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.

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