  Rachael made it home safe and sound.  What a relief to all of us who love her. 



Tuesday, October 2, 2012

Rachael is going home and a bit of Nairobi


What an ordeal getting Rachael out of here and on her way safely home.  The insurance company insisted on more paperwork that the physician insisted he had filled out.  No one was communicating and I spent last evening trying to get it all together. Finally, paperwork is in and we have a plan, but no itinerary.  I waited and waited for the email with the information and had to get some sleep. I would rest in 20 minute increments then check the email.  Finally, after midnight we received word she is booked on the 3:40am flight.  Not going to happen!  Then they wanted her on the same flight tonight.  I called first thing in the morning and said "No way."  After strongly suggesting to them that making an ill person stay up all night to catch a flight would set her back and possibly lead to more complications, maybe on the flight,  they decided to look for more options.  It ended up that we found a flight on Kayak that was perfect and called them and got them to buy that one.  I wondered if they just didn't want to deal or had absolutely no clue.  Other than that experience however, I was very impressed with FrontierMedex and how quickly they responded to Rachael's needs.  I will definitely recommend them to everyone.

As soon as we knew Rachael's itinerary I was able to plan mine. Many of you know my emotional struggle with returning immediately to Atiak where there is a need, and taking one day to recoup. As it was, my travel agent could not get me on a morning flight tomorrow, just an evening one, which would be too late to drive north. The decision was made for me taking all the angst out of it.  It feels like it is a sign from God and a release.  So...tomorrow Mt. Kilimanjaro - a dream I've had since being a little girl. Thursday early morning flight to Entebbe, Uganda, then a ride to Gulu, then Paul our driver from the birth center will pick me up there. I should be in Atiak by late afternoon. It will feel good to get back. 

At the same time, I do not for one moment feel my time here was not as important and necessary. I was blessed to be in the right place at the right time, and I was blessed to be able to be of service, but mostly, I was blessed to be given such joy in having this woman brought into my life. This whole experience has taught me much about inner strength and resiliency, about protection, about patience, about trust, about empathy, and things I am not even aware of yet. Plus I got to catch a baby in Kenya - how cool is that? :)










In the meantime, I want to describe the bits of Nairobi I've experienced.  The immense beauty mixed with such intense poverty is overwhelming at times.  I had hoped to visit Moffat again today but it is getting too late and I have to get up early.  The people are the nicest people I have ever met, the driving is one of the worst driving I have ever experienced (India may tie).  At night in the hotel when I would return from Rachael I would watch TV.  The television shows are hysterical - they have Spanish and Swahili shows dubbed in English.  But what makes it even more absurd is the voices do not go with the characters at all and there is no tonal differences except when someone is hysterical.  I wish I could post a video here.  Top three commercials:  a cooking oil commercial that I swear borders on porn.  It is shocking!  A commercial in Swahili I think is about finding the right phone plan for your needs - it is a morbidly obese woman (the largest woman I ever saw) on a couch frantically pulling cell phones out from every fold in her body clearly looking for one she cannot find.  The last - a toothpaste commercial that ends "For those who spit blood while brushing their teeth."  I have gotten to know some of the men selling things on the street and have enjoyed my conversations with them.  It has become my little neighborhood here and I will miss it when I leave Thursday.   Actually, I will be gone all day tomorrow so this is really the end of my time wandering.  I will not miss the hospital however!

Today, while driving Rachael to the airport (I do not drive we take a cab) there was a funeral service van that had "Dolphin Friendly" on its door.  I am posting a photo below because I myself couldn't believe it when I saw it.  What is a dolphin friendly funeral?




Monday, October 1, 2012

Free at last!

Rachael was discharged today!  Now she begins the task of resting up and getting better for her long flight home.  She was able to walk more than I thought she should and her appetite was great (the food here is delicious which helps I am sure).  She had some nice outdoors which healed her body and her spirits.  As for me, it was a day of waiting and phone calls and trying to get all the pieces together from two different continents and no one communicating with each other.  We were hoping she would fly home tomorrow and really, there is no reason why she shouldn't. But the insurance company is insisting on even more paperwork and the docs are balking.  I find it much easier to be patient in Atiak where there is quiet and life just is.  In the city here I expect everything to function efficiently.  This is my lesson of the day, patience.  In the meantime I am enjoying this day with Rachael and soaking up every moment I can with her.

Rachael in her happy to be discharged face and drummer pants.  And her new Kenyan shirt that says "Everything is Alright" in Swahili.


Getting some fresh air and sunshine - healing on all levels


And surprise of all surprises, I don't think I did anything today that would embarrass my family.  Maybe a first for me.

Sunday, September 30, 2012

You never know what the day will bring


Rachael continues to improve and I am astounded at how strong she is. She was able to walk the corridor today and jaunt around her room several times. She also had the strength to sit up in the chair a few times.  She still needs lots of rest but it is wonderful to see her get better bit by bit.  Also, she slept great last night without oxygen!!!!   As you can see in the photo, I am trying to pump her up with lots of calories with yummy milkshakes and smoothies.  I finally got her shoes to go home in. The hospital lost hers - I have no idea how as they were always in her room. Oh well.  Mission accomplished. And the other good news - she will be discharged tomorrow!  I can't wait to get her back here to the hotel where we can relax and sit in the shade I can rub her feet and comb her hair.  Yes, I've been doing that in the hospital but it will be so much nicer in the shade by the pool here.  The hotel staff is very excited and wants me to make sure I let them know exactly what time she will arrive so there will be flowers and fruit waiting, a wheelchair if we need it, and whatever special food she desires.  This shows that as hard as it has been, I have been well cared for too.


While Rachael rested (except when I called to check in on her and woke her up), I went with Moffat Osoro to his clinic and birth center in a very impoverished section of Nairobi.  You can find it on Facebook:  FreMo Medical and Birth Centre.  I was given a tour and was quite impressed with what he has created. The rooms were simple yet well stocked, the facility was neat and clean and had a lovely courtyard.  He has been given a lot of help by donors and especially by Vicki Chan, a midwife from Australia.































Note the awesome scarf used for hanging.





While I was there there was a woman in early labor and then 3 other women showed up.
I helped a bit and was blessed to welcome baby Nicole into this world.  She is quite a cutie.


As I write this I am in my hotel room listening to the Islamic Call to Prayer ringing through the neighborhood. The cars outside are slowing, night is falling.  There is a hustle and bustle I am not used to.  I am beginning to love Nairobi. Even the slums have a simplicity and beauty within all the chaos.  I know that sounds strange, but it is true.  Maybe it is the humanness of it all - raw as it can be.
Oh, and did I mention I saw a three legged goat today?

Saturday, September 29, 2012

Out of the city for a bit

 Rachael continues to improve, but very slowly.  She walked around her room twice today and sat in the chair for a few minutes each time.  That is twice as much as yesterday!  She is still having a hard time eating, but given how sick she was an all the medication she has been on and still continues to be on, it is not surprising.  She does like chocolate milkshakes, however, and I will make sure she has gallons of it.  Yesterday she tried Ensure and it actually didn't taste too bad.  

It is astounding how terrible the hospital food is. Last night I thought she had chicken with a sauce over it - it was actually pizza.  Even as chicken it looked inedible.   Her lungs are much improved and she has only needed oxygen a bit, and that is when lying down.  We are still hopeful she will discharged soon and that a flight can be arranged soon after that.  It is beginning to settle in that she is really going home and as absolutely happy as I am about that, selfishly, I have to say it breaks my heart to have to say good-bye. 



I took the morning as Rachael rested to get out of the city and visit Nairobi National Park.  It was so beautiful and I felt like I was on safari. I even bought a safari hat so I would look good to the animals.  It was  very healing to spend some time outdoors surrounded by grass and trees and life.  Not the hustle and bustle of this big city.  It ended up I had my own private tour guide who amazed me with his keen eyesight and knowledge.  We saw: hippos, tortoises, monkeys, antelope, buffalo, impalas, zebras, rhinoceroses (or to Beorn - goats), giraffes, ostriches, vultures, other birds, some other kind of little animal...The really cool part, as we came on other tour trucks we would stop and talk to find out where everything was and no one had seen anything!  My driver Charles said it was because I was good and the animals knew it and wanted to see me.  I found that funny.  He also said "Hakuna matata" which made me miss my little boys so very much and I broke into song.
Laurelism of the day: On the tour I was trying to scope out the horizon looking for animals.  I was very excited because far off on the Masai land there were lots of white - zebras!  I tried pointing and telling and getting more and more excited and animated and then Charles said "Um, actually, those are cows."  It was far away.

Friday, September 28, 2012

A little better - there is hope

Rachael continues to improve slowly.  She was able to talk via skype and on the phone and have moments of being very chipper.  She still needs a lot of rest, however, and is very very weak.  She walked to a chair today and had a few minutes where she was able to sit up.   I hope to post photos soon of our afternoon trying to make some order of her very gnarly, knotty, dreadlocked hair.  It took a while but we did it.
We are hoping she will be discharged Monday and be able to go home soon after that.  Her malaria is gone, her pneumonia is improving, and her colour is much better.
Being in the hospital she does not get much sleep, but hopefully they will leave her alone tonight.  Tomorrow I am going to work on getting more calories into her.  The restaurant at the hotel is amazing and everyone here is very concerned about her.  I will have them whip her up some yummy protein shakes.
I can't begin to share how absolutely friendly everyone is here.  So very polite, helpful, kind...The hotel staff asked if they could visit Rachael and send flowers.  The security guards ask about her, even the telephone people who I have spent a lot of time with lately trying to get phone and internet gave her a modem to use and sent her a note.  I can't wait to see more than this little neighborhood and experience how incredible this country is.
My faux pas today:  I went shopping to get some sneakers which I will need soon if I go to Mt. Kilimanjaro or even if I check out the Nairobi Park, and some clothes - just a pair of shorts and a tshirt.  I've been wearing Rachael's which are beautiful but I didn't pack anything that matches and I look ridiculous.  Rachael also needed a few things.  There was a sale on shoes and I found a pair that may not be too uncomfortable for only $14 (listed in Kenyan Shillings). I was so excited.  Then on the cab ride home I realized it was actually $140.  At least they are really good shoes!

Thursday, September 27, 2012

Life is such a mystery


I don’t even know what day it is. I think it may be the September 26, or is it the 27th?  It has been a journey.  Rachael is getting better slowly, but not without a constant battle with the healthcare system here.  It wasn’t until this afternoon that I really felt I could relax and breathe and know that the road ahead will be rough for her, but she will be ok. 
The outpouring of support and love from everyone on Facebook (God I love Facebook!) is almost too much.  I am humbled and grateful and so very blessed to have been here for her, but also that she came into my life.  I have no doubt this is the daughter I never had (sorry Thor, you lost your title) and could not love her more than my own biological urchins.
And the connections!  I called John the other night when I was very worried.  Matt Greenberg, a doc in the ER who John actually knew in Bethel, AK, was on and they researched and thought and helped so much. Matt has a friend who was also in Bethel who happened to be in Sudan and specializes in tropical medicine. Matt gave John her information and was in contact with her until I could be. Then, to make it more amazing she happened to be in Nairobi! Jill Seaman is my new hero!  She offered advice, support, love, and even offered to cancel her flight back to Sudan if I needed her.  She checked in this evening so we could discuss Rachael's treatment and will be calling in the morning after doing some research.




I have been amazed at Rachael's smile and laughter these days.  Her strength is astounding.  We hope she will quickly recover and be able to go home within a few days (with a medical escort).  I will miss her terribly, but cannot wait to see her actually have the strength to walk again.
And the Laurelism of the day?:  I was wearing Rachael's sarong as a skirt and after getting yelled at by the doc was told I had a call from the embassy. I knew I was being kicked out of the country!  I walked through the ward full of people and my skirt fell off - totally onto the floor.  It was humiliating to say the least. The good news is it was the evacuation insurance people wanting to check on Rachael's condition and let me know the options.  
I have decided that once she leaves I will need a day or two to process and relax and try to figure out what happened.?!  It seems like some strange dream and I can’t seem to connect parts of my life anymore.  When skypeing with the boys this morning I saw our living room, and it just didn’t make sense.  I can’t explain it.  So, I will relax and maybe take a journey to see Mt. Kilimanjaro – a dream I have had since a young child.  Who knows?
Then, back to Atiak – which I do miss.  I felt one of the most profound connections with that place and the work there.

Rachael and oh the places we shall go!


September 24, 2012
Rachael is very sick with malaria.  At first we thought it might be her antiretroviral medication she is taking after a finger stick.  We did test her with a rapid malaria test 2 days ago but it was negative, making me wonder about the accuracy of these tests.  I am very worried about her.  We went into Gulu today to have her test for malaria and typhoid, do the marketing and try to get me some internet time.  She proceeded to get worse even though she rallied for a bit yesterday and this morning and I got a message at the coffee shop that I needed to go to the hospital immediately.  After she took the antimalarial she started to have facial swelling to add to all the aches, pains, high fever, nausea…I am very worried about her but glad I am here to care for her.
She opted to come home to Atiak given the care at the hospital was less than she could here.  We had to provide food and water, they wouldn’t give adequate fluids even though she was clearly dehydrated, and they didn’t even have the medication they said she needed.  And this is the good hospital.

Taking care of Rachael:


Rachael is an absolutely wonderful 23 year old midwifery student (though at this point she is a midwife in every way except licensing) from West Virginia. I was very lucky to get her for a hut mate.  She is gorgeous, fun, intelligent, adventurous and just practically perfect in every way.  She began her midwifery training after living in New Zealand for 2 years and has practiced in the Philippines and Trinidad and Tobago.  I am in love with her.
Midwife Rachael and Stewart, our cook Nitey's son











Midwife Rachael earlier this summer after an amazing night of babies!



September 25th, 2012

 It has been an overwhelming day and I am so very very tired.  I am not sure where to begin and though I need sleep more than anything, I am waiting for food and will take the time to tell this strange story.  I am sure it will make more sense if you start later, but this is where I am now.
As I write I am in Nairobi, Kenya.  Not anyplace I expected to be on this trip.
I spent last night checking Rachael every hour. She slept well and after adequate fluids she actually seemed to be getting better. I was concerned about some findings and called John and he and a MD at CVMC researched and looked up and even found a physician in Southern Sudan if we needed.  I did a thorough examination and felt that she had not worsened since leaving Gulu. In the morning her fever was gone and she said she felt weak and in pain, but better.  But when I looked at her it was clear she was not – she was jaundiced and when she tried to stand she could not. We decided then to take her to Kampala to the hospital there hoping for better care. However, in the hour it took to arrange everything she got much worse and we arranged for her to be flown out of the country. But first we needed to get back to Gulu hospital where the medivac people would arrange it.  We somehow got another IV in and got on the road. Our amazing driver Paul sped and got there in record time – a little over 2 hours. I can’t even begin to describe the conditions of these roads and how often the ambulance/truck breaks down and all the other things that happen.  The whole time I had to squeeze the IV bag to get even drops of fluid in. In the meantime, her dear friend (somewhere in the Middle East I think) arranged the medivac out.
I was scared, very scared.  The journey was difficult for her and her fever was worsening.  It took hours in the hospital for the air ambulance to arrive to Gulu but finally she was on the flight, and me with her to make sure she was safe and had someone there with her. What a relief to get her with adequate medical care. By the time we left I was very worried about her condition and lab results. She rallied on the plane and by the time we reached Nairobi Hospital she seemed much better – she was able to sit up somewhat and actually smile. 


I can’t even begin to tell you how worried I am.  Her original diagnosis of malaria may be true, but too many other things are going on and they are doing further diagnostics. I feel she is much safer here, but I worry that she will get worse.
As I write this, it is after midnight and I am eating my first meal of the day. I am actually in a pretty nice hotel across the street from the hospital, room service just arrived, and there are flush toilets and a real shower.  I packed only a few things – Uganda clothes at that.
I will meet with the doctor tomorrow morning early to discuss the results of all the tests and x-rays and ultrasounds.
I forgot to mention how the first thing I did on arrival in Kenya was insult the police.  I left the air ambulance with our passports to get them stamped at immigration while they got Rachael in the other ambulance.  But immigration was not there and we could not leave the airport without our stamp.  They insisted we leave our passports with them and I pick them up tomorrow and I freaked.  It was just too much.  I actually said something about 3rd world countries and passports and corrupt police and really I was just scared.  I had no choice however and after apologizing a zillion times and explaining how tired and stressed I was I hope they understood. They did not seem happy with me, but said they did understand my concerns.  The medivac people advocated to no avail as well but it was agreed the passports would be delivered to me.  In addition, they booked my room and took very good care of both of us.
I will try to post this tonight but it may take a while for me to figure out the internet.
Wish Rachael well. I will be staying with her until she is on the plane back home to West Virginia. Hopefully it will be only a few days, then back to Atiak.


Second day - have I really only been here 2 days????


September 23, 2012
Today is my second day and it has been calmer.  There were some issues at the center and two of our midwives left (one student who just arrived 1 day before me but is just too overwhelmed, and one awesome midwife who I am really confused about – we need the help but it is administrative issues – politics even here uggh!!!!).  I was very sad and overwhelmed and Midwife Rachael is still sick but no one came in today and labor and I discharged my birth from last night – a very very long hard birth with 5 hours of pushing an acyclytic head but she did it. Sometimes running outside into the night with the thunder and lightning to run and roll on the ground in the most basic core of our being birthing ways.  It was astounding and lovely to watch but the traditional midwife here and her attendant did not like it at all. To be honest, that baby would not have turned at all and would not have been born if she hadn’t done what she did.  The baby crashed at the end and I had to resuscitate right at the birth – but no ambu bag to be found.  The mom was 18 and her first baby and had prenatal care so we knew she had been HIV negative months earlier.  Without thinking  and because I had to, I wiped off his face and started mouth to mouth and compressions.  I only puffed and wiped my lips off good after, but then got so worried I did the only thing I could think of – I gargled in hand santizer!
He sort of came around slowly and was very gunky and to be honest I did not know if he would survive the night.  But his eyes were open, his heart was strong and he was trying to breath.  When I awoke the next morning I immediately checked on him and he was strong and crying and lovely.  I then learned the TBAs (traditional birth attendants) do not resuscitate.  If they had taken the time and gotten one of the other midwives it would have been too late.  He would have died.  I feel in many ways my purpose is complete. I go forward imagining and knowing he will do great things (and just pray he is not one of the 50% that will die before his 5th birthday). Again I am overwhelmed and humbled and know I am where I am supposed to be.

We had been short on interpreters for a variety of reason but they are back now and I had the most delightful lunch of rice and guacamole and cabbage and good, fun company.  All meals are outside; food is cooked over charcoal or the fire.  There are chickens but I will get a stick. I am stronger than I think it appears!

As I write this I am trying to charge my computer. I still do not have internet but Midwife Rachael  (who is my hut mate and awesome and I will write about later) and I will go into Gulu in a few days for supplies and get internet and phone time as well.  The TBAs are awesome and will care for these mama’s and while I feel worried at how short staffed we are I also feel that it is how it is.  My nebulizer finally arrived this morning and so far so good.  I trusted it would arrive sometime but was not surprised it took an extra day.  Africa time is what it is and there is no rush.  I have learned more patience in the last 2 days than my last 45 years. Carmella the TBA today will take all labors and I will sleep.  If I don’t keep  waking up to go outside and look at the stars – so very amazing and awe inspiring.  

Midwife Rachael

Carmella, on of our traditional birth attendants

Rachael's and my hut


View from my shower, pretty sweet!


Our ambulance, sadly this is with Rachael waiting for her flight and Paul our wonderful driver.  This did not happen then but are the best photos to show what it is like




So concludes my second 24 hours. It would be perfect if all my boys were here.  2 days and it feels like a month or lifetime or that I have always been here – though I have so much to learn about how things work!  It is good, and very very very difficult.

Arriving and first day


Where do I even begin…The flight?  I left Burlington September 19th and arrived in Entebbe, Uganda 24 hours later.  It was fine, exhausting, 20 hours in the air and very interesting people.  They had made a mistake with my reservation and I did not get a window seat during the day flying over Africa.  I got up and walked around and tried to peak out other’s windows unobtrusively to see my first viewing of this amazing Continent. Finally, one man who kept waking up when I would try to sneak a peak while he appeared to be sleeping invited me to have his seat and he took the one next to it.  It turns out he was a 22year old man who goes to school in Burlington Vermont and lives a few blocks away from Wolfie. He was delightful and heading to Sudan to teach English for a few months.  I enjoyed his company and his stories and it felt good to give him my phone so he could call his mother when he arrived.

I wasn’t sure who was going to meet me or if indeed they would. For some reason I felt really calm about it. I had met two people heading to Western Uganda and then the Congo – one was a meteorologist and one was a medical anthropologist. Both were working for the CDC studying the plague and weather influences. It was decided that if no one was there for me I would go to their hotel and figure it out in the morning. At the very least I could hire a driver to take me up north.  As it was I walked off the plane to the most amazing crescent moon – I don’t know why it seemed different but it was.  After getting my visa I was pleasantly surprised to find I did not have to go through customs – that definitely relieved a lot of my worries about all the medications and herbs I was bringing.  Then, there he was, a wonderful man holding a sign with my name.  I immediately liked him and his brother.

Ali, the driver was gentle and kind and Suma his brother, a medical doctor, were sweet and helpful and very polite and concerned about my comfort.  They asked if we could please stop at the hospital – their cousin who is 21 weeks pregnant was being discharged (at midnight – she had been waiting for a ride all day) after being treated for a bladder infection.  Charity waddled to the car and immediately I could tell she was very very sick.  After trying to get information about her symptoms and treatment I rummaged through my bag and got her the best antibiotics I could spare that may hopefully help.  I feared she had a true kidney infection, not a UTI, and needed IV antibiotics.  The good news, 2 days later she is doing much better.  So, I wasn’t even in the country for 1 hour and already I was being put to work!

Going to her home was fascinating. In the dark on these wild streets, the shacks, the noise, the parties, the fires, the children, the police stops. Tired as I was I just took it all in. Then we arrived on a road so rural it made Vermont’s mud season roads seem like new highways.  She lived right on Lake Victoria surrounded by banana trees and I could only get glimpses in the dark.

I made it to my hotel in Kampala, one close to where Ali “sleeps” and was surprised at how calm I was. No running water, very hot, I couldn’t find an electric outlet, the most beautiful views and the nicest people. So, at around 1:30 am I tried to go to sleep.

September 21, 2012

The next day I awoke and went and had breakfast – samosas and hot milk with sugar.  It was so delicious and simple.  We left on the long journey and again I took in the sights, this time during the day.  Ali and his cousin drove me the 7 ½ hours to Atiak and told me much of Uganda’s recent history and their views on politics and religion and everything we could think of. They introduced me to “yellow.”  They are bananas in all ways except the taste – oh my, the aftertaste was the most delicious orangey yumminess ever.  We lunched on them as we drove up.  As we passed the Nile River (I couldn’t take photos as guards were there and it was forbidden) there were lots of baboons on the side of the road.  They stopped so I could just watch and laugh.  














As we got further north the infrastructure changed to smaller villages and again, roads that were shocking even to me.  The 40 mile ride from Gulu to Atiak takes 3 hours you have to go so slow. I loved watching all the schools and children and naked boys trying to cool off in streams.

When I arrived in the birthing center compound I felt immediately at home. I was in awe and a bit overwhelmed, but at home all at the same time. It is very beautiful and so primitive and simple and yet so intricate in the details.  I met everyone who was here and all were very welcoming.  I took a tour of the grounds and wished I had brought my boys – children are everywhere and very welcome.  I decided to do my nebulizer and had my adapter handy and then proceeded to blow it up. I didn’t realize I needed an inverter (which for some reason I think is blown up it self now but that is another day and story).  Not a good start but I was able to order one from Kampala which would be driven to Gulu then brought up by boda boda (motorcycle taxi) hopefully the next evening.  Then, after a delicious meal of rice and beans the work began.  1 labor came in then 3 calls within 1 minute.  I hadn’t unpacked and I was busy and happy. 


The first woman I cared for was having her 8th baby. She just arrived in labor and was struggling.  She was scarred deeply on her chest and I was told it was from the LRA.  At a young age she had been abducted and had her first children with them.  It was heartbreaking at my core, I cannot imagine such suffering.  She had a difficult birth but the most beautiful little (big!) girl.  She wanted to name her Laureli but I felt so unworthy and overwhelmed I laughed and said “no no no!”  She kept insisting but then I said, name the baby in the morning.  In the morning she asked me to name the baby Laureli or give her a name and I chose Beatrice. I was told it was an honor for them for us to name the baby. In retrospect, maybe I should have agreed to Laureli but it felt just too big and I had only been there a few hours. 

Lillian and baby Beatrice:




Within 30 minutes of her birth another woman had a lovely baby boy in the caul.  He had the thickest bag I had ever experienced and at first I couldn’t even imagine what it was.  The next morning a woman on her 7th baby walked in and delivered within minutes, another boy, another beautiful baby and mama. Midwife Amy caught that baby and we helped lift her off the floor as she was practically sitting on his head it happened so fast.

Each woman hopefully has an attendant, usually her mother or a family member – someone to help feed them then wash all the laundry after.  The woman are not given much support and indeed it is hard to support them the way we do in the States – they are very quiet and do not make eye contact and they do not speak English and they appear uncomfortable around us.  The attendant is in the room for the birth and is very helpful. After, they go to the fire and boil water and wash all the sheets and towels from the birth and prepare food.

I had only a few hours sleep and was tired.  Soon another woman walked in, alone.  She was 15 years old and had no prenatal care. She was obviously very very sick and was delirious. With the limited interpreter we had we determined she was almost 38 weeks and was contracting. She was terrified and traumatized and we later learned she had been raped. Her family had kicked her out of her home and the father’s family did not want the responsibility but now it was a police matter – not about the rape but about if they would have to take care of her.  But her vital signs were not good and her blood pressure was scary  (at one point 225/110) and we had no urine sticks to test for protein.  Was it preeclampsia or HELLP?  Was it an infection (UTI or kidney, chorioamnitis)? Was it malaria?  Was it rabies (she actually did start foaming at the mouth)?  She clearly needed to go to the hospital but she did not have an attendant and they will not allow you in without one as the attendant feeds and cares for you.  OK, so one of us 4 could go but we were very busy and 2 are students and one was very sick herself.   We really couldn’t spare anyone yet we were worried she would die soon.  Truly that is what was going on with her condition.
How to get the blood pressure down even temporarily?  We got meds from the local pharmacy which did help initially but she was still sick and delirious and scared and her labor was getting stronger.  But, first problem hopefully solved until we could work out the rest.  Next the attendant issue.  As a miracle someone found her grandfather in town who was at the police with the father of the baby’s family.  They agreed to set aside all differences to hopefully save her and the baby’s life and one of them became an attendant. Again, no regard to her emotional state regarding this family or the conception of her child, but I was grateful someone would go. Just in time.  Midwife Rachael agreed to go on the transport even though she was ill and of course the truck broke down and then Consey’s blood pressure started to get even higher and then Rachael started vomiting.  Yikes!  But they finally made it and dropped her off and hopefully she will be ok.  They don’t always have physicians or medication at the hospitals, but this one was better than most.

That concludes my first 24 hours at the birthing center.

Wednesday, September 19, 2012

On my way!

210 pounds of bags later and I am on my way.  I can't believe how easy it was getting through security but it just validates that this is meant to be.  The person checking in my bags was encouraging me to pack more books even though it would put the checked in bags overweight so I wouldn't have to carry them, the security people helped me unpack and load up everything and did not give me a hard time about my 2 huge carry ons, no lines, everyone was friendly and curious about what I was doing and wished me well.  And the salad I bought is actually fresh and delicious.

I am excited and nervous. I miss my boys already but feel  confident they will do well and have a great time which makes it easier to leave them. Plus, they are with those who love them as much as I do and that feels perfect.

Until I post again...
Oh, and check out my newest Uganda haircut.  I kept trying to keep it longer but decided simple is better. I like simple.


Tuesday, September 18, 2012

All packed and ready to go!


Each bag weighs 50 pounds and I am taking 3 of them, plus 2 packed to the brim carry-ons (the black and red bags laying down), plus my "personal bag."  I just hope the airport scale is as forgiving as ours.  I also hope they have good carts in Entebbe - there is no way I will be able to navigate through customs with all this stuff.  Thank goodness for wheels!
Until I am able to post again - Dong maber (Acholi for "stay well" I think).

Please also check out Mother Health International: www.motherhealthinternational.org to see where I will be traveling and the work I will be doing.

Sunday, September 16, 2012

Thank you!

Thank you to all the people: family, friends, and even strangers who have offered their support as I embark on this remarkable journey.  I am astounded at the generosity of this community near and far.

 As I reflect on the last 5 short weeks and how easily it has come together with such short notice, I am convinced this venture is necessary and will lead me further on this path which is my life. I only hope I am worthy of the task ahead and can serve humbly and with enough skill to make a positive difference.

I have often hesitated and questioned the wisdom of doing this, especially with regards to my own health.  It is daunting to go so far away when in the safety and comfort of my own home it can be difficult and frightening when I fall ill so violently and quickly.  I have a strict regime in place that will help, good medication, and faith that this is where I am supposed to be so therefore it will be fine.  To some this may sound naive, but I believe we all have a purpose and this is part of mine - I have no doubt in this regard. I go forward knowing that with my own good judgement and skills I will be protected.  For those who are worried about me, I hope this allays some of your fears. If not, continue to send your blessings - to me and the families I will serve, and that should make a difference too.

I have named the site Midwife Pilgrim and it seems appropriate. I am a midwife first, pilgrim second on this journey.  But in many ways it is the other way around.  I am traveling, searching for the sacred, finding my home which is always within oneself.  Quoting one of the early pilgrims: "But now we are all in all places strangers and pilgrims, travelers and sojourners, most properly, having no dwelling but in this earthen tabernacle; our dwelling is but a wandering, and our abiding but as a fleeting, and in a word our home is nowhere, but in the heavens."  ~ Robert Cushman    

I will try to post regularly but have no idea how the internet situation is.  Something about 3G and cell phone something or another and little thingys you plug into your computer and very slow if it works at all.  If I can't log on and post I will still write often and post everything when I return.

I have almost completed packing (photo of my huge bags to come soon!), and if I can just relax and try not to think of the zillion little things that can still be done, I will be alright.