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.

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