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.

Saturday, June 26, 2010

june 26th 2010

things are going smoothly here, as smoothly as i could hope for in hinche, haiti. things seem to be flowing more and more easily. each week seems to be passing more quickly. understanding and speaking more creole helps sooo much, with everything...things can still be as difficult as always here, but having the ability to communicate...we take it for granted don't we? it makes a huge difference.
i have made a new friend here, who has become kind of my dance partner...it's so nice, having something else to look forward to...i never thought i would find salsa dancing here...but yes. we have been practicing together once or twice a week, and going out maybe once a week...the house where i live i have to return before 10pm, but...it's still nice to go out for a couple of hours...i hope it continues...
i am 4 months into my time here...still on the fence about whether to stay longer or not...the longer i am here, despite how bleak it was for the first 2 months, how difficult it is still on many levels, i feel myself habituating more and more...especially with the language barrier becoming less...i feel more like a part of things here, like alot of people know me, i have some people here i call my friends, i feel close to marthonie and the students...we'll see.
today i dropped into the hospital to visit a woman that i sat with on monday night...she is gone, 5 days later, her family took her away, to bring her to a witch doctor. she may die. on monday night she could barely breathe, her respe were very shallow and labored, more or less 60-80 resps per minute, breathing with alot of effort...i stayed with her, with my hands on her. there was nothing else i could do...i got a nurse up, she found a doctor, who said just to keep her upright...there was no oxygen at all in the hospital...nothing else to do for her...her lungs sounded congested, she was coughing alot from time to time...i was wondering if she had tuberculosis...her dx was severe anemia...yes her hemoglobin was about 4.6 or so...but she also had some kind of lung infection...the next day she was put on o2, in the "ICU"--which is just a room with 4 beds in it, nothing fancy...they did a chest x-ray and a TB test and HIV test...i don't know the results of the TB test yet...she was given a blood transfusion (250cc) and needed more but the red cross was out of blood...today she is gone...i hope they bring her back in before she dies...apparantly her family thinks that her sickness is a "sent" sickness (voodoo)--sent by someone out of jealousy...so they are taking her to someone who deals with healing those kinds of sicknesses...
today there was also a 25 week pregnant woman with eclampsia...she had already had convulsions this morning...placental abruption, fetal demise...on B/P meds but not on mag because her urine output was so little...
there havent been any really spectacular stories recently...normal births, the usual amount of severe pre eclampsia, women getting D & C's with no anesthesia, and some normal births...i always notice that when a woman is starting to push, whoever is in the room kind of descends upon her and starts to order her around, what to do, how to put her hands, how to push, how to breathe...it's annoying, because it doesn't help, it only takes away from the moms' confidence in themselves to push...the other morning this started happening with a nurse and the cleaning lady...i finally just asked them to please STOP talking to the mom...this mom was really fun, she was very vocal, yelling very loud but in a productive way, just following her body...she was very sweet...during her labor i sat with one of the students outside as she was walking around outside in front of us...it reminded me of the old days...labor sitting...how i miss seeing midwives labor sit...
the students are doing ok...they are trying...sometimes i feel more hopeful for them becoming skilled midwives and sometimes i have very little hope...but they have progressed, i have seen that in my time here.
every night i have worked recently i see that the dogs (yes there are dogs that live at the hospital and go in and out of the rooms...) push over one of the trash barrels and eat all the bloody stuff inside...it is so gross...the other night, every single time i walked past where the trash was, there was this really strong smell of blood...then as i rounded the next corner it smelled like old piss...that's just the way it is here...
that's about all...i'm thinking alot about the woman i sat with monday night, hoping that she will be ok...she is still so weak, i can't imagine her being moved around, off oxygen, etc...i'm pretty worried about her.
love you guys...

Wednesday, June 16, 2010

other experiences

so, i have been able to have some other experiences outside the hospital recently...last weekend i went to this other town, called Pinin, with my friend Acner. It is his hometown. We rode on his motorcycle, about 1 1/2 hours each way, on a dirt road with huge trenches, had to traverse a shallow river a couple of times...quite an experience. it was relly beautiful to see the countryside, to see a different place...it just got greener and greener. really fun. people have this plant here that makes a natural fence, like a kind of hedgge, but it's a kid of cactus...really cool...saw alot of places with walkways made out of this plant...walkways and fences. at the town, we went to the market---soo loud and dusty---wow--and the hospital--bigger and nicer than the one here. very interesting.
then the next day, it was this endlessly long day, where i just laid around in my room and didn't do anything, i felt like i had nothing to do except lay down in bed or sit in a chair and read old obstetrics books...so i did that all day, oh yeah and think about my family...so that was the whole day on sunday, until...i went to go practice salsa with my friend Blada, and we had a good time dancing...at the end we danced salsa to a few old school rap songs--which i always want to do with people but people always say you can only dance salsa to salsa music--not true--this was so much fun. Then, it started raining really hard. i just stood in the rain, letting it pour onto me. there were 2 rainbows. it felt like, oh yeah, i do have things to do here, i do have a life here. doing things like this makes me feel this way.
blada and I also went down to the river the other day...and sat on the riverbank...there is green grass now from the rains...not like when i first came, and the riverbanks were just brown and dusty...being there, just right outside of town, it was so peaceful. sooo relaxing. i want to go there more. it's right there, a 10-15 minute walk.
today i helped in 2 births; there were 4 births all together this morning--i have the afternoon off and then am going to work tonight with 3 students. helped one student suture...she did pretty well, for her 2nd or 3rd time...
so...the time seems to be passing faster, which is nice. and, i am enjoying things here more. really enjoying working with marthonie. and the students. and the american MW's who come and volunteer. things are going allright overall. i think there are things that i will never be able to impart to the students and that's ok. but it is frusturating and perplexing too.
it's nice to do other stuff outside of the hospital, to have friends to hang out with, especially to go into the countryside and experience a slightly different vibe.
in a few weeks, one of my best friends, sergio, is coming to visit me. i am so excited!!!! can't wait for that.
i love all of you...

Friday, June 11, 2010

june 11th 2010

So...things are going allright...each day is passing...I am more than halfway through my 6 months here now. Each group of midwives that comes...it's so interesting hearing what they observe about this place, the hospital, the students, the program...everything they see are things that I have already been seeing and thinking about since I arrived in Feb...one of the MW's described this place/town/the overall atmosphere here as "bleak"...that is exactly the same word that came to me to describe the feeling here, a long time ago...there is a detachment that you see in the people...it's hard to understand...someone like me will never fully understand it because we did not grow up under these kind of circumstances...everyone asks me if this detachment may have to do with all of the death that people see...like when moms have their babies, and they just totally check out...is this because so many people have babies that die here? many people have had several babies die. it is very common. yes, maybe that is part of the reason. I'm not an expert on Haitian culture. I don't know fully all of the reasons for this.
Yesterday the day guard at the entrance to the hospital was being really uppity with this woman who was bringing food for a patient there (the families take care of the patients--bathe them, empty their pails that they pee & shit into, bring them food)---this woman had a few mangoes in her hand along with the other food she was bringing. apparantly, bringing mangoes into the hospital is "against the hospital policies". I couldn't believe how rediculous it was. So, mangoes are messy and attract ants, and they are against the rules, but, it is ok that the cleaning ladies in the delivery room are mopping the same bloody stinky water around on the floor, that there are sharps left all around, that there are splatters of blood left on the floor for hours, and dried blood on the beds that never gets fully wiped off, it's ok that there is not enough chlorox to use to clean up...the cleaning ladies bring chlorox in in these tiny juice bottles...just with a little chlorox inside...they have no rags to use to clean up...all of this is ok, but it's against hospital policy to bring mangoes inside? The hospital is ALWAYS out of the most basic supplies, and the familis have to go out and but stuff like IV tubing, antibiotics, IV fluids...all the time...but they are worried about mangoes? The same thing happened yesterday--there was this woman who came in and we were going to make a bed for her in the prepartum room and she had this multicolored blanket...the students said that the hospital wants people to only put white sheets on the beds...oh, so these people who have not enough money for food, and have to buy their medical supplies, they have to buy white sheets to put on their beds? Give me a break!!!
It's ok that there is all of this overt medical negligence...people who are really sick, barely being monitored...but, no mangoes and only white sheets. OK.
Yesterday, Marthonie, she was managing 3 different high risk patients with the students: a woman who had had severe pre-eclampsia, who had birthed the night before (B/P in labor was 240/140), another lady with eclampsia, who had already had 3 episodes of convulsions before arriving, a 38 year old G9 P11 (hx twins and triplets) L 7...also with same B/P, 220/140, and at the same time she was supervising a blood transfusion for someone with a 3.6 hemoglobin. She is really good, she is used to high-risk situations like this. I think that our skills and experience really compliment eachother. If it were possible for me to feel capable of staying here for the next class, I know that we could be a really good team. But...I can't stay here longer. It's not my culture, it's beautiful and special and interesting and I feel so thankful to have come here, but my heart doesn't feel at home here, like it does in some other places, like Mexico...but anyway, yes, I am impressed by Marthonie all the time; I feel like we both are seeing things that eachother know and that we could learn; that's really nice. I am enjoying getting to know her as a friend as well. Sometimes I think that it's hopeless with the students and the grads, but I see growth in Marthonie and myself, and I think that maybe that's the reason I'm here. I don't know. Sometimes I feel more encouraged by the students, and there are certain ones that are more motivated than others, but other times I feel really hopeless for them ever becoming skilled and wise MW's, and I think that some of them don't have the heart for it, it's just a guaranteed job for them...I guess it just is what it is, and maybe it's better than I think...
Part of me would love to stay here and keep working with Marthonie, and really follow through on ideas that would help with our teaching and with the hospital policies...but....no, I can't really see myself staying here.
Right now I am at the UN base here...I have become friends with this guy named Ratna who works here...they have internet...we're eating fried chicken and beer...I don't see the Un guys doing anything useful here for the people, but...maybe they are, who knows. The guys on this base are all Nepalese. They never learn Creole because they barely interact with the Haitians, except for their translators. They all seem like nice individuals though.
There have been steady births, nothing too spectacular...well sometimes there is but I don't always write about stuff in the blog because it's just too much I think for everyone out there who isn't a midwife...
I love you guys! Thanks for keeping up with me through the blog and through email...it helps me to feel connected to all of you...

Monday, June 7, 2010

dissappointments/achievements with students 6-7-10

i felt so discouraged the other morning after working the night with 3 students...one of them was really on point and helpful and helping me to massage and listen to fetal heart tones on these 2 women in labor, and the other 2 were not erally helping...you would think that if they saw me, their teacher, standing there doing this that they would come and do it...one of these women had twins! this is now the 4th twin delivery i've seen here. everything was fine. small babies though. 2.1 k and 1.5 or 1.7 k.
but today, we had skills practice class and it went well, and i could see how they are progressing with certain things. they still need so much help! but they were practiving vaginal exams for dilation, station, effacement, with these models, and that was really good,. we need to keep doing this. practicing htese basic skills. becasue in real life, when i do VE's with them, so many times they are way off. why? still? i don't understand why. there are many possible reasons.
what else...just going day by day, dreaming all the time about my family and community at home...in NC and EP...but atleast here, i am understanding the language alot more, and enjoying my friendship with marthonie tha tis slowly growing, and seeing her open up more and more as a midwife...
i miss and love all of you!!!

Wednesday, June 2, 2010

2 beautiful births today

hello...well it seems that my internet access is more stable now...yes! and each day i have had things to write about. today, i stayed late (till 8pm) because i didn't want to leave this woman who was laboring...also i was concerned about her and about this other woman, and no one there listens to fetal heart tones so i figured maybe i would wait until the students and american midwives arrived for the night shift and then i would leave.
so, i caught this woman's baby...this lovely lady, having her first baby. she was hypertensive, actually she had mild pre eclampsia (B/P around 160-170/100-110) and + 2 proteinuria, but no other signs. she had been on mag sulfate but now was just on B/P meds (hydralazine). anyway, she had appeared to be in active labor last night, when i left, and had been 4 cms BBOW 0 station. then in her chart it was documented that at 6pm last night she was 8cms. well, today in the afternoon, when one of the midwives checked her, she was 6-7 cms. she lad been laboring for awhile. she stayed the same dilation for awhile so we gave her an IV with pitocin (10 IU in 1000 ml). also, we started B/P meds again. there was no more of ANYTHING at the hospital pharmacy, so we couldn't give her the B/P medicine in IV fluid. there was no IV fluid, no IV tubing, no angiocath (to put the IV in the arm--like an IV needle), and also no medication (hydralazine) for B/P. so, basically, what happened after this, was that around 5 pm or so, the american MW's left, and maybe about an hour later i checked her, to see what was going on...hoping that she just had a cervical lip...well, i find her to be only 4-5 CMS. after the night before being 4 cms, then 8, then today being 6-7. the first time i check her, and she is 4-5. her pelvis feels roomy enough...also, she is pushing and can't stop. so, i thought we should call the OB in order foro him to come in and eval her, or atleast for him to know. there was also a VBAC laboring there, her 1st vaginal birth, and they don't usually do VBAC's at all. she was in active labor. i couldn't leave with both of these ladies there. the grad MW's don't monitor fetal heart tones AT ALL. i told them a few times that they should listen to the VBAC lady's FHT's every 15 minutes, because she was in active labor, and they never did. i also told them that we need to listen to the 4-5 cm lady's FHT's atleast every 30 min, because she was on pitocin, and because of her labor progression and her high blood pressure. well, i ended up staying and monitoring them both myself. we called the Dr, who I guess was busy because he said just to continue normal care on them, and didn't say if he was coming in or not. well, my lady, she walked around and squatted and pushed with contractions even though she was 5 cms, and after awhile, she was complete and pushing!!!! so i stayed with her. it was awesome! she was totally present, connected, doing really great. her 2 family members were with her. the cleaning lady came in and tried to kick everyones family out, but i told her we should let them stay because her bb was almost here. so, she did amazing, and had a beautiful birth. a beautiful slow head delivery. here everyone tells the mom what sex her baby is, which is not what i do--i like to let them see and tell us. i asked her what sex her bb was and held her baby up for her to see and she told us all it was a girl, and there was this climactic moment of joy, that i saw in her and in the 2 women with her, that i used to experience all the time in birth with families at MLL, but had never seen here yet. they had tears in their eyees! and she was happy! normally what i see is moms just totally checking out after the baby comes. she was happy! what a joy to experience that again. she had a tiny nick, i gave her 3 stitches. well, while she ws pushing, the other lady who was there, the VBAC, also started pushing. i helped to get stuff ready for her birth, and encouraged the MW to listen to FHT's after each contraction, which she didn't do because she just isn't used to doing it at all. i listened a couple of times. this lady had her baby, all was fine. the cleaning lady kept telling them both how to push, and finally when she said something to my lady, i told her to stop telling her what to do and what not to do, because she was doing great on her own and the bb was coming. geez! people want to help, but they end up taking away peoples' confidence by telling them what to do. my lady, i was just so happy for her. i had been worried about her. i had thought that maybe she did need a c/s. she was so appreciative for the help. it was really special. after all of this. Dr Celestin, the main OB here, he arrived, and saw that they had both birthed, and was really happy and left.
It was great. Another great thing from today was my meeting with Marthonie...things are just getting better and better with us. We are becoming better friends, learning together, trusting eachother more. I am so thankful for this. I never thought that this would happen, at the beginning when I first came, and there was not this openness, this collaboration. Man, the beginning was so hard. I am so glad to be 3 months into it.
Now, if we could only get our graduates to listen to fetal heart tones...

Tuesday, June 1, 2010

busy-ish day today, 6-1-10

today...it was a somewhat busy day...we had 2 nice pripip births, normal, nice, no big issues. there were also several women there with incomplete abortions...the OB did 3 D & C's in a row (scraping out the rest of the uterine contents). the third one, this woman was just in agony, in so much pain, and people are just standing around...ignoring her...i had to lead a student over to her side, and tell her to comfort her. she was doing some kind of paperwork, and was conflicted about what to do, and i said, what is more important? this woman or the piece of paper?! geez. there was a woman who was "5 months"--maybe 20-24 weeks, who had pre eclampsia, had swelling all over, and delivered a dead baby...i caught her baby, it was very small, the placenta was small, and friable and pale...there was another woman there whose baby had died in utero, she was around "7 months"--an 8/7 (8th pregnancy, 7 previous births). being induced. one of the knees was coming down through the cervix, which was about 3 cm dilated...poor lady. yesterday there was this woman who had been in the earthquake in port au prince, who came in and said that in the earthquake, something had fallen on her head, and that ever since she has had a headache that doesn't go away. it's so hard to know how to help people sometimes...is she just chronically dehydrated and undernourished? is she just traumatized from the quake? PTSD? is something really wrong? there is nowhere to send her for any of the tests that you would do to rule out a real problem, so what do you do? what do you do about people not having enough food and water? i see so many people, kids and adults, who yes, you look at hem and they look like they are starving. you want to help everyone, but you can't, and you know that if they have already come to the hospital here, they're at a dead end...where else are they going to go?
marthonie and i have been talking about trying to do some kind of continuing education for the MW grads who work at the hospital...i think we're going to start with neonatal resusitation, and then do labor monitoring, fetal heart tone patterns, kinds of decelerations and their significance...that would be a good place to start.
there is no one else here to do that for them.
well...just another normal day here. a few ladies with pre eclampsia, a few stillbirths, a few normal births, a few abortions...all in the same room.
it is very interesting. very very interesting.