Catching up... Around the Island

So on my last Tuesday in town we (M the NZ student midwife, V the British tourist, and myself) decided to go exploring together by taking a rental car and drive around the island. The total distance is approx 160km or 100 miles. The rental car was a funny little Daihatsu "I wish I were a 4wd" mini SUV, but it had the high clearance that is necessary to safely make it on some of the unsealed roads. So M and I started by heading over to p/u V at his resort which was outside of town on the number 2 lagoon (or Emtem) on the NE side of town. We then set out heading SE on the main road around the island, this was unfortunately a mistake as we forgot to head to the market to pack our pick-nick, and we were to find that there were very few places to stop and eat along this side of the island.




We decided to take a offshoot unpaved road south to visit the white sands beach area, Tamanu, and hopefully find a nice spot for lunch. The road was quite bumpy and brought me back to being a kid a driving around the high dessert area in California to visit my cousins. My travel-mates complimented my driving and were happy to let me stay behind the wheel as it was a manual transmission and they drive on the right side of the road in Vanuatu (in NZ and Britain they both drive on the left.) We saw what looked like an abandoned resort and stopped for some pictures. We then stopped at a place in White Sands and they had a swimming hole and the main tourist attraction was turtles- they wanted 2000vt (US $20) per person to see them.











We all made faces and the guy lowered it to 1500vt, but we all agreed it was still too much, we decided to head to the bar for a soda (200vt/$2 each) and to enjoy the view. We were all getting quite hungry by this time so decided to head out, we continued on the unpaved road which was now running east along the ocean and stopped at Beachcomber resort for some very expensive mediocre food. There was a 3 piece band that started playing as soon as we walked up (with a donation sign of course.) They played a lot of pop rock in the traditional string band style of the island which is related to Reggae. It was quite amusing. The resort was known for it's natural hot springs on the ocean shore, but funny enough the inside one was empty and but there was a large swimming pool that overlooked the beach.





We then headed back on the unpaved road north back to the main highway around the island. It was stunning, to our right was the ocean and the left was bush (jungle) filled with Banyan trees, and covered in vines. We passed through sporadic traditional villages, where the people would stop smile and wave at us, skinny dogs would try to jump in front of the car, and pig's & chickens would run for cover.











We also saw many Ni-Van construction crews who were working on sealing the road around the island. We didn't stop much along the road back towards Port Vila, just pulled over for the occasional photo-op's. We were also hoping to stop at the cascades in Mele which is on the north side of the island near town and wanted to get there before dusk (5pm) came and with it the increase in mosquitoes.









We enjoyed our AC and kept driving when we got to North Efate the roads became quite hilly and curvy... and the little Daihatsu complained as I had to down shift into 1st gear to get up the hills- I think I can, I think I can- but it made it. Unfortunately we didn't make it to Mele until dusk so we decided to pass on visiting the falls as it is known for it's hungry insects. We did enjoy seeing the locals walking home from work or outings as we swooped back SE on the road back to Port Vila in time to see the sun starting to settle lower in the sky. We decided to head to Erakor lagoon before heading back to our hotel for some supper.

technical difficulties

I'm trying to recover my iPhoto library which is now coming up as empty. I have many of my Vanuatu photo's saved elsewhere but I am still frustrated. Will post what i recover soon.

23 babies

So I tallied up my numbers yesterday and I have done 23 births in 2 weeks at Vila Central hospital. Definitely more boys. I have sutured about 5 times, helped a few women avoid episiotomies, managed 12 births with little more than a nod from the staff midwives, consulted the OB's, and given loads of women loving care with mostly non-verbal communication. I am so happy I have come. It has definitely been worth the expense. In the next few days I will say my good byes with lovely homemade meals and get more photos posted.
As for today we are taking a car to go and explore the island so I'm off. More later.

More babies, most of them boys...

4-11-09
More babies, most of them boys. The hospital is going great, did a tour on Friday of all of the different wards with an Ausie nurse who is teaching in the Vanuatu Nursing program. Managed a few births of which I had 4 of said nursing students as observers, and one just about hit the floor. Poor girl I just saw her white as a ghost start to slide down the wall, but my hands were quite busy with baby catching & placenta delivery. I had more opportunity to suture, which I still find distasteful, but I am feeling much more adequate at doing it.

I rushed out of the hospital on Friday to try and catch a few “Couch Surfers” (online travel community) at a bar in town for happy hour but the rain caused delays and I was ½ hour late and they were no where to be found. I wandered to the open market and then got a bus up to the hotel. When I arrived there was quite a lot of cooking going on in the “baby doc lounge” and it was not anyone I had met so far. Turns out a bunch of Peace Corps were in town for the weekend and were bunking up at good old Coconut Palms… they were also having a feast night with Porto Rican food. They invited me to join, which I of course did. It was great having a bunch of Americans to chat with over great food.

Saturday I spent most of the day at the hotel doing homework, then jumped in the pool at 4pm and stayed in until the sun was setting. I didn’t go to the hospital which was weird, but figured I deserved a day off- too bad I wasn’t out enjoying it but did homework. I still have lots to do and unfortunately some of it I can’t do here because my books didn’t arrive in time to bring them with me and I have had internet challenges.

Today (Sunday) we (NZ SMW & Brit from plane) were hoping to head out in a rental car around the island but they cars were all booked so we will do it on Tuesday instead. So Meg & I sat about talking and then wandered down to town, which unfortunately we forgot it was Sunday, it was deserted.

So after making some dinner decided to head into the hospital for the evening. It was a good night, I observed a cesarean section, and then caught a baby from a 1st time mama that was very young (her chart said 13yo, but the docs and I think she is more like 16yo). Her labor went great, but in postpartum she had a cervical prolapse (meaning the cervix protruded from the vaginal opening. It was very shocking to have that happen on someone so young. She had obviously been through some serious abuse in her short life. I then headed home to the hotel and passed out while writing this blog.

More rain...

Let see if I can catch you all up…sorry I haven’t written much, without free internet and with companionship I am opening the laptop less.

My experience at he hospital is going well. The 2 babies I had written about in my last post, the one with the tongue-tie has yet to have been clipped but I did make his mama a syringe nipple extractor, as there are no breast pumps available. With this tool she has been able to express colostrom and get the baby to the breast a bit more, he still does not suck well but with a nipple shield and spoon-feeding he is becoming more active & awake. His sweet mama is become quite my fan, and has even asked to stay in touch via the internet. She was still at the hospital as of last night (day 4 postpartum), and may be heading home today. I still think the baby should have the frenulum clipped but the doctors seem to feel that it will be fine, they say they don’t do that here. The other primip mama I was concerned about, baby did develop jaundice and need to be treated with billi-lights, but has since gone home.



The labor ward has been pretty quiet since Sunday, we have had a few C-sections, a few born before arrival (BBA), and I have caught 1 and assisted with a vacuum extraction. There was one more fetal demise, for which I was not present, the baby crashed and mama was rushed, as quickly as possible in Vila to have a cesarean, but it was already too late. The mama that had the breech demise came in to have her tubes tied but I was not present. I hope she is coping well with her loss. I ended up working quite a bit with the intern doctor who handled the breech, and it has been hard on me. I am moving on but still feel the loss deeply. I know that I am doing a lot of good here and that it wasn’t really my fault but I still wish I could change it. Yesterday I stopped the midwives from cutting 2 episiotomies, for which I did a little dance of success. The midwife said she finds them easier to repair and I passed on the wisdom that I have been trained about that if you put two pieces of perineum together they will heal. Both women had mild 2nd degree’s that needed very little suturing.

The new hotel is going quite well. I am enjoying having company and the “Baby Doc lounge” is a nice place to prepare meals and socialize with my fellow New Zealand student midwife. Yesterday was lovely but rainy, we went down to the market and had lunch with the locals, and then M and wandered down the water-front with plans of heading to the arts 7 craft market area to do some tourist shopping, but ran into some friends (another intern & the brit from my plane) and didn't make it. We stood about talking for a good hour before wandering down the road to show the brit the yummy sandwich place(for his lunch) and M and myself got ice cream cones. We made tentative plans to rent a car for the 3 of us to head out and explore the island, and parted ways.

Today we had the other volunteer NZ Midwife Christine over for lunch, I made a coconut curry with eggplant and the mystery greens served it over ginger rice. It was great to have time to debrief with an experienced midwife who practices similar to those of us in the US. Then I did some laundry, which with luck will be dry tomorrow, since the rains just don't seem to want to stop for much time though it is supposedly the dry season it continues to be quite wet. Unfortunately it’s not too great for getting out and doing stuff. I will likely head into the hospital soon to see if any mama’s are ready to have babies, if not I‘ll prep supplies & clean.

Tomorrow I plan to meet with some "couch surfers" (online web community of travelers) at a local bar for happy hour. That's it for now.

Later on easter night

4-4-10 5pm

Trip to the hospital went well. I missed a lot of mamas & babies as most had already gone home. It could be the midwives took pity and let them go early as it is Easter. There were still a few of my babies there that needed a little more help. One was my 2nd catch from yesterday they kept her because she hadn’t pooped- oops that was my fault. I showed them how to do belly massage & bicycle to help with belly fussiness but also checked her chart to make sure I was remembering correctly, this little girl had pooped right after she was born all over her mama, and I didn’t chart it. I’ve gotten so lax at charting over here, they really chart so little but terminal meconium will not be left off one of my charts again. They also asked to name the baby Adrianna for me. That’s actually two baby girls born yesterday that will be named for me, what an honor.

I then went on to check in with the other mama’s whom were still there … One was still in because her little boy had yet to breastfeed, I had helped in her care early when she was admitted but she didn’t have her baby while I was there. I worked with her for about 20 minutes, I really think the baby is tongue tied, which when the baby’s frenulum is too short which prevents the baby from sticking out its tongue and often causes them not to nurse/ or nurse well. In the US this is often corrected by snip the tissue with surgical scissors, it’s quick and baby usually nurses immediately after & recovers quickly. Fortunately the pediatrician was in the ward so asked her to evaluate and talked to her about the procedure. I don’t think it is something they do over there, but I hope they do it. His mama is worried about him not going titi, as they call breastfeeding, and there is really nothing to lose. The doctor seemed sympathetic so I am hopeful, she may ask another doctor their opinion. If a different midwife had been on I may have talked to her about doing the procedure.

Next was one of my last mama’s it was her first baby and I am worried that she will not breastfeed often enough. I do feel for her though as she is probably quite sore, she was bleeding heavily and I was afraid she had a cervical tear since in Vila we practice active-management with pitocin (syntocin), and then they get a dose of methergine, so post-partum hemorrhage is very rare. The doc checked her with retractors to hold back the walls of the vagina, and after a 10 minute evaluation announced that it was just uterine bleeding. So she then got an IV drip of syntocin over the next few hours. Her baby was nursing fine but had a shallow latch, I showed her how to help encourage a better latch and how to take him off when he stops, but all in all I’m afraid she’ll have a lot of nipple pain.

So as it turns out I went to the hospital for baby checks, I was there for just over and hour. I escaped without getting wrapped up in admitting or catching babies. I’m proud of myself, as that is a challenge.

I then came back to my superior room at the Coconut Palms Resort, relishing in the air conditioning, and the mindlessness of cable tv. I proceeded to fall asleep for that nap I needed. I had planned to wake and splurge on dinner downstairs in the restaurant. The hours posted in the room were 6-10pm, but when I arrived at 9pm they had stopped serving, so back to my room for curried rice & lentils.

The entrance to the maternity ward- and me.

One of my Saturday Mama's


"Baby Adrianna with her sweet mama"

"And my sweet little toungue-tied boy- named Jaden"

The superior room- my easter treat!

4-4-10 2pm

I arrived at the new hotel, which is a modest resort, but they cater to you more here. I was greeted with a nice cold glass of orange juice, which reminded me that I left my nalgene water bottle in the refrigerator at my old motel- so now I must remember to go and pick it up tomorrow. It’s nice to see other travelers. Though my old hotel was nice enough, it was not on the tourist destination list. I felt I was the only expart there, it was mostly occupied by Ni-Van and the Ni-Van hotel staff. There is also a pool here, which I plan on getting into as it is not surprisingly very hot out today.

For tonight I have their ‘Superior room” which includes air conditioning, which is heavenly, a private bathroom, and a balcony- Happy Easter to me. Tomorrow I will move to the shared rooms- which are nice but more like a hostel/dormitory like. I requested to be roomed with the New Zealand Student midwife that is also at Vila Central hospital.

My plan for today is to settle in for a bit then walk to the hospital and get baby & mama pictures from yesterdays births, as they will all be discharged home by this evening, assuming everyone is doing well. Then when I return I will likely nap & enjoy the rest of the day in the a/c.