Merry Christmas Happy New Year and Hello Avie

Boston is the last place that we thought we'd be spending Christmas, but nevertheless there we were. A little explanation:

Tuesday December 22nd 10:30 AM Botswana time, we received a call from Alison saying that her water broke in the middle of the previous night. After a quick trip to Cambridge Hospital, she was whisked off to Mass General for admission given that she was only 33 1/2 weeks along and the course of things was quite uncertain.

We knew immediately that we couldn't stand by in Ramotswa while such big, important and uncertain events were happening, so we began a very hectic 4 hours to contact the Peace Corps Country Director, re-arrange things, cancel things, arrange for transport, close up the house and get a flight to Boston. In the 95 degree heat, I sweated through my clothes twice, but who's counting?

Six hours after the call, we had received Peace Corps authorization and were on flights to Jo'burg, Atlanta and Boston, arriving there on the 23rd, 29 hours after leaving our house. It really does feel like a small world.

Upon arrival, we began a series of discussions with Alison, Jason, their steadfast and incredibly helpful friend, Heather Lane (a Yale classmate of Alison's and a nurse midwife) and the doctors and nurses at MGH about what to do. A plan gradually came into view, but all was overtaken by natural events--funny how that happens.

Alison started contractions on her own during our pow-wows and moved along exceptionally quickly. After only 6 hours of rapidly progressing labor, Avie O'Keefe Marshall (Avie rhymes with "navy.") was born at 9:30 p.m. that evening. She weighed in a 4 lbs. 11 oz. and 18.5 inches, a good and healthy size for a baby born six weeks early. Avie is currently in the Newborn Intensive Care Unit (NICU) as a precaution, although we are elated that no invasive treatment like a respirator has been necessary. She is breathing great on her own and is taking to feedings like a champion. She's got her maternal Grandfather's appetite and she is a beauty like her Mother and Grandmother.

Alison was in the hospital until Saturday the 26th. She is walking, eating and settling into her new role as a Mom. Jason has just been a terrific support and partner. They are a great team. Avie will likely need to stay at the hospital for awhile. The doctors are calling her the "star of the NICU," so we're cautiously optimistic she will be moved to a less intensive unit or discharged soon.

From here on, I thought it best to let Alison give an update in her own words.


Our week has been out of the ordinary but overall very good. Physically I feel great (thank God for a quick labor and delivery!) and mentally I am also doing well. Our impatience to get Avie home has to be tempered with our desire for her to grow and thrive and she is getting the best of care here. I have to say that having a rock solid marriage to a fantastic husband has been a gift I couldn't have imagined. Jason has become such the protective Daddy and husband- I can hardly lift a finger before he is there to help. He's also far surpassed me in diaper changing and has even caught a few surprise poops on their way out without a flinch! Last Thursday was the first day that he was able to properly hold Avie (more on this below) and it warmed my heart to no end to see my little family all snuggled together. We both could not have been doing so well without the incredible help of our parents. We have had meals cooked for us, laundry done, shopping completed and lots of hugs and good conversations. Not many people have families like this and we feel very blessed.

So, on to the little Miss. She is progressing exceptionally well, both in our opinion and the opinion of the providers here. Basically, she is just being given more time to grow and get strong. She has not had some of the complications of prematurity, i.e. "forgetting" to breathe (apnea), intolerance of feeds (vomiting or not pooping), and slowing of the heartbeat (bradycardia). She was old enough and developed enough that these really didn't make an appearance. Obviously, this helps her prognosis a lot. However, she still has a few hurdles to clear. For the first 6 days, she was under phototherapy lights to help lower her bilirubin levels. Bilirubin is a compound that is formed with the breakdown of red blood cells. Older babies also have this in the form of jaundice. Too much jaundice can harm neurological development, so it's crucial to keep it under control. The problem with the phototherapy is that Avie could only be out of the lights for 20 minute breastfeeds. Poor Jason didn't get much time with her at all until she finally came out of the lights on the 31st. So she is out of "bili-jail" as we have been calling it. She also needs to prove that she can eat all the calories she needs to gain weight by mouth. For now, she is still getting tired on the breast long before she has completed a feed, so the rest of her food is being delivered via nasogastric tube directly to her stomach. The goal is that over time, she will eat more at each feed and need less and less by the tube.

We are not being given a time line at all as to when to expect discharge. Everyone here is encouraging us to take things one day at a time and let Avie set the pace. Again, it's our impatience to get her home that's bothersome, she's doing everything right.


It is a truly memorable Christmas that none of us will forget. We send along wishes for a Happy and Healthy New Year to all of you.

Kgosi and Kopo