Haiti Blog Aug 30 - Sept 6, 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.


A Party with the Student Midwives

Midwifery Student Suzette and I, we worked together the first week

Me and my good friend, Esther

Guerlie and I

One of the things that was most different for me on this trip was my own deeper connection with the midwives. Many of the senior midwives are truly becoming friends as we get to know each other year after year. Genette, Magdala, Filomen, Guerlie, Marie Denise, Esther. The first year that I came to Haiti, I was excited to get to know them all, but had little facilitation of that process. The in-country coordinator of the Midwives for Haiti program went on vacation hours after our arrival and just said what amounted to, “You can handle it, right?” Ami and I did a great job of just jumping in, even without any Kreyol. Half way through our 2-week stay, I thought, the program should have some sort of get-together for the future volunteers to meet the Haitian students and midwives. I should recommend this in my feedback to the program. Not long after thinking that I thought, well, why don’t WE have a party?
So, that’s how our partying with the Haitian midwives began. This year, we had the party at the new Midwives for Haiti compound. It is a large, beautiful house with room for their classroom, guest rooms, kitchen, dining room, nice bathroom and shower. Upstairs, a whole second apartment is where Marthonie, the Haitian nurse-midwife and Director of the program stays. The cook at the house prepared the food for the party that amounted to larger amounts of what we always eat: rice, sauce, fried chicken legs, fritay (fried plantains and acra) and pikliz. I made a chocolate cake from a cake mix that I bought at the Ebenezer grocery story. The Ebenezer is an air-conditioned grocery that caters largely to foreigners and wealthier Haitians. Although it is the biggest grocery store in Hinche (or maybe the only), it still only had 3 aisles. Most Haitians buy their provisions at the outdoor market: produce; spaghetti; beans; Magi bouillon cubes which are put in EVERYTHING; canned tomato paste; large, round disks of manioc cracker bread; beef, goat, chicken both live and parts; 50 pound bags of American rice. Carrie made brownies from a coveted box of brownie mix brought from the states. The cook made two more strawberry cakes with actual frosting and decorations.
The party got to a slow start since in the beginning the food was not ready. I showed a slide show of photos of the current class that everyone enjoyed. Then, Ami, Dina and I sang them an updated version of our Kreyol song. We created the song the first year from all of the Kreyol that we knew which was very little. The song says: How are you? How are you? I don’t know, Not know. Then it goes into many of the Haitian greetings for each other: Pa pi mal, Nou la, Na boule, etc. It is a very funny little song that every one really loves because Dina plays ukelele and everyone joins in. This year we added a couple of verses:
Nou konnen plis  (We know more)
Kreyol pou nou  (Creole for you)
Pou chante nou (To sing to you)
Pi bon chante   (A better song)
Le nou travay  (When we work)
Pou bebe yo  (with the babies)
Se la vi  (It’s their lives)
N’ap sove  (We are saving!)
Kijan ou ye?  (How are you?)
N’ap kenbe.  (We’re holding on.)
Pral retorne  (We will return)
Ane procien  (Next year)
Pral sonje nou  (We will remember you)
E espere  (and we hope)
Ki nou ka sonje nou!  (That you can remember us!)

It was a big hit and we have it all on video. I’ll see if we can get it up on YouTube.
Needless to say, we all had a ball at the party, the food was demolished and everyone went home content. The midwives sang us their song of thanks at the end which was the perfect ending to our stay with them. As we were leaving, we noticed the huge pile of dishes in the sink and the two cooks preparing to do the clean up. We felt bad to leave all the mess, but then we noticed that they were happy and singing our song. It was a good day for all.


Genette to come to the US for MANA conference!

I am so excited to say that Genette got her visa on Tuesday! I really think the efforts at the embassy and some critical emails to the embassy really made a difference. She is the first midwife from the Midwives for Haiti program that has successfully acquired a visa to come to the US. One of the criteria that the US embassy looks at to consider granting a visa is a person's salary. Now, of course, the Haitian midwife salaries are nothing like US salaries. Genette makes $6000 per year. This is not to her advantage in trying to come to the US. The embassy looks at this as a sign that she might see how much more she can make in the US and attempt to stay. I am sure that this is why Esther's visa application was rejected. In my emails to the embassy, I emphasized Genette's commitment and dedication to midwifery in Haiti. She is so deserving of this continuing education opportunity.

I think that this will be a significant step in developing Genette's leadership potential. She is already hired as the Clinical Director of the Midwives for Haiti program and is one of the main leaders of the Matron program. Along with Magdala, Dina calls them the power couple. They developed the Matron program which is a 20 week education program for traditional birth attendants in the small village of Haiti where still the majority of babies are being born. You can see what a difference Magdala and Genette are making in terms of education, empowerment and continuity in the Midwives for Haiti program. By bringing Genette to the US, I am hoping that she will be able to expand her vision of midwifery-learning skills and concepts through the conference and in San Francisco.

If you would like to help fund Genette's trip, please send checks to my address: Maria Iorillo, 206 27th St. San Francisco, CA 94131. Write your check out to Midwives for Haiti and put Genette Thelusmond in the memo line. Thanks!!

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