Childbirth on Cebu

The Philippines

May 1999

Cebu Birth Center

We went to Cebu to visit Mercy in Action, a Christian non-profit organization supported by individuals and churches from a variety of Christian denominations and backgrounds. In September of 1998, Mercy in Action opened a free maternity clinic in the Lorega section of Cebu City.

Students are exposed to the role of the experienced caregiver from their very first day in the clinic. After a period of observation, the students begin to provide the care themselves under the supervision of a preceptor. In addition to a basic missions course, the school offers advanced training in Midwifery and Primary Health Care to equip Christian workers to share the good news of Jesus Christ through mercy ministry in areas that have no doctors. The object of the Midwifery and Primary Health Care training program is to teach maternal, infant and family health and wholeness from a Biblical Christian perspective.

Students are involved in deliveries, along with a wide variety of situations surrounding prenatal, postpartum and newborn care. Students learn the practical and unique problems faced in the third world, and gain valuable experience in maternal/child health care and midwifery in another culture. Students come from a variety of backgrounds and life experiences. Some are young and unmarried, some are married with young children, and some are older and have raised their families. Being a part of the midwifery school is a commitment of great depth, and is often a life-changing journey for the students.

The average class size is 10-15 midwifery students per year. The students learn through observation first, with a chance to discuss cases immediately. They were thrilled to have us visit and immediately took me aside to ask for my expertise on the current complications they were encountering. The curriculum can be stringent—the combination of study with the clinical and birth rotations require flexibility and sometimes long hours without sleep.

We met this mom and her baby, who was coming to the birth center for her 6 week postpartum visit. At all times the students are encouraged to nurture their own relationship with God, as well as reaching out to support and receive support from each other and the staff. In this way, everyone is able to work together toward the goal of bringing the love of Jesus to all those for whom they care.

Father's House Baby Home

In addition to the clinic and midwifery school, they have established an orphanage, for young children whose parents, for whatever reason, are unable to raise and properly care for them. All students are expected to volunteer their free time to work in the Father’s House Baby Home.

The director of the school, birth center and orphanage – and our host – was Vicki Penwell, a licensed midwife and mission pastor with the Vineyard Christian Fellowship. Vicki and her family have traveled for years in Asia, setting up clinics and medical mission outreaches. Formerly she directed a birth center in Alaska, a mother/child clinic in Mexico and two maternity centers for the poor in the Philippines. Vicki’s educational background includes a Bachelor of Science degree in Midwifery from the National College of Midwifery. She holds a license in midwifery from the state of New Mexico and is a Certified Professional Midwife, like me.

She has delivered babies on three continents and worked in midwifery for the past 20 years. In addition, she has studied tropical medicine, third world diseases and health education issues. She has gained a broad base of experience from working with doctors and other health professionals in many countries and settings. She often says that the poor people she cares for have been, and continue to be, her best teachers.

Father’s House is a safe refuge for abandoned, neglected or abused babies. They provide each child with love and care, lots of holding and cuddling, nutrition and medical attention, and wherever possible, a set of parents to adopt them. If infants were never abandoned in streets or doorsteps, or left unwanted in hospitals or slum dwellings, there would be no need for their baby home. However, in the Philippines as in many places, this is a tragic every day reality. It is their desire for Father's House to be a place where God's love is expressed in a practical way to the "least of these" in our society.

Cebu Maternity Hospital

Twelve years ago, Carol, one of the midwives I was traveling with, worked for World Medical Relief, a non-profit organization in Detroit, MI, that provides medical supplies and equipment to hospitals and clinics in developing countries. While working there, Carol met Alberto Herrera, who she affectionately called Babe. At that time, he worked for the mayor’s office in Cebu, but when he was visiting friends and family in Detroit, he and his family would volunteer at World Medical Relief, packing boxes of medical supplies.

While working together, Babe invited Carol to go to Manila and other outlying cities on a short mission trip. Although Babe now works for the Cebu Department of Tourism, when he heard that Carol had returned to the Philippines to visit, he arranged a tour for us and gave us the red carpet treatment. I am sure that not only Babe, but many of the hospital administrators we met, hoped we would see the needs they still have today and help them meet those needs.

Our tour began at the Cebu Maternity Hospital.

This is a typical early labor ward at the Cebu Maternity Hospital. Entire families would accompany the laboring mother to the hospital and care for her during her early labor.

While working together, Carol and Babe sent over 25 container loads of medical supplies and equipment to the Philippines alone. That trip was so emotional for Carol, realizing that they would have nothing had it not been for the work they did. Even today, 12 years later, Carol is still choked up thinking about what it would have been like for them without the supplies World Medical Relief provided.

Some items such as the bandages and gauze get used up, but the hospital beds, bedside tables, bassinettes and lamps they brought to Cebu are still in use today. The beds in this picture, provided by World Medical Relief, were typical of the hospital beds used in the US in the 1950s. Notice that the bedsheets are different as many of the people brought their own sheets for the beds.

This ward was for active labor and for women who were high risk. Unlike our hospitals today, no supplies were provided automatically. If a woman in labor required an IV or medication, the family would be sent to the pharmacy to purchase her needs and then bring it back to the hospital for her before it would be administered to her. Sadly, loan sharks were out on the streets in front of the hospital to loan the family the money necessary to buy whatever their family member needed and would then charge them outrageous interest rates.

The Philippines uses the European model of midwifery care--using direct entry midwives for care of women during labor and birth. Like my own education, they incorporate nursing skills in the education of their midwives, although they are not nurses. Globally, these midwives have the lowest infant and maternal mortality rates, despite the lack of the high technology available in the country.

In the Cebu Maternity Hospital, all women gave birth in the delivery room. But we noticed that there were four beds in this delivery room, permitting four women to give birth at the same time. Although we were pleased that our tour included admittance to all areas of the hospital, including this room in the midst of a delivery, we were struck by the lack of expectation, on the part of both the midwives and the mothers, of privacy.

World Medical Relief solicits US hospitals for donations of hospital supplies and equipment and area physicians for good dated pharmaceutical samples. Countries in dire need of these supplies could then make application to World Medical Relief for these materials. In some years, they sent supplies to over 23 countries.

While working for World Medical Relief, Carol developed a system for massive sorting and packing of 5’ square containers for shipment and set up a Saturday volunteer program in a 12-story warehouse there. Sometimes they knew where the supplies were going and sometimes they did not. Some boxes were packed with a variety of general supplies that could go anywhere, such as syringes, IVs, stainless steel basins and gauze, while others included hospital beds, bedside tables and outdated hospital equipment. All of the equipment seen in this operating room was provided by World Medical Relief—the heart monitor, clock, tables, basins, lights, BP machine, and anesthesia machine.

This young mother proudly showed off her newborn to us. Filipinos are sweet, open, easy to get to know people, who care deeply about the needs of their homeland. Many of Babe’s childhood friends were doctors in Detroit and would also volunteer their time on weekends at World Medical Relief--on average sending 100 shipments annually either by container or taken on short term mission trips.

This newborn is introduced to us by a Filipino midwife as we passed in the hallway.

And here, in the recovery room, the entire family greets the newborn and mother following the delivery.

Here in the postpartum ward, there were two mothers and two babies in each bed and babies requiring special care are in basinettes in the background.

We also visited the newborn intensive care nursery. Again, these basinettes and billirubin lamps, for treating babies with jaundice, were provided by World Medical Relief. Most of the nurses and midwives we met expressed gratitude for all the supplies that had been provided, but were quick to point out how great their needs still were.

Here a new grandma introduces her new granddaughter…but notice the way the baby is wrapped in a warm, fuzzy bunting…despite the unbelievable heat.

Cebu City Hospital

Our next stop was the Cebu City Hospital. By comparison, this was not nearly as clean or organized as the Cebu Maternity Hospital.

Here in the labor ward, we found conditions to be much more disgraceful. The beds—again, provided by World Medical Relief--often held two laboring women. Notice that there are no sheets on the beds. Whatever bedding is in use, is provided by the family themselves. Families provided most of the care for the laboring woman as there was little nursing care. Notice the young father-to-be by the second bed, fanning his wife in labor. Remember, the temperature here was well into the 90s and humid.

Here a young mother and her newborn rest on a bed with no sheets in the recovery room following their birth.

But most shocking of all, the recovery rooms were so full that the hallways were lined with beds…and each bed contained two mothers and two babies!

Next we visited the Pediatric Ward. This image is forever burned into my heart. This child is being “bagged” by his father. They have no respirators in the hospital, so the father must use a bag and mask to squeeze oxygen into his child’s lungs by hand to keep him alive. They do not have the staff to do the bagging so it must be done by the family. The mother, in the yellow shirt in the foreground, was sleeping in a chair with her head on her child’s crib. Presumably she is resting so she can take over the bagging when the father gets tired. I guess if both parents fall asleep and stop bagging, the child dies!

Here in the emergency room, much of the equipment was again provided by World Medical Relief…the IV poles, lights, gurneys and the lightboard on the wall for viewing X-rays. One of the hospital administrators who was conducting the tour told us how much they need an EKG machine and begged us to try to help them obtain one. Very sad.

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