Home again

Now I sit in my living room, back in chilly Duluth, trying to wrap up this blog. This poor underused blog. Well, I am now ready to admit that I am just not a writer and therefore not a good person to blog.

I am going to try to make up for it in pictures!

Thanks for reading, the few posts I did manage.

Love,

Caralee

Volcano?

My good intentions to write more were not enough. I can't beleive that 3 weeks have gone by since I last wrote. Time is flying by as I try to cram as much as I can into my last days here.

I climbed a volcano. I had three goals while here: catch as many babies as I could, go snorkeling, and explore a volcano. Check, check, and check.

The volcano experience was sweet. My alarm went off on my phone at 1am. I woke up rubbing my eyes confused. A birth?? Nope. I quickly got ready putting on my sneakers that I had packed but had not worn until that morning and my sweatshirt which had also not been worn yet. A bit later I was meeting our driver in front of the clinic and the newest volunteer from Canada and my Canadian preceptor and her daughter. The drive took about an hour.

It was pitch black at the base where we met our guide. With torches and the makings for breakfast we started the two hour hike. The sky was amazing, full of more stars than I had seen since in the boonies in Timor last year. We walked through loose volcanic rock along a trail past onion gardens and one small family compound. Our guide set a quick pace and it was tough keeping up.

We made it to the top an hour before the sunrise. The guides started breakfast while we found a quiet place to sit and watch as the sun began to peak over the mountain opposite us. The top was even a bit chilly and we found ourselves huddling together sipping the cokes that we bought from another guide. The quiet lasted just minutes as the other groups arrived. It seemed that the trekkers just kept coming. We could see their flashlights as they made the hike up the side of the volcano. As the sun finally came over the horizon there were nearly 40 people there with us. The guides served us breakfast of banana sandwiches and boiled eggs. We were told that they usually cook the food in the heat vents from the volcano but because of the sulfur levels they used cookstoves.

The monkey whisperer

Wow, I find it crazy that nearly two weeks have already passed since I last updated here. I have settled into Bali time, going slowly and swimming and napping often. It is pretty much the only option once the sun gets right above us at about 10am until it ducks back down about 4 pm. During this hottest part of the day just sitting causes the sweat to run down my face and back. It seems silly now that I was worried about being here during the rainy season. There have only been a few nights where the rain has poured down waking me up to the intense sound of torrential rain on our plastic roof. Otherwise the days have been sunny and hot.

Most days I come over to the clinic early, before the staff arrives to check email and video chat with Ben. The clinic is just about 20 feet from the house I am staying in. I just walk through the pumpkin vines where the chickens are pecking about and through a family compound where the woman are usually drying rice or cooking and right into the back of the clinic. It is quiet and peaceful at this time of day.

The rest of the day is spent hanging out at the clinic, reading, chatting with the midwives or staff and trying to find some time to take a dip in a pool.

I have a few favorite people that I like to find time to chat with. There is a Reiki practitioner who comes every Tuesday and Saturday. He is a very pleasant man with bright white hair against his dark skin and a big smile. He holds group healing sessions in between doing Reiki with the women in labor. He is a great doula! He coaches the mom through pushing and shows the dad how to support her, feeds her sips of water and encouragement, and gives the midwives feedback on where the baby is and how the baby is doing. I love it when he is around. Last week we spent some time chatting. He has asked me to help him with his English so we sit and chat when he is not busy. His family is of a higher caste of healers although he did not begin practicing until recently when he used Reiki to treat his own cancer.

Another of my favorite new friends is a young midwife who just started at the clinic. She is responsible for all of my new Indonesian and Balinese slang which absolutely cracks up the other midwives. When she is working we sit around and she gives me language and cultural lessons.

I have been able to tag along to two transfers to the hospital. The first was for a laceration that we could not repair here. We arrived at the hospital at 4 in the morning. As we walked into the delivery room there was a woman who had just birthed her baby. I watched through a separation in the thin curtain as the nurse took the still wet baby from the doctor and carried it across the room naked and screaming. She took it behind a glass and wiped it off and clothed it and then left it alone under a bright light for the next 2 hours. I caught glimpses of the mom on the thin table behind the curtain, alone, sipping water, as I stood next to the mom I was with.

Now about the monkeys... I am in a small village just outside of Ubud. To get into Ubud, it is just a short walk down the road and through the Monkey Forrest. Yep, I get to walk through a Monkey Forrest on my way to the ATM or the grocery store. The monkeys are great but it is the tourists who are truly entertaining. You see, these monkeys are smart and they know that the tourists can buy bananas to feed to them at the entrances to the park. They also know that the goods are usually stored in some sort of plastic bag or otherwise shiny container. Now, even though there are signs everywhere warning folks of the sneaky monkey tactics, many of these foreigners do not heed the warnings and end up with a monkey on their back. Literally, a hungry monkey clinging to their back, leg, or arm. I have tried to get a picture of this but always miss because the screaching (of the human) scares the monkey off very quickly but not before they get their little banana grubbing monkey fists on the goods.

I have taken to hissing at the monkeys. You know, like, being the lead monkey or something. You can't give them an inch or they'll well you know, get your banana...

I do love the monkeys. In many ways they remind me of a cross between my cats, my mom, and my husband. I can't even begin to explain so use your imagination. The baby monkeys ride around on the mama monkeys clinging to their bellies. The teenage monkeys spend the afternoon chasing and humping each other and the old fat monkeys just sit around giving strange looks and scratching themselves.

Galungan

Last week was the start of the most important Balinese holiday, Galungan. Many of the midwives compare it to Christmas and I suppose in several ways it may be. Each person I asked to describe the significance of the holiday explained it very differently but I think that I have a general idea. Galungan celebrates the triumph of good over evil. It is a time when the families welcome back ancestors and gods to their family compounds where they make offerings and entertain. Each day is devoted to something the first being prayer, the second visiting, and I am unsure of what is to come. The holiday ends next Saturday.

The week before was very busy with the Balinese busily preparing and creating offerings by weaving palms together in amazingly creative ways. I spent a lot of time watching them expertly crafting little bowls, plates, fans and other decorations using only palms and bamboo.

On Wednesday was the first day of the 10 day celebration and the big temple day. All of the Balinese I saw were dressed in their temple clothes, beautiful tops and sarongs. The entire village shut down during this day. In the road, each family compound constructed a panjor, or a long bamboo stick intricately decorated with woven palms that has an alter next to it for offerings. On a late walk that evening I was impressed by the volume of offerings many of the families make, full cakes, big baskets of fruit, and gifts.

The next day was the party day where everyone was out visiting and exchanging gifts of fruit and rice soaked in liquor. I really liked some of the liquor soaked rice we were given but then one of the office people told me I should probably not eat it all for breakfast...

In the roads were barong parades. Barong are two people costumes that the children wear and march around with a band of children playing bells and drums. The kids are looking for donations to pay for school and were frequently seen stopped in front of some of the compounds "teasing" people to come out. The barong costume looks like a cow that mated with some sort of camel and then overdid it on the makeup. It is really very pretty, like everything in Bali no detail is spared.

The clinic has been very quiet because most of the staff is spending time with family. Of course the midwives are here and with the low key atmosphere I have been working on my language with the midwives as often as possible. This usual means I spend a lot of time being laughed at (or with, depending) as I mispronounce a word. You know, you miss a critical syllable or put the emphasis in the wrong place and you may have just called someone something awful or told someone that you need to drink a poo. See, if you say that you would like a big water here in Indonesian, it actually means poop. I learned that very quickly. Another of my favorite stories is of the night butterfly. One of the volunteers was trying to ask a Balinese about a moth. He didn't know the word but did know the word for night and butterfly. However, when he put them together the conversation became a bit weird and the Balinese was puzzled. Turns out, a night butterfly here is a prostitute. Now in retrospect that made a lot of sense but you aren't thinking that way when you are scraping words and meaning together.

Yesterday morning my roomate and I decided to go for a walk before the heat became intense. We walked for an hour and found ourselves way out in a village amongst rice fields. Here the pace was much more laid back than Nyuh Kuning, the village I am in, and certainly more relaxed than Ubud which makes Canal Park in June look tame even though it is the off season here. The rice paddies were abundant in this village. As the sun rose and heated the fields the air changed and smelled sweet and earthy. The sun gets so strong by about 10am that you can see the steam come off the damp dirt and feel your sweat evaporating the minute it pops up on your skin. The people in the village were very keen to chat with us a little, I don't think many foreigners get out that way on foot. By the time we realized that we should probably turn around, we were way out there, the sun was frying us and the dogs on the road were even more cranky from the heat. We made our way back slowly, seeking out as much shade as possible.

So, that afternoon we found a pool. The pools here are totally priceless. This one felt amazing and had some shade and a view of a nearby rice paddy. After a long hard day, I did 2 hours at the prenatal clinic that is held twice a week.

At the same time as the prenatal clinic is an acupuncture clinic that is currently being done by a Doctor of Chinese medicine from Australia. The Saturday clinic is a pregnancy and fertility clinic and I was able to assist/ watch as he did treatments on several woman experiencing infertilty and one woman with a breech baby.

Then it was over to do prenatal after prenatal. I was responsible for palpation, fundal measurement, and fetal heart tones. Now this was an intense lesson on palpation. See, I am palpating the woman's belly to feel for the uterus, baby, size, and position but I don't see their chart first and although sometimes I could understand their answer in Indonesian to my question of how many weeks they were, often I would misunderstand or just not catch it. That or they may have been answering in months or they didn't know. Bottom line is, it is very different using just your hands to find landmarks and size when you don't know where to start looking.

Ketut Caralee

This morning finds me recovering from a cold. Yes, a cold. Figures. I travel to the tropics in the fall and end up with a cold! Sunday night I passed on 3 births because I wasn't sure what I was coming down with. However, I did observe the birth of a 4.5 kilo babe and a very involved perineal repair.

I am at the clinic providing labor support for a second time mom. My Indonesian for the birth room is evolving and now I can describe position changes, whisper encouragement, advise to eat and drink and to discuss birth order.

About birth order. Bali works in a caste system and order is very important. In fact, all babies are named according to the order they are born. Which leads me to my new name: Ketut Caralee. One of the office staff and I were talking on Sunday about my family and she wanted to know what number child I am. After telling her I was the fourth, she called me Ketut. Now she calls me Ketut Caralee everyday.

I was just sitting and talking to one of the new midwives here who has just finished school. She told me that she does not have a boyfriend yet because she has not found a potential husband in her caste system. When I asked about arranged marriages she told me that some families do but she wants to fall in love. I agree with her. I could only imagine who my parents would have picked for me!

Oh yeah... birth...

Have I mentioned how lucky I am to be here? Thank you so much to everyone who has helped me get here. I really can't say that enough. Ben, you are amazing for being so support of my wild ideas, including traveling across the globe for months. Next time you are coming with me.

This entry is for my birth junkie friends... While I am thanking people, thanks to my midwifery gurus especially Jana. You know, I actually hear her voice in my head when I am attending births. The Canadian midwife has adopted me as her mentee and the two of them have a lot in common.

Yesterday we were doing a prenatal with a buley (ex-pat) from the midwest states and my Bali mentor grilled me on details much like Jana would. It was very comforting and familiar. This woman is due in just 3 weeks and I am planning on providing a childbirth ed class for her and her husband as well as attending the birth and providing pp doula support. Our prenatal was fun, the Aussie mid, Canadian mid, and I all providing counseling on different topics including GBS from 3 different perspectives. Very enlightening.

There was a woman in labor at the time and just as we finished up the prenatal, this second time mom was ready to push. I was able to catch this beautiful big baby boy over a minor first degree tear with a nuchal arm (thanks Jana for all of your discussion and training regarding this). A nuchal arm for all you non-birth peeps is one that is up by their neck. It makes for a tricky time to avoid more damage. It was my 2nd suture here as well. Because the women squat for everything they really suture all tears and they suture a lot! Meaning they put in a lot of stitches.

On Thursday morning I attended 2 births with first time moms. The first pushed for four and a half hours. It really looked like the baby wasn't making much progress and there were some fetal heart tones that were a bit low so the midwives prepped to transport her to the hospital. Not unlike at home, when faced with more intervention and the prospect of having to travel 45 minutes to the hospital, something changed... I turned around and the head was crowning! I tapped the midwife on the shoulder with a big smile and pointed to the now visible baby. This small, delicate baby boy was born into my hands floppy and pale. My first resuscitation. I breathed for the baby and he came around after a few minutes. So intense.

After a shower and a bite to eat I caught a second baby. Another first time mom, 17 years old. Her and her husband were so young and very sweet as are all Balinese I have met. When the mother is ready to push and the baby is low, the husband crawls behind her on the bed and supports her while she pushes. So far, all of the moms seem to birth in this position and do not seem interested in doing it differently. However, the midwives do not encourage pushing until the baby is so low that the mothers are spontatneously pushing. Passive descent is the way to go.

This mom birthed a good size baby but another nuchal hand produced a big tear (second degree). I was able to suture this tear with many many stitches and a lot of guidance from the senior midwife. Interesting cultural note: the midwives use the sound Mm mm to say Uh huh. To us this would sound like they were saying "no" but it means "yes". It is hard to get used to. I go to make a stitch and ask "here" and they say mm mmm and it takes me a minute to go 'oh, that's yes'. I am getting used to it though.

The midwives are very sweet and very patient with my language and skills. Many speak a fair bit of English but I am trying hard to learn more Indonesian. The problem is that many mix Indonesian and Balinese so it is hard for me to look up words in my dictionary that is only Indonesian. I have thought about getting a Balinese dictionary but I wouldn't know where to look anyway! My roomate keeps reminding me that I have only been here a week. It is so comfortable that I feel like I have always been here in a way, though.

The clinic is very sufficient and the volunteer and student midwives are definately not NEEDED here. Sometimes I feel like I am just in the way but most of the mids are very generous and eager for me to jump in. Often it means that there are 2-3 Balinese mids, maybe 1 professional midwife and me. A crowded room with many differing opinions. I am paying a tuition to be here so I feel good about helping the clinic in that way.

They keep first time moms here for 48 hours and multips for 24 hours. Yesterday I was able to chat with the father of the first baby I caught here. He spoke very good English and was able to tell me about the rituals they use for the placenta. Usually the father is keen to get the placenta as soon as possible to take it home to the family compound and bury it in a coconut. He says it is a tradition and was unable to tell me the significance of the coconut. Maybe it is just practical so the dogs and animals everywhere don't dig it up. We also collect all of the blood from the birth in sarongs and baby blankets. This along with anything else that has blood on it goes into a plastic bag that we give to the family. They dispose of it. The significance has to do with making sure that no black magic can be done on the baby. They do not want the baby's blood or mother's blood available to anyone, or perhaps anything. I hope to clear up more of my ignorance on their beleifs while I am here. Most Balinese are Hindu but as the midwives explained this morning, Bali Hindu is different than India Hindu.

This past week the midwives and others have been working hard to get ready for a big celebration that is happening this week. Everytime I visit the midwives room they are preparing beautiful offering out of palms. I have taken pictures but for some reason I am having a hard time uploading them. Keep an eye out for them if I ever figure it out.

Arrival!

Hello again! I made it to Bali and it has been wild. My experience here is so different than Timor!

I flew into the airport in the middle of the night. Customs was tricky and because I was carrying computer equipment for the organization here, they stopped me to have a look through my bags. I had been given a hint to put my clothing and underwear all over in my bag to maybe deter a full search but this didn't work and I ended up with my clothing, underwear, and other personal effects spread all over the customs table. A $50 bribe later and I was on my way.

A driver from the clinic was waiting for me and we drove the45 minutes to the village I am staying in. It is quite populated here and the drive was a bit claustrophobic. The roads are very narrow with constant housing the entire way. The air was sweet and warm with lots of breezes and I enjoyed the ride with the driver who spoke little English. Although I tried to speak a bit with him, I was exhausted and had a hard time thinking straight.

At our destination, I couldn't get into the ashram where I was supposed to be staying so the driver took me over to the clinic. I got there and the midwives greeted me and offered me a space to sleep on the double bed in the office. I curled up next to one of the midwives and tried to doze off. However, there were 2 woman in labor and soon I was woken by an American midwifery student from Colorado who had been called over to catch the babies. She showed me the ropes and I attended 2 births back to back that morning! Later that day after eating at a local warung (road side restaurant) and meeting several other volunteers, I attended another, assisting the American student and the Indo midwives.

Still having not slept, I made plans to go on a bit of a holiday the next day. Why not? I had put in a hard 4 days traveling and arriving! Only having been here 5 full days so far, I am learning, again, that this is not the American work work work mentality. I made plans with the American student, an Aussie midwife, a Canadian midwife and her family to go to Amed on Monday and Tuesday to snorkel.

Snorkeling was amazing! We visited a reef abouta 2 hour drive from Ubud and rented a beautiful place just 20 feet from the ocean. I saw amazing fish and coral and spent hours hanging out in the water and have a very sunburned butt, or bum, to show for it. After hanging in the ocean for hours we would get out and swim in the pool right by the ocean. It felt so nice to relax. I have a feeling I will be doing a fair bit of that, but hey, why not? I'm in BALI!

We came back late on Tuesday. I was staying at the ashram with a Californian L&D nurse and another American volunteer. The ashram was nice but very noisy because it is right by the road instead of tucked back in a compound. I spent a few night there but now I have moved upstairs from the Aussie midwife. I really love it there and it is nice to have the company. See, the others in the ashram are moving out this week so I would have been in that big place all by myself.

Wednesday I hung out with the American student in the morning, it was her last day and it was hard to say goodbye because she was so sweet and taught me a ton about the place. We also bonded a lot on our vacation even sharing a bed.

That afternoon I went for a walk with the Canadian family around town and picked up some groceries. There is so much great art for sale here and the clothing and carvings are amazing.

I am going to try to get this out now so you all can read it. I will write more later!!