Sunday, September 12, 2010

From Illysa Foster

I have disallowed comments due to a plethora of spam/pharmaceutical industry comments. So I want to add some here:

Thank you, Maria, for sharing your long days and nights in Haiti with the public. Having been there myself just six weeks before, I found tremendous solace in your stories of triumph and loss. Hooray for you, Ami and Dina for bridging the divide of language and culture to see the lovely midwives of Haiti for who they are-women in service of other women and their families. I hear hope in your voice that rises in me as I remember the joy in working with bright students there and in seeing the beauty of Haitians-those with the most authentic smiles one can have the honor of witnessing. Thanks for sharing the pain, too. That resonates deeply, as well.

Blessings to you and your work,

Illysa Foster

Thursday, September 9, 2010

Haitian Women Need Mesh Panties

I never cared too much for the white mesh panties that every American woman adorns after giving birth, whether having given birth in a hospital or at home. The Haitian midwives have nicknamed them "sexy coulottes." I have a newfound love for these American throw-aways.

The Midwives for Haiti program is stocked with the weekly supplies brought in by the American volunteer midwives. Ami and I brought head lamps, wrist watches, rain ponchos, fetoscopes, baby clothes and blankets, 100 units of pitocin, 3 bottles of misoprostol, suture material, and the miscellaneous supplies donated by midwives -- cord clamps, gauze, syringes, tape.

There will always be demand for these items. Yet, this is the bare-bones minimum.

What I really wanted to give the women giving birth was a simple, clean pair of mesh panties and a single Kotex pad. Whenever we found these items in the storage room, we brought them to the hospital and gave them out. The women always received them as a gift. I saw it as a moment of dignity. Finally getting up off of the birthing table, to be able to feel clean and complete was a simple dignity that only one who has given birth can describe. The cushioned GYN tables of the Hinche hospital are only minimally cleaned after each birth. There are no pillows or sheets. Often I saw the mother resting her head on the metal rail at the head of the bed in between contractions.

The cloth that the mother brings for the birth is soiled quickly from the normal fluids of a baby being born. Blood stains her skirt that she has drawn up to have the baby. Sometimes, if she's lucky, a sister will come in after the birth with a clean set of clothes for the mother and the baby. Cotton cloths, usually from a torn sheet, are placed in her underwear to absorb the lochia of postpartum.

The simple, bright white of a clean mesh pantie and Kotex felt like a luxury each time it was placed. I especially wanted to give them to the mothers who lost their babies. I felt that they were leaving with nothing. I desperately wanted to give them something to express our compassion, to honor their work.

The other thing we gave out was water. While we were organizing the storage room, I found a bag of water. It was a black shoulder bag filled with approximately 15 small, plastic sacs of water. Upon seeing them, I could tell that this is how they sell clean water in the market. A commodity. When I inquired about the water, I was told they weren't being given out because then everyone would want them. I packed them up to bring to the hospital.

Whenever Ami and I were working, we made an impromptu policy that each woman in labor would receive a sack of water. In the heat and the relentless work of labor, the water was gulped with gratitude. Before we left Hinche, Ami and I bought two large plastic bags of water sacks from the market and left them in the Maternity ward. It was our final gift.

Paul Farmer's guiding premise is to care for the poor with dignity and commitment. If a TB patient was living under a leaky roof, well, of course, they wouldn't get better. Therefore, a prescription for a roof repair was written and carried through by Haitian carpenters.

In birth, women need respect and dignity as well as anti-hemorrhagic drugs.  They need clean mesh panties and Kotex. They need water, not only to prevent dehydration, but to honor their hard work. As a woman would shuffle out of the maternity ward, adorned in her new mesh undies like her American sisters, I would feel the tiniest glimmer of relief -- we had given back.

Matthew House 25

Here is the You Tube link to Dina's piece on Matthew House 25.

Sunday, September 5, 2010

Journal Entry: September 4, 2010

I rarely slept later than 4:30am in Haiti. With the heat and the roosters and the dogs barking, by 4:30am, I was done for the night. Most of Haiti wakes up by 5 anyway. If I went outside by 5:30am, there was always a soccer game in full swing. The equatorial light was bright by this hour and the day had begun.

The roosters. I didn't tell you about the roosters. There are roosters everywhere in Haiti and they call back and forth to each other all night long. Sometimes there's a lull and you fall into a deep sleep, only to be abruptly awakened by a cock-a-doodle-do that seems to come from about 3 feet from your head. 3 or 4 more roosters will call in response, each one more and more distant.

I would wake up at this hour under our mosquito net and contemplate getting up. The heat was already heavy and the best thing was to just get up and sit on the porch. Some mornings I would get up and write on the computer, other times I would just get ready for the day.

Today was no different. For our last night in Haiti, we slept on the roof of Matthew House 25 in a tent. It seemed quite appropriate given the thousands of families in tents all over PAP.

Yesterday we took our small, 6-seater plane from Hinche to Port Au Prince. While waiting on the dirt and rock airstrip for our plane to arrive, Esther ran up for one final good bye. She was dressed for work and I was utterly thrilled to see her wearing my Birkenstock clogs that I had given her at the party the night before. I had wanted to give a few things away, but when the party started rockin', I forgot. At the end of the evening, Esther pulled my aside and asked me about the clogs. I was so glad that she mentioned it. They fit her perfectly and will be so much more comfortable that the thin and worn plastic sandals that most people wear.

I gave Magdala a dress. Here in Port Au Prince, I gave my sneakers to the boy I promised them to, Paolo. I gave the amputee who "saved" me when I was giving the kids lollipops and got swarmed, an umbrella. I gave the 14 year old amputee girl a flashlight as well as the young mom with the 5 month old with malaria. We gave onesies, a G diaper cover, and body wipes to Roseman, the woman who was in labor in the tent city on the first day we arrived. She labored all night, a 7th baby, with progressing beyond 7 cm.

We ended up transferring her which really meant: 1) she went to the nearest maternity hospital and the gates were closed for the night so she couldn't get in; 2) she went to another hospital where they refused her care because she wasn't registered there; 3) she came back to Matthew House while a young, well-connected medical student called around to find a place that would take her. She made calls to Sean Penn's camp, while I re-evaluated how we could take her back. Maybe if she birthed in Matthew house instead of her tent, if she had a bad hemorrhage, we would be better able to see what was going on. And 4) she was finally allowed to go to a Red Cross hospital in a "sketchy" part of town. A driver brought her there. She labored all night and didn't progress. In the morning, she was given pitocin and delivered a healthy baby boy.

Seeing the baby at 9 days old, he seemed small to me, under 6 pounds. He also seemed hot and lethargic. The mother said that he was nursing well. A medical doctor from the US had checked him out today in the tent city, said he was fine and gave him vaccinations.

As we were saying our goodbyes in the tent city, Darling, Matthew's young mother, began chanting Ami/Zamni (zamni means friend in Haitian Creole). We vocal boom boxed our Kijon ou ye and "the rain/comes down." It was a spontaneous outpouring of celebration in our meeting. Bennis, a young boy, loved our "How are you?" song. As we were leaving, he continually asked me for a soccer ball. I joked with him, showing him that I didn't have a soccer ball in the small purse that I was wearing. In the end, I ran and got him a baseball cap.

The rest of the clothes donations were left at Matthew House for Tey to distribute as needed. I am wondering if I will ever see these people again. Dina, Ami and I all fell in love with Haiti. I told Esther that I would come back next year. Yes, I would like to come back. I would like to continue the exchange that we began. At the end of our party, SheLove said that we were their favorite midwives even from day one. We asked her why and she said the we had given them the most love. Yes, I felt that. The love flowed both ways. We bonded through our hard work, our grief, our joy, our long, hot nights together, our vision for women and their babies. Midwives are the same throughout the world. We give of ourselves to be with women in their most vulnerable moments. We believe there is power in birth. We believe that women should be treated with honor and respect and that these simple gifts will provide lasting effects on a mother's ability to do her job well. Kindness, love, respect are all for free. Even the lowest resourced areas can give these away to any mother.

Brother Michael at the Maison Fortune often would ask in the evening circle, "What has Haiti given you today?" It is a question to punctuate the fact that we, as Americans, as foreigners, are receiving, more than giving ourselves while we are here. Haiti has given me  a glimpse into the harsh realities of global midwifery. Haiti has shown me hope through the smiles of the children. Haiti has given me an opportunity to witness the strength of women, midwives, who go back to work, day after day, not knowing whether the day will be weighted heavy with joy or grief.

Thank you.

Saturday, September 4, 2010

I'm back in the US. Stuck in Miami International Airport without a computer. Will blog tomorrow.

Friday, September 3, 2010

Last Night in the Hospital in Hinche and A Party

Ami and I deliver a stillborn baby each on our last night in the Hinche hospital.
Sonise is the first. She is young. She says she’s 20 but I still think these women may be younger than they say they are. She is pre-eclamptic. She’s received Mag Sulfate but her baby is already dead. She doesn’t believe it when she’s told the news.  We put the Doppler to her belly and can not find a heart beat.
She pushes for awhile in the usual Haiti-style — on her back. It’s taking a long time and she’s quite uncomfortable. She asks if she can get up and use her bucket. I say that she can be in whatever position she would like.
She ends up squatting by the side of the bed and pushes the baby out on the floor. We quickly grab a blue surgical sheet to place on the floor underneath her. It’s really the first birth we’ve seen that is not on the GYN table. The placenta is born easily a few moments later. We move the mom back up to the table. Now, the 39 week baby is on the floor and the mother is looking down at her. Ami and I have developed a pattern of wiping off the baby and half wrapping the baby up, swaddle style, in a blue paper towel. Sonise wants to see and hold her daughter. Her sister is with her and is arguing loudly that she shouldn’t hold the baby. For a moment, there is chaos as the sister is protesting and Ami and I are insisting that this mother can process whatever way she needs too. Adeline, the midwife, is also arguing against holding the baby. We win the argument and Sonise holds her baby girl for a long time. It really seems like a rarity for someone here to bond with their stillborn baby. Sonise takes her time. It is good. Denial, anger, she’s blaming another hospital for the death of her baby. I know that she is going through the appropriate steps and I wait patiently for the grief.
I tell Sonise, “No, it is not the other hospital’s fault. These things happen and it is so sad.” Sonise insists that she wants to take a photo of the baby. After some difficulty, she gets 3 photos of the child on her cell phone. She seems happy with that. She wants to dress the baby. Again, the arguing ensues from her sister. Again, Ami and I support this woman’s choices. This is all she has of this baby. She puts a small hat and white cotton dress on the baby. She doesn’t seem put off or repulsed by that fact that her baby is dead.
Another photo. We tell Sonise that we will always remember her and her baby. She will always remember her baby. Sonise names her Daphne.
Ami’s stillbirth is in the over-flow postpartum room because the mother stayed there too long and now the baby is coming. We move some supplies down the hall to where they are. The woman is resting her head in her husband’s lap, not unlike many of our births in the states. The dark brown amniotic fluid of death is becoming all too familiar to me. The small, macerated baby girl is born soon. The mother and father only look at her for a short while and do not hold the baby. It is all very sad. This is our first birth with a father in attendance.
The rest of the night at St. Therese is unusually quiet, interrupted only once with the prayerful singing in the postpartum ward as Sonise and her family grieve for the lost baby. I am happy that she is processing this death in a very conscious and real way. Both of the babies tonite had been the mother’s first. We have another woman in labor tonite —it is her fourth. None of her babies have been born alive. We are hoping this one will be different.


I want you to leave Hinche with a story of life and hope. It is the story about our fete, our party.
I didn’t even have time to blog yesterday because Ami and I planned a big party at the Maison for the midwives. Midway through the week in Hinche I thought that it would be a good idea for future teams of midwives to have an American party to get to know the Haitian midwives. I knew that Ami and I were connecting so well with them, we laughed and joked in Creole at the end of each shift. We took photos together. We processed the death of our mother that had died on a deep level, together. Our relationship with them was strong and loving. I was afraid that many of the other teams were missing this true exchange. Thus, maybe a party would help them break the ice.
But then the next day I realized, I want to have a party for them. Ami was immediately game. We asked Brother Michael at the orphanage if he would ask the cook to make food for us. We wanted fried plantains and the crispy, fried potatoes sticks, hot dogs. We wanted the cook to buy avocados and eggs at the market so that we could make deviled eggs and guacamole. Ami, Dina and I would go to the market the next day and buy Haitian caramels and limes. We ordered up 6 cokes, 6 Sprites and 12 beers. Jean Louis’ brother would get that for us. Jean Louis is the founder and head of the orphanage. Everyone was amazed and excited that we were throwing a party. No one had ever done this before at the orphanage. We invited all the student midwives and the graduates that we had been working with. They all said they would come and seemed truly excited about it.
Yesterday was the party. After our night in the hospital, we came home and cleaned up a bit. Then we left at 8am to go on the mobile clinic. We drove 45 minutes out of Hinche and then walked for 25 minutes until we reached a small building that looked like a typical Haitian school. Dirt floor, wooden benches. This is where we would see the women and three were already waiting. By the end of the morning, Magdala and Philomen, as well as two student midwives, had seen around 25 women. Ami and I mostly observed, tired from the night before. We got home around 1:30pm and the party was at 3. We scurried around trying to find a CD player, worrying that the drinks hadn’t arrived yet. They would have to be put on ice in a cooler. The cook had made an amazing spread for the party — besides what we had ordered, she had made a beet salad, a pasta salad, the spicy cole slaw that we often ate, and popcorn. POPCORN!! We were so psyched!! The kitchen table was full of food. I got to work making the deviled eggs. I even showed the cook how to pipe in the filling by cutting a corner off of a zip-lock bag, filling the bag and oilá, you’ve got a pastry bag. I made her taste one, she liked it.

The drinks came at a little after three. On Jean Louis’ recommendation, we changed the order to a case of Cokes, a case of Sprite and a case of beer. He told us that with what we had ordered at first, that wasn’t a Haitian party. We were expecting 20 people. Our driver, Ronel, was meeting everyone at the hospital and would drive them to the Maison. At about 3:10pm, the thunder rolled in and it began to rain. At 3:15pm, the truck load of midwives showed up, all of them crowded into the back of the truck, now with 6 or 7 umbrellas providing shelter. We were delighted!
The midwives arrived, dressed to the nines — make-up and jewelry. We had told them to not come in scrubs, this was a party! One woman came in a long, lavender dress that looked like a maid-of-honor gown in the US. She was gorgeous. Everyone was excited and happy. I had a slide show running on the laptop of the pictures of our time with them. They were immediately drawn in, laughing and hooting when they would see themselves in the show. I offered drinks all around. The food was devoured in no time. Small plates piled high with all of the offerings. I saw many people going back for seconds. We had even found a bag of Oreos that had been left behind by some other midwives. I told them in Creole that I made the deviled eggs and the Ami made the guacamole, but the cook had made everything else. I also told them that I am Italian, so I really like it when they ate a lot. Everyone loved the food and drinks.
Now, Dina, of course, had been playing ukelele all week. On our first night in the Maison, we heard some kids playing the ukeleles, so Dina tuned them and played one off and on all week. She wrote a song in Haitian Creole that we now sang to the midwives. The song was made up of all the simple and common phrases that we had been using all week. Here’s the translation in English (of course we sang in Haitian Creole):

How are you?
How are you?
I don’t know.
How are you?
Not now.
Not now.
How are you?
Not now.
How are you?
Not worse.
How are you?
We are here.
How are you?
I’m fine and you.
Oh, we are chillin’.
(Maria’s solo)
        Don’t cry because we are going.
        Don’t cry because we are going.
        Don’t cry because we are going.
        (repeat from the top.)

The response was obvious, immediately. Everyone was hooting and hollering and joining in the chorus. They loved watching the crazy Americans, singing their silly song with Dina on the ukelele. They clapped and cheered when we told them that Dina wrote the song herself. We laughed together, truly joyous and grateful for meeting each other. The Haitian midwives got together and sang us a song back. It was a beautiful song of thanks. I couldn’t understand the words, but I understood the sentiment and “Merci.”
After more chatting and socializing, exchanging emails and telephone numbers, the midwives piled back into the truck and said goodbye. The rain had only lasted about 10 minutes, so the truck was dry. I watched them leave from the second story porch, trying to capture one last photo. Esther, Genette, Adeline, Fedeline, Bien Aime, Marthonie, Anise, Monide, Magdala. Would I remember them all?

I will remember them in my heart. I will remember Haiti.


Wednesday, September 1, 2010

Nou La

Haitians have another response to "how are you?" that reflects their resilience and optimism. Kijon ou ye? How are you? Nou la. We are here. We are here reflects their affirmation that they are still alive, here today, that is good. I have noticed that death is talked about without emotion. My father died. The baby died at nine months. Death is as hard a fact around here as life. We have already seen two funeral processions — the first was through the center of Hinche. Hundreds of uniformed men and women slow-stepped in time while a band played. Their was one line of people on each side of the street. At first we thought it was a church parade, but then it became clear that there was a hearse at the very back of the line. There were uniformed men and women first, and then children, all dressed in white. The band was next, followed by the hearse and the family. It felt very much like a New Orleans jazz procession. Ami says it is called a Second Line. The hearse driver was tapping his hand out the the car window in time with the music. The second procession was much less ornate. We simply saw a band of people carrying an ornate coffin down the street. There was no crying or talking. They were just doing what they needed to do. One night in the hospital, when there was a lull in births, I took a walk around the courtyard to get out of the stuffy, clawing heat of the labor ward. I started to hear a loud commotion and someone yelling loudly. It was a woman’s voice and I thought it was a new woman in the throes of labor. I went towards the sound to see what was going on. As I approached, a woman was wailing, “Mama, mama.” Over and over, interspersed with sounds of grief and heart-break. I would occasionally understand a few words in Creole, like please and leave. Mostly she just cried Mama over and over. This is the second time I had heard the keening in as many times as I had been at the hospital. The grief was so clear and pure, a total consumption of this woman’s body. They were people gathered around her, but no one tried to stop her process. She occasionally would spread her arms wide, bearing her soul in her willingness to bargain her mother’s life back. I stood with the group, watching the woman. It didn’t seem rude or disrespectful, on the contrary. It seemed that the more people who gathered around, the more this woman was honored and held in her space of sorrow. Sure enough, not long into this, the same men who had carried out our pregnant woman on the stretcher came trotting along with a small body wrapped in a white body covering. A Ford Explorer had pulled up that had all the seats taken out of the back. They put the whole stretcher into the truck and then the men got into the truck as well. I can only assume that they were bringing the body to a funeral home, or home. The next stop on it’s journey. The rest of the family were able to load the keening woman into the front seat of an old pick-up truck. Her keening quieted to a soft focus stare. The family climbed into the back of the truck and drove after the Ford Explorer. The hospital was quiet again.

Ami and I have settled into a routine of going to the hospital every other night to help out. The students were not there on the weekend, which made it a little different. Still, we connected with the midwives and shared with them more as peers. On Friday night, we went over for about 5 hours and I delivered a baby because they wanted to see how I did it. A healthy baby girl. At the end, I asked if I had lived up to the Haitian standard. We all smile and joke after a long night at the hospital, relieved and tired. On Monday night, the students were there, Josette and Marie Denise. I am so impressed with their skill and professionalism. They are almost done with their year long training program and I am confident that they will do well. Josette and I dealt with two second degree tears together. She is a girl after my own heart. Her suturing is meticulous and precise. We did the suturing together on the second mom because the sulcus tear was deep. She asked me if I would do the deep part and then she would take over. So we did it together. I also showed her a few new ways to hold her needle holder “to make her life easier.” She totally got it and I was so comforted to know that these women will be sutured well. I continually reminded them that where there is a question about access to clean water, it is very important that the tear is completely closed to avoid infection. Josette and I were two peas in a pod, figuring out our suturing job. I love being a perfectionist about suturing and obviously she did too. At the end, I told her I loved her in French. She smiled back and said, “I love you, too,” in English.

The same night we had a ninth timer and a second timer. All healthy baby girls. Active management of third stage has contained the onslaught of postpartum hemorrhage. So many women here are having there 6th, 7th, 9th babies.

I also tried out a new technique that I was so excited about. We found a whole bunch of clear plastic bags with drawstrings in the storage room. They looked like bags that may have been used in the US to hold women’s belongings while in labor or maybe the freebies that women leave the hospital with. Basically, here in Hinche, we have what we have and if we don’t use the stuff, it just sits in the storage closet. So I had an idea. We are going to use the bags to set underneath the mothers to collect the blood, amniotic fluid, everything including the placenta during and after the birth. Then we can take away the bag, the same way that they do it in US hospitals with the big, blue cone shaped drapes that collect and measure blood. I felt that using these bags would keep the women’s cloth cleaner, keep the beds cleaner, make the midwives' lives and the cleaning lady’s life easier. But most of all, it would allow the women more dignity in birth. By not having to sit in the puddle of their own blood and body fluids, the mother’s would feel cleaner and more dignified. It’s the little things.

So we tried the technique on the three women that delivered that night. All the midwives were thrilled with how it worked. They noticed that the table was cleaner, there was less mess to deal with afterwards. They were happy and I asked them to show the other midwives our new plan too. I told them to use up all the bags that we had and that we would try to get more. I felt happy with a good night in the Hinche hospital.

We walked home in the morning. By 5:30am, the sun was up and the day had begun. Families were here to see their loved ones in the hospital. We had brought Cokes with us the night before, for the midwives and SheLove, our interpreter. They don’t drink coffee here, mostly running on adrenaline and allowing some of the midwives to sleep, on the floor. Two midwives slept on the countertops. I was nursing the last Coke as we left the hospital. We passed the vendors setting up, one woman asked me for the Coke. “Blanc.” White girl. She motioned for the hand out. I gave her the Coke and said, “Bon jour.”

Nou La. We are here.