Thursday, August 30, 2012

Nou La

Midwifery students and their teacher, Marthonie

Nou La is we are here.
Tomorrow is our last day in Hinche. I feel like the time has flown by. I feel like I haven’t posted enough. I feel less of an observer, recorder than the two previous visits. We are in the groove with life in Hinche—St. Therese at night, the orphanage during the day; bumpy rides in the pink jeep, halting Kreyol that makes me feel like I am tripping over myself when I open my mouth. Dina says this is not true and she is impressed that I am speaking in “paragraphs.” Dina tells jokes in Kreyol, so we are even.
The first two births of last night’s shift came within 15 minutes of our arrival. Two healthy babies. Then, I slept. Earlier in the day, I had travelled to Port Au Prince with Genette, the young and inspired clinical director who I am trying to bring to the MANA conference. We left Hinche at 4am to arrive in Port Au Prince by 6:30. We went to the US embassy to try to get her passport. It is always by appointment only at the embassy. Even so, there is a long line that you need to wait in. I had come along, hoping that I could speak on her behalf and confirm her reasons for travel. But, I didn’t have an appointment. Either did Genette. Her appointment had been last Friday, the day that the “hurricane” was supposed to pass through. The day they closed the embassy. She had heard on the radio that all those with Friday appointments needed to arrive on Wednesday for their rescheduled appointment.
I worked my way up the line for Americans and simply told them that I had had an appointment on Friday that was cancelled and that was why I didn’t have an appointment for today. They let me through the security gate and I passed onto American soil.
The American embassy is a solid-looking structure compared to all the other cement and rebar buildings in Haiti. It looked like the outside was granite and the doors were heavy glass. Inside it was air-conditioned, clean and electronic. Each person hoping for a visa needs to get in line to speak with one of the cashiers. The cashiers sit on the other side of a glass window and speak to you through an intercom. It is here that I learned that today’s rescheduled visits were only for Immigrant visas – not the kind we were looking for for Genette.
I told the cashier my story: that we had come a long way; that I am leaving on Saturday; that I want to be here for the appointment. Isn’t there some way that she can be seen today? No. You will need to send us an email to try to expedite her appointment. But who receives those emails? Can’t I just talk to them today? No. You will need to send an email. Can I speak to a supervisor? Oh, you were supposed to have an appointment on Friday, the day of the hurricane? Then, you will need to send an email. You see where this was going.
Strike one. Not out yet though. Genette never even made it through the security gate. To take advantage of our trip to PAP, I asked Genette’s brother Gito, who had driven us to PAP, if he could show me the Neg Mawon. It is a famous statue outside of the President’s palace in Petionville. The Neg Mawon symbolizes the freed slave who was now marooned on this tropical island. It is a symbol of strength and commitment for the Haiti people. 

I also saw the damaged presidential palace. 

After a small bite to eat, we headed home. When I arrived back at Maison Fortune, I sent an email.

Needless to say, I was tired that night, and, after our first two births, I slept for 4 hours. Soon after I woke up, a woman came in with a small hand peaking out of her vagina. This was not good news in any way. She was only 30 weeks pregnant, dangerously premature. The baby was thought to be in a transverse position, but as the baby began it’s descent to be born, the hand retreated and a small rump appeared. The staff midwife and the students could not find a heart beat, so the baby was presumed dead.
With a stillbirth in a breech position, the students know that the best thing is patience and to let the birth proceed at it’s own pace. The baby’s limp and lifeless body slowly emerged. There is always a point in a breech birth that looks odd because the body is out and the head is still inside the mother. With a complete lack of muscle tone, the baby’s body slowly crumpled in a small heap as we waited for the head to be born. Then, a small convulsion of the baby’s body. Was that for real? Is this baby alive and fighting for life? It happened again. Yes, this was a faint sign of life in a baby that we thought was no longer living. But truly, this movement was only a reflexive action of the baby’s nervous system. There was no muscle tone, no reflexes, when the baby was finally born, no breathing effort.
So here was the flip side of the coin of our experience with the baby, Miracle. Was this baby in need of a massive resuscitation effort that couldn’t be sustained and that would ultimately not save the baby’s life? Was a day or two of living worth the effort? This baby was unresponsive, not breathing, unconscious, but had a slow heartbeat. Without words, we all knew that this baby wouldn’t make it. It was too early, too difficult a delivery, too far gone. We were the ones who had to suffer through the 20 minutes of its short life. Who gets to decide who lives and dies? Is a massive, heroic American effort to resuscitate a baby the right thing to do when there is absolutely no ongoing care here for premies? Even if the baby were to live, the risk of brain damage is great. Is it fair to ask an already impoverished family to take on child that will always be a burden? The answers are impossible to know, so instead you go with your gut. For me, I knew that this baby wouldn’t make it and that instead, it might be better to have the mother just hold the baby for the few minutes of its life. Except in Haiti, most mothers don’t even look at their babies that are born healthy and alive. The mother declined the offer to hold her baby.
We wrapped the baby in a small, blue surgical towel, giving some semblance of comfort. The baby lived for 20 minutes and never made a breathing effort except for its spasmodic, occasional agonal breaths. Later, the mother stood in her white mesh “culotte,” unsure of the next steps when you are leaving the maternity ward empty handed. It was her first baby.
The next, and final, baby of the night was born healthy, if not full of drama. The mother was reluctant to open her legs and was quite loud in her travail. The mother’s name is Darling and she named her baby girl, Guerline. She smiled when I asked to take a photo of her and her baby. A moment of pride.

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