March 26, 2018

There had been no water for almost 3 days in my village, and I was desperate for a proper shower. Thankfully, there was still water in Carrie and Justina’s village. Both Carrie and Justina (the other nurses) have been gone for two weeks (going on three weeks) now on a medical missionary training in Greece. They offered their teteyen (bathroom) to me, however, so that I could have a proper shower. I have been the only nurse in the clinic now for the past two weeks, though Talice and Samantha (the short-term missionary nurses that came with me this year) have graciously made the two-hour hike from Emrang and back to help on Sunday, the busiest day of the week. To say it’s been a challenge is an understatement. Not only do we assess patients ourselves, but we also diagnose and prescribe and dispense their medication. It becomes a challenge when their case is complicated, or when there are many patients. It was nearing twilight when I was showering in Carrie and Justina’s teteyan on Thursday. I heard people running frantically on the trail, then stop suddenly and call my name. I didn’t know who it was, but I could tell from their voice that It was urgent. They told me they came from Leplep, a village about an hour away, and there was somebody in difficult labor there. They were on their way to Niyug (a village about 30 minutes from ours) to get help. They had heard that Carrie and Justina left, and weren’t sure if they could get help from the clinic. “Coincidentally,” or rather, by God’s divine providence, I just so happened to be in Carrie’s bathroom that was by the trail, and they heard me showering. They told me they would go get help from Niyug, then stop by on the way back to Leplep. I quickly finished up my shower, whispered a prayer, and ran to Ate Lalay, a local missionary teacher, to inform her of what was taking place. It was nearing 7:00 p.m. when they returned, and the sun was well set. An option for an emergency flight from PAMAS helicopter could no longer be an option because it doesn’t fly at night. I gave them the stretcher and instructed them to bring her to our clinic to deliver. They agreed that they would do their best, then set out. I tried to look for her chart, to see if she has been in our clinic before for a prenatal, or at least find some history on her. I couldn’t find her chart, so I figured I would just ask for more information when they arrived. I began to prepare my supplies and the back porch for her to deliver there, since our birthing house wasn’t quite yet ready to be used. I reviewed also what I needed to do for the birth, and prepared as best as I could for as many complications that I could possibly face. I also instructed Ate Lalay what to do to help, and what questions need to be asked. We figured it would be about an hour to Leplep, then maybe two hours back because the trail is difficult and they would be carrying somebody. Ate Lalay returned home to finish her work, and I went back to the dorm to check on the girls, wash my dishes, etc. At around 9:30 p.m. I went back to the clinic to finish reviewing and preparing my supplies. I was a little skeptical of whether or not they would come back. I knew that Carrie and Justina have had trouble in the past of getting the Palawano women to deliver in the clinic. The Palawanos have their own midwifes in their villages, and they prefer the comforts of their own home. However, the midwives aren’t all trained, and aren’t always practicing the best hygiene. It’s actually mandated now by Filipino law that women deliver in a hospital to reduce infant mortality rates. We’ve been encouraging the women to come and get prenatal check-ups and to deliver at our clinic. Many have complied, but the majority still deliver at home, which is why I had my doubts of her coming. At around 10 p.m., I reasoned that if they haven’t arrived already, she must have already delivered there. Or, if they need me, they know where I live so they can just come and get me. I returned home to get some rest. At around 12 midnight, I heard Ate Lalay calling my name, “Casey, they came!” Quickly I woke up, grabbed my keys, and ran to the clinic. When I arrived, there was nobody. But still I opened the clinic and began to prep what I needed for vitals, including a BP and Doppler. Finally I heard the girls running back and saying that the guys carrying our laboring patient were still probably in Sung Sang, a village about 30 minutes away. I began to get information from the girls, and discovered that she was bleeding a lot. I asked how far along in her pregnancy she was, and they weren’t sure. I asked how far along in her labor she was, and they said she went into labor at 2 p.m. earlier that day, but because everyone has been preparing their fields for planting, nobody was at home with her. At around 5 p.m. when everybody arrived, she showered, and that’s when her water broke. Shortly after she began to experience excruciating pain and was bleeding profusely. She has been bleeding since. Red flags were raised everywhere in my mind as I began to realize this lady, who has been actively bleeding for the past 7 hours, might not be in the best condition when she arrives. I quickly grabbed I.V. needles, starter kits, fluids, and began to get ready to push fluids when she arrived. I was right. When Piti, our hemorrhaging woman arrived, she was clearly in shock. She was pale, sweating, cold, and barely responsive. I quickly started an I.V and pushed fluids, opening up the line. Her respiration’s were markedly fast, and her pulse in the 120s-130s. I tried to get a blood pressure, but her pulse was so faint I could barely hear or feel it. When I tightened the pressure cuff, I got a reading of 80/40–a sign of evident shock. There were no fetal heart tones upon auscultation with the Doppler. I realized that we might have just lost the baby, but I was determined not to lose this mom. When I checked to see if she was crowning, I discovered that she had already saturated through one entire blanket with blood, right down through to the stretcher. The blanket was so saturated that you could wring blood out of it. No crowning noted, and I knew not to do a vaginal exam with active bleeding. Thankfully, as I was working on Piti, our missionary team rallied together to help. Kuya Naphtalie, another local missionary, was already on the phone working out transportation to pick her up at the base of the mountain as soon as I said we need to get ready to send her out. Ate Lalay had been helping me get her story, and translate what I don’t know. She was also corresponding via telephone with Talice and Samantha, more experienced nurses, updating her about her condition. After she was stabilized, I told them we needed to go out to the hospital ASAP. The Palawano men that brought her quickly grabbed the stretcher and we set out. The trails here in these mountains aren’t easy. They’re narrow, and sometimes nonexistent. There are parts of the trail that are incredibly steep—such as the first quarter of our hike. I felt like I was going to pass out as we ran up the steep hill to go down to the lowlands. And I wasn’t even carrying much! I was very impressed with the way the Palawanos supported each other. With every village they passed, more men came to help carry the stretcher. They switched out every so often when one was tired. Though the trail was narrow and slippery—some of the men almost fell down the mountain trying to maneuver through the trails, they slipped the stretcher off their shoulders and on to another with such ease that the patient was unbothered. The whole way down I kept praying, “Lord, please help her make it.” Whenever we would stop to rest, I would reassess to ensure she was still doing okay. After what seemed like forever, we finally made it safely down to the lowlands at 3:30 a.m. I was impressed with the speed that they were going, though difficult the trail! It took us about 2 hours and a half, and that was with carrying a patient. That’s usually the time it takes me to go down without carrying anything! Thankfully, Daniel Luí and Dr. Bernard from PAMAS were waiting at the base of the trail to take us to the hospital (another answer to prayer, because our usual lowland missionary was out of town that day, and Daniel just so happened to hear his phone ringing in the middle of the night!) We brought her first to the government hospital. Some of the challenges that our people face in the lowlands is racism. For some reason or another, the people in the lowlands, particularly the city, are racist against the indigenous people. It was evident in the hospital staff’s indifferent, lethargic, and frustrating treatment of our people. She was soon transferred, because they weren’t well equipped for her case. We arrived at the private hospital at about 4:30 a.m., and discovered her hemoglobin to be 4 g/dl. She was in dire need of a transfusion. There was no blood on stock in the hospital, so thankfully Daniel and Dr. Bernard set out to go find some at the other hospitals. They quickly found blood, and brought it back to the hospital where Piti was in. We waited, and waited. Though I kept asking the nursing station what was going on with her blood, or where was the doctor, the response I kept getting was, “It’s coming,” or “She’s coming.” Finally, at about 9 a.m., with a little more urgency and slight frustration in my voice (and some reprimanding from my mother, a seasoned nurse), I reminded the nurses that this was a patient who has been actively bleeding for more than 10 hours now. Her hemoglobin is incredibly low, and she needs blood NOW. I told them that I would like to call the doctor myself and tell her that it is an emergency and she needs to be seen NOW. Evidently aggravated and grumbling under their breath, the nurses began moving. They grabbed the blood, and began to prepare for transfusion. Another nurse called the doctor in front of me (she wouldn’t let me talk to the doctor), and informed her of the emergent situation. Within an hour, blood was infusing and Piti was whisked away to the ultrasound room, where our suspicions were confirmed—she was placenta previa. No fetal heartbeat was appreciated. She was finally in the operating room, and by 2 p.m. she was back in the ward. They brought the stillborn baby out to us when it was delivered. We didn’t have any baby clothes, just a tadjung (a multipurpose wrap that the Palawano women use for clothes, sleeping, etc.) to wrap the baby in. When Piti came out of surgery, I asked if we could have some time in a private room for her to have with the baby. There was no private room, but transport graciously said they would give us the chapel for a short time so that she could have some time with her baby alone. Piti asked if we could stay with her, so we did. In the chapel, with Piti’s baby in her arms, the adrenaline finally worn off, sheer exhaustion began to overcome me. I had no more strength to hold in my tears. I wept along with Piti and her sister-in-law as I have never wept before. When all our tears were shed, I noticed Piti looking at the picture of Jesus on the wall right above her. I asked her, “Piti, do you know who that is?” She nodded yes. I then took the opportunity to appeal to her animist heart, “Piti, that is the Son of the one and only true God. He sent His Son for you and me so that we can have eternal life with Him. Even though we die, if we believe in Him, He promises He will come again one day and take us home with Him in heaven. There will be no more death and sadness there. Piti, do you believe that? Do you want to have faith in Jesus?” Solemnly, Piti nodded, and closed her eyes. My friends, God is truly so good. He gave Piti a close encounter with death so that He can show her that He wants to give her eternal life. He spared her life now so that she will have another chance to choose Him. Friends, there are still more people like Piti among these mountains who have yet to believe. Won’t you please pray for more laborers to be sent out to reach them?

Update (3/29/18): God is so good! Piti was discharged yesterday. She has been recovering very quickly by God’s grace! I was still with her on post-op day 1, and helped her get up to chair, cough and deep breathe, etc. By the end of post-op day 1, she was able to get up to the bathroom and void. She is recovering very well, and is looking great. The color is back in her face, and she is smiling and beaming with life. All glory to God!!! Because of the nature of her operation, she won’t be back in the mountains right away. But by God’s grace, she will be staying in our farm in the lowlands surrounded by a loving, Christian family who will support and nurture her. Thank you everyone for your prayers and support!

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