Saturday, August 3, 2013

This is Haiti

 On my third shift in the hospital, I worked with an American nurse-midwife named Cathy. I helped with a couple of deliveries as she labor-sat with a 9th timer who was almost complete. It was unusual that she wasn’t just spitting her baby out. Her contractions were short and far apart. We had her up and walking but she became a spectacle in the labor ward. She has gray hair and thus, many people, waiting in the hospital for other loved ones, started staring at her and following her around. They wanted to see how this “gran moun” (old lady) would deliver. We finally gave her a private space in the maternité so that she wouldn’t be the object of such gawking. The labor (or non-labor) was going on for hours.
Finally, it was decided that her labor would be augmented with pitocin. I didn’t think that this was a bad idea, seeing that she was a hemorrhage risk and that the weak labor pattern would make that worse. Within an hour or so of receiving pitocin, she was screaming her baby out. Again, a little unusual. I would have expected a 9th timer to be an old-pro. Anyway, the baby came. But, it didn’t breath. There was meconium staining and the student midwife on staff was slow and clunky with her aspiration of the baby’s nose and mouth. As I saw that the baby was not breathing, I asked for the ambu bag and began the resuscitation. The baby was still unresponsive and apneic (not breathing). Within a minute, we had also begun chest compressions because the baby’s heart rate was low. Cathy did the first shift of chest compressions as I bagged the baby. I began the mantra of neonatal resuscitation. One and two and three and breath and one and two and three and breathe and…… Over and over. The baby, a little boy, was not responding. He most likely had meconium in his lungs and the, ultimately, quick delivery did not allow for enough squeeze to get it all out. Most people believe now that meconium aspiration is the result of an in utero distress. In the U.S., we deal with it often in the NICU and the babies live.
This little guy, though, was not going to have that advantage. We resuscitated him for 30 minutes, which is a long time for that kind of thing. He was finally breathing on his own, but he never took a full cry and he had the rhythmic agonal gasping of one who is desperately trying to receive air. Miss Genette offered that we could try to find a pediatric doctor to help. I thought that was a great idea and so I carried him out of the maternity ward and across the courtyard to the largely, ill-equipped pediatric unit. The baby boy was breathing on his own, but was still limp and unresponsive. Cathy and I would continued ventilating him with the ambu bag which seemed to be offering him more support. Miraculously, the doctor somehow came up with an oxygen machine. So, we put a nasal cannula on the baby and observed.
He definitely seemed to be doing better with the oxygen, but I still felt that this baby needed more care. Could we transfer him to Paul Farmer’s hospital 45 minutes away in Cange? The doctor agreed that this was a good idea and said that he would make the arrangements. I left the hospital about an hour and a half after this birth, having stayed with the baby the whole time. I felt that he was doing a little better. He had a little better muscle tone, but he still hadn’t cried and most of the time, his eyes were closed. He was receiving the oxygen and was now under the care of the pediatrician. I was adamant with them that this baby needed to be watched carefully until he was transferred to Cange. Miss Genette left the hospital 3 hours later and the baby still had not left yet.
The next morning, back at the hospital for another shift in Labor and Delivery, I asked about the baby. Miss Genette did not know, but we finally found another midwife who had the news. The baby had died on route to Cange.
I felt numb. This baby would have lived in the U.S. But this is Haiti, and the hospital does not have a NICU, does not have good suctioning equipment, does not have endless supplies of oxygen. I don’t even know if the baby had medical support on the drive. All I know is that a family member accompanied him.
I saw the mother in the postpartum ward and told her how sorry I was. She was resolute and quiet. I also knew she was about to pick herself up and go on with life. There is no time in Haiti to mourn the loss of a baby when you have 8 other hungry mouths to feed. Death is sorrowful and yet, not unexpected. The town of Hinche has at least 3 or 4 coffin shops where the wood workers display their hand-made boxes along with school benches and tables. We saw a coffin being carried down a dusty, dirt road by a procession of pall-bearers and community members. Out in the middle of nowhere, obviously they were headed to a burial spot. Death. This is Haiti.

Women waiting for prenatal care at the mobile clinic
At the orphanage, we have been playing and hugging and getting to know the girls even better than before. We have been staying at their orphanage, which is now separate from the boys. It is nice this way. The girls can maintain their own little world, not having to worry about their safety or the taunting that comes with the sexual tension of teenagers.  Of course there are the occasional sibling spats: hitting, crying, hurt feelings. But it doesn’t seem to last long and for the most part, the girls are happy and peaceful. I wonder sometimes about how to give them things in the most appropriate manner. We brought a volleyball net, 12 balls, knee pads, team T-shirts. That all went pretty smoothly. But then I also had my special gifts – earrings, necklaces, shirts, all “extras” from home that I knew would be appreciated by the girls. It is hard to give one girl something. There is a strong need and feel for equity and justice amongst Haitians. But, inevitably, there are the girls who become our favorites. My favorites this year were Joska and Marlande. They are both about 9 or 10 years old. Marlande is confident, beautiful, a strong singer during the evening prayers. She was affectionate and fun with me. When I gave her a special beaded bracelet, she gave me a big hug around my waist. She is easy with her love. Joska is more reserved although when pushed for a photo, she strikes the pose with ease. She is thinner than the other girls and Dina says the house mother told her that she has a medical condition. I do not know what it is. But, I enjoyed her easy smile and feisty spirit.
On the last day, we were cleaning up and I had a leftover baguette. There were a few girls sitting on the porch outside our room, so I offered it to them, saying that they had to share it. As soon as I gave it to them, a near riot ensued. Like a pack of wolves, they pulled and shouted and fought over the bread until a house mother broke in. This is Haiti and although I only heard it mentioned twice, I know the girls are hungry. They eat plain spaghetti in the morning, beans and rice at noon, and cream of wheat at night. Always the same, except for one day a week, when they get a chicken leg.
With the final clean-up, I swept the front porch and scooped the trash into the garbage bag that we had been using all week. One of the girls offered to bring the trash to the garbage area for me. I was happy for the help but also wondered in the back of mind if she was going to go through our trash.
Of the many things that I had brought to Haiti, one of them was a stack of this year’s baby cards. My plan was to cut up all the little faces and create a matching game for the girls. Place all the faces face down, and see if you can find two little baby faces that would match. As it turned out, the weeks were full and I just never got around to it. On the second to last day, I threw away half of the cards, and on the last day, I let go of the rest, realizing that I just wasn’t going to get to it and that it was going to be too hard to explain – cutting out the faces, matching them up, sharing the sets. Everything seems to need a lot of set up and organization around who is going to keep everything together so that pieces don’t get lost, games are kept in order. In the same vein, by the time we left Hinche, we only had 4 out of 12 volleyballs left – some had popped, some were hidden away by the girls for soccer, others I just don’t know.
Later in the morning, I was reminded that this is Haiti. The girls started popping up with the little baby cards in hand. They were fascinated by the photos and the names on the back. It was so funny to hear them pronouncing the American names – “Maxine Danger,” “Emeline.” They even wanted me to put the postcard up on their empty dormitory walls. I obliged, humbled. No matter how many hair ribbons and bubbles and Uno games that we give out, they will always feel a desperation for more. Even though they truly appear happy, I need to remind myself that they lack the foundational elements that a family provides. They have had to re-create their family life with 52 girls and 4 house-mothers. Believe me, it is far better than many. But, they will still fight over bread and pick through the trash. 
This is Haiti.


Twins: Solen and Solange