Hi Folks,

I'm going to start this post with a question...Why is there always ONE mosquito that finds its way into the net at night??? In spite of my nightly ritual of netting the bed before the mozzies come out to play, there always seems to be one little pest that makes it in. I had my revenge when I found him this morning, but I am itchy and busting out the Benadryl cream. 

Moving on. Along with the collapse of the dining area, it was an interesting week here. We have started the rebuild and the new dining area will be made with a brick base and metal supports. Much of the grass roofing was salvageable, so that will help, because dried grass is hard to come by in the rainy season.

Thank you to everyone who kindly made a donation. Please continue sharing the fundraiser, is you're so inclined. Every little bit helps! 

MHI Fundraiser

It's crazy to think that there is only one week left of the training. The time has flown by! It's always a bonus when cases come up that we have spoken about in class. We have had two mothers with twins, one in first trimester and one in third trimester. Twins can be a challenge in both cases, the first trimester being the best time to determine whether the babies have their own sacs and placentas, and the third trimester basically looking like a bag of arms and legs. Both were a great opportunity for the students who scanned them. 

We did have a very complex case that was a tragedy for the mother, but an incredible success for one of the midwives that I trained last year. Gertrude was trained in my last group, and she officially works for the Sisters next door, however they do not really have a functional clinic, so she is not very busy. She will sometimes come to the birth center to help, but for the most part has been bored and desperate for work. Rachel and the Sisters recently came to a partnership, allowing us to use their (mostly empty) new clinical building and also giving Gertrude a "job" doing outreach for the birth center. She takes a portable ultrasound machine, gifted to us by Butterfly, and goes to the villages to check on mothers. Earlier in the week, she scanned a first-time mother and found a significant defect, anencephaly. This is where the skull does not fully form and is not conducive with life outside of the uterus. She asked the mother to come to the birth center to be rescanned by me but was not sure if she would comply. Gertrude forgot to mention the case to me, so the mother came back and was first scanned by two of my students. As I looked over their shoulder while they scanned, I could see something was not right, but I usually wait to see if they can spot an issue then I bring it up when I rescan the patient. Both of them identified a problem and I confirmed the diagnosis when I rescanned the mother. So, this was a complex situation. I was so proud of Gertrude and the students who identified (correctly) a very complex congenital defect, but we still had to have a very hard conversation with the mother and her husband. 

Needless to say, it did not go well, and the whole situation is very culturally complex. The mother broke down in hysterics; the father walked out and went to sit somewhere else. I went to the birth center to get some assistance, while the midwives who scanned her brought her to the birth center. Harriet took over, brought the father back in, got the mother calmed down, and gave them some treatment choices. The baby is approximately 23 weeks and the best treatment for the mother and baby is to terminate the pregnancy by inducing labor. The baby will not survive once delivered, and going through labor is much less traumatic for the mother if it happens now. She was given the option of going to the main hospital in Lacor or coming back to the birth center, and they went back to their village to think about it. We have not heard from them since. 

The mother is a second wife, and this was her first pregnancy. This is where it gets more complicated. Second wives often start as girlfriends that end up getting pregnant, which moves them into a 2nd wife position, into the family unit, and explains the common animosity between wives. If the pregnancy is not viable, she is in a very precarious position. The husband may kick her out of the family, her family will most likely not take her back if that happens, and she is blamed for the unsuccessful pregnancy. Whew, it's a lot. All we can do is hope that it works out for everyone. 

The students closed out the week struggling but improving in their scanning, looking forward to the weekend. Most of them are still knitting away, and Sharon even finished her first hat!

 Rachel received a last-minute invitation to meet with some potential funders in Kampala, so she drove down on Saturday and will fly back on Wednesday. Dorothy, from the African Cancer Foundation, will fly me to Kisumu on July 23rd and I will work at one of her mobile clinics for two days pro bono. She has expressed a definite interest in working with me in the future, so I am hopeful that this is just another step towards that. I have also had two people reach out to me through my website and social media, and I will have a meeting on Tuesday night with one of them and I will be following up with the second this week. 

Along with the rebuild of the dining area, an additional shower is also being built, closer to my hut (yippee!). I don't think it will be finished by the time I leave, but it will be done by the time I come back in the fall. 

Yesterday, Saturday, I spent almost the entire day and evening working on a lecture about the fetal heart. Max has been asking for it, and I am hoping to use it in the future for some advanced training. This morning, I am taking a slower start writing this blogpost, and afterwards I am going to work on a "questionnaire" for potential clients, later today I will meet with the knitters and finish a hat that I am making for Zilla's niece. I will check in next week, before heading to Nairobi, and in the meantime, here are some photos from around the compound kitchen area.

I will wrap it up for now, hoping all is going well for all of you back home, and I have to get back to the hat that needs finishing! 

Much love, Jo/MB