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.