a young woman dies today

the woman who i wrote about yesterday, who had had eclamptic seizures and then was in a coma all day, she died today. this morning she was actually conscious for awhile, although disoriented. i was surprised; there seemed to be hope. but then, she fell into a coma again, and it was obvious that her whole body was shutting down. there was no urine output today (and only very bloody urine since yesterday), her lungs were totally congested today, and she went into agonal breathing. i stayed there as she was in the process of dying, but wasn't there the actual moment that she took her last breath. it is sad. she has 2 kids here. she was 29. this makes 3 women in the past month here who have died from eclampsia. maybe 5-6 in the past 5 months.

eclamptic woman today

today the first thing when i walked into the prepartum room, there was a woman having convulsions (eclampsia). a 4th timer. i got marthonie quickly and she administered 2g mag sulfate; she had already been on mag; her blood pressure at its highest had been 170/120, and she had been there since the previous night. she then delivered a stillborn baby, about 35 weeks gestation, and then seized again, and then, was unconscious the whole rest of the day, until i left at 4pm. there is so much eclampsia here. peoples' health is so borderline. everyone has high blood pressure, is undernourished, and chronically dehydrated. i stayed through the lunch break, basically holding vigil with her family, and doing rounds on her. the urine in her foley catheter was wine red. kidney failure? her family sang over her, prayed over her...
i didn't want to leave their side today when i came home...i think she is going to die tonight, because her state didn't improve at all today...she never regained consciousness...her eyes were jaundiced also, and her pupils unreactive...her lungs sounded a little congested...not alot, but definetly a little...
this was day one for the american midwife volunteer for this week...welcome to st therese hospital...
i was once again impressed by marthonie's competance in managing eclampsia...
maybe tomorrow morning there will be good news...maybe whe will have come out of it...but i feel like that's not likely...

leaving in 1 month

It's very hard for me to imagine leaving so soon. Last weeIk found out that my living situation here at the rectory would be ending after august, and I took it as a sign and decided to make arrangements to leave here instead of searching for another living situation. There are many good reasons to leave after august--which would complete the 6 month committment--such as spending a long quality visit with my family in NC...which I have been longing for ever since i arrived here...but there would have been many good reasons to stay as well, such as: it's only another 2 months or so (Nov), helping Marthonie to finish everything up, continuity with the students, getting stronger in Creole, continuing to develop friendships here....even after making the decision to leave, I can't help but feel conflicted about it, and wonder if I made the right decision. my seat is reserved on a flight leaving Haiti on the 27th of August. It is really hard for me to imagine the reality of leaving so soon. Am I ready to leave? There have been so many things that have been so hard here for me...nontheless I have become more at ease with the whole situation as time has passed...and so many people know me around town...
It's like I finally have a life here, I finally speak Creole, I am close with Marthonie and the students, and really enjoy being with them...why has this been such a hard decision to make and why does it continue to torment me? I imagine leaving, eating lots of vegetables again, playing with my niece, playing my mom's piano...I imagine coming back for graduation in November, if Midwives for Haiti will help pay for the trip...that would make it okay, perhaps...
My relationship with Blada is very sweet too, just sweeter and sweeter...I love the fact that we dance together...and practice together...he is beautiful...
Nadene is coming this week and we will talk about everything again...it's probably the right thing to just continue with the plan to leave...but what if they don't find a good person to replace me? I can't help but feel responsible at this point.
I think after this week, after Nadene's visit, everything will feel more clear and definite.
Love you guys...
Reina

bathing in the river

my experiences here just seem to get more and more interesting and intense. several recent events i wanted to write about...ok, one thing that i haven't mentioned but i will now is that i am dating someone here. for about the past 1 1/2 months. his name is blada. we dance together. he is my dance partner!! and we have been developing a relationship, that has just gotten sweeter and sweeter. it's pretty simple also--simple, slow, and sweet.

so, the other day, we knew it was going to rain, but we (blada and i) set off walking to go to this place where they made a hang out spot, like a mini beach, on part of the river...as we were walking there, we got drenched. then when we got there, it was unreal...i saw several people i knew from town, there were alot of people there hanging out...it's out in the country...so we get in the water, it's shallow but has a current and i was able to swim in it...which felt so good...we swam together for awhile, danced in the water together, then got out, then sat with some people in the water further upstream...then walked around, danced on the grass...then...what do you know but this BAND comes walking all the way down the muddy dirt road, to the "beach", and is playing this kind of traditional music called "rara"--similar sounding to what they play in the street in funeral processions...it is homemade metal horns and a drum with drumsticks and a hand drum...so they are playing, and it was so interesting...it was like the group consciousness was altered by the music...people were dancing, some of them almost trancelike...this one guy, he was either really drunk or crazy, the way he was acting...it was really intense...plus of course wherever i go i am really noticed, and lots of people make different kinds of comments/commentary...so of course that was mixed into the situation as well...oh and the band was playing and actually walked into the river, and was standing in the river playing...this guy was waving around a Haitian flag...it was wild. i felt really honored to be there, to have such an intimate glimpse into this corner of peoples' lives here, of the culture here...i feel that way all the time, but this was really pronounced...

things at the hospital never cease to be interesting...there have been steady births...i just attended the 100th birth today at St Therese hospital since i have been there...yesterday there was a woman who had already had eclamptic seizures, who was in labor and birthed a stillborn baby...who was growth restricted but also premature...it's hard to say how many weeks she really was...when she birthed, another MW caught her baby, but i asked her if she wanted to see the baby, because i noticed that the baby was just being tucked away in the sheet below her...she wanted to, so we sat her up...she started touching the baby, and the MW's scolded her, because it would make her hands dirty, and then she would contaminate things around her...so i gave her a glove...so she touched the baby, a little, then the MW who caught her baby asked her if she was done (she wasn't really done) because i guess she wanted to finish up...those brief moments were important...
the 29 week baby that was making it got DISCHARGED...2 days ago...it wasn't time yet, the bb was still being fed with a tube, the mom wasn't good at putting in the tube yet and also wasn't on top of expressing milk...i am worried about how this baby will do...

today one of the OB's did a surgery for an abdominal cyst on a woman and he brought in the contents for us to see, because it was so interesting...it was 2 ovarian cysts--one was almost the size of a basketball...i don't usually think that ANYTHING is gross, but, honestly, this grossed me out. the big cyst was filled with fluid, all of these little clay-covered balls, that were soft, maybe 1/2 cm diameter, balls of hair, there were TEETH, embedded into the sack of the cyst...the smaller cyst was mostly full of this yellowish jelly-like substance, and also with balls of hair...it was really gross but fascinating.

there is always the usual mix of ladies there with hypertenstion (like 180/120), pre-eclampsia, and eclampsia...today it looked like almost everyone who had an IV in place, the IV's were dry, with blood infiltrating into the tubing...they get left like that for a whole day sometimes...because people usually have to buy their own supplies so since no one has any money, they walk around like that...
i found out a few days ago that the house where i stay with the catholic priests, the rectory, they are going to have some new priests coming to live here and are going to need to occupy my room after august. they have been planning for that. which means...that i am probably meant to come home after the 6 months. this seems like a pretty strong sign. i have to admit though, as much as i have suffered here and looked forward to returning home, i still feel really torn about leaving, especially about leaving before this class is finished...it would be only 2 more months...it feels like i am being torn away from the people here, from marthonie and the students...from a rich intimate cultural experience, which has been both so precious and so relentlessly hard...i guess wither way that things turned out, i would feel like i didn't complete the other side of it...if i stayed, i would feel like once again another year has passed without being able to spend quality time with family and community in NC...who knows next year if i would be able to set aside 2 months to come and visit...

i am still waiting to finalize my plans until Nadene and Steve from Midwives for Haiti come here next week...but it looks like that it what is going to unfold...
that's about all i guess. i feel so thankful for this experience which has been so so interesting and has helped me to remain fluid, adaptable, open...i have recieved so much, and i hope that i have shared an equal amount...maybe, hopefully...
love you guys...

reina

july 14th

so...the last few days have been interesting...i just got home from doing a birth with marthonie, of a lady who it was her 12th time giving birth. she had a huge belly, and we weren't sure if she didn't have twins. marthonie and i stayed late to do her birth. i had talked with her yesterday and she was telling me that she had 5 living children. the other 6 had all died at various ages--3 months to 2 years. her pushing stage took ashile because she had this huge swollen anterior lip (of the cervix) but she wouldn't let us push it back. she was praying and singing the whole time...along with another woman in labor who was also singing (the women here sing and hum alot in labor) and who was going to get a cesarean after laboring all day with the same dilation (6cms) with a face presentation, which wasn't applying good pressure to the cervix. i was in a cesarean today too, because there was this lady in active labor, not progressing well, with thick mec, and i came in in case the bb needed to be resusitated. he didn't, all was fine. there was a baby born the other night who was about 29 weeks gestation, and is making it. we are tube feeding him colostrum. he weighs 1 kilo (less than 2 1/2 pounds). there is another baby who is 1.2 kilos, who is a little premature but mostly growth restricted, as the mom had pre eclampsia and probably has chronic hypertension. this baby is BF well, because he is able to suck. the other baby can't suck yet. it's interesting how this little 29 week old baby is vigorous and doesn't need oxygen and just needs help eating, whereas we see 33 week old babies that die.
just a little update...
reina

already july!

today is july 7th or 8th. june went by pretty fast, and july already seems to be moving along pretty fast too. things here are flowing along pretty well. all of the time, with so many little things in the hospital, in the street, everywhere, the depth/richness of the culture becomes apparant. the way people talk, the different accents people have, body language, etc. it is so, so interesting. i feel very lucky to have such an intimate look into another culture. there are many things that are always hard, but i guess i have gotten more used to them.
sometimes i get annoyed with the american midwives who come here for 1 week and have so many ideas of things to fix at the hospital, and so many questions for me that i cannot answer about the system here...they notice many things that i have already been dealing with for 4 months, and some of it is also their culture shock. i get really frusturated too, i feel overwhelmed too, at the enormity of the problems of the hospital, the healthcare system here (there is no healthcare system), peoples' apathy, etc. but...if i tried to fix everything at once i would go crazy and also, it's not my place to do that. it's very interesting, the constant influx of american volunteers. they all have really true observations and god ideas, and they witness death here and it is sad, and hard to understand, when we come from a culture where we can fix practically everything, where there is always a next step, a further option, for finding help. the opposite of here.
there is alot of death here. a couple of weeks ago there were 2 women who died from eclampsia. one of them was only 25 weeks pregnant. newly wed, first pregnancy. it happens. it is very sad. babies die, there is no NICU in this hospital, there is barely oxygen. babies who are slightly premature, who would definetly make it in the states, they die.
the woman who i was worried about, whose family took her out of the hospital, who could barely breathe and needed to be on oxygen etc, who i wrote about last time, well, i never saw her again. i imagine that she has died.
last week one morning when i arrived at the hospital there was a procession to behind the hospital in front of the morgue, and a large group was mourning the death of an 18 year-old, who had died at the hospital. i just was there, as a witness, it felt natural to be there. people were all mourning together...women throwing themselves on the ground, weeping...chanting...this one woman kept chanting: "pa gen moun anko...pa gen moun anko" which means something like "there is no one left anymore".....afterwards i asked someone what problem the 18 year old had had, and they said "nothing" in a very sad way, almost as if to say "people die here for no good reason"...
there have been more births recently; i have been in almost 100 births now since feb. today we had 2. there have been some interesting births for sure. nothing too crazy. also i am trying to focus on postpartum care with the students, having them follow up with the women and babies from the births they do, doing pp education, newborn exams, etc. i have also been spending some time with them in the prenatal clinic. we always do pn, pp, post op care with them in addition to labor/birth.
it has been really hot. it cools off a little when it rains. i miss cool weather. i never thought i would say that. i do miss cool weather. i think el paso may have been hotter than here, but it's a different kind of heat, it's so humid here. and i wear more clothing here.
still contemplating every day how long to stay...there are good reasons to stay longer and to go...i love learning a language...i'm at the point now where i'm just absorbing so much...feeling more ready to delve into French as well...
my friend sergio from el paso is visiting me right now...it's been interesting...it's cool having someone see where i am...there is nothing to do here though...but it's cool. i hope that he's happy he came. i think he will be leaving in 2-3 days. i wish i could make it more comfortable for him here, but the reality here is that nothing is easy. nothing.
so...maybe i will leave this post at that...i love all of you...thank you for your comments...i look forward to seeing all of you again one day...
reina