ASSESSING MATERNAL NEWBORN CARE IN MOLDOVA

Approximately two months ago I (Eileen) was copied in on an email from a doctor in the U.S. to our humanitarian couple in Moldova.  He was interested in pursuing a maternal newborn care project in Moldova and wanted our couple to be the eyes on the ground so to speak.  The name of the doctor was the same as someone I knew 40 years ago while in nursing school. I responded back to him and asked if he happened to be the same Rob Clark who lived on the SLC avenues in 1977 and was married to Anne Clark.  As it turned out he was someone who was in my student ward when I was in college. I was in the Relief Society Presidency of that ward and his wife was the Relief Society President.  We later spoke on the phone and it was fun to catch up and hear about their family, and in turn he also asked about ours.  Many years ago I left nursing school to go have a spinal fusion. At that time,  I was released from my calling in the Relief Society Presidency and moved back to Colorado for the operation.  Rob and Anne were married, and I don’t believe I have communicated with either one of them since.  This interaction was a reminder of what a small world it is within the church.

One of the major initiatives for LDS Charities is a program entitled Maternal Newborn Care (MNC).  This program aims to teach appropriate medical skills to physicians, nurses and midwifes in countries where perhaps the training is lacking.  The programs include training the providers with training in areas such as  Neonatal Resuscitation (NRT), Essential Care for Every Newborn (ECEB), Advanced Life Support in Obstetrics (ALSO)  and, Helping Babies Breathe (HBB).  Each program is structured to have a different level of intensity to meet the varying needs of the providers in the country where training will take place. While we were in Indonesia we worked for over a year to implement an HBB program for over 500 midwives and a few dozen doctors and nurses in a rural area.  We were released from our mission just six weeks before the program was formally initiated. Although we would have loved to have seen the training, we were pleased when a picture of the doctors we had worked with ended up on the front page of our church’s newspaper (the Church News).  

 Dr. Clark has been heavily involved in the MNC program for many years and has done training programs in India, China and Nepal.  This is the first year he will be working in any European country.  He also has his own practice in addition to being on several committees. He is extremely busy. When he discovered that I was a former Newborn ICU and Labor & Delivery nurse he asked if I would be willing to visit Moldova and assess the needs there. This was a huge pleasure for me as I have missed my nursing profession immensely.  I had the support and encouragement of my manager in Frankfurt and also my husband, which was a blessing.

The history of Moldova is complicated and it has changed hands over the years from being a Russian and/or Romanian territory to being independent. Most of the people speak Romanian while some in the South and East speak only Russian.  The Russian Orthodox Church is prevalent there and it was very common to see onion domed churches with glistening golden roofs in almost every village.  Statues of Jesus on the cross are commonplace, even on the sides of the roads away from what would seem to be other signs of community. When we first rode in the taxi to our hotel I was surprised to hear the singing group BeeGees on the radio.  We soon found that American/British music from the 70s and 80s seemed to be played everywhere, and often quite loudly. 

Elder and Sister Vogelsberg have been serving in Moldova for a little over 18 months.  Elder Vogelsberg did an excellent job of navigating the roads from one town to another.  Some of the roads off the main highways were covered with potholes. He would sometimes swerve to miss them and on occasion had no choice but  to drive over them.  A portion of our journey was over dirt roads.  This gave us the opportunity to see the villages, which we always enjoy doing.  It seemed that about half of the homes had an outhouse in the yard.  I was told by our translator that many homes do not have running water, but rather obtain their water from a nearby well.  Local wells were decorated ornately with a handle and a pulley to obtain water from a bucket.  Many of the wells have become contaminated due to runoff from the fertilizers used in the nearby farming fields. There have been several clean water projects in Moldova implemented by LDS Charities over the years.

We visited six hospitals trying to get a feel for the needs of each local unit.  The hospitals in Moldova are divided into three levels.  We found that the lowest level (Level 1) hospitals were smaller with fewer patients, however their staffs still tried hard to have the appropriate equipment and care for their patients.  Unless there is an emergency, these hospitals only take patients who are beyond 36 weeks gestation, with Level 2  hospitals taking patients from 32-36 weeks gestation, and the three large Level 3 hospitals looking after the more critical obstetric patients and neonates.  Dr. Clark had asked me if I would be willing to visit a few of the smaller local hospitals to learn more about the need for training, if any, in the rural areas.

We found that the hospitals were clean, with much of the necessary equipment needed for care of the mothers and newborns. There was one location where the  director of the hospital was a little skeptical and was reluctant to give us information or allow us to see his units. In all of the other five hospitals the doctors seemed proud to tell us about the care they were delivering and more than willing to show us both their Labor & Delivery and Newborn Care units.  In one location the neonatologist had posters lining the walls of her unit. These posters were algorithms about what to do in case of an emergency.  In this particular hospital they were in Russian.  We were pleased to see the LDS Charities logo in the corner of the poster. This doctor had attended an NRT seminar/training sponsored by LDS Charities in 2011, and is still using the training manikin and written training materials which were given to her.  This was great news for us as the whole purpose of the program is to “train the trainer,” then have the trainers reach out to do training in their communities. 

We do not know at this point if or what kind of program will be implemented in Moldova.  That decision will be made by Dr. Clark when he visits in May.  We did have multiple requests for NRT, HBB and maternal emergencies training by the physicians.  For me, it was extremely satisfying to be back in a hospital again.  I was grateful for my good husband and companion who not only took notes for me while I interviewed the staff, but also is savvy enough that he could prompt me in certain situations to notice something which had gone unnoticed earlier.  In one instance we were told by the director of the hospital that many deliveries were done with forceps rather than a vacuum suction. While in the delivery room, Russell asked me what a certain piece of equipment was. It turned out it was the vacuum suction machine. When I questioned the obstetrician as to whether forceps or vacuum suction was used in their deliveries she looked in shock at us and said “ NO FORCEPS!”  I was grateful for this good catch by my husband, the accountant.  I also appreciate the efforts the Vogelsbergs took to transport us around and give us their insights. Our interpreter, Doina was extremely valuable.  She is a member of the church (only one of about 100 who are actively involved in the church in Moldova).  She  speaks Romanian, Russian and English fluently, and didn't hesitate with any of the medical terminology. Her services were very needed as the only individuals we met in our travels who spoke English were  a family in one of the patient rooms. The mom had just given birth the previous day and her husband and nine year-old son were there visiting. Interestingly they all spoke English.  We admired their beautiful baby and congratulated them on their new addition.  Families with multiple children seem to be something we don't see often in Europe, other than in Moldova.

I was grateful for the opportunity to be involved in a small way with this future MNC project. I am hoping that perhaps it might take place before our departure next fall.  Maybe we would be able to meet again some of the good people we met on this visit.

Russian Orthodox church under construction

You would normally only see one of these cars in the movies

Russell correctly identified this as being the "vacuum suction"

Doctors, Elder and Sister Vogelsberg and Eileen, neonatologist holding manikin from prior LDSC training

Notice the LDS Charities stamp

Algorithm for emergencies in Russian

Emergency supplies 

Neonatologist with baby manikin used for training purposes

This family with their new baby all spoke English

Emergency supplies in NICU

Our translator Doina in black coat talks with obstetrician and neonatolgist in Russian

Once a grandma, always a grandma. I loved the newborns

Doctors and missionaries in one of the NICU units

REFLECTIONS ON ROME

Eileen training Elder Herway on our computer humanitarian system

This past week we traveled to Rome to train Elder Tom and Sister Anita Herway.  If you have read our previous blog postings you might be aware that the Herways were in our ward in Belgium 16 years ago.  Elder Herway was the Bishop of the ward and I (Eileen) was the Relief Society President. Sister Herway was the seminary teacher for our teenagers.  We have only seen them once during the years following our return to the United States. Last August, while attending the Hague temple, we ran into the Herways again. It was a wonderful reunion in many ways. We all felt like the meeting was more than coincidental. The Herways had come to the temple praying and fasting to see if they felt any specific promptings before they submitted their missionary papers the following week. We were aware of a newly opened position in Italy to serve the refugees coming across the Mediterranean Sea from North Africa.  Since Elder Herway spoke Italian and both have had years of experience working with the refugee population in Belgium, we felt that this position would be a good fit.  As it turned out, a couple of months later they received a formal call to serve in Italy with a specific emphasis on refugee aid.

There were several occurrences during our brief time in Italy which reminded us of the tender mercies which are part of our lives. 

A few weeks ago we heard that Alitalia was on strike and some of our humanitarian couples would not be able to fly on their scheduled flights from Madrid to return home. At that time I spent a great deal of time Googling “strikes in Italy”.  One warning which came up on several internet sites was that a transportation workers strike would occur on March 8^th.  That was the day we were planning on traveling to Italy.  I contacted our church travel agency to determine if our flight was still on. They didn’t have any information that it had been cancelled. After some consideration we changed our tickets to fly out late Tuesday night.  Wednesday, traffic in Rome was a nightmare. We were very grateful that we were able to spend the time training the Herways instead of being stuck in traffic (or worse, perhaps not even getting to Rome).  Wednesday evening we were planning on visiting one of our NGO partners who has initiated a mobile health clinic.   Due to the transportation workers strike we thought we would have to drive downtown to visit the clinic.  At the last minute Sister Herway suggested that we try and ride the metro.  Amazingly enough, despite the strike that day, the metro was going to be running from 5 PM to 8 PM only – just enough time to allow us to travel downtown on the metro, see the mobile clinic as it opened at 7 PM, talk to some of those working with it and then catch a returning train just 8 minutes before the time the metro strike resumed.  We felt very fortunate as traffic was so heavy it would have taken us a significant amount of time to drive.

The clinic we visited was operating by a group called MEDU (Doctors for Human Rights). LDS Charities (LDSC) has partnered with this organization for several different projects. LDSC participated in the purchasing of a converted motor home which could be driven to various different locations.  A variety of volunteers staff this mobile clinic including several doctors. The clinic serves the refugee population and also the homeless.

On Thursday we visited the MEDU Psyche Center. This center provides psychological and psychiatric support to individuals who have survived torture, inhuman and degrading treatment.  From the MEDU website we read, "The project beneficiaries are men and women, of any juridical status, with no distinction whatsoever, who suffered torture or other cruel, inhuman and degrading treatment."  Services offered at this clinic are:

Psychological assessment

Psychotherapy and medical therapy

Referral to public health services if necessary

Medical, social and legal advice (housing, job training, counselling, social and legal assistance, community integration, etc.)

Collecting patient's stories
Research and training on intentional violence and psychological trauma

LDSC is partnering with MEDU to provide a clinic with more space for counseling to be done with the refugees in need of assistance of a psychological nature. While visiting the Psyche Center we met doctors, psychologists and a cultural mediator who was himself a former refugee. The cultural mediator is there to help translate for the refugees and to help offer understanding of their needs.  

The Herways, Russell and I all felt really good about our visit to this clinic.  I was able to ask about various methodologies of treatment for PTSD (Post Traumatic Stress Disorder).  I was extremely impressed with their efforts to determine what services will be of most benefit to the beneficiaries. What a wonderful effort is being done to help those individuals who have suffered violence or psychological trauma.

Several weeks ago we were communicating with President Pickerd who is the mission president of the Italy Rome mission regarding the Herway’s housing and office needs.  He invited us to a missionary zone conference on Friday for the Rome West Zone.  When we set up our training schedule several weeks ago we did not know that the Herways were supposed to be attending a zone conference or even what zone they would be in.  We attended the conference and I was very delighted to see my nephew at the conference.  Elder Ethan Cannon has been serving in Malta with 3 other Elders and a senior couple.  Who would have thought that Malta would be in the same zone as missionaries serving on the west side of Rome?  Perhaps it was more than coincidence that the Herways were serving in the same missionary zone as my nephew.  We tried hard to make sure we were not a distraction to him or the other missionaries, however President Pickerd did suggest that we take a photo together.  It was wonderful to be able to hear the excellent training by President and Sister Pickerd and to feel the great spirit of the young missionaries. 

We returned to Frankfurt after a great week emotionally recharged but physically tired. Galatians 6:9 says “And let us not be weary in well doing: for in due season we shall reap, if we faint not.”  We both feel that this last week we were able to “reap,” despite our falling asleep on the flight home.  We are grateful and feeling very blessed to have the opportunity to help with the humanitarian work in the Europe Area.  

Russell in training with Elder and Sister Herway

Elder Herway and Russell on metro - we were so grateful it was operating for a few hours

MEDU clinic in Rome

Sister Herway exchanging contact information with volunteer

Rome temple under construction

Volunteer intern, cultural mediator and Alberto (physician and organizer of Psyche Clinic)

Professionals and volunteers at Psyche Clinic

Elder Herway and cultural mediator discussing music therapy-They both have been in rock bands

Poster at clinic - this young man was a refugee from Africa, now translator and cultural mediator

Eileen and her nephew Elder Cannon

Elder Cannon and fellow missionaries, Elder Adepoju 2nd to left has a remarkable story of his leaving the Ivory Coast as a refugee. Now he is a missionary

The Elders of the Rome Italy mission

Sister missionaries in the Rome mission

DEVELOPING A LOVE FOR CAPE VERDE

After our conference in Madrid last week we traveled directly  to Cape Verde to train a new couple, Elder and Sister Gerritsen.  The Gerritsens arrived just a few weeks ago. They both have talents which will make them valuable to the work in Cape Verde.  Sister Gerritsen served as a young sister missionary in Brazil and speaks Portuguese fairly well. Elder Gerritsen has worked as a vision specialist.  We are hoping that perhaps sometime in the future a vision project might be able to be initiated by the Gerritsens within their mission.

I (Eileen) always make our travel arrangements. I started eight weeks ago trying to get airplane and hotel reservations to go to Cape Verde. It was really difficult to find availability.  As it turned out we were going right during the middle of “Carnival,” which is a huge holiday in Cape Verde. 

The Gerritsens are living on Sao Vicente in the city of Mindelo.  They will also be covering other islands in the northern half of the Country.  Cape Verde is a chain of islands 300 to 400 miles off the west coast of the Mauritania-Senegal (Africa) border.  The official language is Portuguese, with Creole spoken in the homes and amongst friends.  We found that the people of Cape Verde consider themselves more like the Portuguese than the Africans.  In fact the temple district for Cape Verde is Portugal. Many newly called missionaries travel to Brazil to attend the MTC and the temple.

Mindelo Harbor

Santa Antao

It was interesting to note how much my attitude towards this little country changed during the week.  My first couple of days I was feeling so badly for the Gerritsens, grateful that I was serving in Germany. Today as I travel back to Germany I recognize the love that I have developed for this sweet group of people and for their rugged, arid country.

 Because all of the hotels were booked in the town of Mindelo, we stayed out by the airport; a drive of about 20-30 minutes.  On Sunday morning we took the free hotel shuttle into town.  We were told that the shuttle driver could drop us off near the church which was on his way.  The bus was full of tourists in beachwear and we were in our church clothes. The driver didn't speak any English. He drove into town and pulled up in front of a white church with a cross on the top to let us off. Russell and I both looked at each other thinking to ourselves, we are in big trouble!  We had been told to look for “the green church with graffiti.” This church was white and obviously not ours.  The directions given us were that after we arrived at the church we were supposed to then walk to the Gerritsens apartment, which was around the corner and “in front of the house with pigeons.”  We had heard that it was very difficult to find locations in Cape Verde due to the lack of formal street names and addresses, but this gave new meaning to the challenge.  We got off the bus and started walking. We were the only white people on the street, didn't speak the language and my phone wasn't working as it was out of roaming minutes.  We walked for about 25 minutes looking for any building that looked even remotely green.  I was praying, pleading with the Lord that we could figure out where to go.  We saw a gas station and I went in and asked in Spanish if anyone knew where the Mormon Church was located.  A man responded in French and I switched to French. He said he would point to where the church was. As he walked outside with us he switched to English and said he would walk us to the church.  He said his name was Rui and he was a member of our church, although obviously not intending to attend that day.   I was thrilled to find Rui!  What a tender mercy and a direct answer to prayer.  When we found the church I was so grateful for Rui’s help. It would have been impossible to find on our own. 

The church congregation was small however everyone smiled and was friendly.  An electronic organ was playing pre-recorded hymns. I asked if they wanted me to play. The bishop was happy to have a pianist. Apparently there isn't anyone within the ward that plays.  After church a number of children gathered around the organ looking at the magical way the organ made music when my fingers moved. There was a wonderful spirit at church, although by the end I realized how fortunate we are to have church meetings in English. It definitely is difficult to attend three hours of meeting not understanding any of the words which are spoken.

The LDS church in Mindelo

Boys from branch learning I am a Child of God from Eileen

Sister Rice has been serving in Cape Verde and received her first letter-she was ecstatic

Bishop Neves (center), Paulino Russo,-the two young men are returned missionaries engaged to be married this summer. They have just started washing cars to earn money with a newly formed Member Welfare project 

 On Sunday, Monday and Tuesday we did our normal humanitarian and computer programs training.  Tuesday evening we went to town to have dinner.  The town was packed with people-both foreigners and locals dressed in crazy wild costumes.  I have always thought of Carnival as something kind of risqué, which this particular celebration was not.  This seemed to be a combination of Halloween and the 24^th of July parade in Utah.  The huge Carnival parade with floats was to be held on Wednesday, however by Tuesday night the floats were starting to line up, people were waiting along the streets and families with children in different costumes were waiting along the parade route.  It was fun to see the families doing something together. They were obviously enjoying themselves. Vendors were out on the street barbecuing chicken, selling drinks and nuts. It was quite festive. We just drove by in our taxi after our training rather than watching the parade. Our taxi driver stopped and took a few pictures for me. 

Watching the parade

Aladdin float at Carnival

Chicken being barbequed on the street

Wednesday we took an early morning ferry over to a neighboring island named Santo Antao.  The Gerritsens had arranged for some appointments with potential NGO partners.  The first location we went to was a hospital on the island. We were met by a gentleman that apparently did fundraising for the hospital.  His requests were for money and consumables (like syringes), neither of which were items which LDSC Charities could provide.  We inquired about other needs, but he seemed pretty determined as to what he was hoping we would donate. While at the hospital I wondered what would happen if you had a real medical emergency.  On the return ferry we found out.  There was a young man on a gurney, an IV in place and a neck collar on. He was being transported to Sao Vicente.  My heart went out to him as it looked as if he was either heavily medicated or comatose. 

Russell and Elder and Sister Gerritsen on ferry

It was a 90 minute drive to our next appointment. We went over the top of several mountains.  The drive was unbelievable.  The road was cobblestone the whole way.  We climbed 6400 feet until we overlooked a volcano cauldron and beyond to the coast and ocean below.  During our drive we saw people walking up or down the mountain, some barefoot.  I wondered where these local’s final destination was.  To walk from the village to the top of the mountain would have taken most people several days.  We saw no stores or water sources.  Cape Verde is very arid getting very little rainfall.  The mountains are terraced. Unlike Indonesia’s terraced hills with an abundance of greenery, these mountains were rocky and dry.  Stones were lined up on each terrace.  Children played literally on the side of the mountain.  Several came out to watch us drive past and waved.  I wondered how these people survived.

This man was at the dock with an LDSC wheelchair, he said he was a member of our church

Village on Santo Antao

Houses built into the hillside

Anyone want fish?

Steep, dry mountains

Women can be seen with all sorts of loads carried on their heads

We met Elton, a teacher for one of the schools in the mountains.  Elton had a small request by US standards.   He wanted two sinks and 2 toilets for his school of 24 children and similar facilities for another school in the area.  Elton’s school is a 1&1/2 hour drive from his home in one of the three main cities on the island.  He goes to school on Monday and stays until Friday and then comes home.  The other school was an additional one-hour walk from Elton’s school. At neither location was there any running water for the school or in any of the homes where the students lived.  Elton explained that it was difficult not only for the children but also for the teachers to learn under these circumstances.  Elton is a returned missionary of our church who knows several languages fluently.  He is the ideal example of someone who is trying to give back to the community.  He married a girl he met at a single young adult conference in Cape Verde and now they have a 3 year old son.  We were so impressed with Elton’s efforts, attitude and story.  While providing bathroom facilities in a location where the water source is difficult, we hope that somehow the Gerritsens will be able to help the children in Elton’s small school up in the mountains.

We were late for our appointment so our meeting with Elton was in our taxi (Elton in yellow)

Interesting but good-papaya jam with goat cheese

Sun setting over Cape Verde

As we returned back to Sao Vicente on the ferry I remarked to Sister Gerritsen how fortunate I felt to be able to visit her in such a remarkable place. The living conditions are hard, the language is challenging, the food very different, mail delivery is almost non-existent, but what an adventure!  In a 24 hour period of time we had seen Carnival, driven to the top of a mountain, taken two boat rides and eaten two fresh fish dinners.  We had become friends with several of the locals and even invited our cab driver to join us for a meal. The people are warm and welcoming.  Russell and I really enjoyed our visit.

We went back to our hotel to find over 30 emails awaiting us (just from one day), with several issues that needed to be addressed immediately.  We were both so grateful for this opportunity to visit Cape Verde.  A general authority from our church, Elder Joseph B. Wirthlin delivered a conference address a few years back entitled “Come What May and Love It.”  He happens to be Sister Gerritsen’s father. The people of Cape Verde and the Gerritsens don't have all the seeming necessities of life, but they appear to epitomize being happy regardless of their circumstances.

(Russell’s note) Eileen mentioned how we met Rui on the street while trying to find the church building.  During our visit we also met three members of the church working at the hotel where we stayed, and a taxi driver we flagged down on the street turned out to be a member.  The young woman who checked us out of the hotel did not say much but she discreetly showed me her CTR ring.  It was a good reminder to me to that people are watching me and that I need to act accordingly.  In Germany, if I keep my mouth shut, it is possible to almost blend in.  Not in Cape Verde!  Between the white shirt and tie, skin color, and missionary badge almost everyone knows who you are and they notice how Christian your words and actions are.