Sunday, May 30, 2010

Pa gen problem

Today is thursday. Aisha and I were invited to Joseph's community for the day.  Our plans were to visit the school, Joseph's aunt who needed some health support, to check on a baby that had recently been born into the community, to visit the garden, and to see our little homebirth family. All of this would make for a long day, but as we learned to say in creole "pa gen problem," "it is not a problem."

Joseph picked us up on motorcycles and took us on a very bumpy ride to the church and school in his village of 5,000.  Aisha and I were on the same bike, sitting behind our driver, going up pot hole covered hills and coasting down the other side.  a couple times we had to get off and walk, but our driver kept telling us "pa gen problem." I heard and said that phrase a million times and I wonder what would be a problem?!

 The school is a long shack, probably the same length as many living rooms, that has been divided by chalk boards into four rooms. We handed out pencils and I talked to the head professor about the school, it's needs etc. The children learn math and writing, philosophy, Latin, reading etc. Culturally everyone is good at memorization, but seem to be less so with critical thinking.  And despite the access to education there are no jobs. So getting an education  doesn't help many people get ahead.  When I asked the head professor about music education, he had the children sing us a creole song. It was sweet and the children were thrilled about sharing. The song was about seeds blowing in the wind.

The grandmother that I saw last Saturday when we had the mobile clinic was there, which made me very happy. She is eighty and sweet with her missing teeth. We had a little printed photo of her as a gift and a dress.  There are people that we just connect to instantaneously in life and for me she was one of those souls. She called me her daughter and we kissed and kissed each other on the cheeks.

At the end of our day we went to Joseph's house and met some of his family. There was a baby there that he wanted me to see. While I was holding little baby Jennifer, Joseph told me brother Michael had been asked to be the child's godfather and that I was to be the little one's godmother.  It was very sweet and I didn't know what else to do but agree, which made Joseph very happy.

During that conversation I realized that the father of the baby was the son of the little grandmother I have fallen in live with. So she is sort of my grandmother now and I like the thought of that.  My first act as godmother was to give the little baby girl a doll, the second was to make sure her family will recieve the first brood of chickens (we donated a coup and chickens to the community.)

After we had toured the school Joseph took us to the garden. The community has purchased three acres of land down by the river. A group of Portland midwives that came in the early spring donated enough money that they were able to buy PVC pipes and a pump for an irrigation system as well as two oxen and a plow.

The garden is lovely, surrounded by mango trees, and seems to be thriving.  They are growing eggplant and corn, peppers, basil and fennel. I gave Joseph a bunch of seeds for squashes and spinach, basil, and some other herbs. I was pleased to see the promise of prosperity here because of the generosity of the Portland community!  There were maybe ten people out working the garden that morning, including Joseph's father, who was drivind the oxen and breaking the soil with the old plow. It is amazing what dedication can create. The hope with the  garden is to provide food for the community and to sell produce in the market so that more seeds etc can be purchased for future crops.

Aisha and I were both very moved by what we saw and what the goals of the community are. I had $250 left over in donated money and between that and what Aisha had to contribute we were able to help purchase a chicken coup and chickens for the community. We discussed with Joseph and brother Michael that our hope is that as the chickens breed they will be distributed throughout the community so that each family will eventually have chickens and eggs.  Who knows how the money will truly get used (although Joseph is giving receipts for everything to brother Michael and Joseph hopes to send us photos as the project progresses).  It feels rewarding to help a larger community help themselves.  It isn't any easy thing to accomplish.

One of our translators, Gladious, told a story about Haiti. He drew a little stick figure of a man and explained that the man was a representation of Haiti. Then he described a chain of hands creating a "rope" that extended to this man. He said that the role was all the help coming to Haiti, but "it is sad," he said "all these hands reach towards Haiti and Haiti stands with his arms crossed. Haiti does not help himself.  It is a sad image and yet it seems true. 

Aisha and I had a long talk with Joseph about the same thing. He talked about how difficult it is to get his people to see the bigger picture. Everyone is in a state of survival and that means it is everyman fir himself. To me that makes the Joseph community all the more special, for the association created to oversee the village truly has a grander dream and sustainable goals. When we get home Aisha and I hope we can find a way to support the community further, especially in the building of a school.

After the garden tour we were wisked off to the famous cursed waterfall, about a thirty minute bumpy motorcycle ride away. I couldn't get the full story on why the waterfall is cursed--but it sounded like multiple white people have died trying to swim in the pools and Joseph would not let us near them!  I am glad he kept us safe, but definately wished we could swim in cool water. It was clean and blue and I imagine it would have been refreshing. I am sure the water demons made it enticing for good reason!

As we walked towards the falls children seemed to appear out of nowhere to escort us.  Aisha and I had a little hand in each of ours and we were guided up a narrow and slippery path toward the top of the falls and the voodoo cave. The little boys waded throught the water telling us to step here and there to avoid falling in. It was sweet and everyone seemed to be enjoying the little adventure.

The cave was much larger than I was expecting. Full of bats and swallows; walls covered in names and carvings of faces and stick figures--a bit creepy actually. Joseph informed me that people in Hinche still come to make sacrifices and perform black magic. People still believe that siknesses and deaths occur because of spells--I had to demonstrate to one of the villagers that the salve I was giving her for her excema wasn't poison. It's a strange little world.

Overall it was a magical day--vacation from the hospital and deaths and people who seem to be missing their radiance. It was wonderful to be handed healhy babies to hold and examine. I don't know how everyone knew i was the femn-sage...

Joseph has asked me to come back and see his people again. And I hope that it will be possible. I know Aisha would also like to return and I am curious to talk to the traditional birth attendants in the area. We need to get a grant to build them a school and just help expand the resources of the Joseph community.

At the end of the day Joseph took us to see our little homebirth family. Only
Betchi Love and Rosamine were there. Julmanise, the little girl that Aisha fell in love with was off washing the laundry. So we waited and I played with Betchi Love and the little neighbor boy, and talked with Rosamine about her recent trip to the hospital. They told her that all was well and that hopefully she would wait to have her baby. Joseph has promised to send me an email when she does.

We left them more linens and food and one of the kick balls we brought along. I also checked in on the mama who live in the section of the house behind Rosamine. I gave her supplies for when she has her baby in three months and a three month supply of prenatals and iron. We felt like we were Santa Clause and I hope that the distribution of so many gifts causes no problems. Pa gen problem. I hope that baby Rosamine comes out strong and healthy and that Joseph looks after our little family.

The day ended with a long drive backto Maisson Fortune, the orphanage and a discussion with  the motorcycle drivers (one who looked like he was eleven) about how much we owed them.  The initial response is "however much you wish to give" and thus begins a sligtly disturbing cultual experience. We make an offer, they act insulted, we ask again how much and they refuse to say but make a drama that what they have done for us is so much. So we offer more, they throw up hands and pretend to drive off. Aisha and I get flustered and offer them ourfinal amount, shoving the money, which is more than generous, into one of the driver's hands. "Pa gen problem," I tell him. The other, older driver, leaves in a huff and Joseph gets teary, saying that it is a problem that we have just spent the day helping his people (and the motorcycle drivers are part of that village) and he is ashamed and embarrassed. I tell him that it is not his fault and that he is still in my heart. 

The days spent in that community made the biggest impact on our hearts. I feel like my soul truly opened up to the plight of Haiti. As Joseph said to me many times "you are now one of us. You are one of my village." I am not sure yet how to process that. What does it mean to be part of Haiti of it's sadness and bleakness, of it's tragedy and loss. There have been moments of joy each day--coming home to the girls at the orphanage who want to sing "shante, shante," they say, "song, song." And so we shower and sing with the girls, let them do our hair and fall asleep with the children playing and the dogs barking and the roosters crowing at 230 am and in the morning we step forward to face the unknown one more time, knowing that the day may be better than yesterday or it make be worse, but most likely the sunrise will bring with it another tragedy and little hope. 
Sent from my iPhone

Wednesday, May 26, 2010

A happy, healthy birth...finally...

It's Wednesday morning now. I got home about three hours ago from a night shift. I was greeted by a happy Brother Michael who was making fresh hot pancakes and fruit salad for breakfast. He wanted it ready for when we got home, which is really sweet. Normally we don't eat breakfast until 7pm and it is always oatmeal. The pancakes were a real treat!

Last night was a treat too. Three moms in labor and one birth. Rounds were relatively uncomplicated--aside from a postpartum mama who had come in with toxemia. She was feeling awful, but we were able to get her some medication from the pharmacist and it helped her feel better. Her baby is also sick, but I couldn't figure out with what. I hope the charge nurse will tell the pediatric doctor to see her as I requested. Getting help here means taking matters into your own hands. The women headed in this morning will also check him out. If no one comes up with a plan I will call home and ask for some advice. Rebecca, if you are reading this--be ready for a phone call!!

Around the time I was working with the toxemia mother one of the mothers who had been laboring all night started feeling pushy. We got her to the delivery room and with a little coaxing I was able to get her into a semi-squat. She pushed beautifully for a little over an hour and she had labored sweetly. She was 41 weeks and had been induced that morning for postdates. The doctor had told her that if she didn't have the baby that night he would do a cesarean. Poor thing. She knew she didn't want that.

When she told me about that it had been around 7 pm and she reported that she was really having contractions. I did an exam and found her to be 2 cm with a nice, soft cervix. Then I discussed stripping her membranes with her; told her it would be uncomfortable at least, but I thought it would work. It did. And probably fifteen minutes later her water broke. She seemed to hit active labor a couple hours later. The baby was born beautifully, supported in a squat by a CNM from KY and one of the translators!

I was thrilled to catch a healthy baby boy. Thrilled she wasn't in her back, that her birth was healthy. The little boy weighed 8lbs 2 oz. The biggest baby I have seen here. Cute, chubby, and healthy.

When the mama's aunt came to help, she rattled off in creole the whole story--me promising her she didn't need a cesarean, her having the baby in a position that was supported and more comfortable. It was so rewarding to hear her yell her story with such joy. I needed a good catch and a healthy birth experience. The joy of that mama makes so much of the hardship here worth it!

I thank her for allowing us to assist her in the way we know how!

Akal, akal, akal...

(Heads up readers: graphic, tragic entry. Please preview before sharing with children.)
Monday afternoon, I returned to the hospital to work the afternoon shift. It was around 2 pm. When I walked into the hospital courtyard Reina was there to greet me. She asked me if I could hurry into he delivery room with her, stating that a mom was in labor and had pushed out the baby's arm.

I gloved up as quickly as I could. The mom was on hands and knees and Reina had tried to rotate the baby. The new shift of midwives was on their way to teach class and came in to delivery with me. We quickly discussed what to do for the mama. The baby's hand and arm was completely blue with no reflexes and Reina said that she had been unable to get heart tones--the baby was dead; probably died en route to the hospital. Reina tried to reach for the baby's head to see if she could get it to rotate at all, but was unsuccessful.

I tried next. I had both hands inside the poor mama and was able to get the anterior shoulder to budge a little, but not enough to make any difference. I tried reaching for the posterior shoulder--nothing. We tried pushing against the side of the head from the outside while trying to rotate from the inside--nothing. No budging. And on top of that it seemed like the mama had also ruptured her uterus and the doctor wasn't around to do a cesarean. That meant that if we didn't get the baby out and if the doctor didn't show up soon we would probably have a dead mama and baby on our hands.

My little emergency guide to obstetric complications says to transport immediately for a cesarean for a transverse lie. And with the mentum anterior (face up, chin probably caught on the pubic bone) this made it all worse. The baby was completely compounded and position changes and reaching in to rotate the baby did not work.

Eventually, the doctor showed up and said that he would be ready to do the cesarean as soon as the anesthesiologist arrived. We explained to him our concerns about timing--she had now been with us for close to an hour--and he agreed that she had a ruptured uterus.

Feeling inside her was strange. Maybe because the baby was deceased. The students couldn't understand why Reina and I were trying to get the baby rotated--I feel like they don't understand that where we come from we keep trying even if it seems hopeless that for us sometimes it just feels better to do something.

The doctor put on gloves and tried just as we had. I doubt he was able to reach into the baby's mouth and try to move the baby that way. Reina and I had both tried that, but again nothing helped. Then the doctor suggested removing the baby's arm. I am not sure what he thought this would accomplish; I think he was feeling desperate like we were and he wasn't sure when the rest of his team would show up.

Again, I tried to get the baby up off the pubic bone and again my efforts were useless. Damn transverse lies. Was he really going to amputate this baby while it was still inside it's mother?! At some point in time the anesthesiologist showed up. He consulted with the doctor and I guess they agreed that cutting off the arm was the next step because now the generator wasn't working and without electricity they could section this mama.

I couldn't believe this was all happening. It was like being caught in some horror film. I watched as the doctor took a scalpel to the baby. He cut through the flesh so easily, right along the little shoulder. I silently prayed that the baby was truly dead--I know that he was, but I prayed anyway. As he cut the babies heart and liver and intestines--perfect, glossy, tiny and smooth spilled out through the cavity of the arm. It was horrible to watch and surreal. The smell isn't something I will forget. I still can't believe I know what the inside of a human being smells like.

The arm came off easily and just sat there on the delivery table next to all those little inside parts while the doctor reached back inside mama and tried again to rotate the baby. Again nothing.
We moved mama back to hands and knees and I tried. I reached my hands inside, carefully slid my hands up the baby's back and chest so as to not get poked my the tiny broken and exposed ribs. I had the dreadful thought that my anterior hand was actually inside the body of the baby. It might have been. It wasn't any easier to slip my hands inside now that the baby was armless.

I still couldn't get the chin up off the pubic bone and I still couldn't get the babe to rotate out of the transverse position. What more was there to do? It all felt grotesque and hopeless and completely heartbreaking.

I am uncertain how much time had passed by then. The doctor gave up and left he delivery room after I had tried one last time to change the baby's position. I guess we all kind of did. But in that moment of surrendering to the hopelessness the doctor came back and said he would go through with the cesarean I think regardless of the lack of electricity. He told Reina and I that we could assist.

So I went to the closet and pulled out a newborn onsie and a couple of receiving blankets. I took one and wrapped the arm and the fetal parts up. No one knew where to put them. A nurse said to put it on the floor and that after the baby was born we could put the bundle with the baby. I tucked the bundle of parts carefully under the delivery table. The. Reina and I helped transport the mama to surgery.

Before you can go into surgery it is required that you put on a clean scrub top and clean crocs. Sometimes the surgery ward rubs out and I wonder if they just wait for the clean ones to come or if the staff moves ahead regardless. The attention to protocol here is strange to me. Some things that seem so arbitrary to me seem life and death to the Haitian staff, and things that I wouldn't dream of being casual about are handled in a lackadaisical manner. Reina and I shared a comical moment once we donned our surgical outfits. We had on scrubs that were many sizes too big, pink crocs that were a men's size 11 and big blue hair nets.

Into surgery we went. Miraculously, while the mama was being prepped the generator kicked in and we had electricity. I stood by and watched, holding the receiving blankets in my hands, ready to hold the poor sweet baby. It seemed like it took forever, but eventually I was holding him and being directed by a nurse to place him in the box that was sitting on the floor.

When a baby dies here, it gets put in a box. Sometimes I think more than one baby gets put in the same box. In this baby's box was a blue paper gown, a couple used gloves and some gauze. I was very reluctant to put the baby with the trash, but it seemed I had little choice. So I plopped him in and closed the lid and refused to put the box back down. I watched the mama get sutured, watched her receive a tubal ligation, and held that box rocking it and patting the bottom of it as if it were a live baby I was holding.

The anger came up when the Haitian nurses started laughing. I know that our cultures are different, but it was and still is challenging to feel like this baby was being thrown out like trash. I just smiled and kept rocking the box. It was still very warm. Reina told them that in our culture we hold babies when they die--the nurses just sort of snickered and the doctor commented "this is good."

Eventually, I told Reina that I needed to go. I wanted to clean him off and wrap him up properly. The mama never saw her little son and that is probably for the best, but after nine months of carrying the baby I imagine it is very hard to have nothing. No memory of a peaceful and innocent little face.

Back in the delivery room, I did all of that. I was sad that someone had emptied all the trash bins and thrown away the bundle that was his little arm and other parts. But what could I do? I washed his cute little face and cooed over his sweet little pursed lips. I wrapped him snuggley in the receiving blankets and I just held him and rocked. I was vaguely aware of the midwifery staff and translators watching me.

And I chanted. Akal akal akal akal. Timeless. Deathless. The chant that I was taught in yoga teacher training to do when someone dies. Reina joined in. Then I put the little one back in his box, tucked the blue surgical cloth around him and closed the lid.

On the walk home last night, Reina and I were taunted, yelled at, followed, and harassed. The experience made me so mad. I had just helped deliver one of their own and I was one of two that seemed to celebrate that life, however short. I wanted to yell back at them. I was upset that Haiti and I do not understand one another.

I shared my anger and sadness over our dinner prayers. It felt good to get some emotions out. I know that what Reina and I did took a lot of courage. That it was a courageous thing for me to stand in the delivery room of this hellish hospital and chant akals, but I still feel turned off and numb-- like someone else is attending to the Haitians now, someone else is conducting rounds and getting mothers to nurse. It feels a bit lost over here, a bit defeated.

Tuesday morning, I asked someone where the babies are buried. The little box that I had left in the delivery room was gone. I walked behind the hospital wondering if I would find an area that looked like a little grave yard. Instead I found a pile of trash, remnants of surgical items, syringes, bottles of hospital waste. Among the trash was a lone box and blue surgical draping covered in blood and wrapped like a bundle. Touching it gingerly I realized there was no baby inside. The box and the bundle were empty. I had the horrific idea that a dog had carried it off for a snack.

I have no idea where the baby was buried, if it was buried at all.

“Normally there is no power in the human but the power of prayer. And to do prayer, you have to put your mind and body together and then pray from the soul."— Yogi Bhajan

Tuesday, May 25, 2010

Photo update

Aisha in the delivery room

Sterilized instruments

Monday and Tuesday rounds

A mama had her baby last Thursday with the students and staff midwives. I think it may have been while we were having a mobile clinic day. Reina told me yesterday (Monday) that the story is that no one listened to heart tones during labor and the baby was born with a limp cord. The staff resuscitated the baby for two hours before she turned around. Since then the baby has been in the "NICU," which is to say that the baby is in a crib in a room with other babies in cribs an hooked up to an oxygen tank.

When Laurie left, she gave the mom her hand pump to help feed the baby. I don't know if Laurie got the mama to pump or if the baby was fed. The information here can be contradictory and confusing. Yesterday though, I was told that the baby hadn't nursed in five days, since birth. She seemed to be doing better with her breathing and although she had no reflexes she did have an okay suck response.

I worked with the mother and was able to get her to hand express a couple of ounces of breast milk and then showed her how to finger feed/tube feed the baby. The baby ate about 20 cc of milk, but was clearly worn out from the hard work. In the afternoon and evening the mama fed the baby again.

This morning, however the parents had switched to formula as hand expressing was too tiresome for the mother and she didn't seem to like the hand pump. I wonder what will happen to it as I am sure it is one of the only pumps in Haiti.

The formula was mixed up and ready to go, but the parents hadn't actually fed the baby yet. So, she had gone for about twelve hours again with no food. I took the watered down formula, syringe, and tube and tried to get the baby to suck. Today though she was very weak. She had hardly any muscle tone, again no reflexes, and no suck response. I kept trying to draw her tongue out with my little finger and stimulated her mouth, but it was rather useless.

Eventually, she did suck a little bit. But unlike a healthy baby that with suck suck suck suck and then pause for a second and start again, she would make one feeble suck and then stop for twenty seconds before making a feeble suck again. After a while I just fed the tube down into her stomach and although I continued to get her to respond to my finger, it worked better to put the milk more directly into her little belly.

After that experience I talked to Reina and she and I agreed that the baby was neurologically damaged and the family needed to know. They needed to be given a choice about this little baby's life. I can't imagine how they will possibly take care of a brain dead infant, let alone toddler or adult and of course I cannot imagine how they will take the baby off the oxygen.

The problem though is that eventually they will have to. There are far too few resources to keep a baby like that in the hospital long term. We found the new Cuban pediatric doctor and he agreed to talk to one of the Haitian doctors and together they would talk to the family about options.

After working with this baby, Aisha and I made rounds in the post-op and postpartum rooms. Everyone seemed to be doing okay, today. I bought a bunch of fresh bread and a jar of peanut butter from the Ebenezer, a bright orange store in the center of town, and made little sandwiches for the mamas and their family. No one refused the small snack and it made Aisha and I happy to feed these hungry mothers. Half the time when you ask they report hat they haven't eaten in days.

It is heart-wrenching.

After we did rounds Reina, came and got me. She had a baby she wanted me to see. The little baby will be two weeks old in couple of days and was born with an omphalocele--when the intestines and liver and sometimes other organs protrude through the navel to the outside of the body. It looks like a big balloon attached to the belly that is about the same size as the baby's head. When we were there, a nurse came in to change the dressing. It was wet and smelled like infection, which was concerning.

When the dressing was pulled off the smell of infection was even stronger and the thin sack covering the organs was a greenish yellow. Reina and I groaned and questioned the nurse--when was the baby last seen (right after birth) and when were antibiotics last given (they had been forgotten).

Again, we found the Cuban doctor and he quickly put the baby on antibiotics. I am hoping that it isn't too late and that the infection won't become systemic. Like the Cuban doctor, I am appalled and flabbergasted at the negligence I witnessed this morning. I can't believe that this baby was somehow lost in the shuffle and wasn't properly cared for.

I wish that I had some more beautiful stories to share, but I don't. It seems to me that the cesarean rate is also high here, on Friday three babies were lost and one survived. There are the two babies I just spoke of, a mama with a retained placenta, a mama with a placental abruption, another with a ruptured uterus, two preemies, and last night I witnessed a birth that I feel numbed by--one that I need to share but am uncertain how to retell.

Last week, I think the best birth moment was a mom who had had a previous cesarean and came into maternity contracting hard. She was prepped for what should have been her third cesarean. She had never had a vaginal birth. In Hinche, it can take hours to round up the OB on staff along with his anesthesiologist and nursing staff and this time that worked in our favor. The mama had a beautiful vaginal delivery and pushed as though she was really having her third. It was a gleeful moment for us.

But there haven't been many of those moments. Everyone here seems to have some sort of health problem or PTSD or simply can't get food or water. It's truly sad.

And while I find the people beautiful and the smiles rewarding I can completely understand why Haiti is called Hell.

Monday, May 24, 2010

Delivery room

This is the cabinet where the sterilized instruments are kept.

And a view of the delivery room...

Sunday, May 23, 2010

Open the door...

We woke up this Sunday morning to a group of Haitians singing a sweet melodic and cheerful song. It is four in the morning. The roosters have started to crow and the world is still dark. This morning we also wake up in the home of Haiti, in the home of the poorest of the poor, on the bed of the needy.

I'm still not sure if I am truly experiencing this or if it is all a dream. But at my side, a pregnant woman sleeps propped against the backside of a turned over chair with a few rags under her and a sheet I have given her for a blanket. I wonder how it is that I am curled up on a dirty bed that is probably made of more rags and a couple old and dirty sheets and the pregnant woman is on the hard concrete floor.

Yesterday, we created a mobile clinic at the Joseph Community, a village that is now five thousand strong after absorbing maybe two thousand after the earthquake. The exact number, I don't really remember, only that it was a lot. The three midwives who go home today, Aisha, and myself went. Brother Michael had asked me if I wanted to go Wednesday instead and work the Saturday night shift at the hospital and originally I had agreed. However, when I woke up Saturday morning at 5:30 I had a strong feeling that I needed to be there.

Because Aisha and I were up so early, like the rest of Haiti, we had plenty of time to organize supplies. Aisha put together the mama baby packs that I had collected-- hand knitted hats, baby blankets, salve and soap-- while I packed up vitamins and supplements, pain meds, my equipment, I hoped I had something for everyone.

The drive to Joseph's community is quick, but up a very narrow, steep road (makes Albright Avenue seem paved for those of you that know that road). There were a few moments I wasn't sure we would make it. All along the road were little shack houses some brown and some painted in pinks and blues. We drove by people waving and smiling behind their cactus fences. Eventually we arrived at the top of a hill where a decent sized building stood and to the right a long and narrow stick shelter. This was the communities church and school.

Joseph, a beautiful twenty-six year old man was there to greet us and give us a quick tour before we got started with clinic. The community is trying to be sustainable. They planted a garden that Aisha and I will go back to see on Wednesday--it was too far to walk to for yesterday's agenda. The soil here is terrible and I am amazed that anything can grow at all, but it sounds like the eggplant they planted has sprouted and flowered, if nothing else. I am hoping I have enough money from me to purchase supplies to build a chicken coop and get some chickens. They need compost and chicken manure is a great source of that!

Joseph is aware of the plight of his people and eager to do what he can. Twenty-six and still hasn't completed high school. He knows he should become a doctor in order to better help his village. Joseph is the most graceful, grateful, peaceful, and patient person I have encountered. His heart and dream have become precious to me. I want to do everything I can for his community. So, I am glad that I came with so many supplies and glad I listened to the voice inside, telling me to skip the evening hospital shift so that I could be at the mobile clinic.

The people in Hinche have nothing. Nothing. But these villagers have even less. The church was packed with mothers and children, elders, pregnant women, and a handful of men, who needed health care.

There must have been a couple hundred people and I was the only one of our four care providers who had supplies and I am grateful I had them and in that moment, and so grateful for the midwifery and herbal education I received.

The CNMs were able to diagnose better and write prescriptions for the people, but I am doubtful that many had the money to buy what they would need to get better. Most of the people I saw were victims of the earthquake, refugees from Port au Prince. They have no money. No food. No water. Nothing. Ten people live in a hut as big as a king sized bed. Nothing.

I treated people for fungal issues, skin rashes, fevers and coughs. I did have something for everyone. I taught the old woman with fibroids how to do Maya massage treatments on herself, using water in case she couldn't afford oil. She couldn't afford to return to the doctor and said she didn't have money to refill her medicine. I palpated pregnant bellies, gave herbs to help fight off nausea, and we handed out the mama/baby packs, pre-natals and iron. I was happy that I even had a supplement for aching joints to give the old woman who lived behind the church. She is eighty and we instantly had a love and sweetness for each other.

Almost everyone I saw had a headache, pains in the heart, and a loss of appetite. All of those people had been in he earthquake. Many were still afraid. Again I am glad for the remedies that were donated. I hope they were helpful in supporting these people through their grief, aches and pains, infections, and teething babies. I could not have provided all that care had I not gone to midwifery school, had Mindy Cash not been such a thorough and enthusiastic teacher, had she and Holy Zapf not given me so many herbal remedies, had you all not donated so much money to allow me to buy what supplies I was missing and pay for my travels here.

Yesterday, I felt like I was a true village midwife. For the reward of that feeling I am so grateful.

Somwhere towards the end of our visit one of the CNMs encountered Rosamine, the mama in labor. She thought she had ruptured her water, but when I did an exam later the bag felt intact. Rosamine isn't due for another month. This baby will be her seventh. She reported that all her babies were born in her eighth month of pregnancy. She could be as early as thirty-two weeks.

The CNM expressed concern about her condition and asked me what I thought about going and doing a homebirth-- I don't know how I could have refused. She was having good contractions every three minutes and because it is her seventh baby and the baby is so small we figured she would go fast. Of course that is not what happened.

Plans were quickly made with the mama and with Joseph. Joseph would come back to the orphanage with me, I would quickly pack up supplies--sheets and rags, a mama/ baby pack, pinard horn and Doppler, instruments, gloves etc. And then Joseph would escort Aisha and me back to his village and he would stay for the birth, in order to translate.

We took motorcycles to her house as our hired driver decided last minute that he didn't wish to drive back to the village for some outraging political "we weren't going to help his village people" reason. Unbelievable! But the motocycles were thrilling, fitting, and better able to get up and down the narrow pathway that is their road.

The entire experience still feels unreal. Surreal. Me crouching over a tiny, thin Haitian woman who has wedged herself in a small corner. Listening to heart tones with a pinard horn because I didn't think it was appropriate to use the loud, modern Doppler. The baby sounded perfect. "The baby is happy," I kept telling her.

When Rosamine's contractions slowed down she would go outside in the drizzling rain and walk. I walked with her, pausing to rub her shoulders or squeeze her hips when she paused stopped for a contraction.

Her little house had two single beds with blankets and rags and who knows what else for mattresses. Under the beds a few items like dirt-rich clothing and buckets were kept. There was probably less than a foot of space between each bed and each bed was pushed against a wall. In front of the beds is two feet of space where a chair and small side table were crammed on one side and another small nightstand sized table on the other. One table supported a small oil wick light and the other a few dishes. There was no water or food. No water for the birth and if there had been, there was no way to boil it.

In front of this little table is where we found the mama laboring, wedged between the door, the bed, and the table. Inside the room was the matrone, Felicia and four of Rosamine's children. The eldest, Wilnise, who is twenty-two and has two children of her own. I thought she was thirteen. A thirteen year old son, with the name Julmanise, who looked like he was eight or nine. Little Wilmanise, the eleven year old daughter who looks six and Betchi Love, the four year old, who was sleeping on the bed. I am not sure if they truly know how old they all are.

While there we gave the family some snacks and water to drink. And I gave the little girl a handmade doll--the perfect pink Waldorf doll like the one my mother made me, only with a black face. Wilmanise was beyond delighted. She was immediately in love in that perfect way that little girls can be--so intensely that the doll might be loved into life. It was such a sweet moment. The littlest Wilmanise spent the rest of the evening curled up at Aisha's side and I think Aisha is equally attached.

This is how we spent our night. Cramped in this tiny Haitian house, waiting the arrival of the baby. Joseph translating, Aisha taking photos, me laboring with the mother.

Around midnight Rosamine's contractions slowed way down and we all curled up to sleep. It was too late to get a motorcycle back to the orphanage. By this time we had moved one of the beds outside to make more room for a delivery on the floor, killed a tarantula (the size of a grapefruit), received and sent away the entire neighborhood, and conducted a pre-natal on the pregnant neighbor.

I am not sure how much we slept over those four hours before sunrise. I am still amazed that Aisha and I shared a bed with a Haitian child, (the older ones went to sleep with the neighbors) who peed all over the bed in the middle of the night. Thank god urine is sterile, even here.

Looking over at Joseph and Rosamine trying to rest my heart just aches. I want to stay here and become the village midwife. I want to teach the matrone, who until last night had never heard or listened to fetal heart tones, midwifery skills, so she can better serve her people. I want to build Joseph a chicken coop. I want to bring these little children home so they can have clean water and good food and an education.

Joseph says "the situation of my people is very bad, but this family it is..." and he just shakes his head. He tells me that the song the villagers are singing this morning is about God parting the waters of the red sea. He has faith that his prayers are being heard and his people will be helped.

The song says "Open the door. Open the door God, for I cannot see a way through."

I am dissapointed that I didn't have the opportunity to help this mama have a safe homebirth, but I am happy the baby will wait. It is too early yet. The door needs to stay closed a little while longer. The door to mine and Aisha's hearts however, have opened wide-- my heart wants to swallow this mama and her children, Joseph with his unbelievable wisdom and impossible dream. It wants to swallow his village.

This experience has my heart opening so wide that I can feel it breaking. I remember one of the midwives from Portland telling me that her heart belonged to Haiti. I now know what she means, my heart belongs here too.

"Open the door God, so that we can find our way through..."

p.s. Most photos taken by Aisha Harley

Saturday, May 22, 2010

Making the rounds


Woke up this morning with puffy eyes, a sense of dehydration, and itchy alligator prickly rash skin. Ugh. It is cooler today, which means it is about 75 at 6:30 in the morning. The girls at the orphanage are already awake and playing. When I go down for breakfast they will all want me to take their picture or do my hair. They are always calling at us "photo, photo," it is very sweet and a bit overwhelming.

Aisha and I are trying to figure out how best to spend the morning. My group of three is on schedule for clinic, but the clinic is crowded when the three of us are there, plus the students, graduate sage-femms, translators, and patients. The room (and I will have to take a photo of it for you all) is the size of a bedroom and not the master. There are five beds in the room that are about half the size of a hospital bed and women give birth on these. They are flat, hard, can't elevate at the head, and have metal stirrups--some of which are misaligned and the when have to put their legs across them, which means the metal edges dig in. It reminds me of the clinic in Senegal and it makes me think of photos of births from the early 1900s.

Honestly, the hospital is a bit barbaric, but I hope that everyone is doing the best that they can. Attached to the birthing room is a small storage area and the sink and counter where are the instruments get "sterilized." Every night the housekeeper comes to clean the delivery room and spends the night sleeping on the counter with her feet pushed up against the drying, sterile instruments that are loosely protected by a green surgical towel

I decided to go work in the prenatal clinic for the morning, in the afternoon I would meet up with the other midwives to help teach a case review class. When we arrived at the hospital the clinic wasn't busy yet there was one woman who was being treated. She had come in after having a home birth for a retained placenta. That mean that we had to go in and manually remove the placenta make sure that her bleeding would stop. She was yelling in agony. It was awful. It is really hard to witness all the mamas who birth in pain and who birth alone. Her baby was lying on a nearby table so I did a quick exam on him before leaving to go do postpartum rounds and the prenatal clinic. He was sweet and beautiful and healthy.

In the post op room there are maybe eight beds. They are okay and rusty with crappy matrresses. Some of the beds lean and it seems like it would take too much effort to sleep on them. Some of the mamas are alone and others are surrounded by family, often siblings.

This morning, I discovered that a mama who was 23 and having her first baby had ended up having a cesarean. Of course no one could tell me why. The mama had labored with such beauty and determination and we had given her so much labor support. It was dissappointing and even more so to not have a reason. I think though that Aisha and I have been invited to her house for dinner sometime next week. I am excited at the possibility of meeting her family.

I also worked with the mama that had a cesarean Tuesday morning. She had had a long hard labor and seemed almost possessed and her baby's heart rate kept dropping and dropping. Anyway, she eventually had a cesarean and I was amazed that the baby survived and seems to have suffered no brain damage from the oxygen being compromised. This mama was doing well. I had brought her some supplements to help fight infection and heal from the c section. She was very grateful both for the herbs and for the labor support. She said she was happy that I had never left her side. I told her it was my pleasure--she shook her head at that, as if she didn't understand it was possible. Her little boy, born too early had been named Edouonne.

I treated everyone in the room and brought back medicines and herbs for some of the women later that day. Everyone needs something. Everyone complains of stomach pains and most haven't eaten in days. In part I think for cultural reasons--the women won't eat until they had their first bowel movement post birth--and in part because they have no money to buy food. They have no money to buy clean water.

Evelyn was last woman I worked with in the morning rounds. Sadly, she had lost her baby. She said she had had an abortion, but her baby had been nine months when it died. Evelyn hadn't had a cesarean, but must have been induced and then delivered her dead baby. Her milk was starting to come in. She was so shut down and sad and hopeless. Her friend was hiding under the bed and reported that they had traveled a long way, from the border of Republica Dominica, to get help and they had no money to get home. No food. And when I asked if she needed pain medication she said "I cannot have because I have no money for water." It broke my heart and It broke Aisha's heart. It is hard to write about. We were able of course to give her water and some pain meds. I expressed a little milk from her swelling and hard breasts, rubbed them with arnica because that was what I had, and showed her friend how to help her bind them so that the milk will start to dry up. It isn't fair that women are reminded by their aching, hard, and swollen breasts that there is no baby to drink the milk, no baby to hold and nurse and love.

I am grateful for the donated homeopathics. They have been helpful and the remedy I gave her seemed to help. Later Aisha and I brought Evelyn and her friend a bag of supplies and food, a new dress ( thank you Ann Holland for the maternity dresses) and what we hope is enough gouds (Haitian dollars) to get them both home safely.

The afternoon was spent doing pre-natals with the students, who still have a lot to learn, especially the basics, which I find a bit strange since they are halfway through the program. And the evening ended with a mama coming in for a placental abruption. Her baby had died en route and she was being induced with pitocin and waiting for the blood to arrive from god knows where for her transfusion. Why she didn't have a cesarean is beyond me. In the states it would have been an immediate service. She, like the mama who had the retained placenta in the morning, was in excruciating pain. The report this morning was that her baby indeed didn't make it, but she did. Last night two other babies were also lost, one toddler, and there was one normal birth and a healthy baby.

Photo update

Here I am with some of the girls from the orphanage. They love to have their photos taken and always want to play with my hair.

This is where I'm staying. Tarantulas and all!

Aisha, Laurie and Christy, who are here in Haiti with me.

Thursday, May 20, 2010

Eviche, Tuesday

I know that this is all a little mixed up. We have been so busy that it has been challenging to find the time to stop and write. Tuesday, after we came back from our Monday night and slept we went to check out the bishop's closet in Eviche The bishops closet has become famous as a black hole for the donated supplies. I had been told that the mysterious closet was a ten minute walk from the hospital and it was difficult to get the keys to unlock it.

I imagined it was some solitary structure, like a metal shipping crate. I had been warned that it was hard to get supplies out of it if we ran out of something while at the hospital. The closet is just that, a large storage area in the bishop's house. The house is huge with a garden in the center and pink walls. It is guarded by two gates--one big and blue with a security guard--i imagine that that can all slow down the process of retrieving anything out of the closet, like a bag of IV fluids (something we needed and ran out of Monday night).

At the roof top is the famous black hole full of supplies. We took bags to stock for today's mobile clinic and Reina, the midwifery volunteer that is here long term. She has clearly been doing a great job as the supplies were all fairly organized (and more importantly the hospital has been stocked well enough although we have needed to dig for some of the supplies).

We packed up a bunch of vitamins, mama baby packs, a scale, urine dip sticks--all the prenatal basics. We also looked through the donated instruments, many of which are in terrible condition, and were able to pull out enough that each of the Haitian midwifery students could have a kit for suturing! We were even able to give them all at least one new bright and shiny instrument! I wasn't there yesterday (wed) morning when they received them, but am sure they were excited. I remember being excited about my suturing instruments.

After we went to Eviche, we napped again at the orphanage, our little oasis, in preparation for another night shift. It was challenging for me to sleep for long-- between the barking dogs and the children playing, so eventually I got up went to the courtyard to play with the girls. And that story will have to wait for another time. I am putting my dehydrated prickly heat rash self to bed!

Taking some antacids as I am trying to digest the goat innards stew we ate for dinner and hoping the tarantulas truly don't climb up to the second floor, as brother Mike's been an adventurous evening...good night!

Mobile Clinics

The heat today is stifling. We have gone to a little village called Bassim Zim to do a mobile clinic. We took a forty-five minute drive along a narrow and bumpy dirt road to get here, ducking out of the way to avoid sticker bushes and tree branches. It was great to have an opportunity to see the country side and the handful of families that have gardens. The area where we are for mobile clinic has a small school with two different classes of about fifteen students each. They have class in one large room, each group in it's own corner. Goats are tied up along the back of the building and there are turkeys and chickens.

We set up clinic in a newly constructed concrete building. Our two translators found benches for the women to sit on and we used two benches put together as an exam table. The pre-natals happen here once a month and women are given the very basics--bp, checked for anemia, asked about previous births and any complications, fetal heart rate is assessed, and the position of the baby.

Last night we spent time packing up vitamin bags for the women all the donated pre-natals, iron, folic acid, and antacids. I am grateful that we had so many supplements donated and that I can put them to good use. We have another mobile clinic scheduled for Saturday at the Joseph's community, an area I am eager to visit.

The women we saw today (we only saw 6 as the priest forgot to announce we were coming during church) were all under 120 lbs and between 26 and 33 weeks. I was happy that only one woman had elevated blood pressure, as I had expected to see more of that. I have to say it was disappointing that we were unable to treat more women.

We are headed back to Azil this afternoon, the infirmary where starving children are treated. It is the most intense and heartbreaking part of our experience thus far and I am not sure anything will top it. The nuns need a lot of help cleaning, changing, and feeding the children. There are four rooms filled with cribs and a small child per crib. They all want and need love and attention and to be held, so that is what we will do with our afternoon.

More soon...

Wednesday, May 19, 2010

I think it's Wednesday?!?!

Monday night Laurie, Cristy and I jumped right in and went to our first hospital shift. Logistically it has been hard to negotiate the scheduling. There are three unexpected women here and although there is a lot to do we have a limited number of translators etc.

At any rate we were feeling ready to jump in and so took the first shift. It is hard to remember exactly everything that has happened. My clock is a bit messed up from working all night last night as well. Monday, Wed, Friday the students are working and it is our job to help instruct them. They work alongside the graduated sage-femmes who work week long night shifts. Not so fun.

When we arrived the first night were three women in labor. A 27 year old woman having her first baby, a woman having her third and another primip laboring. The first mama had her baby within about two hours of us being there and just as she had started to push the ob came in and forced delivery with fundal pressure. I am not sure of his motivations or if that is a semi standard of practice. There seems to be an idea that some woman won't have the babies fast enough. Consequently the mama had a deep perineal tear. But the 6 lb. baby girl was healthy.

Our second mama was about 5 cm when we arrived around 7 pm. She was not having strong or consistent contractions and labor continued slowly throughout the night. Baby started off posterior and it was hard to get the mom to change to a position like hands and knees that could help her. We managed a few position changes but without much success. And as mama continued to labor the baby began to appear stressed, it's heart rate declining. Eventually, after doing some more aggressive techniques it was time to call the ob.

The ob works, from what I can gather, from 7 or 8 am until 7 pm. He is the only ob that we have encountered. A few months ago there was another ob on staff. Calling the ob in the middle of the night does not guarantee that he will show up. I imagine he has to draw the line somewhere or he will burn out. Not a job I could have, it would be too hard to say no. And even when he is called he doesn't always answer and when he does he has to call a driver who rounds up the doctor and his staff, driving them all to the hospital.

And Haitian time isn't fast paced as it is. So, when we finally called, after getting the baby out of it's posterior position but unable to correcting the swollen and de-dilating cervix, we really hoped he would show. It was about 2 am and we were out of resources and ideas and baby was really showing signs of distress. As the night progressed and mamas labor continued to slow we worried that we would probably lose the baby and possibly the weakening mother. It was and is still challenging to feel that helpless. All we could do was continue to support the mama and hope the ob would come to the hospital in time.

In the wee morning hours the babies heart rate bounced between 90s and 60s, well under the normal range and it really started to seem grim. We still weren't even sure the ob would come. In the end he did and prepped the mama for a c section. Laurie and I went into the OR with him and three other staff.

It was an ordeal finding clean scrub tops to wear into the OR--our shirts were far from sterile, but there isn't much here that is. We finally found paper hats to cover our hair and clean scrubtops and extra large pink crocs. I am certain we looked like clowns. The doctor was efficient. The OR was a small room that attached to what seemed like the supply closet. It was surprisingly well equipped with meds, instruments and machines, but seemed very primitive as though it belonged back in 1930.

A strange looking pumping machine, the cross like surgical bed and the piles of suture made it all the more surreal. But the cesarean was straight forward and within a few minutes, just before 6 am, I handed a 6.5 lbs baby boy who needed a lot of stimulation, but amazingly enough, no resuscitation. He was a little fighter and I hope he won't suffer any great damages from his prolonged distress.

Once the baby was stable we took him to the students for his exam and shots. And then we packed up and made the 30 min walk home in the already building heat. It was probably close to 7 am. The sun was blaring already. We walked by a church that is being constructed and where a group of men were having early morning choir practice. It was a touching way of ending the night.

Now to bed. Sorry that these aren't coming faster. There is a lot to do and it is hard to not just crash when I stop moving. I am doing well aside from a terrible heat rash! Tonight is only my second night sleeping. I sure that I will and hoping that I sleep through the barking dogs and confused roosters (they wake up at three am around here!). Tomorrow, if all goes as planned we will have a mobile clinic day!! Vitamins and supplies divided and ready to go! Good night.

Monday, May 17, 2010

In Haiti

I made it! Along with my friend Aisha, a midwife from Cali and Laurie, another Portland midwife. Our flight was canceled on Friday, so we arrived a day later with our truck load of luggage and eager-to-help spirits. The drive from PAP to Hinche, the town where we are staying was an adventure. Most of the way it was a winding and narrow dirt road that went through the mountains. It was actually fun and very beautiful.

It was overwhelming walking off the plane. I was ill from the flight or the anticipation or the energetics of Haiti or all the above, and deeply moved when we stepped off the plane to the greeting of live Haitian music. It was hard to not dance and to continue on our way to customs.

Our dirt road drive took about four hours. We passed the rubble and devastation of PAP. It was unreal. Like the city had been bombed. And the tent cities created white and blue patchwork near the base of the mountains we traveled through.

Stopped for a delicious and spicy lunch in some small mountain village. Women were singing for us there. And just happy to wave and be smiled at. It easy to fall in love with Haiti. It is very dry and very beautiful.

We are staying at an orphanage. There are 250 kids here. The orphanage I think has been in place for the last 20 years. Or at least Brother Harry has been here that long. The girls (and I think there are about 80) have only been here for a year. Thirty of them since the earthquake. And another space was rented to house the boys that came. The youngest child is three and the oldest 27. None of them will ever be adopted. For the most part, the kids fend for themselves, but do go to school and three will go off to college on scholarships in the States!

Our hosts are Brothers Michael and Harry. They are lovely and patient with us. Food is more than rice and beans. We have a cold shower and sometimes electricity and a semi flushing toilet. It the Hinche Hilton!

There are three extra ladies that came but weren't on the list and some are unsure about letting us work at the hospital on some nights. It is going to take a lot of initiative to get anything done. But so far i think we are headed in the right direction. Today we toured the hospital, met the ten midwifery students and Reina, the midwife from the States who is here for another three months. She has been here since March? And speaks good Creole already!!

Tonight we have our first night shift at the hospital with three of the students. I am curious to see what their skill levels are and nervous about my own ability to deal with emergencies that we never really have to in the States. I am glad to have Laurie and Cristy here with me.

Already though, I know I have touched one life. A woman in line for prenatal care who probably needs a million items like vitamins, that we take without thinking about the blessing of. In some way we connected and were both moved by our equally open hearts. And I know that in this environment where there is nothing, that compassion and love will be the most important things I can provide.

There is a saying here. When you ask "how are you," the response is always "I am no worse than I ever was."

Sent from my iPhone

Monday, May 03, 2010

Preparing for Haiti

Yesterday, Aisha, a dear friend, photographer and Haiti-trip companion, and I sat down and packed our green rubbermaid bins. We are taking four and one extra duffle bag. I have been gathering supplies for the last two months, thanks to all your generous donations, and feel for the most part that we are well equipped. It is hard to think about what to take, what to leave behind, and how to have a little something for everyone. I keep going back and forth on what to take and what to leave behind. Yesterday I bought a bunch of little things to take to Massion Fortune--the orphanage. I have candy, bubbles, stickers, soccer balls, nail polish, soap, and the much sought after peanut M&M's!

Off we go! Our flight leaves in a couple of hours. We have 355 lbs of luggage between two of us.  We are already in the cultural "hurry up and wait" mentality with multiple flight delays. Our 12 pm flight isn't leaving until at least 5 pm and I really hope that we don't miss the Miami to PAP connection. I wonder if I can reach our driver, Moliere, if indeed we need him to pick us up later. But baggage was greatfully checked all the way to PAP after we were told we would need to recheck it all in Miami. Now they are telling us that if our flight doesn't leave today we won't be able to leave until Sunday. There has got to be a different option. So send us Sat arrival time energy. I don't want to miss two days of work and time at the hospital in Hinche. That isn't part of my plan.
Here we go....hurry up and wait.

Ps. I was hugged by the TSA woman who had to search me. How many people have had that pleasant experience going through security! Blessings are hidden in everything.