Haiti Blog Aug 30-Sept 3, 2010

Monday, August 30, 2010

Journal Entry: Aug 27-28, 2010

The women come and come. Very few moments in the labor ward at night are quiet and without a woman in labor. The women come into the delivery rooms when they think they are ready to deliver. They are checked by a midwife or student. If she’s 9 cm or more, she stays and waits to feel the urge to push. If she is less than 8cm, she is sent back walking. Tonite we arrive and there are no sterile instruments. The autoclave is packed and I press the button that turns it on (once we have electricity again, that is). I’m not sure if it’s really working though. The midwives are not sure how the autoclave functions.

We can’t find cord clamps either. I know we had a huge bag full the other day. Ami and I will need to go to the storage room tomorrow and restock. Of the delivery areas, room 5 has two delivery tables. We still need to teach the midwives to use a private room as long as one is open. They gravitate towards putting the women in the same room.

The first mom this evening is having her second child. She pushes out a strong, healthy boy. She doesn’t loot at the baby. I tell her congratulations and that she’s done a good job. The baby is big and beautiful and healthy. My Creole for birth is improving every day. I place the mother’s hands on the baby on her chest. She does not engage.

I am reminded of how harsh these conditions are. Can you really fall in love with your baby if it’s chance of surviving its first 5 years is questionable. Can you open up to your baby if there is another woman laboring 3 feet away from you?

I pull the Haitian midwife aside to scheme about how to get this mom to bond with her newborn. The midwife hasn’t been so nice to her, so I want to engage the midwife on a different level too. In a whisper, I tell the midwife that the mother isn’t bonding well with the baby. I suggest that if she talks to the mother, telling her that she did a good job, that her baby is so beautiful, that her baby is so smart, that the mother will bond with the baby. If the mother is happy, the baby will be happy. If the mother is sad, the baby will be sad. Not far from her years as a student, the midwife complies. She talks to the mother. The midwife is more animated and engaged in the joy of a live birth. I see her smile.

The mother begins to respond when we tell her the good news — she has a healthy baby. 

Baby number 2 is a 17 year old mother, having her first baby. She screams so loud on her final push that I have to walk away from her for a second. The screaming brings the baby and she has a healthy baby girl.

I can tell that this mom has a small tear. I ask Bieneme, the midwife, if she would like to sew or would she like me to do it. She says she knows how to sew and that I can do it.

I want Esther and Bieneme, the midwives, to watch the suturing. I am here to teach. I tell them that I have been a midwife for 24 years and I still watch other people suture. Esther is eager to watch, she was with me on the first night as well. She thanks me a lot for showing her. I get the feeling that they don’t suture often because few women actually tear. Bieneme says she practiced a lot in class on foam. I say that it is different on people and that we should always watch so that we can show each other new tricks.

The third baby of the night, a healthy baby girl, is born in the postpartum ward.

The postpartum ward is a large room with 10 beds. Every bed is full with at least one person and some women are sleeping on the floor. This is also where some of the women wait while they are in labor.

Adeline and Bieneme are chatting in Room 1 when we all hear the loud grunting of a baby coming from across the courtyard. Bieneme springs into action and is out in a flash. Before I even get up from where I am sitting, I hear the lusty cries of a fresh baby from the other room.

It’s a girl, big, strong, covered in vernix. The mom’s fifth girl. I can sense she is a little disappointed. She also has two boys at home. Being a 7th time mom, her labor had putzed and putzed, and she had been continually sent out of the labor ward, not ready. As oft will happen with grand multips, with one final wave of intensity, the baby was born.

A mouse scampers across the floor of the delivery ward. It is 1:30am and 3 babies have been born since we arrived at 8. Thankfully, they are all beautiful and healthy. The pace tonite is steady but manageable. The albino gecko is on the ceiling.
                                                           ***************

At 3:10am, the 7th time mom is brought in from the postpartum ward. She is having heavy bleeding. Bieneme does an exam and removes about 250cc of clots. The mother has already lost at least 500cc. The midwife is discussing cytotec in Creole. I wake SheLove to help me with the translation. I get 800 mg of cytotec from the Cabinet. I motion to hand the tablets to Bieneme. She says, “You do it.” I place the tablets rectally that are known to be the savior of mothers in the developing world. The husband comes in and brings the tubing and Lactated Ringers that he bought at the pharmacy. This means we can give her IV pitocin. The women are required to buy their own IV supplies because all the other patients in the hospital have to do it that way and they do not want the pregnant women to set a precedent. The injustice of this seems absurd to me. Are they really going to withhold a simple life-saving treatment because they are afraid of offending the other patients? Isn’t a maternal death from postpartum hemorrhage far more offensive?

Thankfully this woman had the resources. We give her the IV. Soon she is snoring and her vitals are very stable. We let her sleep. I tell Bieneme that since she is a grand multip and has lost more than the usual amount of blood, that we need to check her vitals and bleeding every 15 minutes for about an hour or so. Bieneme looks at me and simply says that she is going to sleep. Bieneme is not a student, she is one of the paid midwifery staff. Thus, I can’t really instruct her what to do. Instead, I model, “I’ll watch her then.” Thankfully, the mom’s vitals stay stable and the modeling may have worked. Sometime in the morning I see Bieneme go in to check in on the mom. I asked Ami, “Is she going to check her blood pressure?” As Ami nods her head, I say, “Bon.”

A fourth baby is born before the night is over, another girl. Around 4am, the electricity goes off in the hospital in anticipation of the light of day. We have to work by flashlight and headlamps until the sun comes up. By morning, with all the baby’s born and the 7th timer sleeping, the midwives congregate in Room 3, our usual charting station. We chat, take photos and relax now that all is quiet and the shift is almost over.

Ami and I walk home at around 6am. It is bright daylight and cooler than midday. There is a pick-up soccer game already in action across from the hospital. The field is also where the dirt runway is for the small, 6-seater planes that fly into Hinche.

Women are selling food along the side of the road — fried plantains, avocados, hard boiled eggs, sundries. As we pass the empty churches, the ethereal sound of the church choirs practicing seeps onto the street.

The mile and a half walk home is grounding and peaceful. We are happy to be here in Hinche.

Tuesday, August 31, 2010

A morning at the waterfall

Wednesday, September 1, 2010

Nou La

Haitians have another response to "how are you?" that reflects their resilience and optimism. Kijon ou ye? How are you? Nou la. We are here. We are here reflects their affirmation that they are still alive, here today, that is good. I have noticed that death is talked about without emotion. My father died. The baby died at nine months. Death is as hard a fact around here as life. We have already seen two funeral processions — the first was through the center of Hinche. Hundreds of uniformed men and women slow-stepped in time while a band played. Their was one line of people on each side of the street. At first we thought it was a church parade, but then it became clear that there was a hearse at the very back of the line. There were uniformed men and women first, and then children, all dressed in white. The band was next, followed by the hearse and the family. It felt very much like a New Orleans jazz procession. Ami says it is called a Second Line. The hearse driver was tapping his hand out the the car window in time with the music. The second procession was much less ornate. We simply saw a band of people carrying an ornate coffin down the street. There was no crying or talking. They were just doing what they needed to do. One night in the hospital, when there was a lull in births, I took a walk around the courtyard to get out of the stuffy, clawing heat of the labor ward. I started to hear a loud commotion and someone yelling loudly. It was a woman’s voice and I thought it was a new woman in the throes of labor. I went towards the sound to see what was going on. As I approached, a woman was wailing, “Mama, mama.” Over and over, interspersed with sounds of grief and heart-break. I would occasionally understand a few words in Creole, like please and leave. Mostly she just cried Mama over and over. This is the second time I had heard the keening in as many times as I had been at the hospital. The grief was so clear and pure, a total consumption of this woman’s body. They were people gathered around her, but no one tried to stop her process. She occasionally would spread her arms wide, bearing her soul in her willingness to bargain her mother’s life back. I stood with the group, watching the woman. It didn’t seem rude or disrespectful, on the contrary. It seemed that the more people who gathered around, the more this woman was honored and held in her space of sorrow. Sure enough, not long into this, the same men who had carried out our pregnant woman on the stretcher came trotting along with a small body wrapped in a white body covering. A Ford Explorer had pulled up that had all the seats taken out of the back. They put the whole stretcher into the truck and then the men got into the truck as well. I can only assume that they were bringing the body to a funeral home, or home. The next stop on it’s journey. The rest of the family were able to load the keening woman into the front seat of an old pick-up truck. Her keening quieted to a soft focus stare. The family climbed into the back of the truck and drove after the Ford Explorer. The hospital was quiet again.

Ami and I have settled into a routine of going to the hospital every other night to help out. The students were not there on the weekend, which made it a little different. Still, we connected with the midwives and shared with them more as peers. On Friday night, we went over for about 5 hours and I delivered a baby because they wanted to see how I did it. A healthy baby girl. At the end, I asked if I had lived up to the Haitian standard. We all smile and joke after a long night at the hospital, relieved and tired. On Monday night, the students were there, Josette and Marie Denise. I am so impressed with their skill and professionalism. They are almost done with their year long training program and I am confident that they will do well. Josette and I dealt with two second degree tears together. She is a girl after my own heart. Her suturing is meticulous and precise. We did the suturing together on the second mom because the sulcus tear was deep. She asked me if I would do the deep part and then she would take over. So we did it together. I also showed her a few new ways to hold her needle holder “to make her life easier.” She totally got it and I was so comforted to know that these women will be sutured well. I continually reminded them that where there is a question about access to clean water, it is very important that the tear is completely closed to avoid infection. Josette and I were two peas in a pod, figuring out our suturing job. I love being a perfectionist about suturing and obviously she did too. At the end, I told her I loved her in French. She smiled back and said, “I love you, too,” in English.

The same night we had a ninth timer and a second timer. All healthy baby girls. Active management of third stage has contained the onslaught of postpartum hemorrhage. So many women here are having there 6th, 7th, 9th babies.

I also tried out a new technique that I was so excited about. We found a whole bunch of clear plastic bags with drawstrings in the storage room. They looked like bags that may have been used in the US to hold women’s belongings while in labor or maybe the freebies that women leave the hospital with. Basically, here in Hinche, we have what we have and if we don’t use the stuff, it just sits in the storage closet. So I had an idea. We are going to use the bags to set underneath the mothers to collect the blood, amniotic fluid, everything including the placenta during and after the birth. Then we can take away the bag, the same way that they do it in US hospitals with the big, blue cone shaped drapes that collect and measure blood. I felt that using these bags would keep the women’s cloth cleaner, keep the beds cleaner, make the midwives' lives and the cleaning lady’s life easier. But most of all, it would allow the women more dignity in birth. By not having to sit in the puddle of their own blood and body fluids, the mother’s would feel cleaner and more dignified. It’s the little things.

So we tried the technique on the three women that delivered that night. All the midwives were thrilled with how it worked. They noticed that the table was cleaner, there was less mess to deal with afterwards. They were happy and I asked them to show the other midwives our new plan too. I told them to use up all the bags that we had and that we would try to get more. I felt happy with a good night in the Hinche hospital.

We walked home in the morning. By 5:30am, the sun was up and the day had begun. Families were here to see their loved ones in the hospital. We had brought Cokes with us the night before, for the midwives and SheLove, our interpreter. They don’t drink coffee here, mostly running on adrenaline and allowing some of the midwives to sleep, on the floor. Two midwives slept on the countertops. I was nursing the last Coke as we left the hospital. We passed the vendors setting up, one woman asked me for the Coke. “Blanc.” White girl. She motioned for the hand out. I gave her the Coke and said, “Bon jour.”

Nou La. We are here.

Friday, September 3, 2010

Last Night in the Hospital in Hinche and A Party

Ami and I deliver a stillborn baby each on our last night in the Hinche hospital.

Sonise is the first. She is young. She says she’s 20 but I still think these women may be younger than they say they are. She is pre-eclamptic. She’s received Mag Sulfate but her baby is already dead. She doesn’t believe it when she’s told the news.  We put the Doppler to her belly and can not find a heart beat.

She pushes for awhile in the usual Haiti-style — on her back. It’s taking a long time and she’s quite uncomfortable. She asks if she can get up and use her bucket. I say that she can be in whatever position she would like.

She ends up squatting by the side of the bed and pushes the baby out on the floor. We quickly grab a blue surgical sheet to place on the floor underneath her. It’s really the first birth we’ve seen that is not on the GYN table. The placenta is born easily a few moments later. We move the mom back up to the table. Now, the 39 week baby is on the floor and the mother is looking down at her. Ami and I have developed a pattern of wiping off the baby and half wrapping the baby up, swaddle style, in a blue paper towel. Sonise wants to see and hold her daughter. Her sister is with her and is arguing loudly that she shouldn’t hold the baby. For a moment, there is chaos as the sister is protesting and Ami and I are insisting that this mother can process whatever way she needs too. Adeline, the midwife, is also arguing against holding the baby. We win the argument and Sonise holds her baby girl for a long time. It really seems like a rarity for someone here to bond with their stillborn baby. Sonise takes her time. It is good. Denial, anger, she’s blaming another hospital for the death of her baby. I know that she is going through the appropriate steps and I wait patiently for the grief.

I tell Sonise, “No, it is not the other hospital’s fault. These things happen and it is so sad.” Sonise insists that she wants to take a photo of the baby. After some difficulty, she gets 3 photos of the child on her cell phone. She seems happy with that. She wants to dress the baby. Again, the arguing ensues from her sister. Again, Ami and I support this woman’s choices. This is all she has of this baby. She puts a small hat and white cotton dress on the baby. She doesn’t seem put off or repulsed by that fact that her baby is dead.

Another photo. We tell Sonise that we will always remember her and her baby. She will always remember her baby. Sonise names her Daphne.

Ami’s stillbirth is in the over-flow postpartum room because the mother stayed there too long and now the baby is coming. We move some supplies down the hall to where they are. The woman is resting her head in her husband’s lap, not unlike many of our births in the states. The dark brown amniotic fluid of death is becoming all too familiar to me. The small, macerated baby girl is born soon. The mother and father only look at her for a short while and do not hold the baby. It is all very sad. This is our first birth with a father in attendance.

The rest of the night at St. Therese is unusually quiet, interrupted only once with the prayerful singing in the postpartum ward as Sonise and her family grieve for the lost baby. I am happy that she is processing this death in a very conscious and real way. Both of the babies tonite had been the mother’s first. We have another woman in labor tonite —it is her fourth. None of her babies have been born alive. We are hoping this one will be different.

                     ***************


I want you to leave Hinche with a story of life and hope. It is the story about our fete, our party.

I didn’t even have time to blog yesterday because Ami and I planned a big party at the Maison for the midwives. Midway through the week in Hinche I thought that it would be a good idea for future teams of midwives to have an American party to get to know the Haitian midwives. I knew that Ami and I were connecting so well with them, we laughed and joked in Creole at the end of each shift. We took photos together. We processed the death of our mother that had died on a deep level, together. Our relationship with them was strong and loving. I was afraid that many of the other teams were missing this true exchange. Thus, maybe a party would help them break the ice.

But then the next day I realized, I want to have a party for them. Ami was immediately game. We asked Brother Michael at the orphanage if he would ask the cook to make food for us. We wanted fried plantains and the crispy, fried potatoes sticks, hot dogs. We wanted the cook to buy avocados and eggs at the market so that we could make deviled eggs and guacamole. Ami, Dina and I would go to the market the next day and buy Haitian caramels and limes. We ordered up 6 cokes, 6 Sprites and 12 beers. Jean Louis’ brother would get that for us. Jean Louis is the founder and head of the orphanage. Everyone was amazed and excited that we were throwing a party. No one had ever done this before at the orphanage. We invited all the student midwives and the graduates that we had been working with. They all said they would come and seemed truly excited about it.

Yesterday was the party. After our night in the hospital, we came home and cleaned up a bit. Then we left at 8am to go on the mobile clinic. We drove 45 minutes out of Hinche and then walked for 25 minutes until we reached a small building that looked like a typical Haitian school. Dirt floor, wooden benches. This is where we would see the women and three were already waiting. By the end of the morning, Magdala and Philomen, as well as two student midwives, had seen around 25 women. Ami and I mostly observed, tired from the night before. We got home around 1:30pm and the party was at 3. We scurried around trying to find a CD player, worrying that the drinks hadn’t arrived yet. They would have to be put on ice in a cooler. The cook had made an amazing spread for the party — besides what we had ordered, she had made a beet salad, a pasta salad, the spicy cole slaw that we often ate, and popcorn. POPCORN!! We were so psyched!! The kitchen table was full of food. I got to work making the deviled eggs. I even showed the cook how to pipe in the filling by cutting a corner off of a zip-lock bag, filling the bag and oilá, you’ve got a pastry bag. I made her taste one, she liked it.

The drinks came at a little after three. On Jean Louis’ recommendation, we changed the order to a case of Cokes, a case of Sprite and a case of beer. He told us that with what we had ordered at first, that wasn’t a Haitian party. We were expecting 20 people. Our driver, Ronel, was meeting everyone at the hospital and would drive them to the Maison. At about 3:10pm, the thunder rolled in and it began to rain. At 3:15pm, the truck load of midwives showed up, all of them crowded into the back of the truck, now with 6 or 7 umbrellas providing shelter. We were delighted!

The midwives arrived, dressed to the nines — make-up and jewelry. We had told them to not come in scrubs, this was a party! One woman came in a long, lavender dress that looked like a maid-of-honor gown in the US. She was gorgeous. Everyone was excited and happy. I had a slide show running on the laptop of the pictures of our time with them. They were immediately drawn in, laughing and hooting when they would see themselves in the show. I offered drinks all around. The food was devoured in no time. Small plates piled high with all of the offerings. I saw many people going back for seconds. We had even found a bag of Oreos that had been left behind by some other midwives. I told them in Creole that I made the deviled eggs and the Ami made the guacamole, but the cook had made everything else. I also told them that I am Italian, so I really like it when they ate a lot. Everyone loved the food and drinks.

Now, Dina, of course, had been playing ukelele all week. On our first night in the Maison, we heard some kids playing the ukeleles, so Dina tuned them and played one off and on all week. She wrote a song in Haitian Creole that we now sang to the midwives. The song was made up of all the simple and common phrases that we had been using all week. Here’s the translation in English (of course we sang in Haitian Creole):

How are you?
How are you?
I don’t know.
How are you?
        

Not now.

Not now.

How are you?

Not now.
        

How are you?

Not worse.

How are you?

We are here.

How are you?

I’m fine and you.

Oh, we are chillin’.
        

(Maria’s solo)
        Don’t cry because we are going.
        Don’t cry because we are going.
        Don’t cry because we are going.
        

Everybody……….
        (repeat from the top.)

The response was obvious, immediately. Everyone was hooting and hollering and joining in the chorus. They loved watching the crazy Americans, singing their silly song with Dina on the ukelele. They clapped and cheered when we told them that Dina wrote the song herself. We laughed together, truly joyous and grateful for meeting each other. The Haitian midwives got together and sang us a song back. It was a beautiful song of thanks. I couldn’t understand the words, but I understood the sentiment and “Merci.”

After more chatting and socializing, exchanging emails and telephone numbers, the midwives piled back into the truck and said goodbye. The rain had only lasted about 10 minutes, so the truck was dry. I watched them leave from the second story porch, trying to capture one last photo. Esther, Genette, Adeline, Fedeline, Bien Aime, Marthonie, Anise, Monide, Magdala. Would I remember them all?



I will remember them in my heart. I will remember Haiti.