Tongue tie

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(Note: I failed to pull out my camera at the clinic, so pictures on this post are from a google image search.)

Yesterday was my first clinic shift. Endorsements from night shift to day shift (when the off-going midwives share information about patients in labor or who have just given birth with those who are coming on shift, and the staff pray together) is at 6:00 am, so I was up very early. I discovered the water pressure in my shower is fantastic before 5:00 am and that walking to the clinic (takes about half an hour) is still sweaty in 90% humidity, even when the sun isn’t up yet!

I had planned not to be the primary midwife for any births for the first several shifts I attended, in order to give myself time to “re-orient” to the clinic. It’s been two and a half years since I was last here, and during that time I’ve been working in my own private practice in the States. A lot of the protocols are different here, and the paperwork (such a big part of any healthcare provider’s job!) is very different. So no birth stories yet.

There was still plenty to do without catching a baby. I took over care of a family who had given birth a few hours earlier, giving baby’s first bath and monitoring mom and baby until it was time for them to be discharged. I did a 6 week postpartum checkup for another midwife who is out of town right now. I discussed clinic protocols and paperwork and watched how the supervisor worked with her two students during the one birth that occurred during our shift. And then, the “God appointment” for the day.

One of the students who I had not met before had come in to do a postpartum check for a mom who had given birth yesterday. The baby had already lost an excessive amount of weight during the first 24 hours of life and though the new mother was patiently working with her baby, breastfeeding was clearly not working. The baby struggled to latch on and then once at the breast was not able to suck effectively.

Effectively supporting breastfeeding is one of the most important jobs a midwife has during the early postpartum period. Especially among poor families in the developing world, successful breastfeeding can literally mean the difference between life and death for a baby. After both the student midwife and the supervisor had spent some time working with this mother and baby with no success, the supervisor asked if I could come and help.

I took a brief history from the student, observed the baby’s breastfeeding attempts for a few minutes, and then asked the student if she had checked the baby’s mouth for a tongue tie. “Well, I did the usual newborn exam, but I don’t know how to check for tongue tie,” she said. I took the baby from the mother. Before I could even begin my exam, the baby began to cry, showing a very obvious anterior tongue tie. The lingual frenulum (the small piece of tissue that attaches the underside of the tongue to the floor of the mouth) was tight and extended all the way to the tip of the tongue.

A baby’s tongue mobility is very important for effective breastfeeding, and tongue tie is a frequently overlooked cause of breastfeeding problems. A frenulotomy — a simple “snip” to release the lingual frenulum — often makes a dramatic difference. The earlier it can be corrected, the better for breastfeeding, so when tongue tie came up in my practice in Ohio I usually did the frenulotomy within a few hours after birth or at the 24 visit. I was fortunate to have received excellent training on tongue tie while in Ohio from two tongue-tie experts, IBCLC Alison Hazelbaker and Dayton dentist Dr. Gregory Notestine, who has been correcting tongue ties for decades and whose technique I adopted. I’ve clipped quite a few tongue ties over the last few years, including a few older-than-newborn babies whose issues were not discovered soon after birth.

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The supervisor and the other midwives at the clinic were excited to hear I had experience with frenulotomy and eager to see the technique. After explaining what we wanted to do to the baby’s mother, we got out sterile gloves and small sharp sterile scissors. The procedure takes only a few seconds. Moments later, the baby was breastfeeding — sucking well and effectively for the first time. Wish I could have bottled the joy and amazement on this mother’s face.

Bamboo beds are here.

They said it would be three and a half weeks. And today, right on schedule, the bamboo furniture guys came to deliver our beds. They made a delightful din hammering them together with mallets made of bamboo.

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These fellows assembled the beds using these tools, plus a machete:

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No Ikea hex wrenches here!

The finished product is quite impressive. Here are the bunk beds:

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It feels very nice to see actual beds in our rooms instead of just foam mattresses on the floors. Sora and I have a four-poster canopied bed. Ezekiel has the same in his room, which will also be a guest room when we have visitors. Here’s Hosanna visiting his room right now:

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The frames are perfect for the young monkeys who will be inhabiting them:

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Now we just need to figure out which kids sleep on which bunks…

Many thanks to Ate Elsa from the birth center who helped us place our order for this furniture, serving as a translator and ironing out a few snags along the way.

To market, to market…

Buying groceries is still a bit of an adventure. Many foods that used to be staples are not widely available or are imported and so very expensive (cheese, pickles, chocolate chips.) Only a few limited vegetable varieties are available. But the tropical fruit is abundant, delicious, and very affordable. The best place to buy produce is not the grocery store (which, unlike in North America, tend to be located inside the shopping malls) but the market, which sells not just fruits and vegetables, but all manner of other items as well: rice, fish, flowers (including incredibly ornate funeral arrangements), used clothing, brooms…

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The market is huge, covering multiple city blocks.

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Fruit vendor

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The vegetable section.

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Heaps of pineapples.

I visited 9 different vendors and bought fruits and vegetables for several days. For an extra 2 pesos, you can get your pineapple cut up:

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Expert slicing and dicing.

Here’s what I came home with:

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Yum!

  • A bunch of bananas, 39 pesos
  • 4 papayas, 24 pesos
  • 2 large avocados, 14 pesos
  • 2 pineapple (in slices in the plastic bag), 24 pesos
  • 6 fuji apples, 60 pesos
  • 6 delicious mangoes and 5 mangosteens, 155 pesos
  • a kilo of kalamansi (small green citrus fruit in the pink bowl), 50 pesos
  • half a kilo of small purple onions, 30 pesos
  • a cabbage, 4 large carrots, 2 chayote, and half a kilo of green tomatoes (no red ones available), 92 pesos

Total cost: 488 pesos, or just a little over $12 USD.

Meat

I have taken to ordering meat from roadside stands on the Main Street we live near. I walk out of our apartment, up the driveway to the gate, wave and say “kumusta?” (“How are you?”) to Raymon or Ronan, the two guards who split duty at the gate. Whichever one is on duty, the black leather of his shoes is always shining as though a drill sergeant were going to inspect them.

I mention the gate because it is the very stark barrier between wealth and poverty.

Once through the gate, I walk down another alley, and then cross the road. There is a lady standing under a tarp, behind a charcoal grill. She has a bamboo fan in her hand, and she has seen me coming since I first stepped out of the alley. (It’s not hard to spot a 6’2” Kano walking down the street here, and besides, this is my third time.) I order four pork kebabs (total cost: 24 pesos, or about 60 cents), which she promptly places on the grill and starts fanning the coals to cook them. This action produces clouds of smoke, but it’s my lucky day, and the wind is coming from behind me. The lady kindly invites me to sit on a bench while I wait for her to cook the skewers.

I look to my right. The shop is actually built directly on top of the planks that bridge a drainage ditch running all the way down the street. The bottom of the ditch contains sewage. I look down into it, and there, about five feet away, is the bloated corpse of a drowned rat.

Then I look back up and smile at the lady who is fanning the coals and cooking my pork skewers. She finishes, and dips them in some sweet sauce, deposits them in a plastic bag, and hands them to me. She works hard, and the food she serves is good.

I did not get a photo of the rat, and I’m not sure I would have posted it if I had. Here is the bag of pork skewers. They were delicious.

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This is the way we wash our clothes…

A family of six makes a fairly significant amount of laundry, so one of our top priorities on moving into our rental house was getting our newly purchased washing machine functioning.

In Ohio, I had a spiffy expensive extra-large-capacity front-loading washer, along with a matching dryer. Just about everywhere I lived before that, I had the typical American top-loading automatic washing machine and, of course, a dryer. In the Philippines, most clothes are washed by hand: according to a government demographic survey, only about 45% of urban Filipino homes have a washing machine (for rural households, the number is less than 18%.)

The American-style automatic washing machines are very expensive here, so I went for a more economical non-automatic washer. It cost a little over $200 USD and it looks like this (or it did before I took the protective plastic wrap off the lids!). The larger tub on the left side agitates, and the smaller tub on the right side spins:

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Fresh from the store!

The washing machine lives outside, on the large covered patio right off my kitchen. It attaches with a hose (not included with the washer, but purchased separately) to one side of the large outdoor sink:

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Just add water!

There’s no hot or cold wash option, because there’s no water heater. There’s no setting on any of those dials for small, medium, or large load because the water level is not automatic. You turn on the tap at the sink and the left side of the machine starts to fill, and you turn the tap off again when the tub is as full as you want it to be. If you go do something else and forget about it, the water will just keep coming. After you’ve turned on the water, you add your soap and when the soap is nicely mixed, you can throw in some clothes:

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Bubble, bubble…

Then you turn the lefthand dial to start the washer agitating and can go do something else for 15 minutes or so.

When you come back, you turn the middle dial from “wash” to “drain” and the water drains out. Normally the drain hose is put directly into a floor drain to avoid standing water which would be a breeding ground for mosquitos (trust me, we don’t want any more of them around than we have already!) There is no floor drain on my patio so it goes into the drainage ditch (fortunately, the drainage ditch really does drain and standing water has not been a problem):

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Down the drainage ditch…

After the water has drained you move your clothes from the “wash” side of the laundry tub to the “spin” side, put on the lid, and turn the right and dial to start the washer spinning out the last of the soapy water. However, the left side of the washer holds a lot more clothes than the right side, so even when you pack the clothes in tight you sometimes have to spin the clothes in two or three batches.

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It goes round and round and round and round and…

Wash, rinse, repeat: next you flip the middle dial back from “drain” to “wash” and move all the laundry back to the left to rinse out the soap:

If you see suds after you’ve agitated your rinse load, you might have used too much soap. And you might need to drain, spin, and rinse again.

Finally, you move all your clean and soap-free clothes to the spin basket one last time. Then you hang them out in the sunshine:

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Hosanna handing clothespins to our wonderful Filipina “laundry fairy” in our backyard.

Back in the states, I used to joke about a “laundry fairy.” Well, I may not have an automatic washing machine any more but I finally have my very own laundry fairy! I appreciate her much more than I ever did my fancy front-loading machine at home. I can only imagine how incredibly stressful keeping everyone in clean clothes would be without her help.

Alas, it’s been raining for three days and we’re now got quite a bit of waiting laundry. We do have a few clotheslines for hanging things that are “under cover” but they don’t hold as much and the clothes dry much more slowly without the bright sun to help them. Hopefully the sun will come out tomorrow!

Floods!

We owe you all a lot of updates from the last few weeks that we’ve been without internet at home (it was just installed yesterday) and we will be posting them bit by bit over the next week or two. Sharing our mundane daily life in Davao is going to wait for another day, however, in order to put two urgent prayer requests before your eyes today.

First, there have been unusually heavy rains since we arrived. Normally it rains at night (almost every night) and is sunny in the daytime, but the last two days we have had non-stop rain. Starting last night there were flash floods in low-lying areas of the city near the Davao River and the rain is still coming down. Many have been evacuated and in some areas the water is up to the roofs of the one-story houses. According to the local news there are still some families trapped by the floodwaters and waiting to be rescued. Please pray for safety for the rescue workers and those living in the affected areas and for a respite from the rain!

Photo from TV patrol Southern Mindanao's facebook page.

Photo from TV patrol Southern Mindanao’s facebook page.

Second: The rains are also affecting the area further north of Davao City which was devastated by last month’s typhoon. We have many friends and co-workers who have been traveling regularly to the affected areas to do relief work. Because of the damaged roads, it takes many hours to get to the village where they are working even though it is not really that far away! One of our friends is there now with a team that went up a few days ago to rebuild a church and distribute supplies. Shortly before they were to start back to Davao they received word that there had just been a landslide nearby. They are now going to assess and try to offer assistance to those affected. Please pray for those who may have been injured or lost homes or loved ones as well as for the team (especially that they will be able to get back home safely — the heavy rain will not make it any easier!)

Update: the team returned safely. Thanks for your prayers! Please continue to pray this week for a respite from the heavy rains and for safety and protection for those in low-lying areas.

Our family has not been affected by the flooding as our home is on high ground. We first learned of the flooding on our way to church this morning — the bridge we crossed over the Davao River was full of people with umbrellas looking over the edge at the flooded houses on the riverbank. On the way home, our taxi had to turn around and take another route to avoid a very large deep puddle, but that’s nothing compared to the rest of the city!

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Puddle deemed too deep for our taxi.

Our rental house

We’re not moved in yet because our foam mattresses haven’t arrived yet from the Mandaue Foam store (we custom-ordered an extra long one since mattresses here are not built for the comfort of six-foot-tall Kanos.) They should probably be ready today or tomorrow. We’ll move in then, and our bamboo bedframes may come in another three weeks.

We are very thankful to HB, another missionary and a friend of Sora’s from her previous visits to Davao City in 2009 and 2010. When SAMS gave us permission to buy plane tickets (i.e. confirmed that our fundraising was going well enough to send us), Sora got online and asked KM, the director of the clinic, to put out the word that we were looking for a house. KM, ever the realist, informed her, “Our families have been having a hard time finding a place. You should probably expect it to take a month or two after you get here.”

The very next day, she wrote again. “HB found you a place.”

Our townhouse is in a very quiet, gated cul-de-sac. It has three floors, with a large kitchen on the middle floor, three bedrooms and two “comfort rooms” (to use the Filipino euphemism) upstairs, a carport (for the vehicle we don’t have yet) and two more rooms downstairs, a two-level covered patio and a cute little backyard just waiting to be filled with tropical flowers. The location is fantastic: only a short walk to Victoria Plaza and Abreeza malls, and 5-10 minutes away from both the birth center and Faith Academy.

We had prepared ourselves to have to buy all our furniture and appliances when we arrived, a somewhat expensive proposition. Secondhand items are occasionally available (for instance, when other missionaries leave the country) but unlike the states, there are no yard sales and no craig’s list. For the first time in our married life, we have a house full of brand-new items.

My favorite is this round dining table, which the delivery guys assembled for us:

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Our spacious kitchen with our shiny new microwave, refrigerator, and chest freezer (the freezer came with a free rice cooker!):

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One of the two outdoor sinks (there’s one on each level of the patio) with our non-automatic washing machine:

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The stove will also live outside on the patio, so as not to heat up the house:

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Kids on the living room couch, watching a movie on the iPad while we waited for the delivery guys to return with our appliances (the truck couldn’t fit our whole order at the same time!)

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Delivery guys and Matt assembling fans:

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We’ll take some more photos later, when we move in.