Monday, August 10, 2015

What day is it?

After a hugely successful week, we arrived in New York City. Not without our final medical adventure though.

After our 3-hour car ride from Hinche to Port Au Prince, checking our much reduced baggage, and settling in to await our flight, Viola fainted and threw up all over the floor. Although she has had episodes like this before, it was still quite dramatic and worrisome for all of us. We laid her down on the floor and I rubbed ice on her neck and back until she felt better to sit up. She borrowed an extra skirt from Norrell and felt good enough to walk onto the plane. The plane ride was uncomfortable and harrowing for her though, vomitting again twice. By the last leg of our trip, Miami to JFK, she had stopped throwing up but was now experiencing body aches all over. Could this be chikungunya? Ugh. She was able to lay across 2 seats with her head on my lap, and that got us landed in New York.

By Sunday, Viola was feeling intermittently better, but still not 100 per cent. Dina was the next to start feeling some intestinal distress. Because Viola is almost back to normal, I am convinced that it is not a mosquito-born illness like chikungunya or Dengue fever. She never had a fever. But most likely, the combo of illness from the toddlers at the Azil, water-born microbes and motion-sickness. Dina seems to have a typical Haiti dysentery. It is a hazard of the trip. We all managed to stave off the mosquito bites, maybe half a dozen each. But it is so hard to make sure that you do not drink the water. We took daily bucket showers and water can get in your mouth. We ate produce that hopefully and probably was treated correctly for us, but so easy for something to slip through. Even the way dishes are washed can lead to an unfriendly microbe ruining your day.

So, we are here in NY. Viola and Dina are sleeping way passed 10:30am. I think this will be the last post unless I put up some more photos here and there. Thanks for tuning in, thanks for all your donations, whether you donated money, time, clothes, stuff. We made it all happen together and supported a small town in Haiti, called Hinche.

Thursday, August 6, 2015

Kijan ou rele?

How are you called?

Aug 6 Blog:
Guest Bloggers: Viola & Eva
            Today, in order to remember the names of our sixty five friends at the orphanage, we decided to take photos of each of the girls with their name tag. With the much needed assistance of Barbara, we managed to pull it off with minimal chaos.

Wednesday, August 5, 2015

Three for One!

We are quickly falling into a regular rhythm in Haiti. Volleyball at 6am (Maria and Norrell “off to work”), then a big nap for us, off to the boys’ campus for lunch and Kompa-guitar playing, moto-taxi ride to the Azil (the orphanage run by Mother Theresa’s order), moto-taxi to the Midwives for Haiti house for dinner and intermittent WiFi, then back to the girls’ for partying and cold-bucket showers.
Last night was especially hot, but that didn’t stop us and the girls from Maison Fortune from hanging all over each other for hours.  Sophia has an amazing voice and we prompt her to sing her favorite songs for us (Justin Bieber). At one point she wanted me to translate Bieber lyrics into Kreyol. She would sing the line in what she thought was English, Viola would translate it to me in English and then I would attempt to translate in Kreyol. It was exhausting and hilarious.
Our Kreyol is getting better and better (pi bon!). Last night I was so proud of myself when I figured out that Islande is actually NOT speaking Kreyol but nonsense words. That was until Viola told me, “Oh yeah, she always does that”.
Today was long, exhausting , and fun. I did C/S number one at 11am.  Dr. Celestine gauged my interest in doing the surgery.  I said, “Sure, I’ll do it,” so there I was in the OR, without him.  Luckily the scrub tech and the anesthesiologist were both Cubanos, so we had a good time.  Sponges and sutures seem to be rationed; sponge, suture, and instrument counts were nonexistent.  EVERYTHING is broken in the OR, but rigged just so.  My second C/S was a 28yo HIV+ lady whose first baby died.  She had an ugly vertical keloid scar.  I did her C/S +tubal and an extensive scar revision. C/S number three for the day had “CPD”, basically completely dilated with extensive caput after just one hour of pushing- a soft call, but not my place to lecture them today.  By this case, people were coming into the OR to watch and some were taking pictures of me. 
There was one patient who took a large dose of malaria medicine in an attempt at self-abortion.  She got the D&C, just like she did at her last undesired pregnancy.  This is a mainly Catholic country, where pharmacists don’t usually sell Misoprostol to women, and where many women are denied tubal ligation due to their age (i.e. under 35yo with 3 kids and 3 late miscarriages did not qualify this week, but the HIV+ lady got her desired tubal).

Chajman lou a. The heavy load. I am here because I think I am helping. If I wasn’t able to do even some small part, I think I wouldn’t come. But the load is heavy and many hands make light work. Veronique, the house parent at the girls’ orphanage where we are staying, is in charge of 65 girls from ages 3 to 20. She knows exactly who is who and what their particular needs are. She knows the 3 girls with learning disabilities and she tells me that she gives them extra special time with her. She is dedicated and committed.  Together we brought our little 3-year-old with the burns to the state-of-the-art hospital an hour away.  She was happy to have me along, as she had never been there before.
Thus a question: how would you know how to access a health care system if your whole country has never had one? As Haiti’s healthcare infrastructure grows, so does the need for the people to know how to use it. I was happy to feel useful, certainly knowing how to work the system even if it wasn’t my own. We waited for 4 hours to see an emergency room doctor. On the crowded benches that looked like pews, a man said that he had been waiting for 24 hours.
No way, I’m an advocate if nothing else. I had taken a tour of this hospital when it finished 2 years ago, so I knew there were other areas where we could go. By talking to a doctor at the nurses station on Pediatrics, I was able to gain entrance into the actual emergency room through a back door. I just wanted to talk with someone and try to get our little girl triaged appropriately (and much quicker than 24 hours).
 I found a blond American doctor. (We certainly do stick out here.) She was from New Orleans, and I understood later that she is one of the teaching doctors here for the Haitian medical residents. People deferred to her. She was willing to come out and look at Jenica and let me know if we should stay or not. Movement in the right direction. She looked at the burns and actually thought they were 2nd degree, no admission to the hospital needed, but in order to get meds and bandages, we needed to wait our turn in the waiting room. Pray some more for help soon.
It certainly begged the question: how long do we wait? 3 hours? 10 hours? 24 hours?  It seemed like we were close to being seen, but it was still so hard to tell. The girls (we had brought along a 4 year old with a rash, too) sat quietly, drinking a kool-aid drink and eating a Haitian street sandwich. Darlene takes care of Jenica like an older sister. Mind you, she’s four. More people fill the Emergency Room church of Paul Farmer. Most have home-doctored injuries like our Jenica. Will they all wait 24 hours for care?
One thing that’s different for sure about the Haitian system and ours: we paid $1 for Jenica to be seen.
Three hours into our waiting, a young Haitian doctor appeared by the reception desk. I jumped at the chance to talk to him and simply ask where we were in the queue. A 3-year-old with burns? He didn’t even know about her! But he was friendly and kind, and went looking for her chart.
By an hour and a half later, Jenica had been seen by the doctor, received sedation to do the debridement of her burns, and was all bandaged up, ready to go home. I was truly grateful for the care for our piti (little one). The female Haitian doctor that we saw was competent and compassionate and obviously knew what she was doing.
Am I helping? For one, I know that I am just as committed to our home base-orphanage as I am to the midwifery program. We are here and we help where we can. If it is helping Veronique and a 3-year-old, so be it. If it is resuscitating a newborn in respiratory distress, so be it. If it is helping the midwives to stay committed to their work, so be it.

The load is heavy. I am willing to do some lifting.

Tuesday, August 4, 2015

A Haiti Day

Prestige is the local beer here and we sit and drink. It has been a long Haiti day for all of us. Lots of stories to tell, but for now, I will just send photos, and rest. A longer post tomorrow about our adventures.

Monday, August 3, 2015

First Day at the Hospital


 Norrell blogs today:
Today was our first day at the hospital.  We arrived by motorcycle taxi with our translators at 07:00. The first thing that struck me was the odd odor of the place- kind of a fermented B.O. mixed with the open pails of urine at the bedsides and some fish market added in there. It was amazing that all waiting areas were already packed at that hour. We viewed the 8 bed antepartum room, the 8 bed postpartum room and the 5 bed delivery area. Maria and I were locating the supplies when we noticed a midwife rubbing a toweled lump on the counter in the delivery room.  We came over and found a 7 minute old girl who had a normal heart rate, was breathing, but very very limp. Not much was happening to attend to the baby.  Maria grabbed an ambu bag and started resuscitating her.  We found out that her mother had just delivered in the antepartum room after an eclamptic seizure.  We spent most of the morning working on this baby, trying to get pediatric attention, trying to get her care in the NICU  ( the first one ever in Haiti ) but they 'were full'.  Just after noon we finally got her into the NICU for IV fluids, oxygen and antibiotics.  The mom was receiving IV blood pressure meds and IV Magnesium to prevent further seizures We will give an update tomorrow.
We struggled with limited supplies and an overall lack of urgency sensed at the hospital.

When we left in the afternoon we returned to the boys'  orphanage for a meal, and Dina jammed on a guitar that only had 4 strings.  She played with a boy from the orphanage who played 'KOMPA' jams on the uke.

Viola and Eva set up the volleyball net at the girls' orphanage and had a big time.

Then we went to the 'Mother Teresa ' orphanage to play with the babies (prob 20 crib in a room) and the group of 3 and 4 year olds.  We think we taught them some songs, maybe they thought we were crazy, but it was fun and we intend to do all of this again tomorrow.

Sunday, August 2, 2015

Nou la nan Hinche!

Arriving on the weekend has afforded us the opportunity to "hang out" with our Haitian friends while we gear up for a busy week ahead. The girls at the orphanage have easily fallen into a common love fest with us. We hang out on our porch and speak to each other in English, Creole and the universal language of hugs and cuddles. Last night we met the newest girls at the orphanage, 3 to 5 year olds, who are all about the lap time.

This morning we awoke to our first medical adventure, Haiti-style. One of the sweet 3-year-olds, Jenica, received 3rd degree burns on her leg and arm from the open air cooking fire. I heard a commotion in the morning as all the girls ran to the kitchen. Seeing Veronique, the house mother, carrying the little one, I wasn't sure what was going on. Later she came to us and said that the girl had been burned. Although the burns were small, the largest one being only 3cm by 1cm, it was deep and definitely 3rd degree. 2 other areas on her arm were sheered of skin. When I arrived, she was weeping, face down on the bed, to allow the back of her leg to be exposed. The house mothers were worried. Cyclically, she would cry out in pain.

For 4 years, I have carried burn gel and 2nd skin burn bandages in my bag just in case one of us got hurt. I ran to our dorm room across the way, calling to Norrell along the way to get dressed and come see. Together we dressed the wounds with burn gel and cetocaine gel and 2nd skin. Norrell went off to the hospital to talk with the doctors there, returning with antibiotics, burn ointment and liquid tylenol. By mid morning, she was up with the girls, sitting quietly with a Dum Dum in her mouth.

We spent the afternoon at the Azil, Mother Theresa's orphanage, in the middle of Hinche. The girls instantly fell in love with the babies and toddlers, planning on their return for the rest of the week.

Motos and mosquitos and many moments of joyful connections. Tomorrow we begin our work at the hospital.

Here are photos from our day:

Saturday, August 1, 2015

We are here, we are here, we are here!!!

Having left San Francisco at 4:30am on Friday, we are now sweating away at the Midwives for Haiti house in Hinche on Saturday evening. Here is what we have done so far:

Successfully transported 500 pounds of donated clothes, shoes, sneakers, medicines, medical equipment, volleyballs, nets and team T-shirts. Other fun essentials for the orphanage include nail polish, a Table Tennis set, backpacks, crafts supplies and 180 photos from our previous trip to give to the girls.

Met Ronell, our driver, and travelled the 3 hours that it takes to traverse the 75 miles up and over the the mountains to the Central Plateau

Arrived at Maison Fortune and hugged all the girls that we have missed so much: Joska, Marilande, Betchilove, Ani, Neslande, Salanta, Michou, Menoushka, Astride, Marilise, Barbara, Marie Denise, and on and on.....

Had lunch at a Haitian restaurant with the founder of Maison Fortune, Jean Louis. First Haitian food for Dr. Norrell and her daughter, Eva

Took our first moto rides of the season: 3 motorcycles carrying the 5 of us from the orphanage to the Midwives for Haiti house --woo hoo! What's not to like?

Chatted with the lovely coordinators at the MFH house about our busy week ahead.

The plan is to blog daily about our adventures. Here we go!!!!

Monday, January 26, 2015

Welcome Emilia!! by Maura

It's Emilia's day 6 and I still find it hard to sit and write about the birth, mainly due to the incredible emotions that it brings to memory and I feel like words won't do justice to the miracle of life.

Though I had started feeling strongish Braxton-Hicks about a week before Emilia was born, stronger and more rhythmic contractions started on Friday December 19. A friend from my college years came to my house earlier that day and we chatted for about 2 hours until I wasn't able to sit comfortably anymore and I said I needed to go to sleep. Unfortunately, sleeping was not something I was going to be able to do until much later. 

My husband Andrew came home around 7pm and I told him that I thought things were starting. I asked him to grab some coconut water on the way home from dropping my mom off at her house - so glad he took it a step further and he shopped as if we were going into labor. Once home, we tried going to sleep but since I couldn't, I decided to move to the guest room and watch a movie so that Andrew could get as much rest as possible. At around 10pm I texted our doula Sophia and told her that it looked like baby was on the way but I didn't think anything was going to happen that night. She suggested I try a bath and some wine to relax. 

Around 1am Andrew joined me in the guest room and helped me through early labor. Things seemed to be progressing, so Andrew called our doula at 4am to let her know that I was having contractions every 5 minutes for about a minute per contraction. Sophia arrived about an hour later and got immediately to work, helping us look for better positions for me to labor and overall just doing things to make Andrew and me feel comfortable. 

As contractions got closer to 3-1-1 we called Maria and she joined us at about 9am. She checked me but I didn't want to know how dilated I was so we just continued with what we were doing. Contractions just keep getting stronger and stronger and around 1pm I started feeling some back labor. After a shower, I got into our tub and from the bathroom floor Andrew helped me through those contractions for about 1 hour. Since Maria knew that we had taken Rachel Yellin's Hypnobirthing class, she suggested we used her guided meditations and so we did. I do believe the "tapes" helped. I was able to take a quick nap in between contractions and generally get more relaxed. 

The mucous plug came out at around 2PM and Maria told me that this was a great sign that things were moving in the right direction since it most likely meant that my cervix was opening nicely.

All sensations really intensified after 3pm, the back labor got a lot stronger and I just felt like my hips were being ripped apart. But every time I said "I can't do this anymore" Andrew would tell me "yes you can, repeat after me, yes I can" and so I would repeat after him that I could do it. I had also made some affirmation cards that Sophia would move around for me to read and kept reminding me that my reward was meeting my baby. 

While in the tub I had also started feeling a vague feeling of pushing. With all those signs Maria decided to check me again around 4pm and thank goodness I was 8 centimeters dilated. I finally felt that I was going to meet my baby! And about an hour later my membranes released. 

Maria called Sue (our second midwife) and around the same time the back labor really intensified. Maria and Sue suggested several positions to try to move the baby but nothing seemed to work until Sue suggested I put my knees on the edge of the bed and my head on the floor and it was almost instant! I got up and walked around the kitchen and immediately started pushing. I was really scared at first but Maria guided me through what to do. Once Maria was able to feel the head she asked me if I wanted to try the birthing stool and so we did. 

We moved back into the guest room, Andrew sitting on the bed behind me holding my arms while I sat on the birthing stool. I continued to push and soon enough I heard Maria said "Maura, reach down for your baby". I just couldn't believe my baby was finally going to join us! As soon as she came out, Emilia was placed on my chest and that was pure bliss. Having my brand new baby in my arms and Andrew holding the two of us, my heart melts just thinking about that moment.

After Maria and Sue finished checking Emilia, Maria asked me to push the placenta.

Everything just seemed to have been a dream after that. Maria gave me a few stitches and soon after the three of us were on our bed just in awe of what had taken place in the last 24 hours. 

I truly feel blessed to have had Maria, Sue and Sophia as my birth team and of course my husband Andrew for being my strong companion. We can't wait for all the memories to start building with our Emilia as part of our family.