Emergency Midwifery in the Wake of Typhoon Haiyan

In response to Typhoon Haiyan OHO has created grants to fly CNN Hero of the Year, Ibu Robin Lim, and several other experienced midwives in to ground zero to assist the 25 000 women due to give birth this month. Here is her first project report. "We gathered by 5:30 am, Team Bumi Sehat/Wadah including Teresa, Cecille, and myself, to evaluate the Maternal/Child health situation. We had Maita as our guide, a very-first responder from the Rotary Mactan, Efren Penaflorida came to evaluate the needs of children and Doc Handley to bring water filtrations systems. We were given a lift on a Korean C130 cargo plane. Upon arrival the devastation at the Tacloban airport was staggering. The Filipino Air Force soldiers at TOG8 were super helpful. They had pitched their tents on the tarmac cleared, but just right there were twisted remains of a Fire and Rescue station. It was hard not to notice the steel coffins stacked near the mess station, laying-in-wait, for the still missing soldiers, lost in the violence of the largest storm in recorded history to make landfall. We were given face-masks for the drive from the airport into the city of Tacloban, to protect us from the smell. Recalling the destruction I saw as an early responder to the 2004 Indian Ocean Tsunami, where most of the coconut tress were spared, while all others were washed away. Here, in the wake of Yolanda, the winds uprooted the coconut palms, nearly all of them.  We saw cars hanging from the remains of upper stories of buildings. Twisted metal, and all the dreams and hard work and lives of hundreds of thousands of people, appeared to have been put in a blender. I saw a bent old woman, sweeping the crooked floor of the remains of a shack, with no walls and no roof. There was police commotion as two bodies were pulled from the roadside rubble. We proceeded through the ruined landscape, to the Eastern Visayas Regional medical Center. Uncounted numbers of people waited in near silence, for medical help. We were cheerfully taken toward the maternity ward, barely coping with the smells of a hospital that was damaged and drenched in a storm, and left with no running water for clean-up. The first baby we saw was a tiny premie. The recovery room was full of many mothers breastfeeding their babies. Other mothers stared blankly with empty arms, their babies had been born too soon, and had not survived. In labor and delivery we met a mother who had just delivered a second twin, the first one was born before they were able to find transportation to hospital. She was left alone on a stainless steel table, her feet still in stirrups, with her tiny second twin in a sterile glove box, beside her. She offered to allow us to see her baby. This child would not have survived outside the womb, no matter what. We tired to comfort her, soon her husband arrived, with the first twin daughter, perfectly formed, but also deceased. Many tons of sorrow, in two small cardboard boxes. A teenaged girl was there, hoping to find answers, she was pregnant, and spotting, and afraid. Another mother was there, with complications for a bad abortion. She already had five children, and was worried how to have another, since her house washed away. Katlynn, age 22,sat perfectly still and made not a sound, it was difficult to tell she was in labor, yet, she was 7 to 8 centimeters dilated. I rubbed her back.
Ibu Robin Lim
Ibu Robin Lim
Then came in Jaclyn, she was a first time 18 year old mother-to-be in early labor, so lovely, but she was shaking. Her blood pressure was high, but we could not determine how high, as the hospital sphygmomanometer was broken. She was put on IV fluids, and given oxygen. She sat quietly in a corner, on the wooden labor beds, and trebled. I checked fetal heart beat, it was normal. Fortunately the fluids and oxygen seemed to help. And her shaking (which could have been small convulsions) calmed. A fifth-time and an eight-time mom arrived in labor, and walked the hallways. Katlynn got me to help her into the delivery room. The birth beds had not been cleaned. I chose the least bloody one, and found some disinfectant and cleaned it as best I could. Remember, the hospital has no running water. Katlynn began to push and then decided she did not want to give birth just yet. Her husband and she had argued before the storm. She was sure he had not been seen these last 16 days, was due to him being mad at her. She told herself that he was with their 2 year old daughter, and that they would come home some time soon. She just crossed her legs and sat bolt up on the birthing table. The doctor then talked her into an IV with pitocin. I took Dr. Suryo aside and expressed my fear the Katlynn would not be a good candidate for an IV, as she was mentally unstable. The IV was put in, to sped the birth. It cranked up the contractions, which made Katlynn angry. She began in her quiet, strong, determined way, to demand a cesarean. Her baby was on view, even when she crossed her legs. With the strength and stealth of a lioness, Katlynn ripped out her IV and jumped off of the ridiculously high delivery table. She took off, wearing only her blood stained blouse, out of the Delivery ward, and made her way, striding down the dark dirty hallways. The doctor and I followed. We implored her to let us find a clean-ish private place, for her to give birth. She kept on moving. She led us right in to the not-so-modern Chemo and Radiation room. Next we visited X-ray. Then there was an empty room in which a Filipino man and a Spanish man were prepping to paint. She marched up toward the men, but just then had to squat through a contraction.  Noticed the rusty broken window open a crack. She shoved it wider ajar and proceeded to climb out, onto a collection of garbage and shards of broken glass. I held her tight, but she was getting away. I feared for the baby now, and that Katlynn’s feet would be cut up.  The Spaniard shouted; “Need some help?” and the doctor yelled, “Yes!” With the help of the very large and strong Spanish guy, we were able to pry Katlynn back in through the window, and he carried her back to Labor and Delivery. It was a sight. Her mother then came in, and yelled a lot at Katlynn, even slapped her. I was saddened, and asked for peace. Now, with a lot of help, we were able to convince Katlynn that she could not have a cesarean, when all she need do was push for 5 minutes, and her baby would be born. I had noticed earlier that the baby was posterior, but because she never uttered a single complaint in labor, the doctors felt I was mistaken. Once she began to push, I became more convinced, as it was just much difficult than most 2nd time mothers’ experience. It took some struggle, Katlynn was given another IV, this one she promised she would not rip out, but she said this with a smirk, which worried me, so I camped by her let arm, to guard it from her. With a lot of effort, Katlynn pushed her posterior Baby into the light. He was beautiful! Once he was born, this mother became tranquil, smiling. Never have a seen a more dramatic display of post traumatic stress disorder. After the birth came a shy call from the hallway… “Are the mother and baby alright?” It was Francisco, the Spaniard who carried Katlynn back to the delivery room. She called for him to come in, and he gently greeted the Baby, which the now-calm new mother named Francisco. There were seven more mothers in labor, arriving just before the curfew.  Some high-risk women had delivered outside of health centers, and haemorrhaged, because they could not travel at night, after curfew."
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