Welcome to my blog!

This blog was created with the intention of sharing my life and midwifery experiences with my community as I branch into international midwifery. I hope to keep people up to date and in touch with me, and with the places and people where I'll be.

Wednesday, March 31, 2010

march 31st 2010

i enjoy writing this blog, it feels like writing in a journal, except i know that i am sharing it with all of my friends...i hope that you guys find it interesting...for me it helps me to feel connected to all of you...there would be no way to capture everything or describe the real details of what i see here all the time, but at least this can give you guys a glimpse into some of the parts of my life here...my work here...
things seem to be going better and better...man, it was so hard in the beginning...it still is, but at least now i am getting the language more, and am more used to my daily life...it's so good to put ourselves in these situations, where we have to drastically adapt ourselves...you look around yourself and see how the people are so proficient at living on nothing, and you really see how easy your life is...it is amazing...and very sad...you see the injustice in it...how is it possible for the resources in some places to be so limited and for other places to have such an overabundance? of everything? it's incomprehensible.
so...yesterday we worked at the hospital...today there was class for the students with the volunteer american midwives and marthonie and i had our weekly planning meeting...i am happy with the way my relationship with marthonie is unfolding...we have alot to learn from eachother and together...she is experienced with managing pre-eclampsia and eclampsia with meds, for example...and i have seen other people do it here but i need to do it with my own hands...so i have her to guide me...we both want to learn how to do manual vacuum aspiration (for women who come in with incomplete abortion) and we may be able to find someone here to show us...the 2 doctors here do it all the time...in the delivery room...i have seen it many times now...anyway...i can learn alot here as i also share my knowledge and experience...yesterday for example, i put this woman in hands and knees, she had an anterior lip (the top part of her cervix was not fully dilated)---and the new cuban doctor said that he has never seen someone use that position...he was asking me about it...so we all have things to learn...one good thing here is that there doesn't seem to be alot of ego involved in peoples' work...the haitian dooctor, he is a really nice guy...works cooperatively with everyone...i really like him as a person, and like everyone...it is a weird thing to like someone and separate yourself from your dislike for them when you see how they may treat the women...he is very rough, but always smiling...an interesting combination...the cuban doctor who was here, he got moved to another place...but there is a new cuban doctor...we went out and had a beer together tonight...the other guy, dr "papito"--that was what everyone called him--he was a character. very dramatic. we got into a few arguments, but we liked eachother and he showed me some things...we did a breech delivery together, and he also let me watch a cesarean and 2 tubal ligations that he did...and explained everything that he was doing...this new cuban dr, i like him well enough--it's the same thing: you get along with them, and then you see them be really rough with a laboring woman, and not even know that they're doing it---they think she isn't cooperating and they just keep going...but you know that they don't even see the pain that the woman feels. they don't TRY to hurt the women. they just have no awareness of how the way they are touching her is affecting her.
yesterday, we arrived at the hospital (me, marthonie, the students, and the american volunteers) and the first thing was a somewhat premature birth (34-35 weeks). after this, there was this woman who had come in the night before after delivering at home, because her placenta hadn't delivered. 2 midwives had tried the night before to get it, and couldn't. so, everyone was waiting for the haitian OB to arrive to do a manual removal. luckily, one of the american midwives had brought some ketorolac, a pain med, and we gave this to the woman. well, the doctor tried to get the placenta and he was just pulling out little pieces. he said his hands were too big, and when he said that i volunteered to help him. and he was grateful and let me do it. it was a very hard manual removal, it tool me awhile to get the placenta to fully separate, because it was implanted way high, way in one of the top sides of the uterus. it was HARD to get. finally it came, and was complete, minus the pieces he had already pulled out. this is what i mean that peoples' egos aren't involved. he was glad for the help.
he also left us yesterday with this woman who had been on pit augmentation and was pushing when he left...she started pushing before she really had a good urge--the cuban OB had pushed her lip back and then started doing fundal pressure, which i got him to stop...but that was how her push started...well, she pushed for almost 3 hours, and it was hard. defineltly some degree of CPD going on...we finally got the bb out with a vacuum...one of the MW's did it...now that i saw how it is done, i see that it's a very simple device, that we definetly should have on hand to use in situations like these...the FHT's (baby's heartbeat) had been good throughout the push, but for the last 10 minutes or so they were VERY high. the bb needed extensive resusitation...
we will see what tomorrow brings...
some days i feel like i am getting used to my life here and feel content, and i definetly always feel thankful for the opportunity to learn from the people here...not only in the hospital, but everyday people....other days, i can't imagine being here for as long as i committed and i just miss home and family/friends...but...this is what i chose so life will just continue to unfold here....
ok, love to all of you...
still no luck uploading pictures...

Friday, March 26, 2010

Last 2 days at St Therese Hospital

So...the past 2 days have been very interesting...yesterday, there were 2 situations that were pretty intense. Firsst of all, in the delivery room at St Therese hospital, women are coming in all the time. So many women, all the time. All different situations are happening in there all at once. Women coming in with incomplete abortions or in the midst of spontaneous abortions, women in early and active labor, women coming on for labor checks, Drs doing D & C's, somen coming in with high blood pressure...there was one night I worked a few weeks ago where in addition to several births and other women in labor or there with high blood pressure, I swear there were alteast 20 other women sho walked through the doors that night, for labor checks. So, basically, there is always someone walking through the doors.

Ok, so yesterday, this woman is brought in by a Matron, a community midwife, and a man, from another town. She had actually birthed in a hospital, the day before, and had had eclamptic seizures. She still had a floey catheter in, and an IV with mag sulfate (anticonvulsive med) and apresoline (antihypertensive med). Well, they had cut a huge right mediolateral episiotomy, and had not repaired it. The matron also reported that she had bled alot. So, they had brought her in for sutures. I ended up doing it. Her tissue was just gaping open and since it was one day later, the only way for it to heal together was to scrape it and make it bleed and then suture it. I used a single scalpal blade and just scraped and scraped until all of it was bleeding enough. I sutured it in 3 layers. I had to--it wasn't 3rd degree but it was very deep. I was suturing it and even though I had given her lidocaine, it was really hard for her. It was so hot in there...you always sweat so much here...towards the end of the repair, I guess the sweat must have been dripping off my face, because a couple of the students started fanning me and wiping off my face and neck. They are very sweet with me.

So, another situation that was going on all day yesterday was that there was this woman who was very, very sick. She was near death. She was a 35 year-old 8/7 (8th pregnangy, going to be her 8th birth). She had high blood pressure (160/110, not as high as alot of other women I've seen here) and other obvious signs of severe pre-eclampsia. Her entire body was swollen. Her face, hands, even belly. Pitting edema. She also had preexisting asthma. So, she was having all of these signs and also started having respiratory distress. She was having air hunger. She was breathing erally fast and shallow. Her lungs were filling with fluid. Marthonie and the Cuban Dr (I'll write about him sometime---he's a character) worked on her, gave her several different drugs to stabilize her. Also her bb was breech. The plan was to do a c/s and then a tubal ligation. To prevent another pregnancy, which could kill her. Eventually she had the c/s, and then a little while later had a massive hemorrage. She soaked an entire sheet with blood. When I saw her after this, she was intubated and on oxygen and on a ventilator. The only one they have in this hospital I'm sure. I watched Marthonie work on her the whole time and watched her communicate with this woman, who was so comprimised, so close to death, and I was so impressed and touched by Marthonie as a midwife. She is very skilled in managing eclampsia---she has seen it so many times. But she stayed with this woman and kept talking to her and reminding her about her baby. I stayed with her and we walked away from the hoepital together. She said that she was thinking about this woman's other 7 children.

Today, this woman is doing well. She is present. She can talk, eat, breastfeed, etc. It was amazing to see people working together and saving someone's life--they literally saved her life--with such incredibly limited resources and materials.

Another woman's baby died yesterday--she was postdates (43 weeks) being induced with pitocin; no one listening to fetal heart tones...the baby died.

That was yesterday. Today, when I arrived at the hospital, someone had died (not the first time) and there was a crowd and their covered body was being put into the back of a pickup truck.

We had 4 births today--all were nice, normal. I caught one of these babies. I decided to forego my lunch break to stay and catch this woman's baby. It was really nice. While I was with her, this other woman was carried in by several people. She was severely preeclamptic. Marthonie, who had also stayed, started her on mag sulfate (to prevent convulsions). It was hard, she was really resisting, everything; her IV got pulled out twice; after a little while she started having convulsions. This was my first time actually seeing this. She got somewhat stabilized, and the OB came in--(we had to call him in)--and he did a sono h=on her and said she was around 29 WEEKS. I had thought her belly seemed term. I don't know. I'll see tomorrow how she is doing.

I am understanding more and more Creole. I can't speak it well at all but I can communicate alot better than I could. Even if it's not correct.

I wish I knew more about pharmacology. I just never had needed it before. Here, it would really help.

Ok. That's all for now...

Wednesday, March 24, 2010

march 24th 2010

So...I haven't been able to write for a little while because I haven't had good internet access and time to write. I had to move; I am settling into my new living situation pretty well; it's at a Catholic rectory. I was very sad to leave my new family, the girls, at the orphanage, but this was for the better. And I will visit them. Anyway, things here...they are going OK. It is never easy. But things are easier than when I first arrived. Each day, I am understanding more Creole. I still don't speak it well...but it is coming along slowly. I am collaborating with Marthonie, the Haitian midwife teacher, well. That is nice. We are becoming friends and having a good time together. I have alot to learn from her and vice versa. I enjoy the students. There is alot of beauty and strength that I witness in the people here all the time. But there are also so many challenges. I go up and down with my feelings, with my optimism. Some days I just feel so overwhelmed and hopeless, and then a little while later something happens, usually it is someone reaching out to me with genuine interest, and that lifts me up. The other evening I went walking and I met these 2 17 year old girls on the street and they just took me into their arms and walked around with me, talking to me...like in the moments when I feel the most alone, someone comes along and puts time and interest into communicating with me.
There is alot that I am supposed to do, and I have a hard time seeing how I will do a good job accomplishing it all, although the other American MW's who come down and the directors of MW's for Haiti all think it's so great that I'm here. I am collaborating with Marthonie to create classes that the students need in order to be able to graduate in November. We are reinventing the curriculum basically. That is a huge task. I am helping to orient the American MW's who come to volunteer (every week) and put them into the schedule. Marthonie are making the schedules for classes and clinical time. I will teach some classes and am helping with the students in the hospital. The problem is, in the hospital, there are so many different things happening all the time in the delivery room, that they have never learned continuity of care for the women they care for, and also for me, it feels impossible to really learn how the hospital functions, because 1) there are so many different things happening at once, 2) there is a language barrier, and the charting is hard for me to follow, 3) there is not much organization between the different people working and between the different rooms (antepartum, delivery, postpartum)...also not to mention, there is no running water, hardly any supplies, and no bathrooms at the hospital...so that makes it really hard to clean between clients and also makes it hard to take care of them, keep them drinking water...people come in with nothing...their family has no food or water for them and no money...usually they have to buy meds and IV supplies...so if they have no money...than oh well...it's hard. The instruments don't work, really you wouldn't imagine the conditions that people here work under. In the delivery room, there are women in labor who are witnessing the woman next to them getting a D&C with no anesthesia...(alot of women come in with incomplete abortions and then the doctors extract the rest in order to prevent infection...)MW's for Haiti has brought alot of supplies which everyone uses...we have these 2 small cabinets with the supplies, so it's a total disaster...how can you stock a delivery room with 2 small cabinets?
The environment here, it is harsh. The rains still haven't started yet. I really look forward to them. It is dry, hot, very dusty. The road has lots of motorcycles all the time; there's alot of air pollution, and alot of burning of trash. Motorcycles here are used for taxis. People pile onto them. 3 or 4 people even. Babies, kids. On bikes too. I love seeing the resourcefulness of the people. Economically here, there is hardly any work. People want to work, but there's not auch industry or resources. You can see the mountains all around, which are bald. Flying here and seeing the mountains...it was so sad. Just bald.
I wasn't able to put pictures on my blog yet...I did try...I think I will send a group email to send some pics. I miss everyone and am thankful to be here and to be learning about life in the ways I sought to by coming here, I did want to throw myself into a situation like this in order to see real life, to see how people live in order to have a more realistic perspective of the world, but...it is hard. Even though I know those reasons and am glad to be learning and seeing more things.
So, anyway...thanks to all of you for your love and support...

Saturday, March 13, 2010

new hope?

today is march 13th. all of you if you have read my previous postings/emails are familiar with how the situation has been in different ways. well, there are new and positive developments, and i am starting to have some hope for the work that i am supposed to do here. last week, this MW named Wendy was here, and she helped me alot, and tried to build bridges between me and the 2 Haitian midwife teachers, and just really tried to support and uplift everyone. she just left today; now Nadene and Steve are here--they are the founders of Midwives for Haiti. They totally understand the situation and what has been going on here, and they are very very upset about: the way I was recieved by the other midwives, the way the students are being trained and the apathy and lack of compassion that many of them display, the actual lack of skills and knowledge that they have in the birth room, etc. they really want me here, and they also really want to overhall the program and if needed start from scratch again with the students. also, for all of the same reasons that this other MW had who wanted to start a birth center here, but now isn't, they want to have a birth center in order to have our own turf to actually teach midwifery and provide safe care to the women. to centralize everything. there is a building on the hospital grounds that Wendy and I stumbled upon this week that is perfect; they have meetings this week with the hospital administrators to discuss its use. they have been very kind to me, and very sorry for the hardships of this first month. i am afraid to be too hopeful, because things have already been so hard, and because honestly i lost so much of my hope on that one day of my first day in the hospital when i saw the gang rape birth. the midwife who participated in that birth, in the holding down of that 15 year old girl, she is leaving after april. the other midwife, she seems more receptive to me and i think that we will be able to work together. another piece of this is that in order for me to be able to explain my thoughts to her and why i would do some things differently, i need to have a better command of the language. the language is definetly coming. but it is a process. that will make everything so much easier...well, a little easier.
some recent births...today, i helped 2 MW graduates (from a different class) and a nurse in a birth----nadene and steve were there, they saw that i had to ask them every time to listen to fetal heart tones, or else no one did...many things. but it was a good birth, and there was some good learning.
yesterday, the Cuban OB (there are 2 OB's) asked me to do a birth with a recently graduated general doctor, a woman who want to med school in Cuba and is here for 6 months or so...so, she caught the bb and I helped her, and guided her through perineal support, and she was very sweet and receptive to working with me...things went very well. the placenta took about 10-15 minutes, but she and I both felt that it was not fully seperated for that whole time, and then when it was separated it came...this birth was a good learning experience for the studetns--they were watching...(some of them)...
the day before this, we had a sidewalk birth, and this birth was really uplifting to me because it was the first really spontaneous birth i had seen so far....what happened was that this lady, a 3/2 (3rd timer), was checked by the nurse and was 7cms and was sent to walk...well i ran to get something and came back and she was kneeling on the walkway (which is outside, it goes around the courtyard, which is in the middle of the different sections of the hospital)...anyway she was pushing, and there was no way to move her...she had her bb there, spontaneously, without anyone yelling at her or anything...i was so happy. also, i really liked her, we had started becoming friends from me hanging out there (she stayed thre about 5 days before going into labor and then was induced--which alot of people do...) so, i was so happy to be in her birth. it contained a sliver of the joy that i used to experience with my clients at Maternidad La Luz...which was like a salve to me...a funny thing about this birth was the cleanup...as usual there was no water, anywhere...we had brought some rags and clorox, so here i am, being an example to the students, cleaning, as midwives should, and here i am by myself, scrubbing the trail of blood off the cement, and at the end of this trail was a puddle, with flies on it, and i really kept telling myself, really telling myself that this puddle wasn't my responsibility because it wasn't from this birth, but as i got closer i realized that indeed it was...so luckily this little girl, i think from the woman's family, brought in a little juice bottle, some water, and that really helped my to finish. sho else would have done it? the cleaning lady was mad at us (the american MW's) because now we have the fame of wanting people to birth on the floor, which they hate--and she had said that she wasn't going to clean it up. i chuckled to myself as i cleaned it up, because i was uplifted by the birth, and because it was so radiculous that i had no water or anything to clean up this walkway that had blood and poop and amniotic fluid on it...right where people walk....
so, yes, i am feeling happier than i was, but still with trepidation to get too excited or trust that things will get any easier...i feel that everyone at the hospital is nice, and open to me, including the studetns, and including the doctors...that is good...i feel thankful for this opportunity for learning and growth, however hard it is...it is definetly a priveledge to be here...but, the other reality is that some of this reality is so harsh, and i see abuse that is so unnecessary...there are many facets to it.
what else...we'll see if there can be long-lasting changes made through nadene and steve being here this week...like i said, they are very upset about how their program is going and are ready to start the students over again...and the teachers.
what else...maybe that's all for now...i think i must sound really excited compared to how i have sounded before...i feel...supported, by the organization i am here with. which feels good.
we will see how things go. that's what i keep telling myself.
thank you to all of you for your kind words. i don't always have much time to email so it may take me a little while to write back.

Monday, March 8, 2010

how things are going--march 8th

things are going a little better i guess....there are so many little things that have contributed to my experience here that i wish i could include, to better describe my life here...let's see...the first couple of weeks were really hard and i was pretty depressed all the time. not only was i seeing very sad things in the hospital and feeling helpless to do anything and seeing alot of apathy on the students part and so feeling helpless to teach anything, the other part of this that i am just putting together now is that the haitian midwives still haven't accepted me. so, i haven't been taken in or been shown how things go, and i have been trying to figure alot of stuff out by just going there and working with whoever was there, and working nights, etc. at this point, there is finally someone here who represents midwives for haiti who has been working with them for years and she is working to help build bridges and to emulate an atmosphere of collaboration so that this can continue. so, we will see. also nadene and steve, who run MFH, are coming this week. so...all of this seems very positive, that there is a small hope for improvement, although it's hard to have alot of hope after the way things started. but, she seems really optimistic, so...like i keep saying...we will see.
living in the orphanage is a pleasure. all of the children are so open and loving with me...i finally took some photos yesterday, and soon i will post them...sometime soon i will take some pictures of the town...you you guys can see what it looks like...the girls where i live are amazing...amazingly affectionate...i have this one friend, her name is jennifer, she's 19, from port au prince; she lost 2 brothers in the earthquake; she is helping me ALOT with Creole; she is very patient and explains things to me; she understands what i am trying to say better than anyone else; she really takes time to help me. i feel so thankful for her. all of the women also, they enjoy spending time with me. i wash my clothes outside with them; we hang out; yesterday we had a dance party--all of the girls---or some of them---with 2 people drumming...the kids here are really good drummers...and dancers...
i will post some of these photos soon...and eventually of the hospital and town...
the weather is nice...it's warm...it's beautiful. it still hasn't started raining much yet.
i wanted to say to all of you that i really feel all of your love and support...i have from the beginning...i really feel your love and that you're holding me in the light, and i wanted to say thank you for that, and for thinking of me, and supporting me.
so for now...maybe that's all.
love you all...reina

Thursday, March 4, 2010

march 4th 2010

Things are going OK. It has been hard so far, different aspects of living and working here. But, I am just hoping that things will get easier and especially as the language comes more. I am learning Creole, it is coming, slowly. The people in this town are friendly. The town is dusty; the rainy season hasn't started yet. There is alot less food and fruit than you would expect. But it is greener than El Paso. The landscape...pretty, small wooden houses...goats and chickens running around....
I walk everywhere I go. I have been going to the hospital with the American midwives who come and volunteer here for a week at a time. I am spending time with people from here and that is how I am learning Creole.
Things at the hospital...are going OK, maybe a little better than before. It is hard to come in and help and teach being new here, and also with the language barrier. And also because what is being taught and what is being modelled by the students is so different than the way I work.
I am trying to feel at ease at the hospital. Apart from the kind of/lack of care there, there are other challenges, such as no supplies and running water. They run out of gloves, clorox, everything. Alot of the supplies the students use are donated by the American midwives who come. Yesterday there were 4 births. Three normal births, one cord presentation that ended in a c section--baby was fine--and also there were 2 babies who were twins, very premature, probably about 30 weeks or less, who we cared for for about 6 hours until the first one died and then the next one died during the night. Atleast this time the parents were able to hold their babies. This was their 4th set of twins to die. They have one living child, who wasn't a twin. I'm sure that all of her twins were always premature. It was sad for them. But this was the first time they had held their babies. It took over an hour for me to get someone to bring an oxygen tank to give the babies oxygen, and then I had to search for tubing, and there was only tubing for one baby, so we had to keep alternating between the babies.
With the lady who had the cord presentation, she had come in and no one was paying attention to her, and we were busy with a birth and with the premature babies, but finally we went over to check on her, after her being there for awhile, we discovered that the cord was there in front of the head, and luckily there was a big bulging bag in front of the head (her water hadn't broken). So I spent the next 2 1/2 hours or so with my hand holding the head up off the cord; we called the Dr; it took him about 1 or 1 1/2 hours to arrive; then there was the issue of her needing to be prepped for the c section, and at this hospital the patients have to buy EVERYTHING that they need, in terms of medicine, so they weren't going to do the c/s until she could buy the antibiotics...so I kept asking how much it was, no one know; finally someone knew more or less, so I gave them the money to get the stuff, and it only ended up being about $15...basically, if there had been no one to but these supplies, she would have just waited and waited...
So, in one way, I feel gratified to be here, and thankful to be seeing what I am seeing, even though alot of it makes me really sad...and in another way I feel like what difference does it make...am I really going to make any kind of positive impact...
Time will tell...I miss all of you...thank you for all of your support...