Tuesday, August 30, 2011

Back to San Francisco Births: Mila Arrives!

I absolutely loved being pregnant.  I have never felt so beautiful.  Feeling my baby dance inside of me was one of the most incredible experiences of my life.
I felt so blessed to have the support of such an incredible community. Midwives, doulas, Waldorf teachers, yoga teachers, open minded friends...
all surrounding me with encouragement, faith, and priceless advice.  But, no one is able to tell you what your birth experience will be like.  Not even guess.
But, it seemed that everyone around me was experiencing 3 day labors and was at least a week overdue.   Cesar and I were prepared for the long haul. 
I was due on the 4th of July.  The anniversary of our first date, five years earlier.  The night of July 2, I was glowing:) I felt so full of energy and spent the evening with a close friend.  We were making plans to go to the farmer's market early the next morning.  I came home and fell asleep.
At 5:30 a.m., the feeling of warm tea being poured between my thighs woke me up.  The water just kept flowing.  I did not move, but whispered to Cesar, "Love, I need a towel."  He seemed completely confused by my request.  I think he thought I was dreaming.  "Really, Love, there is a lot of water coming out!"
"OH!"  I put the towel between my legs and waddled to the bathroom.  I sat on the toilet and listened to the dripping of the fluid. After a minute or so, I checked the color and smell.  Seemed fine.  I could hear the voices of both Maria and my doula, Jamae, telling me to go back to sleep.
I snuggled up to Cesar but could not stop giggling.  The water was still dribbling and I was wide awake.  Cesar had to leave for work at 6:15 a.m.  We knew that he had two weeks paid off when the baby arrived, but figured that nothing would really happen until the evening.  We decided that he would go and I would call if I needed him.
I kissed him goodbye and began to strip the bed.  I felt happy, calm, and excited to prepare the house for my sweet baby.
I started down to the laundry room and suddenly had to grip the railing.  Whoa.  I have never even experienced a menstrual cramp,so this was fascinating.
The contraction lasted about 30 seconds, so I assumed an hour or so would pass before the next one arrived.  I put the sheets into the washer and began pouring in the soap when another contraction came.  I remember saying to myself, Maybe they are just cramps because so much water came out.  Uh, yeah, it's called labor.  Haha.
I made it back up the steps and called Maria to let her know things had started.  It was only 6:30 a.m. so I decided to wait to call Jamae.  I went back to my household chores, pausing about every 7 minutes to meet a new contraction.  By 7:30 a.m.  I called Jamae and told her how the morning had gone.  She seemed a bit in disbelief and told me she would come make us breakfast and take a look at me.  When she arrived I was trying to get the attachment for the hose onto the kitchen sink but the intense pain in my lower back had control over the skill of my fingers.  I kept dropping it in the sink and was getting frustrated.  Jamae was laughing, politely, at me and told me to back away from the sink and come into the living room to relax.  By this point my back was killing me.  It was as if the contractions lived there and every few minutes would vibrate around my lower torso and meet at my navel.  All of the advice we were given in our birthing class seemed irrelevant.  I wanted to let go.  I wanted to practice my release and meditation skills.  I did not remember anyone talking about back labor.
By 8:30 a.m. Jamae was paging Maria and calling Cesar.  Without noticing, I had lost myself.  Even writing this, my memory is foggy.  I remember Jamae saying, "Wow, I think this baby is coming before lunch. I have to make some phone calls!"  I was trying everything to escape my back.  The birthing ball, the chair, the bed, the couch, walking, leaning...nothing helped.  I was crawling along the floor watching her fill up every large pot in my kitchen with water and place them on the stove to boil.
"Don't worry," she said, "you will be able to get in the tub really soon!"  I was confused.  "I thought I could not get in until the end?"
She looked at me with wide open eyes, "This is the end! You sped through the beginning and the middle!"
I am not sure how much time passed as I wandered the house in attempt to find a comfortable tone in which to moan.  I always assumed I would be too embarrassed to make any noise.  But, the low OM vibration was the only thing that gave any relief. 
I had reminded myself every day while I was pregnant not to fight the pain.  Surprisingly, it worked.  Every part of me wanted to give in to it.  The hardest part was dealing with my physical existence.  How do I explain that?  I wanted to fall completely into the pain and let it bring my child to me.  But, I had to stay conscious enough to work with my body and place myself into different positions.  One thing that I realized later, must have helped so much, was that I was rarely asked any questions.  I was never forced up into my mind, but allowed to stay in my meditative state.
When I was finally allowed to lie down into the 100 degree water, it felt like heaven.  Now I know why they call it the midwives' epidural.
It was not only the heat in my back, but the buoyancy of my body and sides of the tub embracing me.  I felt safe and held.
I was not aware, but Maria was at the hospital at another birth and was worried she may not make it on time.  So, she asked Sue to come right away.
I remember feeling someone's presence and opening my eyes to see her looking at me with a sweet smile.  She simply said, "Hi Christina, it is so good to see you like this." 
She checked the baby's heart rate and assured me that I was doing great. She added such a lovely energy to our space.
Another mystery amount of time passed as I floated and moaned to cooperate with the work of my body.
The next thing I know, Maria is there asking me to turn around so she can check me.  As soon as I looked at her and felt her touch me, a deeper part of me was able to relax. It was not that I was waiting for her, but remember thinking, now that she is here, everything will be fine;)  She has an incredible inner strength and way of making you feel completely safe and supported. 
I was fully open with just a bit of a swollen cervical lip.  She moved it aside and the baby's head slipped passed.  Moving right along.
Cesar told me later that he had never ridden his bike so hard.  It usually takes him an hour to get home and I think he made it in 40 minutes.
Hmmm... I never asked him why he did not take a cab!;) 
Because all of the windows were open, when he arrived he could hear me moaning loudly.  It scared him a little and he ran inside to see everyone here and a ton of supplies and emergency equipment. He thought something had terribly gone wrong and just stood there in shock. 
Maria smiled at him and asked him if he wanted to jump in.  He changed his clothes, got in the tub, and began rubbing me in a way that was never taught.
Instincts are a beautiful thing.  He said it took him a few minutes to not feel completely worthless.  I was sweating, moaning, and pushing so hard and he just wanted to help me.  At some point I voiced my urge to go number 2 and Maria suggested that I come out and sit on the birthing stool.
When I opened my eyes and looked at that hard wooden stool covered with pads, it looked so scary.  Not one part of me wanted to leave the tub.
But, I figured it was not purely for her entertainment and so I did.  My body felt so heavy and the pain so intense.  I do not think I lasted very long before tipping forward onto my hands and knees.  My urge to use the restroom increased and I asked to sit on the toilet.  The second I landed on the seat I had my "best" contraction.  Every tiny muscle I was holding released at that point. I could feel the baby coming down.  I was squeezing the life out of my husband and telling him to get me back into the tub.  The walk seemed like miles.  But, I was so relieved to be back in the water.
After pushing for a while longer, I asked Maria, "Where is she??"  "Reach in and find out.:)"  she said. I put my fingers inside myself and I could feel her tiny head and tons of hair! 
Everyone kept reminding me that I was doing great and that the baby was moving down with each contraction.  Her heart continued to beat at a healthy rate and she was working hard with me.  I think I pushed for another 20 minutes when I heard Cesar say, "I can see her head!"  When she began to crown I could feel the ring of fire that everyone warned me about.  For a couple of my friends, this was the worst part of labor.  For me, it was a welcomed distraction from the excruciating pain in my back.  It was 11:30 a.m. when I was suddenly handed my baby.  I cannot explain at all what it felt like for her body to come out.  I truly feel like I was drugged.  Nature is brilliant that way.  I am sure if I could remember, I would never have another baby;)
But, I remember distinctly the second I held her and saw her face for the first time.
This was profound for many reasons.  Throughout my pregnancy, some part of my ego held onto this fantasy that the moment I looked into her eyes, I would see a part of myself.  That I would recognize her as "mine".
This could not be further from the truth.  I held this precious being in my hands, and realized she was not mine.  She is a child of God and it is my responsibility to help her on her own destiny.  I am so blessed to have been chosen by her and I remind myself of that every day.

Friday, August 19, 2011

Leaving Haiti

Even our exit from Haiti proved to be a metaphor and a challenge. When we had arrived 2 weeks prior, I knew that one of our most challenging moments of the whole trip would be getting out of the airport with all of our baggage and wits intact. Last year, gratefully, Sister Mary from Matthew 25 House, met us at the immediate exit from baggage claim. Calm and seasoned, she greeted us and led us through the maze of porters to our van. Even with our “chosen” porters, there was still jostling and arguing as others tried to get a piece of the action. This year, Sister Mary was not there to greet us at the gate. Courtney, Susan, Dina and I were in our most unwieldy moments — Courtney had 3 large duffels plus her personal items, the rest of us had 2 plus carry ones. At least we had 2 carts to carry the mother load.
Since Sister Mary wasn’t there, I implored the group to stay together and to stay put. I went further down the exit way and looked for our ride there. No one with the Matthew House sign was about. I went back to where everyone was waiting and we decided to make our way down to a waiting area that was underneath an awning. Of course, the porters followed suit and wanted to help us every step of the way. I didn’t want to engage them just yet because our ride wasn’t even there yet. Of course, now everyone said they knew Sister Mary and Ricardo, the driver. Most of this was just a rouse to get us to pick them as our porters. Annoyed by the constant pestering, I finally gave in to one of the porters who insisted that he knew where Ricardo might be and that we could wait there. Again, I told my group to wait while I investigated. I was highly suspicious about this “VIP” parking lot that this man was talking about.
As suspected, the porter led me over to a secluded parking lot that did not contain the Matthew 25 house van. Instead, I recognized it as the place where, last year, a group of men surrounded one of our volunteers and stole her iPhone. There was no security here, so it is a perfect place for a heist to an unsuspecting visitor. I told the porter thanks, but no thanks and made my way back to the shaded waiting area. I would know our guy when he arrived.  Thirty minutes later, we were safely on our way to Matthew House.
Leaving Haiti proved to be an even greater challenge. Last year we went on American, simply waiting on line with the rest of the travelers to check in and go through customs. This year we were at the other gate.
Haiti’s airport is small by any standards. It does not have terminals. It simply has two entrance ways: one for American Airlines, and the other for all other international flights. An even smaller airport down the road services in-country flights on 6-seaters and small prop planes. The international airport, named after an ex-slave, army commander who led the country’s fight for independence, is frenetic at best during midday when most planes take off. We arrived with 4 and half hours to spare (little did we know that we would need every minute of that!). Porters again were vying for the few dollars they would earn by carrying our bags. This time, the tease was that they would take us to a special line, “just for us”, ahead of all the chaos. Somehow I felt that this was unjust and metaphoric. Don’t the rich always do that? With the power of money, we literally step over those at the bottom, those without means, and give ourselves the best ride. I was happy to patiently wait with the Haitians on line; we had 4 hours, after all.
But it wasn’t really a line. It was a cramming of people up against a door, that wasn’t open yet. No one was moving, just waiting. Even those on the “VIP line” were just waiting like the rest of us. It was hot. Dina and I had a lesser load than on arrival, but we still had our wheeled luggage, plus my jump bag, back pack, Dina’s Timbuktu bag and her heavy camera backpack that held thousands of dollars worth of video equipment. We had to keep an eye on it all, carefully holding onto our spot in the throng. It took an hour before they even opened the door and started to let people in. It was the worst of bottlenecks. 6 or 7 porters at a time, trying to make good on their promises to get people in first, the “secondary” line trying to cram it’s way in through at the same time. Literally around 300 people trying to make their way through one small doorway, and don’t forget their luggage. As you can imagine, we moved by inches. When we finally got to the ramp that led up to the door, we were boxed in by people. Tensions were high and shouting matches erupted more than once. I didn’t feel anxious, just curious to witness this glaring example of disorganization, a metaphor for life in Haiti. No one wanted to be last. Everyone was in a me-first, dog-eat-dog frenzy to get what was rightfully theirs. The line was moving, even at a snail’s pace. We still had 3 hours.
Once we were at the top of the ramp, I thought the pressure would ease as we entered the airport lobby. For a moment, we had breathing room as we all made our way down a ramp to the first x-ray security check. All of our bags had to go through and I am quite sure that they did not do a thorough job. I was only concerned about getting to the other side and collecting our bags before the masses enveloped us again. On the other side of the security check, the wall of people was immense and still. It seemed that no one was moving. It was unclear exactly what to do, but I figured that if we followed the crowd, we would get to where we needed to be. We were travelling to St. Maarten on an airline called Insel Air and we had met a few people on the line that were doing the same. I figured that if I kept one eye on these few markers, I would know where to go.
At one point we found ourselves waiting in the middle of the sea of people that now completely filled the airport lobby. Again we inched our way forward, trying to keep our spot in the “line.” Dried mango slices and one water bottle sustained us for the hours of waiting and inching. We were passed by a number of American Christian groups with slogans like, “Puttin’ Feet to Faith” and Rock Solid Church. They wore the tell-tale dusty sandals of mission work in Haiti. A college group from the University of Pittsburg had done the same. All were headed back home on the Delta flight. All had paid their way to the head of the line.
At this point, an airline agent said to everyone on the right, “Insel Air,” and pointed to the left. So now everyone on the right had to cram their way through to the other side.
It was almost 2 hours later before we reached the check-in counter. But an even more curious thing had happened. By the time, we reached the counter, Dina and I were almost exactly at the end of the line. How had all those people passed us? I had always seen us in the middle of the pack, jammed fore and aft with someone else’s suitcase. It was fascinating. I also realized that it had really been no big deal. We were going to get through with time to spare. Dina noticed that the man at the very end of the line was trying to cut in front of us. Would it really make a difference if he made it in front of us now? With great effort, he snuck his luggage up to the counter in front of us, causing an argument with the meager security guard. It was that important for him not to be last. I told the guard in Kreyol, “N’ap prale.” We are all leaving. “Pa gen pwoblem.” Leave it, it is not a problem.
After passing through Customs, there were roped queues and plenty of space. The fight was over. The same group of people who moments ago were clawing for position melted into a calm group of civilized travelers.
We had half an hour to spare.
The fight for the bottom is something that is demonstrated wherever human stratification exists. Who is first? Who is last? Who is the richest? Who is the poorest? No one wants to be the bottom. It is demonstrated with midwifery politics: CNMs versus CPMs versus “lay midwives;” gang fighting: Asian vs. Black vs. Latino; abusive households where the man beats the woman, the woman abuses the child, the child kicks the dog. In Haiti, there is a desperation to not be at the bottom of every heap, already having claimed that spot in the Western hemisphere for such inglorious attributes as maternal mortality, infant mortality, literacy rates and poverty.
We all got on the plane. We all made it out of there. Most Haitians fly to St. Maarten for employment. We were perhaps 2 of only 5 white people on the plane, headed to an inconceivable resort island, too close to justify the disparity, too far to share the wealth. When Dina and I arrived at our timeshare on the island of St. Maarten, we were astounded by the beauty and opulence. We had dinner and went back to our room, cold, by the way, from air-conditioning and a ceiling fan. After two weeks of sleeping on the porch in a mosquito tent, Dina’s only comment was, “This pillow is ridiculous.” We settled underneath the down comforter, and didn’t wake up until 12 hours later. 

Tuesday, August 16, 2011

Cholera: Up Close and Personal

Our last night at San Therese was peacefully uneventful. We had two live births within a half hour of each other around 2am. The rest of the night Susan and I napped on a yoga mat or chatted, disturbed only once by the keening of a woman across the courtyard. I immediately recognized it as the signal that a loved one had died.
Friday was our last full day in Hinche. My day was crowded with last minute filming of Genette, the bright, young clinical professor at Midwives for Haiti; packing; stopping for one last time at the Ebenezer (the air-conditioned super market); making Grandma’s tomato sauce one more time on the open charcoal fire; going to Magdala’s for dinner at 4pm and figuring out how to carry the still warm sauce with Dina and I on the back of a moto bike; getting back from Magdala’s in time to meet Genette and my other Haitian midwife friend, Esther, at the Crystal Bar for one final farewell.
Within the folds of my busy final day, I was introduced to cholera. When we went up to the hospital to film Genette, we asked if we could observe the UNICEF cholera tents set up in front of the hospital. Twelve large, white tents were set up, each with a UNICEF stamp on the front. They were much more like circus tents than camping tents, having the neatness and formality of a well-heeled NGO. There was a triage tent as well as men’s, women’s and pediatrics. Most of the tents were empty or only partially occupied, which was a relief to the senses. Each tent had 8-10 stretchers lined up in two rows. Each stretcher had a hole in the center with a bucket underneath, carefully containing the vector of a deadly disease.
Most people did not seem in intense suffering. Many had IVs, but most were hovering about, biding their time for the disease to run its course. There was a fascinating container that was the encampment’s water supply, a 12 ft. by 12 ft. giant water balloon, used for bathing and drinking. A naked man on a stretcher was being carried away, perhaps after a needed rinsing off.
To leave the cholera area (the whole encampment is walled off with security at entrance and exit), you need to have your hands rinsed with water treated with bleach and step on a pad soaked with disinfectant to clean off the bottoms of your shoes. We had made our observation. No photos allowed. My obligation to witness the suffering of the Haitian people is fueled by my desire to comprehend the magnitude of the disparity that I wish to amend. I am constantly trying to evaluate whether we are making a difference.

In the afternoon, I had an even closer look at the cholera epidemic. When we arrived at Magdala’s house for dinner, a very special invitation I might add, she said that she had to place an IV in a child up in the tents on her land. Of course, I offered to help and we all trekked over to the small plot of land that she had let the government use as a cholera encampment. There were only 4 tents, each labeled: triage, observation, transition, morgue. A small, dehydrated 3 year-old girl, dressed only in her underwear, was on her mom’s lap. She was sitting up and animated, but the two nurses who monitor the encampment had decided that her condition had gotten worse and that she now needed an IV. We set about to work, looking for the most accessible vein to place an IV. On a healthy three year old, this is always a challenge, tiny veins, a scared patient, few options. Working with Nilove proved to be no easier, her dehydration making it even harder to find a strong, plump vein to work with. We tried multiple times to insert the IV catheter, each time to the wailing and tears of our little patient. Her cries were eerily reminiscent of the laboring women, a uniquely Haitian song of pain and suffering. It was heartbreaking to understand what she was saying in Creole, “Mama, let’s go home, let’s go home.” We tried on her hand; we tried in the antecubital space. None were successful. I found a small toy in my pocket that I had figured could be given away at some point. Here was that point. The toy calmed Nilove for a few moments. We finally got a good stick in her hand but the sigh of relief was only momentary as the little girl jerked her hand away and the catheter pulled out. Both Magdala and I looked at each other in disbelief. Our only good stick was now worthless. We tried in her foot, the other antecubital, and the other hand. After 6 tries and running out of the smallest angiocaths that we needed, we gave in to our own failure.
Nilove would have to continue her oral hydration therapy and hope for the best. She would not die; she simply needed hydration support until the cholera passed, and isolation to help prevent the spread of the disease. The only other patient at Magdala’s encampment at this time was an older woman, in her 70s. She too was ambulating and would not die, simply biding her time. We rinsed our hands and stepped on the disenfectant pad. As I saw the iodine-colored water run up over my flip flops and onto my bare toes, I wondered how effective this ritual was.
It had taken us an hour to finally acquiesce to our lack of success. Magdala is an amazing midwife, giving of herself in areas where she should not be taken to task. She says they have seen over 50 people in her tents. We walked back to her house for an amazing Haitian feast of fried tilapia, beet salad, a green salad with fried goat, avocado, cornmeal cakes, a “lasagna” of sorts (layers of lasagna noodles separated by a ground meat) that went perfectly with Grandma’s tomato sauce, Haitian spicy coleslaw, spicy goat sauce with onions, fried plantains, a few fried potatoes, and black rice with dried mushrooms. It was a feast of appreciation and hope for our future working together. Magdala’s husband is a pastor and deeply religious, he asked me to say the prayer before the meal.
When a pastor asks you to say something, you speak: I prayed for the little girl up in the cholera tent, I prayed for the continued strength of Magdala and her family to offer safe haven for the poor and the sick. I prayed for Magdala’s continued work as a midwife, to reach the pregnant women in the villages and bring them a better birth experience. I prayed for strength for us all and for hope, for our continued working together, each year, to create a better world.

Thursday, August 11, 2011

The Candor of Death

Last night we were met at the door of San Therese hospital by the candor of Haiti’s infant mortality rate. We arrived around 7:30pm or so for our 11 hour shift. There was a woman in labor who, within moments, was pushing out her baby. The student midwives were not ready, and I scrambled to find supplies while the others delivered the baby. While gathering instruments we needed, I uncovered a crumpled chux on one of the delivery tables. I opened it up to see if it was usable and found a full term dead baby. In my hurry to deal with the delivery, I was unexpecting and vulnerable. It took me by surprise. But the midwives were working, business as usual. No one seemed very interested in the body. I asked the student midwife what we were going to do with the body. She didn’t have an articulate response. Finally someone, the  night janitor, realized that we needed a box for the body. She ran and reappeared wth one. We placed the baby in the box and of course the question, then what? We needed to keep the baby here until morning until the janitor would dispose of it in the appropriate way.
This is life and death in the maternity ward. I would later learn from the day janitor  that he buries 2, sometimes 3, stillborn babies a day. The math is too horrific to calculate. The midwives deal with this tragedy with calm and flat affect. They are unemotional. They seem disconnected from the possibility that this small body represents more than the products of an ill-conceived conception. This must be the callous of years of death’s relentless mocking. Even with the best of nights, there is the reminder that babies die here on far too regular a basis.
The precipitous birth of the live baby is finally under control and the baby is dressed and weighed. The live baby also is left on the scale for a long time without an attentive eye. I occasionally go over to check the baby and make sure that the quiet is from sleep and not death’s gnarly grip. The mother is dressed and readied to go into the postpartum room.
Another woman has come into the labor room with a referral from an outlying clinic. She is in labor. We have a hard time understanding the French translation of her referral note. Our interpreter insists that it says that the baby is lying up against the mother’s back, a simple posterior presentation. Susan is sure that she sees the French word for twins on the paper. It is all for naught because the student midwife cannot find the baby’s heart tones. Susan tries too and is unsuccessful. We are here to teach the student’s so I ask Marie Carmen, what does she think? What would she do now? What she thinks is best is to wait until the baby is born and to tell the mother then. I disagree, telling her that if her baby is dead, that we must prepare the mother as soon as we know. If the student has difficulty finding the heart tones, they should always ask the senior midwife for help. Marie Carmen and Susan tried one last time to find heartbeat, met again by the mocking silence of death. The staff midwives decided to send this woman on to Cange, to the Zamni Lasante hospital there. She had a ride , otherwise the transfer would not have been an option. We would not bear witness to her grief.
The second baby of the night was born precipitously in the antenatal room. A student ran out saying that the baby had been born. We all ran in to help and to see the baby that had been born so quickly. When we approached the bed, the baby was on the mother’s abdomen but not breathing. The baby remained quiet and limp, eyes wide, even with our immediate tactile stimulation. I asked for an ambu bag and one of the students ran back to the delivery room to get it. The hospital has no oxygen, so the resuscitation effort would simply consist of forcing room air into the baby. The ambu bag arrived and I quickly set to reviving the baby. Even though the baby’s heart rate remained strong, the baby did not perk up as I had expected. It was hard to say why this baby was having such a hard transition since no one had actually seen the birth take place. Had the baby inhaled amniotic fluid on the way out? Was there meconium? Was this baby infected? I continued bagging the baby for what seemed like a long time, repositioning the mask, the baby, asking for a better ambu bag. Long enough to begin contemplating next steps. There was no oxygen, no pediatricians, no NICU to fall back on. This baby would either live or die right here in front of us. I occasionally stopped the resuscitation effort to stimulate the baby again. We were beginning to see the barest of muscle tone and an occasional small cry. A stethoscope appeared and we were able to hear breath passing, though labored, through the baby’s lungs. The baby had classic signs of difficulty breathing: grunting, flaring, retractions.
Since the baby, a girl, was breathing on her own, we decided to stop the resuscitation. She was out of the danger zone but the next moments would reveal whether she could make it on her own. She remained stable by Haiti standards. In the US, this baby would have been immediately whisked away for resuscitation and continuous observation. The student midwives did a good job of helping out, but observed with an air of bearing witness as opposed to the heroic obligations that drove Susan and me to act. The baby settled quietly onto the mother’s chest and I told one of the students to check the baby closely for the next hour. She should check the heartbeat and respirations every 15 minutes, then check in with me after an hour. If anything changed, she should also let me know.
A quiet calm settled onto the Maternit√® around midnight. I laid down on the cement floor outside of the ward on a yoga mat that Susan and I brought from the orphanage. I told Susan that I was too wired to sleep. She told me later that I was snoring within 15 minutes. I awoke sometime later to find a laboring woman sprawled on the floor across from me. She was on her back, heavy in labor, complaining that she was dying with each contraction. She was accompanied by a shadow sitting next to her, her mother I had assumed. When I heard the American accent of Susan’s creole, I realized that she had moved over to support this woman in her labor. As she sounded pushy, we moved her over to the labor ward. A fifth timer, with 2 living children, I was surprised that it was taking her so long to push. Susan suspected a posterior presentation because of the amount and location of the woman’s pain. She continued to often say that she was dying, which is disturbing in a country where that is a distinct possibility. Her baby was born, without event, bringing us to three live babies for the evening.
At 4am, the praying began. From the depths of the darkened antepartum room, we could here gospel singing and the sounds of a female pastor calling upon God and Jesus to remember them in their suffering. The singing was beautiful and eerie, wafting up from the depths of Haitian spirituality. All 10 women in the antepartum seemed to singing in unison, in harmony, interrupted by the intermittent wail of a contraction. I got up from the yoga mat and watched through the half open, Dutch door for a while. The pastor was walking up and down the aisle between the rows of beds, calling on Jesus in her supplication for redemption. The women were calm and peaceful, obviously knowing the lyrics from years of Haitian church-going.
As the light of day brightened the courtyard of the hospital, a small, old man shuffled in to begin his day’s work. He is the janitor. He emptied the trash barrels into his wheel barrel and picked up the bloodied, medical trash strewn about by the nocturnal scavenging dogs. I knew that this was the man who would dispose of our baby in the box on the labor room floor. I was determined to see this process.
Eddy, for that is his name, loaded the box up on top of the rest of the trash in his wheel barrel. I followed him out of the hospital, explaining that I just wanted to see what he did with the dead baby. He was patient and kind with me, perhaps I was the only “Blan” he had ever spoken to. He loaded up his pick ax and shovel onto the wheel barrel and I followed him out to the back of the hospital. We followed a small dirt trail to the area where he burned the trash every day. The piles of plastics and IV detritus was encircled by a lush grove of greenery and vines. Eddy parked his load and walked into the grove. He selected a spot and began to dig. I asked him if he did this everyday. Yes, there are 2, sometimes 3, every day. The pick ax was almost as big as him and he swung and swung until a small, rectangular grave had been dug. I helped him by bringing over the box with the dead baby. I asked him if he had children. He said only one— the other he had already buried. The current box that the baby was in was too large, so he found a smaller one amongst the rubble and placed the baby inside. I offered him my gloves since his had ripped. I was called away at this point, but felt content with my understanding of the process. The fertile soil of the lush grove entombed hundreds of dead babies each year.

I said goodbye to the woman in postpartum whose baby we had resuscitated. The baby was breathing perfectly now and the mother was all smiles. The ride home on the moto taxi was cool and breezy. I held on to Susan, saying that we had survived the night. Tonight we will be at the hospital again.

Wednesday, August 10, 2011

Poorest of the Poor

Hinche is considered the sticks to all who reside in Port Au Prince. This is where the poor people live, out in the countryside. It is the 5th largest city in Haiti, with 50,000 people, a hospital, bustling commerce, a central plaza, a large market on Wednesdays and Saturdays. The people here are poor. The hospital does not have running water nor 24/7 electricity. The Red Cross blood bank was temporarily shut down when their solar panels were stolen.
Hinche Market
At the orphanage, boys play soccer with torn, knee high soccer sox, no shoes. Some play without even that, kicking barefoot a soccer ball on the dry, dusty, rocky earth. The children here are orphans or have been left because their families were too poor to feed them.
The midwives are paid $1.50 an hour for work that saves peoples lives. A teacher can possibly get paid $3.25 an hour at the better schools. The midwives say that their pay is not enough. I ask them what they can do about that and there is not really an answer. I think they just live without enough. The unmarried midwives still live with their families. Midwives that are now working in Port Au Prince live communally to afford their living quarters. They say that everything in Port Au Prince is expensive.
We were invited by Gampson, a local boy, to visit his church. He told us that we were going to where the poor people live. A turn off of the main road, heading toward the river, told me that we were heading into the rougher part of town. There were less smiling faces calling out friendly greetings as we walked by. A young boy ran up to me and asked me to take his photo. I snapped the photo and was immediately reprimanded by an adult in the community. “Why are you taking his picture?” I told him that the boy had asked for the photo and his angry interchange came to an end. This is the ghetto, poorer than the Hinche poor, relegated to the river’s edge.
Women and children bathe themselves, their clothes, and pots and pans in the river. The river represents one of the town’s borders. Last year we were told that this was the only place that we should avoid. As we walked deeper into the ghetto, my hyper-awareness increased as the narrow dirt road wound its way closer and closer to the river. We stopped in front of a small tropical shack. This is their church—dirt floor, no electricity, a pastor that was outside to meet us. It seems that everyone’s father is a pastor here, so they don’t look very differently from the other men in town. Within the church, 8 benches, 4 per side, were lined up and filled with children. Dina asked what activity brought them all there this afternoon. The answer was us. It was hard for me to not think about the soccer games, jump rope, cards, chess, music and swing sets that the orphans had at their disposal at the Maison. The orphans weren’t so bad off after all.
Four plastic yard chairs were lined up against the front wall of the church. These were for us. We sat down and they clapped. Gampson’s mother appeared and soon Gampson was handing out the baby clothes that we had brought for them. He handed them out one by one and forced the women to pose with their babies and the new piece of clothing that they chose for their child. I felt badly that we only had baby clothes and nothing for the older children. I asked Gampson to he walk back with us to the orphanage later so I can give him a bag of piwilis (lollipops) for the kids. 
Kids outside church
We are the curiosity and the hope and the problem. Gampson’s mother has been praying for someone like us to come along and take interest in their community. She wants us to come back and set up a health clinic for the people. We tell her that next year we will be coming back with the chiropractors and we can set up a clinic at their church. She feels that her prayers have been answered and she will pray for us all year until our return.  A year is a long time to wait and a three-day fix is only a band-aid.
Gampson's church
With the mobile clinics, we travel to villages outside of Hinche where even poorer people live. They have minimal resources, sparse crops that can be brought to market in Hinche twice a week. Each Saturday, on the outskirts of Hinche,  animal markets sell goats, cows, straw, saddles and rope.  Crowds walk the sides of the roads and for a moment, I feel that this is what India must be like. This is the developing world, what Brother Harry calls the “fifth world,” where oxen pull wooden carts with bent axels, humans pull oversized wooden wheel barrels with unfathomable loads. More people than can be counted go without shoes, a change of clothes, enough food, clean water. At the mobile clinics, we see dehydrated children with fevers and skin rashes, old folks blinded by cataracts.
 At the mobile clinic, the midwives charge 25 cents per visit. Some women don’t even have that. The midwives see close to 40 pregnant women at the busy clinics. At one impoverished village, a rare fight broke out perhaps a result of the heat and frustration of having to wait. One woman arrived topless to the clinic. As she was lying on the sheet-covered platform to have her prenatal exam, I thought her lack of clothing was just temporary. I later saw her speaking with the midwives, bare-breasted—the poorest of the poor. I wanted to give her the labor skirt that was donated by a mother from the US. On this particular day, however, tensions were high and the unfairness of giving to one and not all may have caused a riot.
The spectrum of poverty is multi-dimensional, flowing freely like the river. We observe from the river banks, sidelined, casting nets. If we can catch a few souls, even for an hour or a moment, we feel that we have done what we came to do. The river is endless and deep, such that the retrieval of a few makes an invisible difference.

Sunday, August 7, 2011

It's 10pm in Hinche

It is 10pm in Hinche and I am miserably hot. So hot that I can’t sleep. It’s probably not even 100 but the humidity is heavy and the air is still. The earlier thunder and lightning did not pan out to the rainstorm I had hoped would cool us down. The heat has chased us out of our rooms and onto the veranda to sleep. We, there’s four of us again, pulled out our mattresses and lined them up to be a little cooler. Dina and I use a mosquito tent but the other brave souls go without.
Courtney left a few days ago and is now safely home with her children, visions of the Azeal orphanage still swirling in her head. We have a nurse practitioner that joined our group yesterday, Jane Smith, from Virginia beach. Today, Sunday, was our day of rest. We hung around Maison Fortune, venturing out only to cross the way to see the girls or to cross the soccer field to our Kreyol lesson.

This morning I was enthralled with a young girl named Sofia. She had been assigned the job of making the chicken legs. The children here get meat once a week. Last year it was goat— they would bring in 2 goats every Saturday and that would feed 200 children. This year they have switched to chicken legs. 3 large boxes of frozen chicken legs from the Dominican Republic arrive every Saturday on the back of a motorcycle. On Sunday morning, they boil the chicken, then fry it. This is their Sunday midday meal. Sofia was frying the chicken, sweat beading up on her face. She wasn’t complaining, the heat from the charcoal fire obviously something she was well accustomed to. 


This evening I made my grandmother’s tomato sauce on the Haitian coals. I went over and called Sofia, asking her if she wanted to watch me cook since I had watched her cook this morning. Kennel, our fantastic 19 –year-old Kreyol teacher, helped me get the coals going. We used cans of tomato paste from the one air-conditioned market in town. The 14 oz. cans that we usually see at home with peeled or crushed tomatoes were filled to the brim with tomato paste. I made a large vat of sauce while the curious children looked on, laughing at how much tomato paste I was using. We also made hard boiled eggs and pasta. All of this was a welcomed change from the endless rice, peppered with beans, that has been our daily diet. Often we also have bean sauce, a soup-like liquid made from pinto beans but really much more water than beans. It is usually accompanied by another sauce with bits of beef or goat, onions, potatoes, sometimes a green.
Grandma’s tomato sauce Haiti-style was a complete success. I gave Sofia a small pot with the extra pasta and smothered it in tomato sauce. The children at the orphanage eat plain spaghetti here every morning, so tomorrow I am going to give the girls our extra sauce (of which there is plenty). They eat with their hands so I am not sure how it will go over, but I am sure that any change would be welcomed. I will be happy to see them get some Vitamin A and C, for once. We have wondering about how they are looking and seeming so healthy on a diet of spaghetti and rice and beans. Every day.
Tomorrow we go out on the Mobile Clinic again. We’ll meet the pink jeep in the morning along with the other midwives and students. A structured week lies ahead as we also follow the ebb and flow of visits from our new Haitian friends.

Snippets of Haiti

Haitian Haircut: Monide is the best hairdresser! I have wanted to get my haircut since we arrived. Monide did a great job at her salon called, “Nice Change.” Certainly a nice change for me!
Boat ride on Magdala's man-made lake
Cholera tents
Cholera tents on Magdala’s property: We took a tour of Magdala’s incredible property where she lives. They are already running a school for 600 children. They want to build an orphanage, a guest house and maybe even a birth center with American help. Susan thinks that this is the answer to more humane birth here—Haitian-run, out of hospital birth centers. I am sure you will hear more about this. Magdala and her husband have allowed an acre of their land to be used for cholera tents. They have 7 patients living there.
Children at Gampson's church
Gampson’s church: Gampson is the young man that we met last year with his mother. They were both peddling their goods in front of Maison Fortune. I took a really nice picture of him and his mom, so this year I gave him the photos. They were thrilled and invited us to come down to see the children at their church. The church is a small, one room shack with benches for the small congregation. There were 4 chairs set up in the front. To our surprise, the chairs were for us. We shared with them some baby clothes and thanked them for sharing with us their beautiful country.

A visit from Marie Denise: Marie Denise, one of the midwife students from last year, showed up at Maison Fortune around lunch time. She brought us a liter of fresh cow’s milk, fresh eggs, mangos and corn from her farm. I was surprised and thrilled by her tokens of appreciation. We invited her to stay for lunch, chatting and sharing photos from last year.

Professor Kennel
Charles and Barry: Charles is a young man who teaches French, Spanish, English and Creole in the local high school. His uncle is building a high school called the Mahatma Gandhi School. We are meeting people everywhere we go. I now have two “Haitian sons” and many Haitian friends. Our Creole is getting better everyday, especially with the help of Kennel, a young man at the orphanage who gives us Creole classes almost everyday.

Tobacco lady
Tobacco lady and the Salt lady: My favorite ladies from the market last year were two women selling tobacco and salt. Of course we wanted to see them again, but the market has changed around some with the majority of the vendors now under a large pavilion. We walked around for a while and stopped to buy pineapples. While we were there, a woman said she could take us to where the tobacco sellers were. Before long, we found the tobacco lady who was thrilled to see us once we explained that we were here last year and gave her her photos. The salt lady was right behind her and we agreed to meet up next market day to chat with her.

Saturday, August 6, 2011

A Birth at St. Therese

(Days have been so packed that I fell asleep last night while writing this. All good in Haiti, “tout bagay anfom”. I’ll try to send shorter, more frequent updates this coming week.)
Wednesday night was our first overnight at San Therese. For Susan, this would be her first real introduction to birthing in the Hinche hospital. We are told that there is no running water (turns out no standing water either) in the hospital and now, there is no electricity at all. Because of that, there is no available operating room to do Cesarean sections. There would be a remote possibility to transport someone to Zanmi Lasante, Paul Farmer’s hospital in Cange, 45 minutes away if we needed. As the evening progressed, we would find out that the remoteness of that possibility means that only in the most dire of life and death circumstances would there be enough motivation to put all the pieces together for this type of transport. Here’s how the evening went:
When Susan and I arrived at the hospital, around 9pm, the antepartum room seemed full of women laboring. The antepartum room is a wide, open room with 10 beds, 5 on each side. The women labor here, sometimes with family, sometimes alone. The postpartum room looks similar, but there were only a few women there. A few days earlier, we met a woman in postpartum with a 27 week old premature baby. He was “wearing” normal sized newborn clothes that betrayed the size of his small body. Only his tiny head and legs foretold a story that this baby was probably not going to live. He was breathing well for now, and the mother and father were being counseled to take this baby to Cange, to go to Zanmi Lasante, where he would have the smallest chance of surviving. ZL has a “NICU” with 4 incubators, but that doesn’t mean that there is oxygen or the correct resources or personnel to care for an extremely premature child. The family said they would go and they were trying to find the money for the 45-minute ride. The nurse midwife was being summoned to break the news that this woman was also HIV positive.
That family was not there on Wednesday night. Only a few women were sleeping quietly in the dimly lit postpartum room. Some had newborn infants, more did not. In the delivery ward, which has 4 old, torn, and rusted gynecology tables for birthing, all was quiet for the moment. Susan and I took the opportunity to stock the cabinets with the supplies that we had carried on the moto taxi—the two of us on the back of a small motorcycle, loaded down with my jump bag and each hand full of a plastic bag with supplies. Susan is feeling more comfortable on the moto taxis if she sits in the middle. I love every minute of it, riding on the quiet streets in the otherwise pitch dark, a cool breeze relieving some of the heat of the day.
Through most of the night, we end up with only one person in the delivery room. Her labor is slow, finally reaching complete around midnight. She pushes for more than 2 hours with little progress and not very effective contractions. I check her around 2am and her cervix has closed down to 9cm around the baby’s head, a tight ring that is most likely the cause of the slow progress. We decided that it would probably be best to have her stop pushing for a while and wait until she was complete.  We started a pit augmentation, which I hadn’t seen before, Haiti-style. A Pitocin augmentation in Haiti means that they put the Pitocin in a bag of Lactated Ringer’s and manually manipulate the drop rate until it is dripping at 1 drop every 5 seconds. Susan says that this is the way we did inductions and augmentations in the US in the 60’s and 70s.
Around 4am, we were concerned about signs of an obstructed labor. This mother still hadn’t delivered and her cervix had stalled. The Pitocin was turned off because at one point she had a long, continuous contraction.  Her cervix was edematous and not complete. The staff midwife floated the idea that we transport this woman to Cange for pain meds and a possible C-section. When Susan and I started making phone calls to the in-country directors of Midwives for Haiti, no one was answering their phones. We finally called the driver, Ronel, directly, but he said that he would not drive because it was windy and rainy. It actually wasn’t raining, but the weather report was predicting a tropical storm within hours. Ronel wasn’t moving, he wouldn’t take us to Cange. This was certainly our darkest hour, having a mother who needed help, no possibility of Cesarean in Hinche, no one answering our telephone calls, a tropical storm coming, a driver who was unwilling to drive with superstitions around the impending storm.  Susan and I sat back for a while, watching the now busy labor ward swirl around us, matching the energy of the intensifying storm winds gathering outside.  A pregnant midwife was in one of the “rooms”, having her third baby. The woman in room 2 was keening in pain, finally settling into a dark corner on the floor all by herself. She needed doula support so I asked one of the midwifery students to support her by coaxing her out of the corner and rubbing her back. Another woman was suffering from the painful, spasmodic contractions of an incomplete miscarriage. We had gone from a fairly quiet and controlled space, with one woman in labor, to now all the rooms being full. I parsed out 1 student per laboring woman until the delivery area seemed in better control.
Back to our woman with the obstructed labor—to Susan and I, the idea of transport to a higher level facility seemed like the most natural and safest thing to do. Now we were left with the reality that that would not be possible. Would this baby die? Would this mother die after days of an ineffective process? Around 5am, I noticed that her “labor song”, as Susan calls it, had increased and she was really in a lot of pain. I went to her side and found that the student was no longer there. I spoke to her in Creole that we were trying to find a driver to bring her to Cange, that she might have a Cesarean there. Her wailing quieted down and she did not seem upset about this prospect. It seemed that she simply needed some companionship in her travail and some hope that it would be over soon. Truth be told, I didn’t know what was going to happen next. With the coming of daylight, would Ronel be willing to drive to Cange? Would anyone answer their phones? Would a dokte (doctor) magically appear from nowhere with the 8am shift? Were we really going to experience a tropical storm? I decided to give her one last check of her cervix. Lo and behold, she was COMPLETE!! Yay, some kind of change that we could work with. I found Susan and asked for her help, everyone else was sleeping now, but we were going to try to push again.
The midwifery students helped us with the pushing, and by 5:30am we were seeing a significant amount of the baby’s head, enough to give us hope that this baby was finally coming. We encourage and cajoled her in Creole as she pushed and pushed. The mother did a fantastic job and finally, at 5:59am, one minute before our shift was over, we had our first baby of the night—4300 grams! While doing the suturing, we heard the hearty cry of the midwife’s baby: 2 healthy babies, a successful night after all.
Susan and I soon packed up to meet our moto taxi for the ride home. The mom with the incomplete miscarriage had returned to the antepartum room and was now sleeping, having been given the only pain med that they had here. The mom with the doula was sleeping or walking about, her birthing slow but progressing. All was quiet and calm except for the bustle that would always come with daybreak.
Literally, right before we left, the staff midwife drew our attention to a stillborn baby on the counter. WHERE HAD THAT COME FROM?? Was it from one of the mother’s that we had initiated an induction on because their babies were no longer alive? Did someone new just walk in? I did not know. I only know that Haiti was sending us a clear message, “All is not well. “
Here are some photos from the last few days:
Manushka, orphan girl

Rachel, orphan girl, treating her for eye infection

Spaghetti for breakfast, everyday

Woman in the market

Wednesday, August 3, 2011

N'ap Kenbe!

“N’ap kenbe”. We are holding. We are hanging in there, holding on. I feel that I have found one key into Haiti: communication. Last year Dina and I crash coursed ourselves through a couple of Pimsleur Creole CDs and used a free iPhone app for volunteers to Haiti to learn Creole. This year, Dina found HaitiHub, which is a Skype 2 week class with a wonderful speaker named Carlo. Dina took the class for 2 weeks and I listened in for a week before I left for NY. One of the most valuable things about the class was Carlo’s way of introducing us to sayings in Haitian Creole, which are many.
How are you? The simple act of greeting someone can set off a flurry of call and response answers that define village life. Pa pi mal, things are not worse. “Nou la”, we are here. “N’ap kenbe”, we are holding. “Tout bagay anfomm”, everything is “in form,” everything is good. “Jamn”, or “jamn jamn”, with each greeter’s fist coming together, means strong. We are here, strong, solid. A look into Haiti’s history of oppression, and their own liberation, directly reflects the pride and commitment that Haitians have for their own country. They affirm to each other that all is good because they are still here, holding on to their culture, their people, their children, their life together.
Being able to greet people like this, especially from a “blan”, a white person, has brought immediate smiles, a letting down of the barrier between foreigner and resident. I am here with you, I am holding with you, here in Haiti. I call and respond with you and we exchange a ritual of communication that has been passed down for generations. We are here with open hearts, learning, understanding, speaking with the people.
At the hospital yesterday, Dina and I waited for Susan outside of the prenatal clinic. The small building, which housed both prenatal and pediatric clinics, was crowded with people. Three Midwives For Haiti students worked in a small room doing intake exams. Susan and the interpreter, plus the pregnant woman, would now make 6 in the room. I was happy to wait outside. Sitting on the ledge of a wall, we waited, offering Trader Joe’s dried mango slices to the women and children around us. Opening the door is so easy in Hinche. The people are warm and welcoming with the simplest act of kindness. Before long, we had mothers and children around us, they as curious as us to meet someone from another world. The assumption at first is that we are so different, our landscapes: world’s apart geographically, economically, culturally. But, easily, we find common ground and are laughing at ourselves. By the end, I am able to say in Creole: last year, Dina spoke better Creole than me, and this year, I speak better Creole than her. They erupt in laughter, agreeing and rejoicing that we both are trying to connect. Susan finally comes out of the clinic. She is already recognizing that the best place to find us is in the most boisterous crowd with children and women, laughing and pointing and generally having a ball. 

Monday, August 1, 2011

What do you do in Haiti when it rains?

You go out and wash your hair, of course!
Have we really been here only a few days? So much has happened. We weathered last night’s thunder and lightning storm, only to find that once it starts raining cats and dogs in Hinche, the kids start having a ball. The soccer field and baskeball courts were just as active, except that the mud soccer players now had to share the field with the kids shampooing their hair and others running around bare naked in the rain. The rainstorm occurred just around dusk, light waning, only to be lit up by the dramatic lightning overhead. Boys in the church pavillion were sliding on their bare butts as if the floor was a Slip ‘N Slide. Naked as jaybirds, they pushed off and slid sitting up, over the polished stone floor. This was livin’! Having a ball Haiti-style in the middle of hurricane season. The heaviness of the rain beckoned us to come and play, to experience nature in one of its magical incarnations. Before long, I found myself standing in the middle of the soccer field, rain drenching my clothes and hair. Dina joined me and we worked our way over the flooded field to the pavilion and watched the 20 or so boys, sliding on their bottoms. This was pure joy for them, experiencing no self-consciousness at all that they hadn’t a stitch of clothing on their bodies.
Today we went by jeep to the mobile clinic near a small church amid farming land about an hour by dirt road from Hinche. I say “an hour by dirt road” because it was probably only about 20 miles out. We only saw about 11 women, which is light for MFH, but it was great to be unhurried and practice my midwifery Creole live.
On our way out to the mobile clinic, we picked up Filomen and Marie Ange at the hospital. I got my first peek at Unicef’s cholera tents set up within the walls of the St. Therese hospital. I am sure I will learn more about that later, but early recon tells us that at first, the tents were full, then, as the epidemic came under more control, people started to clear out. There is a sense that there has been a second wave of outbreaks, perhaps even from poor sanitation at these tents.
I met Filomen and Marie Ange on our first trip here. When we saw them, we exchanged exclamations and hugs, so glad to see each other again. Not two minutes down the road did Filomen  start singing our Haiti song that Dina made up last year. We joined in, emphatically, laughing and singing, remembering the words together and knowing that we were all immediately on the same page. We picked up Magdala to another round of hugs and rejoicing, blabbering away in Creole and feeling the effect of a little more language under my belt.
I am so happy to be here, with the midwives again. I know that they are working hard to continue the vision of midwifery in the Central plateau. The mobile clinic has expanded to 16 sights every month, an incredible feat.
Courtney spent the whole day at the Azile. Susan and I went back to the Midwives for Haiti house in Hinche in the afternoon to organize the stock room and bring in the supplies that we brought from the US. We drank beer and ate our stew and dumplings, content with a very full day of work in Haiti. Each day represents a lifetime of learning and appreciation for the people of Haiti—their joys, their suffering, their challenges, their successes.
Ayiti, m’kontan we ou anko! Haiti, I’m happy to see you again.