10/24/11
Each week, there are more things that get added onto the list of things I wanted to write about in my next blog. I have been so busy, and there have been so many changes since the time I departed from Haiti and returned, that I don’t even know how to start.
I was gone for 7 weeks. It was important to go--I had a lot to do--but so hard to be away from Haiti, my students, Marthonie, Genette, Blada…everyone. I have felt so relieved since I returned, a few weeks ago. The students are preparing for graduation. They are now coming over every afternoon (M-F) after working at the hospital to practice their singing and dancing, for graduation. 10 months is a very short time to prepare midwives to work competently. Most of them can’t suture on their own, for example. But, I am very proud of them and what they have accomplished. The first week I returned, at Case Studies class, which we have every Friday afternoon, I just stood back to hear them talk about cases from the week…I was so impressed and pleased to hear how they were discussing between themselves different births and situations they’d dealt with, sharing information…it was really a joy to see this upon first returning, and made me feel so proud of them and hopeful for them.
The money that the community in NC helped me to raise has already begun to be distributed into the hands of many. I can’t even remember everyone so far, but there are always people who are in an urgent situation and just need 5-10 dollars to make it out safely. I’ve never had this luxury before, of being able to help anyone who needs it, and of being more liberal with the amount. A few examples of people I’ve been able to help:
--a 14th-timer, who came in drenched in blood, who had a placenta previa (where the placenta is located right upon the cervix, instead of higher up in the uterus)--luckily, everyone was there when she came in, and we ran around and prepared her for a cesarean really fast…we even got a requisition for blood delivered to the Red Cross…she went into surgery and got a blood transfusion before coming out of the OR…well, she had come from far away and her family didn’t even have 1 clean sheet to put on her bed in the Post-op room. Not even a sheet. Her mother took all the blood-drenched sheets and clothes that they had and walked to the rive to wash them. I gave them some money so they could buy food for the patient and for themselves. It was so clear that they had come with nothing. Thank god, the OR is functioning now. Before I left Haiti, there was no electricity at all and no OR. If this had happened 3 months ago, she would have died in our arms. She knew this. She and her family were very very thankful for the care that was given to her.
--there was a woman who approached me as I was leaving the hospital maybe 2 weeks ago…she is living with AIDS. Her legs were covered with sores that weren’t healing. She is in the HIV program that’s run by Zanmi Asante (Partners in Health)--but she said that they haven’t renewed her card that gives her an allowance for free food. She has children that she takes care of at home. She was so destitute, so poor. In the past, I would have rejected her because she was not in an acute, life-threatening situation. I would have chosen to wait for someone who was more urgent. But, I was able to give her some money for food. Probably about 10 dollars US. She was very thankful. I told her that people in the US had put money together, because when I showed them pictures of the hospital and explained how it was, they cried and wanted to help.
--Right after this, there was an old man in a wheelchair who was skinny and sick--I don’t kn ow with what, but he had a foley catheter in place because he had some kind of urinary obstruction and couldn’t pee on his own and was getting swollen in his abdomwn--he is probably about 70 years old. He didn’t ask me for money, but I could tell he was destitute--I was asking him if he had family in town, who took care of him--he said he has no one. No one to take care of him, to bring him food…he’s just suffering on his own.
People at the hospital, some of them give him food when they bring food for their own family members. So, I gave him some money. He was so so appreciative.
--After this, there were 2 other people who wanted to ask me for money (they hadn’t seen me give him money but I think they knew I had given the HIV+ woman money) and I just had to go after that. I’m not down with people lining up asking me for money. One woman, she was maybe 60 years old, and just wanted a few dollars to buy a new pair of sandals. Hers were totally broken, her toes sticking out. This is most people here though. I didn’t give her any money. Later, I thought maybe I should have.
I don’t want to give people money myself. I want to let the students give people money. I don’t want to reinforce the example of white people always having a lot of money and giving handouts, but so far, I have given some people money myself. I have tried to explain to them that it’s not my money--that lots of people in the US put small amounts of money together to send down to help individual people. I have tried to let people know that Americans are concerned and compassionate and want to help.
--There was another woman who came up to me about a week or so ago…maybe longer ago…she was telling me that she has 5 children, and is behind on her rent as of several months, and has no way to feed them…she started crying as she was talking to me…she said she was embarrassed at having to ask, and that she came to me because “white people have more patience than Haitians” and will listen to you. Well, if this had been before the fundraisers, I would have told her at the beginning of the conversation that I couldn’t help her. But, I listened to her and talked to her and eventually gave her some money, around 10 dlls or so…we talked about her trying to put her kids in the orphanage here, Maison Fortunae…it’s a really good orphanage…the kinds are happy…they provide school, food, community…it’s a good place. But, they don’t take everyone who comes to their door.
So, thank you so much to everyone who stepped forth and contributed so generously to help the people I work with here in Hinche, Haiti. Thank you so so so much, for being touched and stepping forth with such willingness. I appreciate this so much. This gives me the chance to help people make it through when there would be no other way.
Since I returned, I have had good experiences with the volunteers. When people are kind, humble, and approachable, it is always so much more possible to have a mutually good experience. The first 2 weeks I was back, we had a volunteer named Julie, who is a very kind person and very experienced practitioner. I asked her all kinds of questions, the whole time she was here. She could explain anything! I learned a lot from her. For the first time since the very beginning of my time here (February will make 2 years), I visited the Eziel. The Eziel is a place run by Mother Theresa nuns, where they feed malnourished babies and kids in order to give them back to their families, here in Hinche. I hadn’t been back this whole time, because the reality there is so intense, and because I live here and already witness death and extreme poverty on a regular basis, I just never could bring myself to go back. The short-term volunteers usually go. They hold babies, feed them, change them, give them human contact. Well, I walked over there with Julie, and went into the room with the babies. The room is full of metal cribs, with babies of different ages, who look so forlorn and neglected--the sadness is etched into their faces. Their eyes are big, and sad. You look at their little bodies, and you see how starved they are. They are all congested and coughing. There was one little girl, apparently she was at least 2 years old, because she had a full set of teeth. But, her body was so skinny…her head was too big for her body. She was just whimpering. I picked her up to give her a bottle. She could hardly figure out how to suck on it. She had a fungal infection on her skin, around her neck, and also a little infection or stye under one of her eyes. Very fragile health. I just went from baby to baby, holding them for a little while, offering some human contact, stroking their faces, talking to them. Is this doing more harm than good? They are so used to lack of human contact (the sisters are wonderful and take great care of them but don’t have time to hold them). Is this giving these babies some kind of false hope? I really don’t know. There are so many questions I have, that I will never be able to answer.
The whole time Julie and I were with these babies, I was either crying or fighting back tears. It was a huge dose of reality that I hadn’t been ready to face. I felt safe with Julie, like emotionally I could be on the same level with her.
After this, Julie and I decided to walk to the hospital, to check on a baby who we had been helping to feed--helping the mom to hand-express her milk--the baby had suffered some neurological damage probably, around the time fo birth or beforehand--anyway, we walked up there and on the way, there was this group of kids who of course yelled out to us “Blan!! Blan!!” So I stopped to talk to them, and just took my time and made conversation and explained that I am a person who has a name, etc--then one of them said that I had delivered her cousin’s baby…that was good…a lot of people in this community know me now--they may have a family member who I was present at their birth…
So, anyway, the point is that in order for people to recognize me as a real person, I have to stop and talk to them and not be in a rush. Then, they learn my name and next time they call out to me by my name. I have many names here--all are variations of “Reina”--no one really calls me Reina, but some of the other names they call me by are Lena, Klena, Melena, Plena, Pelina, and other such variations. It suits me just fine, because they are making an effort to recognize me as a person.
There was a little boy at the hospital, who was a very bright and also very sweet and wise little 8year-old boy. He said that his father had dropped him off at the hospital back in May, and had never returned to get him. He knew where he was from, but not how to get home, and had no one he could call. Somehow, he was making it at the hospital--people had taken a liking to him. He had broken his leg back in May. He would scoot around on a wheelchair all day…we all noticed him and started interacting with him and helping him and encouraging him to practice walking on his own…he really needed physical therapy…the first day I met him, I told him that with practice and dedication (walking on it) he would regain use of his leg, and his response was: “Yes, with God’s grace/blessing I will regain us eof my leg”--it was like something an adult would say…
Well, Julie was going to try to get him into the orphanage here, so that he would have the opportunity to go to school. He seemed so intelligent, so genuine, like a bright star who had so much potential. Well, we don’t really know what happened to him, because the day before Julie was going to go with him to the orphanage to talk to the director, he was picked up by the mayor. Apparently the nurses who were taking care of him were not happy about this. So, this made us wonder if maybe he was taken to be put to work, as a child servant, somewhere. We don’t know. I hope he is ok.
Schools here, they are so corrupt…for instance where Blada went last year, everyone knew that the director of the school was having sex with 14, 15, etc. year-olds in order to let them pass…this was well-known, and not really hidden. The teachers too. Schools are for making money, which is why most people fail the end-of-year tests in high school. Probably like 75% of people don’t pass. There are people who try year after year. Some people commit suicide when they don’t pass, because they think school is their only way for improving their lives and helping their families, and it is impossible to achieve.
Today, in the Prepartum room (ante partum), there were 8 women. Of these 8, 5 of them were morbidly hypertensive and on IV meds for their B/P. 3 of them were pre-eclamptic. Of these 3, one of them had a B/P of 200/130. Another one, she had such a splitting headache (caused by the pre-eclampsia) that she was moaning and swaying with the pain. I was really really worried about her. She also had facial swelling, high B/P, protein in her urine, etc. The thing that upsets me about her case is that she was admitted since Friday (3 days ago), and her labor never was induced. Until she births, her PEC will only get worse, and she could go into eclamptic seizures. She is 29 weeks--her baby won’t make it. But if we don’t induce her, she won’t make it. Her first baby. We induced her today with Misoprostol (Cytotec). It will need to be renewed every 4-6 hours until she’s in active labor. I hope the midwives do this. She was never induced since Friday, but, she has been receiving regular doses of 2 antibiotics, even though she has never had a high temp.
Besides the 3 PEC ladies, there is another woman who was admitted 5 days ago--last Wednesday--who has been in a coma/unconscious since the time she was admitted. She had given birth the day before, and immediately started having eclamptic seizures. She’s 18 years old, and it was her first baby (she lost the baby). Her mother and brother-in-law have been by her side this whole time. Last week, she seemed so bad, I idn’t think she would live. Her face was so swollen and distorted--even her eyelids were huge. Her eyes were empty and fixed. Her breathing was labored and it sounded like she was snoring. She was on oxygen. Well, today, she is a little better. Her facial swelling has gone down A LOT. And, she’s still unconscious, but she seems closer now to being conscious, like, she’s not as far away. Even her eyes look better, like her life force is returning. I really thought she was going to die this weekend. I am so happy to see her still there, and even better than she was. Hopefully she will continue to get better and better.
Last week, on Friday morning, there was a first-timer who had had a placental abruption (the placenta had prematurely separated from the uterus) and her baby had died and she was now birthing. She pushed her baby out, maybe it took about 2 hours of pushing. She was stoic and strong. A couple of times during this, one of the OB’s came in and wanted to cut an episiotomy. I gently refused to let him do it--the second time he came in, he said that if she didn’t birth within 5-6 minutes, he was going to cut an epis. (He does this routinely; also he thought that she would hemorrhage if she took too long pushing). I really didn’t want her to have to recover from this as well as losing her baby. We helped her to get the baby out before the 6-minute deadline, and then I showed the Dr that she had birthed with no tear, and he was so happy, he hugged me. As soon as she birthed, she started crying and mourning her baby. It was really really sad--I was trying not to cry at all but I did a little.
She was crying out, “my baby, my baby, my baby…” and “when I go back home, people will see me in the street and know I lost my baby…” and even “everyone else, they have their baby, but my baby is going to get thrown away”…(at the hospital, babies literally do get dumped somewhere behind the hospital in a pile of trash…I have told people they can take their babies hole with them and bury them, but they are reluctant to…I don’t want to put it to them like this: “If you don’t take your baby home, your baby will be left in a cardboard box on the counter and then thrown out with the trash and then eaten by dogs”--but that is the truth. But, if I told them that, that would be horrible. Whatever choice they make, they deserve to be in peace with their decision.
She was really sad and really mourning the loss of her first baby. Who knows why she’d had the abruption. The placenta had a huge clot on it, covering most of it. It was a large abruption. Her family was all there coming in and out, also very concerned and sad, some of them crying.
The other OB (not the first one who wanted to cut the epis), came in and told her not to cry, that if she cried her blood pressure would go up and that wouldn’t be good for her. She really needed to cry though. I gently came up to him and said, “She needs to cry--she is really sad because she just lost her first baby. She needs to empty her heart--if she doesn’t do this, she could go crazy”. Well, the next day I saw him and he thanked me for what I had said to him, and he said that I was right, that she needed to let herself cry, and that he had never thought of this aspect of it before. That was really nice that he told me that.
I try really hard to be careful about what I say to people, because I want them to know that I respect them, that I’m not coming in here to tell them what to do. We are all learning from each other. I really do have deep respect for all the people here, even though in the past I have thought that many of them lacked compassion. I can’t judge anyone here. Sometimes, I can help them in ways that I see are possible for me to help, but I am careful about when I bring things up.
This enters into the whole issue too of how do you enter into another culture and help out and not impose your own values upon that culture. Each culture and society has developed ways to deal with problems that exist within their own community. In the past and perhaps still, I have judged and been perplexed by the Haitians’ universal reaction to someone who is suffering, to tell them “don’t cry”. the longer I live here, the more I understand that this is a gesture of compassion, even if at times, it appears so misguided or off (to me). I can’t judge this universal reaction, however counter-intuitive it is to me.
I am a guest in their culture. This is why, I do know that I have a lot to offer, and to take as an example the relationship between myself and Marthonie: each person compliments the other’s experience. We have learned a lot from each other and our diverse backgrounds are the perfect combination and this offers the students a much more well-rounded education. It’s great.
However, even though I know this, I also know that just my mere presence here, although there are many positive sides to it, it also has negative effects on people here, because it reinforces the white savior model. This people has such an intense history with colonialization and white supremacy, and now with the multitude of NGO’s who offer handouts and help to maintain their position of helplessness….it’s not a simple equation. People want to come here and understand everything in one week, and have answers to their questions…there are no concise answers. I don’t have the answers.
10-26-11
Of the 3 pre-eclamptic ladies in the repartee room, one of them birthed last night and had a postpartum hemorrhage and was getting a transfusion this morning (and her baby was born dead), one of them is still not in active labor and is being induced with pitocin (she’s only 29 weeks and it would be better not to do a cesarean--), and one of them died today.
The woman who died today, this was her 4th pregnancy, and she had 3 kids at home. I worked on her 2 days ago and was trying to get all her meds going and get her blood pressure controlled--it was 190/120--and trying to convinvce her to let me induce her labor. Yesterday, she was worse--a really bad headache and swollen face--she still refused to let me induce her, so I got the OB to come in and talk to her and just induce her anyway. He did. Well, the misoprostol wasn’t renewed 4-6 hours later and she never went into labor, but this morning, she was very agitated and uncomfortable. She had a high fever. We did a malaria test on her--it was positive. We started treating her for that, and I didn’t pay much attention to her after that. Well, this afternoon, a couple of hours after I left the hospital, she died. Genette thinks she had an a placental abruption. And just bled to death from inside her uterus from where the placenta had separated. Often people with high blood pressure have abruptions.
10-29-11
Yesterday was our last day at the hospital with the students. I have been feeling very nostalgic about the hospital. It is so special, such a privledge, to be with people there while they are going through the most intense moments of their life.
The day after the woman died--her name was Marie--well, everyone in the prepartum room had seen her die. They saw the whole thing. In Haiti, death is not hidden from people. Everyone has seen it. People have experiences and the community is involved, and everyone talks about it. Well, there was another woman with pre-eclampsia in the repartee room, who saw Marie die. The next day, she was worse, and they had decided to do a cesarean, even though it was her 1st baby and she was 30 weeks. When we arrived int eh morning, her family was praying over her. She was doing worse than the day before. Her B/P was still high, and her face was even more swollen, and now she was also breathing fast, like she wasn’t getting enough air. I listened to her lungs, and they were clear. Well, I stayed by her side for awhile, because her family and she were obviously scared that she was going to die. It was so sad. Some of them were crying. I was standing next to her, and she said to me, “I’m not going to die, am I?” this just broke my heart. Here was this young, promising, valuable woman, who because of where she was born, has not had fair access to ways to stay in health, and now, she is sick enough that she could die very easily, and she has done everything in her power to save her own life--she has been at the hospital for 6 days, in our care…she is slipping through the cracks, getting worse..and it’s not her fault, it is our fault, it is the hospital’s fault, it is the fact that there is no infrastructure here to support our efforts to save peoples’ lives…I wasn’t sure if she was going to live or die, but I told her, “No, you aren’t going to die. We are taking care of you. You’re going to get a cesarean. You’re going to be OK.”
After awhile, she got her cesarean. Her baby was more than 30 weeks. He was maybe 33 weeks. He was pink an looking good, except having respiratory distress. Genette was able to get oxygen for him (our oxygen concentrator only works in the delivery room when there‘s electricity, which there wasn‘t at this moment. Anyway, after I left, one of the Haitian midwives helped the family send the baby to the hospital in Cange. This is such good news. This is the baby’s chance at survival.
Right after this, after this woman had been afraid for her life, waiting to get a cesarean, I walked over to the ICU area to check on someone who was in a diabetic coma whose family had asked me to help them get a doctor to see her, and when I arrived, someone had just died there. An old woman. Her children were middle-aged. She had just died, and they were just starting to weep and mourn her, throwing themselves on the ground, wailing, saying “my mother is dead, my mother is dead…” and I just couldn’t hold my tears back any longer. I always try not to cry in front of patients--but at this moment, there had already been so many reminders of how fragile peoples’ lives are in Haiti, and how powerless they are to change that…I just walked away and leaned over the railing and put my head in my hands, and cried for a few minutes…this is the first time this has happened to me like this at the hospital, and I just couldn’t stop it. Peoples’ grief here is contagious sometimes. When I returned to maternity, there was a 22 year-old woman, whose 7-month baby had stopped moving since the day before and she was now pushing him out. I stayed for the birth, one of our students, Magaly, who has really flourished in our program because she was already very experienced but had lacked sweetness and compassion, and now really really has this in her heart…she caught the baby. Once again, such an honor to be there, witnessing this…to witness a woman having a stillbirth, and a midwife helping her…to see them dealing with this situation in their way…sometimes I think I’m useless here, and I’m more of a witness and learner…I know there are deep changes that I have initiated and followed up with, that I do see…such as the general moral and treatment of women in maternity, by the midwives and the doctors…but, I also feel so helpless and useless sometimes…
The eclamptic woman who was in a coma for over a week, she is a little better each day. She is semi-conscious. She is eating and drinking. She still can’t answer peoples’ questions, but she can say things like “water” if she wants water. I am going to go check on her today.
People at the hospital, they touch me so much…it’s like every week, there is a new group of people who I fall in love with…
Yesterday afternoon Marthonie, Genette and I sat down with the students and each person talked about how this year has been for them. This group of women has been a group of sisters. We are all so proud of them and happy to see them moving on, but it is so hard to let people go too…you think your life is defined by a certain place or group of people, and then it suddenly changes…sometimes you don’t know when that change will come.
This year has given me several experiences that have stripped layers of my identity away from me, unexpectedly. I don’t know why, but I have to trust and move forward. Blada is the one constant, at this point. When I went to El Paso, none of my old friends had room for me to stay with them. I felt pushed away by my old community. MLL was warm and welcoming, thank god. Nevertheless, this was very hard for me. I worked every day in the August heat, going through my stuff and packing it and getting rid of it, so that I can make a smooth transition with Blada to North Carolina, whenever we get our fiance visa.
In NC, I was very busy as well. It was a really good trip, in many ways. I saw my old community through new eyes. I saw things that gave me hope for when I move back. I was very busy with 2 fundraisers that we had in order to raise money so that I could come back to Haiti and help people more. It was intense having to think so much about Haiti while I was gone, because there are parts of it that are painful to think about. But, I did it.
The fundraisers, after all the stress and running around that went into them, were successful, and I was really touched by the fact that people were so interested and willing to help.
Three days before leaving to come back to Haiti, I found out that my life in Haiti was about to change. After everything I have put into the community here and the organization MWH, I am suddenly faced with having to let it all go. Instead of feeling triumphant after such a successful year with the students, I am now mourning the loss of everything I have come to know here. I can’t explain it all here, but someday I will tell some of you the story. I am devastated but all I can do is move on, and try to have faith that things are falling into place exactly as they should. Our life will continue, and the most important thing is that we have each other. This year has been a lot about letting go. Sometimes you get used to your life, and you see yourself as defined by certain parameters of your life. Then, suddenly it changes and what you are left with is yourself. This is how I feel. Maybe it’s not normal for this to happen. I think a lot of peoples’ lives are predictable and stable. Maybe that is what’s normal. I don’t really know anymore.
This is the concise version of what our life has been like recently. Working in Haiti means that you see really intense parts of peoples’ lives. There are very joyous and beautiful parts of living here too. I am just sometimes more focused on the sadness because I encounter it everyday in my work. The beauty here is the strength of the people that shines through all the loss. The natural joy of people, the way people are relaxed, the way people always find a way to make things humorous and laugh about so many things…people simply have a good time and make all kinds of things into jokes. People help each other out--people in the hospital share water and food with others who don’t have…
The students who are about to graduate…I am so proud of them…I love them so much…it has been a huge labor of love, on everyone’s part, each person contributing in the ways they specifically could, to pull this off. The students really care about the women and families they care for. This comes through so clearly in the way they relate to and talk to people. They have compassion. They talk to people with kindness and respect. Sometimes when I have thought of the love I see in their hearts, and the willingness they have to work and the desire they have to save peoples’ lives, I just cry…I wish that they could have more…that they could have better access to the tools they need to save these womens’ lives…but, it is what it is and compared to the alternative of giving up, there is no choice. This is so much better. These women are amazing. They will make a difference.
Saturday, November 5, 2011
Saturday, July 16, 2011
7-1 to 7-16-11
7-1-11
So…so many things to write about always…it would be easier if I could tell these stories face to face…
Today we had 2 births…one was a super easy spontaneous fast labor/birth with a 3rd-timer…the other was a 6/5 with pre-eclampsia who they wanted to do a c/s on because her cervix was swollen because she had been pushing on it for awhile at 5cms and a few other reasons…anyway, we helped her to birth…when we arrived, she was laying on her back (with a swollen ANTERIOR cervix) and she was 6cms and her ctx were weak…we started pit on her and put her forward-leaning and then hands and knees…then I simply held back her cervix she pushed and the baby almost flew out.
When we arrived they had stopped her mag sulfate drip because her urine output was scant and very bloody (really BAD sign)…she was ok though and after she birthed she started peeing a lot and it was clear…huge relief…we put her back on mag and everything was great…
That’s a summary of it…
Last week we had 3 really great births too…the students really have their hearts in the right place…they are doing so well supporting women in labor, doing labor monitoring, etc…I am so proud of them…this year is a lot different than last year…we really started off on the right foot with this group…
5 babies who died this week…2 apparently were stillbirths…one was yesterday, a 25-week baby born alive who died in my arms over the next while…it was with that or let the baby die by herself on the counter…
One died yesterday--I’m sure this baby had aspirated mec…born in the morning, died in the afternoon…
Anyway…there’s always a lot of this…
So I have been trying to get a kind of visa called permis de sejours…it allows you to live here for 1 year, and you renew it each year…it has been so hard…I can’t even explain it in writing…imagine in a country with no infrastructure, no real systems for anything…you have to make a long trip in person each time, only to find out that you are missing more documents or their fingerprinting machine is broken so you’ll have to return…
Well the 3rd and final time I went (to PAP to finish the permis stuff), I went with Blada. We had the most interesting ride up there. You ride there in either a tap-tap, which is a pickup truck, or a papadap, which is a minivan…either way everyone is super crammed in there, sitting on one buttcheek…well, this time, we had the luck of having a very entertaining crazy person in the papadap with us…it was hilarious…someday I will tell some of you who are interested in hearing about it…I will be able to explain it better…not only did we have the crazy person, we also had a woman sho in the middle fo the ride suddenly started screaming and writhing in pain…she was on her period…it was like she was having an abortion or in labor…so everyone supported her, and then after her pain started dying down and she was sleeping between the contractions, everyone started talking about how their labors were and about how boy babies hurt more than girl babies…it was really interesting…
One thing here is that people talk about everything in a group…like, you’re in the minivan and the whole group of people is having a conversation or an argument about something…people don’t hold back their comments…no one is immune to criticism…I don’t know how to describe it…it’s almost communal in a way…like, people keep each other in line in the street…everyone disciplines each others’ kids…
I feel like I’m riding the crest of a wave with the creole language…like, learning at a fast pace…catching more and more little things…
7-11-11
Today is Monday, a class day…the students are taking a test right now…
This past Friday…each day at the hospital this past week was very interesting and good with the students…we did some labors and births together…too many things to describe but one that has been on my mind was on Friday….
We had this woman who was in active labor, 6cms in the morning. When the student checked her, she popped the bag of waters accidentaly and there was very thick
me conium. But, the fetal heart tones were great. Well, her labor never went anywhere all day and although the FHT’s were always good, there was just something wrong, something that was preventing her labor from progressing. Her cervix had been 5-6 cms in the morning and in the afternoon was 4-5 cms and less soft. She didn’t have signs of infection but that could be a reason for the reverse dilation. Her contractions were strong but farther and farther apart. We tried a lot of things, and nothing helped. We had advised the Dr in the morning about her and he had actually decided to do a c/s since 9:30am. Then, for the next 4 hours, he was running around trying to get them to fix the generator, because apparently the generator was broken and so there was no power and no possibility of doing a c/s. well, after 4 hours of trying, it was clear that it couldn’t be fixed. He resigned himself to telling her: “ there is nothing I can do for you.” that is literally what he said. He left. He works all the time, gets called in all the time….he went home to eat something. You wouldn’t believe how hard people work here.
In the meantime, we had also been trying to find a way to transport her to a different howpital. In Cange--about 30-45 minutes away between Hinche and Port au Prince. Well, Cange does have an “ambulnce” which they send here sometimes for really grave cases…we thought they were coming and then they called and said they couldn’t come. Our jeep, the Midwives for Haiti jeep, that is used for mobile clinics, was broken down, but in the process of being fixed. By the afternoon, around 3pm or so, the jeep was fixed and Ronel (the driver) brought her to Cange. A graduate MW went with her.
It was hard--it was like, she was stuck there with this dysfunctional labor and thick mec getting more and more exhausted. Eventually we actually gave her mag sulfate to tocolyze her (to slow down the ctx) because we had already tried augmenting her with pit, and then when I checked her again and saw that she was reverse dilating and also was pushing on her cervix and tearing it and bleeding, we stopped the pit and tocolyzed her instead.
It was a team effort between myself, Genette, the students, the other graduate MW Bienaime, our driver…I imagine that things turned out ok for her and the baby because the baby had been stable all along and she was also not super compromised yet.
The most striking thing to me of the whole situation was when Dr C, the OB, said to her: “there’s nothing I can do for you.” I mean, for an OB to have to say that to someone--for an OB to have to tell a woman this--for an OB to have their hands tied like this and to have to simply tell a woman that there’s nothing else they can do for them---that is really sad. That is a reflection on the entire eituation here--the act that we had to wait all day to transport this lady to a hospital 45 MINUTES away--and that there are no public services like ambulances…
There was another really intense situation this week….a birth on Wednesday…a 5th-timer (5/4) who was diagnosed with “CPD” (it is the largest reason they do cesareans here)--(CPD means that the baby’s head can’t fit through the mom’s pelvis)---
Anyway I advocated for us trying for a vaginal birth and got a lot of hell for it but eventually she progressed to complete (she had been 9cms with an anterior lip only, laying on her back--when we arrived)….this lady was really out of her mind--wouldn’t let us help her at all, wouldn’t cooperate at all…had it in her mind that she was going to die if she didn’t get a c/s….it was really chaotic and crazy---her yelling, her family yelling, everyone upset and scared, them mad at her for not cooperating with us, her mad at me for saying she didn’t need a c/s--anyway it was really crazy until she started pushing…then, she calmed down and started focusing and pushing and working with us…she was on the floor, almost outside of the L&D area…her dad, who had been praying over her, stayed there and held her as she pushed…
Pushing stage proved very difficult…probably her other babies had been smaller than this baby…very hard with fetal heart tones that started getting bad (around 70-80, staying there, with the head still not through the bones)…I called in help from another American MW who was there at the hospital too because I knew she could help me get the baby out…we were doing everything and finally the baby came and was ok after a few minutes of artificial respiration…
The whole thing was intense too because besides the birth being hard, besides the possibility of having a damaged or dead baby, and all the grief that would cause, there was the other reality that I had been the one who opposed the c/s earlier, so if we had a bad outcome, it would have been my fault, in everyone’s eyes. That would have been really bad. As it was, with everything ok, the mom was so so happy and so thankful etc during the postpartum, and so was her family…she had lost her voice from all the screaming so she just kept whispering “thank you so much, thank you so much…” and her family was like “you should always stay here and save mothers”…I was happy for their happiness but I also knew that if the outcome had been different, and it could have been, it would have been the opposite…
The thing is, earlier on, she really didn’t have any real indication for a c/s. one reason for it was that people didn’t want to deal with her crazy screaming anymore.
I’ve had lots of births here where they were headed for a c/s for “CPD” and I helped them birth vaginally…the week before I had another 5th timer with “CPD” who just needed some pit augmentation, a change in position from flat on her back to hands and knees, and then to push back her swollen anterior cervix--then the baby flew out.
Anyway….writing about something never captures the reality in full but atleast it can give an idea.
The students, I am so proud of them. They are doing so well in the hospital. Last week I was able to suture with on eof them and do PPV 2 times with her as well. (PPV=artificial respirations for a baby who needs help to start breathing). It is so satisfying to help someone else do something, to put your hands over theirs and feel them do it with their own hands.
The time here has been flying by. The energy in the house has been easier than in the first several months, which has been so great, because after the first 5 months or so, I was really really FRIED, and the volunteers could see that, and that made some of them feel unwelcome, but there was nothing I could do about that because it was our living situation that was really really unbalanced…the last 2 months have been better--with some breaks from visitors (volunteers) and with Kirsty and Mackenxy moving in a month ago…
Anyway, time is flying and in less than a month, I am leaving Haiti to go to the US for almost 2 months…first I’m going to El Paso for 3 weeks, then to NC for 4 weeks. One of the big reasons for my trip is to go through all my stuff in EL Paso and pack up what I’m keeping and ship it all to NC. So that, when our fiance visa petition gets approved next year hopefully, we can go to NC directly. I feel sad about rapping up my life in El Paso, even though I know I have to and I know that life changes. It was just such a big part of my life for so long, and I feel really connected to the midwives there still. And to the people of Ep Paso/Juarez. I had many friends who birthed in my hands 3-4 times and whose sisters’ and cousins’ births I attended…
I will be so happy to see everyone there again, and relieved to deal with my stuff and move it, but also sad to be wrapping up things there…I would love to visit MLL & El Paso one day with Blada…would love for him to see where I was and for my friends there to meet him…
Also really excited about going to NC and being there with family and friends…
Another part of my trip besides moving my stuff is doing things like renewing my CPR and IV certifications in order to be able to renew my midwifery license when that comes up…hopefully I can do everything I need to on this trip so that I don’t need to leave Haiti again until I leave with Blada…whenever that is…(we hope next year but you never know with stuff like this). And of course the other big thing I am going to do while in EP is to send off our visa petition. That will be such a relief!
This past week at the hospital also, I enlisted the participation of a group of auxilliare students who are in their maternity rotation. The last groups we’ve had, they’ve been awful, so we mostly ignore them. They just sit there all day, not trying to help or learn, playing with their phones…well, the group that started this week is a different story. They are helpful and get their hands in there. I’ve had them come and do massage for laboring moms…I’ve taken time to show them things like explain things to them while I’m suturing…so, we had one birth on Friday where the mom pushed and had her baby on the floor (on a sheet)---and there is a guy in the group, who is really open and had already been doing massage for the laboring mom. So, while she was pushing, I had him squatting behind her supporting her. For like 45 minutes. It was great. This is the only time in their training they will ever see something like this. I talk to them about how to talk to patients. How to be gentle with them and show them that they can trust you. So, it was really great that they could help us in this birth--actually the guy student, he was more positive and helpful than the females. I joked that we will pick him for our next MW class.
7-16-11
So, it has been 2 weeks that the hospital has been without power. The midwives do births at night with their headlamps. There is no functional OR. We’ve had to transport women who needed c-sections to a different hospital in Cange, about 45 min away. If we didn’t have the MWH jeep, some of these transports would have not been possible. Like the woman I wrote about last time, who we transported a week ago, who was stuck at 5cms all day, with thick mec. If the jeep hadn’t been available, she would have eventually lost the baby and if her labor didn’t progress she would have ended up with a ruptured uterus (and would have died).
Not only does the hospital have no power (the whole town of Hinche has no power. Anyone who has power has either solar panels or a generator))---but now, the Red Cross, down the road form the hospital, had all of their 8 solar panels STOLEN a week ago. Which means that all the stored blood was lost, and there is NO blood available for transfusions. There are 2 ladies at the hospital with 4 hemoglobins. There are people worse off than them, I’m sure. Ayway, whoever stole the solar panels is going to cost people their lives. If the town finds out who did it, they will probably kill him. I’m serious. Thieves are punished severely here. One time, Blada witnessed a thief get tied up, beaten and dragged through town, and then burned to death.
Anyway, so the hospital is pretty bad off right now. Sometimes I give some of the patients who are really bad off a little money. Like, a woman in post-op with a 4 hgb whose family is only feeding her some crackers and juice every day, and who doesn’t have money to buy iron injections. One of the students has taken on making food for her and told me about her situation, so I gave her the money to buy the iron. Out of leftover house food money. Sometimes you just have to, people are so bad off.
We had a 15 day postpartum woman come in on Wednesday, having eclamptic seizures. Her parents came with her….she had been seizing all day…we had to restrain her to give her anti-seizure meds because after you’ve been seizing, your brain is abnormal and you are really deranged and out of it---she was trying to bite me and scratch me…the next day, she was a lot better and has been better each day. But she’s not totally here yet. She can’t really speak yet. But, she is holding and BF her baby. Her parents are so dedicated to her…they came from far away, with nothing…nothing to wrap the baby in…everything was dirty…bloody and smelly…so so sad…they didn’t even have a sheet to put down on her bed…I looked through our stuff at the hospital and neither did we…sometimes we have stuff, like baby blankets, baby clothes, etc, but they get used and then there’s nothing…anyway, I gave them some money so they could eat and feed her…really humble and caring people…I talked to them a lot about keeping the baby on the breast, about giving their daughter good food once they get home…
We had another pre-eclamptic woman yesterday, who is 7 months pregnant, 21 years old, who lost her 1st baby at 7 months due to the same condition. I talked with her for a long time yesterday about the fact that right now, her pre-eclampsia appears “light”--it’s not severe/full blown yet, but that that can change at any moment--we had a woman a few weeks ago who had been seen at the hospital 3 days before with a B/P of 90/60 and everything appearing fine, who then came in seizing 3 days later…anyway, I was talking to this woman about the fact that we reall yneed to induce her labor, and that yes, her 7-month old baby probably won’t make it…it was so heart-wrenching because this woman really, really wants her baby…she is still sad about losing the last one…she kept saying that she feels the baby moving in her belly…she kept asking me what I thought were the chances of her baby surviving…at the same time, understanding and resigning herself to the induction, in order to save her own life…
And in talking to her, I just kept coming back to this: that this is so unfair…that in the US, we would be monitoring her condition continuously with blood tests, to know how much longer we could wait to deliver her, to balance the risks for both her and baby and she most likely would not die…it is so unfair that women here have to make this choice…this woman yesterday, she is an intelligent, normal woman, who deserves the options and choices of any other woman…the women here are no less, and they deserve no less.
Yesterday in case studies class with the students, we were talking about eclampsia. I was asking them if they have known women who have had eclamptic seizures, who have either been normal afterwards or been kind of off mentally, or even crazy. (years later). I just wonder, because obviously, you can suffer brain damage from an event like this. Well, almost half of them have had cousins, aunts, sisters, etc who have had eclampsia. This is shocing. This shows how common it is here. All of them said that the people have been normal afterwards. I know that there is different research about how PEC starts, like with placental attachment in the 1st trimester, genetics, etc. but to me, the most obvious cause is malnutrition and dehydration. People here do have chronic dehydration and malnutrition. A pregnant woman needs more of everything, and needs to expand her blood volume by 50% over what it was, by 28 weeks pregnant. These women are HYPOVOLEMIC. They have a thick, contracted blood volume. This leads to placental insufficiency, fetal growth restriction, high blood pressure, kidney damage, etc. the body responds to the hypovolemia the same way it does to a big hemorrhage: the kidneys release renin, to raise to the blood pressure, in order to keep circulating blood through the body, and to the placenta. They also start reabsorbing water, in order to keep the blood volume out. Lack of adequate protein and salt causes plasma (the fluid part of the blood) to leak out of the blood circulation, which causes pathological swelling. This is a simplified explanation of a multifaceted syndrome. There are surely other factors that can exaserbate the process or augment someone’s risk. But, I really feel that this is the underlying cause. It is so clear. When you see it here, it is so clear. When you read about it and put all the pieces together, it is so clear.
The choice that ended up being made, in light of her fervent desire to save her baby if possible, was to bring her to Cange the next morning (this morning), because at least there they have the capacity to care for premature infants…I don’t know if a 7-month baby will make it there, but it’s her only chance.
We only have 3 weeks left of classes, until we start the last 10 weeks of the program, which is almost all clinical. I regret that I will be gone for 2 months of that. I feel really attached to this group of students and will miss them so much and also be sad to miss out on a big part of their learning. There is never a convenient time to leave Haiti. Even though I am excited to come home, to see everyone…it is also hard to leave and I will really miss people here…
What else…the weeks are passing fast.
So…so many things to write about always…it would be easier if I could tell these stories face to face…
Today we had 2 births…one was a super easy spontaneous fast labor/birth with a 3rd-timer…the other was a 6/5 with pre-eclampsia who they wanted to do a c/s on because her cervix was swollen because she had been pushing on it for awhile at 5cms and a few other reasons…anyway, we helped her to birth…when we arrived, she was laying on her back (with a swollen ANTERIOR cervix) and she was 6cms and her ctx were weak…we started pit on her and put her forward-leaning and then hands and knees…then I simply held back her cervix she pushed and the baby almost flew out.
When we arrived they had stopped her mag sulfate drip because her urine output was scant and very bloody (really BAD sign)…she was ok though and after she birthed she started peeing a lot and it was clear…huge relief…we put her back on mag and everything was great…
That’s a summary of it…
Last week we had 3 really great births too…the students really have their hearts in the right place…they are doing so well supporting women in labor, doing labor monitoring, etc…I am so proud of them…this year is a lot different than last year…we really started off on the right foot with this group…
5 babies who died this week…2 apparently were stillbirths…one was yesterday, a 25-week baby born alive who died in my arms over the next while…it was with that or let the baby die by herself on the counter…
One died yesterday--I’m sure this baby had aspirated mec…born in the morning, died in the afternoon…
Anyway…there’s always a lot of this…
So I have been trying to get a kind of visa called permis de sejours…it allows you to live here for 1 year, and you renew it each year…it has been so hard…I can’t even explain it in writing…imagine in a country with no infrastructure, no real systems for anything…you have to make a long trip in person each time, only to find out that you are missing more documents or their fingerprinting machine is broken so you’ll have to return…
Well the 3rd and final time I went (to PAP to finish the permis stuff), I went with Blada. We had the most interesting ride up there. You ride there in either a tap-tap, which is a pickup truck, or a papadap, which is a minivan…either way everyone is super crammed in there, sitting on one buttcheek…well, this time, we had the luck of having a very entertaining crazy person in the papadap with us…it was hilarious…someday I will tell some of you who are interested in hearing about it…I will be able to explain it better…not only did we have the crazy person, we also had a woman sho in the middle fo the ride suddenly started screaming and writhing in pain…she was on her period…it was like she was having an abortion or in labor…so everyone supported her, and then after her pain started dying down and she was sleeping between the contractions, everyone started talking about how their labors were and about how boy babies hurt more than girl babies…it was really interesting…
One thing here is that people talk about everything in a group…like, you’re in the minivan and the whole group of people is having a conversation or an argument about something…people don’t hold back their comments…no one is immune to criticism…I don’t know how to describe it…it’s almost communal in a way…like, people keep each other in line in the street…everyone disciplines each others’ kids…
I feel like I’m riding the crest of a wave with the creole language…like, learning at a fast pace…catching more and more little things…
7-11-11
Today is Monday, a class day…the students are taking a test right now…
This past Friday…each day at the hospital this past week was very interesting and good with the students…we did some labors and births together…too many things to describe but one that has been on my mind was on Friday….
We had this woman who was in active labor, 6cms in the morning. When the student checked her, she popped the bag of waters accidentaly and there was very thick
me conium. But, the fetal heart tones were great. Well, her labor never went anywhere all day and although the FHT’s were always good, there was just something wrong, something that was preventing her labor from progressing. Her cervix had been 5-6 cms in the morning and in the afternoon was 4-5 cms and less soft. She didn’t have signs of infection but that could be a reason for the reverse dilation. Her contractions were strong but farther and farther apart. We tried a lot of things, and nothing helped. We had advised the Dr in the morning about her and he had actually decided to do a c/s since 9:30am. Then, for the next 4 hours, he was running around trying to get them to fix the generator, because apparently the generator was broken and so there was no power and no possibility of doing a c/s. well, after 4 hours of trying, it was clear that it couldn’t be fixed. He resigned himself to telling her: “ there is nothing I can do for you.” that is literally what he said. He left. He works all the time, gets called in all the time….he went home to eat something. You wouldn’t believe how hard people work here.
In the meantime, we had also been trying to find a way to transport her to a different howpital. In Cange--about 30-45 minutes away between Hinche and Port au Prince. Well, Cange does have an “ambulnce” which they send here sometimes for really grave cases…we thought they were coming and then they called and said they couldn’t come. Our jeep, the Midwives for Haiti jeep, that is used for mobile clinics, was broken down, but in the process of being fixed. By the afternoon, around 3pm or so, the jeep was fixed and Ronel (the driver) brought her to Cange. A graduate MW went with her.
It was hard--it was like, she was stuck there with this dysfunctional labor and thick mec getting more and more exhausted. Eventually we actually gave her mag sulfate to tocolyze her (to slow down the ctx) because we had already tried augmenting her with pit, and then when I checked her again and saw that she was reverse dilating and also was pushing on her cervix and tearing it and bleeding, we stopped the pit and tocolyzed her instead.
It was a team effort between myself, Genette, the students, the other graduate MW Bienaime, our driver…I imagine that things turned out ok for her and the baby because the baby had been stable all along and she was also not super compromised yet.
The most striking thing to me of the whole situation was when Dr C, the OB, said to her: “there’s nothing I can do for you.” I mean, for an OB to have to say that to someone--for an OB to have to tell a woman this--for an OB to have their hands tied like this and to have to simply tell a woman that there’s nothing else they can do for them---that is really sad. That is a reflection on the entire eituation here--the act that we had to wait all day to transport this lady to a hospital 45 MINUTES away--and that there are no public services like ambulances…
There was another really intense situation this week….a birth on Wednesday…a 5th-timer (5/4) who was diagnosed with “CPD” (it is the largest reason they do cesareans here)--(CPD means that the baby’s head can’t fit through the mom’s pelvis)---
Anyway I advocated for us trying for a vaginal birth and got a lot of hell for it but eventually she progressed to complete (she had been 9cms with an anterior lip only, laying on her back--when we arrived)….this lady was really out of her mind--wouldn’t let us help her at all, wouldn’t cooperate at all…had it in her mind that she was going to die if she didn’t get a c/s….it was really chaotic and crazy---her yelling, her family yelling, everyone upset and scared, them mad at her for not cooperating with us, her mad at me for saying she didn’t need a c/s--anyway it was really crazy until she started pushing…then, she calmed down and started focusing and pushing and working with us…she was on the floor, almost outside of the L&D area…her dad, who had been praying over her, stayed there and held her as she pushed…
Pushing stage proved very difficult…probably her other babies had been smaller than this baby…very hard with fetal heart tones that started getting bad (around 70-80, staying there, with the head still not through the bones)…I called in help from another American MW who was there at the hospital too because I knew she could help me get the baby out…we were doing everything and finally the baby came and was ok after a few minutes of artificial respiration…
The whole thing was intense too because besides the birth being hard, besides the possibility of having a damaged or dead baby, and all the grief that would cause, there was the other reality that I had been the one who opposed the c/s earlier, so if we had a bad outcome, it would have been my fault, in everyone’s eyes. That would have been really bad. As it was, with everything ok, the mom was so so happy and so thankful etc during the postpartum, and so was her family…she had lost her voice from all the screaming so she just kept whispering “thank you so much, thank you so much…” and her family was like “you should always stay here and save mothers”…I was happy for their happiness but I also knew that if the outcome had been different, and it could have been, it would have been the opposite…
The thing is, earlier on, she really didn’t have any real indication for a c/s. one reason for it was that people didn’t want to deal with her crazy screaming anymore.
I’ve had lots of births here where they were headed for a c/s for “CPD” and I helped them birth vaginally…the week before I had another 5th timer with “CPD” who just needed some pit augmentation, a change in position from flat on her back to hands and knees, and then to push back her swollen anterior cervix--then the baby flew out.
Anyway….writing about something never captures the reality in full but atleast it can give an idea.
The students, I am so proud of them. They are doing so well in the hospital. Last week I was able to suture with on eof them and do PPV 2 times with her as well. (PPV=artificial respirations for a baby who needs help to start breathing). It is so satisfying to help someone else do something, to put your hands over theirs and feel them do it with their own hands.
The time here has been flying by. The energy in the house has been easier than in the first several months, which has been so great, because after the first 5 months or so, I was really really FRIED, and the volunteers could see that, and that made some of them feel unwelcome, but there was nothing I could do about that because it was our living situation that was really really unbalanced…the last 2 months have been better--with some breaks from visitors (volunteers) and with Kirsty and Mackenxy moving in a month ago…
Anyway, time is flying and in less than a month, I am leaving Haiti to go to the US for almost 2 months…first I’m going to El Paso for 3 weeks, then to NC for 4 weeks. One of the big reasons for my trip is to go through all my stuff in EL Paso and pack up what I’m keeping and ship it all to NC. So that, when our fiance visa petition gets approved next year hopefully, we can go to NC directly. I feel sad about rapping up my life in El Paso, even though I know I have to and I know that life changes. It was just such a big part of my life for so long, and I feel really connected to the midwives there still. And to the people of Ep Paso/Juarez. I had many friends who birthed in my hands 3-4 times and whose sisters’ and cousins’ births I attended…
I will be so happy to see everyone there again, and relieved to deal with my stuff and move it, but also sad to be wrapping up things there…I would love to visit MLL & El Paso one day with Blada…would love for him to see where I was and for my friends there to meet him…
Also really excited about going to NC and being there with family and friends…
Another part of my trip besides moving my stuff is doing things like renewing my CPR and IV certifications in order to be able to renew my midwifery license when that comes up…hopefully I can do everything I need to on this trip so that I don’t need to leave Haiti again until I leave with Blada…whenever that is…(we hope next year but you never know with stuff like this). And of course the other big thing I am going to do while in EP is to send off our visa petition. That will be such a relief!
This past week at the hospital also, I enlisted the participation of a group of auxilliare students who are in their maternity rotation. The last groups we’ve had, they’ve been awful, so we mostly ignore them. They just sit there all day, not trying to help or learn, playing with their phones…well, the group that started this week is a different story. They are helpful and get their hands in there. I’ve had them come and do massage for laboring moms…I’ve taken time to show them things like explain things to them while I’m suturing…so, we had one birth on Friday where the mom pushed and had her baby on the floor (on a sheet)---and there is a guy in the group, who is really open and had already been doing massage for the laboring mom. So, while she was pushing, I had him squatting behind her supporting her. For like 45 minutes. It was great. This is the only time in their training they will ever see something like this. I talk to them about how to talk to patients. How to be gentle with them and show them that they can trust you. So, it was really great that they could help us in this birth--actually the guy student, he was more positive and helpful than the females. I joked that we will pick him for our next MW class.
7-16-11
So, it has been 2 weeks that the hospital has been without power. The midwives do births at night with their headlamps. There is no functional OR. We’ve had to transport women who needed c-sections to a different hospital in Cange, about 45 min away. If we didn’t have the MWH jeep, some of these transports would have not been possible. Like the woman I wrote about last time, who we transported a week ago, who was stuck at 5cms all day, with thick mec. If the jeep hadn’t been available, she would have eventually lost the baby and if her labor didn’t progress she would have ended up with a ruptured uterus (and would have died).
Not only does the hospital have no power (the whole town of Hinche has no power. Anyone who has power has either solar panels or a generator))---but now, the Red Cross, down the road form the hospital, had all of their 8 solar panels STOLEN a week ago. Which means that all the stored blood was lost, and there is NO blood available for transfusions. There are 2 ladies at the hospital with 4 hemoglobins. There are people worse off than them, I’m sure. Ayway, whoever stole the solar panels is going to cost people their lives. If the town finds out who did it, they will probably kill him. I’m serious. Thieves are punished severely here. One time, Blada witnessed a thief get tied up, beaten and dragged through town, and then burned to death.
Anyway, so the hospital is pretty bad off right now. Sometimes I give some of the patients who are really bad off a little money. Like, a woman in post-op with a 4 hgb whose family is only feeding her some crackers and juice every day, and who doesn’t have money to buy iron injections. One of the students has taken on making food for her and told me about her situation, so I gave her the money to buy the iron. Out of leftover house food money. Sometimes you just have to, people are so bad off.
We had a 15 day postpartum woman come in on Wednesday, having eclamptic seizures. Her parents came with her….she had been seizing all day…we had to restrain her to give her anti-seizure meds because after you’ve been seizing, your brain is abnormal and you are really deranged and out of it---she was trying to bite me and scratch me…the next day, she was a lot better and has been better each day. But she’s not totally here yet. She can’t really speak yet. But, she is holding and BF her baby. Her parents are so dedicated to her…they came from far away, with nothing…nothing to wrap the baby in…everything was dirty…bloody and smelly…so so sad…they didn’t even have a sheet to put down on her bed…I looked through our stuff at the hospital and neither did we…sometimes we have stuff, like baby blankets, baby clothes, etc, but they get used and then there’s nothing…anyway, I gave them some money so they could eat and feed her…really humble and caring people…I talked to them a lot about keeping the baby on the breast, about giving their daughter good food once they get home…
We had another pre-eclamptic woman yesterday, who is 7 months pregnant, 21 years old, who lost her 1st baby at 7 months due to the same condition. I talked with her for a long time yesterday about the fact that right now, her pre-eclampsia appears “light”--it’s not severe/full blown yet, but that that can change at any moment--we had a woman a few weeks ago who had been seen at the hospital 3 days before with a B/P of 90/60 and everything appearing fine, who then came in seizing 3 days later…anyway, I was talking to this woman about the fact that we reall yneed to induce her labor, and that yes, her 7-month old baby probably won’t make it…it was so heart-wrenching because this woman really, really wants her baby…she is still sad about losing the last one…she kept saying that she feels the baby moving in her belly…she kept asking me what I thought were the chances of her baby surviving…at the same time, understanding and resigning herself to the induction, in order to save her own life…
And in talking to her, I just kept coming back to this: that this is so unfair…that in the US, we would be monitoring her condition continuously with blood tests, to know how much longer we could wait to deliver her, to balance the risks for both her and baby and she most likely would not die…it is so unfair that women here have to make this choice…this woman yesterday, she is an intelligent, normal woman, who deserves the options and choices of any other woman…the women here are no less, and they deserve no less.
Yesterday in case studies class with the students, we were talking about eclampsia. I was asking them if they have known women who have had eclamptic seizures, who have either been normal afterwards or been kind of off mentally, or even crazy. (years later). I just wonder, because obviously, you can suffer brain damage from an event like this. Well, almost half of them have had cousins, aunts, sisters, etc who have had eclampsia. This is shocing. This shows how common it is here. All of them said that the people have been normal afterwards. I know that there is different research about how PEC starts, like with placental attachment in the 1st trimester, genetics, etc. but to me, the most obvious cause is malnutrition and dehydration. People here do have chronic dehydration and malnutrition. A pregnant woman needs more of everything, and needs to expand her blood volume by 50% over what it was, by 28 weeks pregnant. These women are HYPOVOLEMIC. They have a thick, contracted blood volume. This leads to placental insufficiency, fetal growth restriction, high blood pressure, kidney damage, etc. the body responds to the hypovolemia the same way it does to a big hemorrhage: the kidneys release renin, to raise to the blood pressure, in order to keep circulating blood through the body, and to the placenta. They also start reabsorbing water, in order to keep the blood volume out. Lack of adequate protein and salt causes plasma (the fluid part of the blood) to leak out of the blood circulation, which causes pathological swelling. This is a simplified explanation of a multifaceted syndrome. There are surely other factors that can exaserbate the process or augment someone’s risk. But, I really feel that this is the underlying cause. It is so clear. When you see it here, it is so clear. When you read about it and put all the pieces together, it is so clear.
The choice that ended up being made, in light of her fervent desire to save her baby if possible, was to bring her to Cange the next morning (this morning), because at least there they have the capacity to care for premature infants…I don’t know if a 7-month baby will make it there, but it’s her only chance.
We only have 3 weeks left of classes, until we start the last 10 weeks of the program, which is almost all clinical. I regret that I will be gone for 2 months of that. I feel really attached to this group of students and will miss them so much and also be sad to miss out on a big part of their learning. There is never a convenient time to leave Haiti. Even though I am excited to come home, to see everyone…it is also hard to leave and I will really miss people here…
What else…the weeks are passing fast.
Monday, June 20, 2011
6-20 june, 2011
6-11-11
Things here are going really well. This is the easiest time so far this year. The students are doing great; we’re over halfway through the class year. The house is way more relaxed--for the 1st 5 months of this class year, starting in January, we had volunteers every single week, with no break. For 5 months. Now, we have had a couple of breaks, and, for over the past month, we have had all really great, really easy (low maintenance) and fun volunteers. And, Kirsty and Mackenzy have now been here for 2 weeks, and this has added a wonderful element to the household. It feels like more of a community now. We’re living with people who we share a lot of things in common with, even just with our lifestyles and overall beliefs…we get along really really well. It is so good. I like Kirsty so much. Also, with them here, and knowing their vision for their life here, it makes living in Haiti more appealing. They have land in the south…they have lots of gardens…
What a blessing. Blada and I are great, just more and more connected and in love with each passage of time. He is so wonderful, I just can’t wait for those of you who can, to meet him when we come to the US. This weekend is our one year anniversary. A year ago, there was a day that marked a change in the course of our friendship. We had already been getting together for awhile, on and off for 1-2 months, to dance. To practice. Well this one day, we had finished practicing, and then their was a huge downpour of rain. A thunderstorm, with lightning, wind…and 2 full arc rainbows in the sky. A beautiful storm, a sign from nature. This day, we danced in the rain. And then sat down and talked for awhile, in the rain. This day, the energy began to shift. This was the beginning of us dating.
Anyway I could go on about that but I’ll leave it there.
Nothing else too spectacular to report…well, one sad event, which repeats itself every 1-2 months without fail: a woman died at the hospital. She was a small woman, who was very pale and weak from anemia. She came in with a hemoglobin of 5, not as low as some people who make it here--got a transfusion after days of waiting for blood, and then was at the hospital still for about 2 weeks. I spent some time with her, talking to her about her ailment (to her it was a sickness that someone had sent upon her with black magic, someone who was jealous of her…)…talking to her about nutrition and all the thing sshe could eat at home for iron…
Well, this came as a surprise to me because I had just seen her 2 days before, but yesterday I heard that she had died. Apparently she started having diarrhea and vomiting. I don’t know if it was cholera--but it definetly could have been, and I think she should have been rushed over to the cholera tents (in front of the hospital) for treatment. Anyway, I guess she got really dehydrated and died. I don’t know more info about it except for that. She had one child.
6-20-11
Well, this week was crazier than last week. Another woman died at the hospital--this time from a placental abruption. I wasn’t there--apparently she had the classic signs--her belly was hard and full of blood (but no external bleeding). Anyway, they didn’t do a c/s--they don’t always do them for abruptions, if the mom isn’t bleeding a lot and she’s stable--but, in this case, she had already lost so much blood when she showed up, it may have been too late anyway even with a c/s (they don’t have blood available in the hospital)…so, she birthed (a dead baby), and then died 1 hour later.
The next day, there 2 eclamptic women--one of them was 16 years old and came in seizing. She was in labor, 6cms. We got her on mag sulfate…I had to leave before she had her baby, but she was pushing when I left. Most of the time when I was there, she was unconscious, after the seizure. She started coming around a little, getting a little responsive…but really out of it, thrashing her body around, really agitated…when she was unconscious, you could still tell when she had a contraction…she would moan and kind of thrash around..it was still hurting her..
Well, she had her baby after I left (the FHT’s were great the whole time I was there, and we were listening often). I guess the baby wasn’t OK when he was born, and needed to be recessed, and then they gave him to the “ped unit”…(it’s not a real ped unit…)…anyway, he died the next day..there were 2 or 3 babies who died this week…1-2 days after they were born…the hospital just doesn’t have any means of giving care to babies who need anything more than IV antibiotics…they don’t even have oxygen to give them…anyway…this mom, I’m not sure how well she’s doing…I haven’t heard any really bad news, but, I heard that the next day, after her birth, she was unconscious again…I guess she seized again….I don’t know if they were monitoring her appropriately and keeping her or mag sulfate to prevent more seizures…
Well, the same day that she birthed, there was another woman, who had a previa. (the placenta is situated over the cervix…so when the cervix starts to open, the placenta separates and the mom bleeds a lot and both mom and bb can die). This woman, at one moment, I thought she was dying in my hands. She was waiting to be wheeled into the OR for a c/s, and I was doing vitals on her. She was bleeding A LOT, and a few times said that she was going to die right there. Well, she lost consciousness at one point, and I opened her eye and looked into it and it looked like it was flat, fixed. I took her B/P, and it sounded like either 40-20 or nothing at all…it was faint. Well, she was still alive and when I took her B/P again, it was actually 80-40. She got her c/s and a blood transfusion and was OK. I don’t know if her baby made it though.
The next day after the 16 year-old eclamptic woman and the placenta previa woman, there was another woman who came in with an abruption, but birthed and was ok, and another woman who was eclamptic, and, to top it off, there was another woman, who had a bowel obstruction and was vomiting shit. I’m not kidding. Thank god, she was transported to Cange and hopefully had her operation STAT and hopefully was ok.
So, this week was crazy. The students see so much here. They are like 6 months into the program and they’re working on super super high risk sick women. Being a midwife in Haiti means that you will work with a high-risk population, no matter what. You will see death, and severe pathology that midwives (and doctors) in the states would never see. People here become midwives because they want to save peoples’ lives. If you ask anyone here why they wanted to be a MW, that is what they say.
Our new housemates, Kirsty and Mackenzy, we are really enjoying them. We flow super easily, enjoy hanging out together, etc. it’s great. We always had a sort of community here at the house, but now, it’s on a totally different level. They’ve started gardens, compost…he’s an agronomist. He’ll be bringing his little daughter here soon too, which will be nice for the house…we already have Jamlex, our cook’s baby, who comes here with here all the time and is SOO much fun (he’s 14 months old…), so this will make it even more like…a family. Really cool.
What else…I’m still trying to figure out in my mind some way to not be affected by the way people can often be in the street…comments all the time about the white girl…I’ve written about this before…anyway, I haven’t found a way to filter it out yet…but it must be possible, because in order to survive at the hospital, I have had to convert myself to not being devastated every time I see birth rape…somehow, as a survival mechanism, I did that, without even realizing it…so it must be possible to filter this out as well…the thing is that with this, the way people make me feel is that I will never fit in, I will always be strange, different…anyway, still working on that…in the meantime it still hurts my feelings all the time, and Blada has spent countless nights holding me in his arms while I cried about it…there has to be a better way…
We visited Blada’s family this weekend in Okap…(Cap Haitian)…it was so nice to be with them…but traveling there and back is exhausting…plus we went on eday and returned the next…it’s a 4-5 hour ride jam-packed in an old pickup truck, that they have to push start…seriously, the whole road is just rocks…you’re bottoming out the whole time, bouncing so hard that you feel like your organs are just slamming against each other constantly…seriously, this is the reality of traveling in Haiti. Since there’s no actual real government that provides any kind of services to its citizens, such as mail service, it’s the chauffeurs who deliver packages and letters for people along the way…part of the way, it was raining, and the road was just all mud…going up and down hills…this guy, the driver, he is so experienced at driving those hills, he was fishtailing on purpose just to get the heavily-loaded truck up and down those hills…you have to cross a few rivers too…(drive through the river)…one time the water was deep enough that it came into the cab of the truck…
All of this is just another day for people here, who, that has always been the way you travel…you have no other option. I don’t mind it, it is interesting, but also very tiring.
The students are doing great. I am really proud of them. They have the right attitude. They really care about the women they serve. It shines through in the ways they talk to the women, and the energy that keeps them on their feet all day instead of sitting down and yelling at patients from across the room…
Well I guess that’s all for now…
Love all fo you…thank you to all fo you for reading my blog and staying current on my life…
Things here are going really well. This is the easiest time so far this year. The students are doing great; we’re over halfway through the class year. The house is way more relaxed--for the 1st 5 months of this class year, starting in January, we had volunteers every single week, with no break. For 5 months. Now, we have had a couple of breaks, and, for over the past month, we have had all really great, really easy (low maintenance) and fun volunteers. And, Kirsty and Mackenzy have now been here for 2 weeks, and this has added a wonderful element to the household. It feels like more of a community now. We’re living with people who we share a lot of things in common with, even just with our lifestyles and overall beliefs…we get along really really well. It is so good. I like Kirsty so much. Also, with them here, and knowing their vision for their life here, it makes living in Haiti more appealing. They have land in the south…they have lots of gardens…
What a blessing. Blada and I are great, just more and more connected and in love with each passage of time. He is so wonderful, I just can’t wait for those of you who can, to meet him when we come to the US. This weekend is our one year anniversary. A year ago, there was a day that marked a change in the course of our friendship. We had already been getting together for awhile, on and off for 1-2 months, to dance. To practice. Well this one day, we had finished practicing, and then their was a huge downpour of rain. A thunderstorm, with lightning, wind…and 2 full arc rainbows in the sky. A beautiful storm, a sign from nature. This day, we danced in the rain. And then sat down and talked for awhile, in the rain. This day, the energy began to shift. This was the beginning of us dating.
Anyway I could go on about that but I’ll leave it there.
Nothing else too spectacular to report…well, one sad event, which repeats itself every 1-2 months without fail: a woman died at the hospital. She was a small woman, who was very pale and weak from anemia. She came in with a hemoglobin of 5, not as low as some people who make it here--got a transfusion after days of waiting for blood, and then was at the hospital still for about 2 weeks. I spent some time with her, talking to her about her ailment (to her it was a sickness that someone had sent upon her with black magic, someone who was jealous of her…)…talking to her about nutrition and all the thing sshe could eat at home for iron…
Well, this came as a surprise to me because I had just seen her 2 days before, but yesterday I heard that she had died. Apparently she started having diarrhea and vomiting. I don’t know if it was cholera--but it definetly could have been, and I think she should have been rushed over to the cholera tents (in front of the hospital) for treatment. Anyway, I guess she got really dehydrated and died. I don’t know more info about it except for that. She had one child.
6-20-11
Well, this week was crazier than last week. Another woman died at the hospital--this time from a placental abruption. I wasn’t there--apparently she had the classic signs--her belly was hard and full of blood (but no external bleeding). Anyway, they didn’t do a c/s--they don’t always do them for abruptions, if the mom isn’t bleeding a lot and she’s stable--but, in this case, she had already lost so much blood when she showed up, it may have been too late anyway even with a c/s (they don’t have blood available in the hospital)…so, she birthed (a dead baby), and then died 1 hour later.
The next day, there 2 eclamptic women--one of them was 16 years old and came in seizing. She was in labor, 6cms. We got her on mag sulfate…I had to leave before she had her baby, but she was pushing when I left. Most of the time when I was there, she was unconscious, after the seizure. She started coming around a little, getting a little responsive…but really out of it, thrashing her body around, really agitated…when she was unconscious, you could still tell when she had a contraction…she would moan and kind of thrash around..it was still hurting her..
Well, she had her baby after I left (the FHT’s were great the whole time I was there, and we were listening often). I guess the baby wasn’t OK when he was born, and needed to be recessed, and then they gave him to the “ped unit”…(it’s not a real ped unit…)…anyway, he died the next day..there were 2 or 3 babies who died this week…1-2 days after they were born…the hospital just doesn’t have any means of giving care to babies who need anything more than IV antibiotics…they don’t even have oxygen to give them…anyway…this mom, I’m not sure how well she’s doing…I haven’t heard any really bad news, but, I heard that the next day, after her birth, she was unconscious again…I guess she seized again….I don’t know if they were monitoring her appropriately and keeping her or mag sulfate to prevent more seizures…
Well, the same day that she birthed, there was another woman, who had a previa. (the placenta is situated over the cervix…so when the cervix starts to open, the placenta separates and the mom bleeds a lot and both mom and bb can die). This woman, at one moment, I thought she was dying in my hands. She was waiting to be wheeled into the OR for a c/s, and I was doing vitals on her. She was bleeding A LOT, and a few times said that she was going to die right there. Well, she lost consciousness at one point, and I opened her eye and looked into it and it looked like it was flat, fixed. I took her B/P, and it sounded like either 40-20 or nothing at all…it was faint. Well, she was still alive and when I took her B/P again, it was actually 80-40. She got her c/s and a blood transfusion and was OK. I don’t know if her baby made it though.
The next day after the 16 year-old eclamptic woman and the placenta previa woman, there was another woman who came in with an abruption, but birthed and was ok, and another woman who was eclamptic, and, to top it off, there was another woman, who had a bowel obstruction and was vomiting shit. I’m not kidding. Thank god, she was transported to Cange and hopefully had her operation STAT and hopefully was ok.
So, this week was crazy. The students see so much here. They are like 6 months into the program and they’re working on super super high risk sick women. Being a midwife in Haiti means that you will work with a high-risk population, no matter what. You will see death, and severe pathology that midwives (and doctors) in the states would never see. People here become midwives because they want to save peoples’ lives. If you ask anyone here why they wanted to be a MW, that is what they say.
Our new housemates, Kirsty and Mackenzy, we are really enjoying them. We flow super easily, enjoy hanging out together, etc. it’s great. We always had a sort of community here at the house, but now, it’s on a totally different level. They’ve started gardens, compost…he’s an agronomist. He’ll be bringing his little daughter here soon too, which will be nice for the house…we already have Jamlex, our cook’s baby, who comes here with here all the time and is SOO much fun (he’s 14 months old…), so this will make it even more like…a family. Really cool.
What else…I’m still trying to figure out in my mind some way to not be affected by the way people can often be in the street…comments all the time about the white girl…I’ve written about this before…anyway, I haven’t found a way to filter it out yet…but it must be possible, because in order to survive at the hospital, I have had to convert myself to not being devastated every time I see birth rape…somehow, as a survival mechanism, I did that, without even realizing it…so it must be possible to filter this out as well…the thing is that with this, the way people make me feel is that I will never fit in, I will always be strange, different…anyway, still working on that…in the meantime it still hurts my feelings all the time, and Blada has spent countless nights holding me in his arms while I cried about it…there has to be a better way…
We visited Blada’s family this weekend in Okap…(Cap Haitian)…it was so nice to be with them…but traveling there and back is exhausting…plus we went on eday and returned the next…it’s a 4-5 hour ride jam-packed in an old pickup truck, that they have to push start…seriously, the whole road is just rocks…you’re bottoming out the whole time, bouncing so hard that you feel like your organs are just slamming against each other constantly…seriously, this is the reality of traveling in Haiti. Since there’s no actual real government that provides any kind of services to its citizens, such as mail service, it’s the chauffeurs who deliver packages and letters for people along the way…part of the way, it was raining, and the road was just all mud…going up and down hills…this guy, the driver, he is so experienced at driving those hills, he was fishtailing on purpose just to get the heavily-loaded truck up and down those hills…you have to cross a few rivers too…(drive through the river)…one time the water was deep enough that it came into the cab of the truck…
All of this is just another day for people here, who, that has always been the way you travel…you have no other option. I don’t mind it, it is interesting, but also very tiring.
The students are doing great. I am really proud of them. They have the right attitude. They really care about the women they serve. It shines through in the ways they talk to the women, and the energy that keeps them on their feet all day instead of sitting down and yelling at patients from across the room…
Well I guess that’s all for now…
Love all fo you…thank you to all fo you for reading my blog and staying current on my life…
Sunday, June 5, 2011
5/26-6/5/11
5-26-11
Today is my birthday!
What a big difference from last year--last year I didn’t have anyone to celebrate with…had a good day, by myself…made the best of it…today, the students insist on coming over to sing to me…after we work at the hospital this morning…I made some cookies and sweet cornbread last night to share…I think it will be sweet…
The rainy season has begun…just about every day it starts raining sometime in the afternoon…sometimes it rains really hard, sometimes it rains slowly and for a long time…it makes everything more beautiful…the trees are greener…there is less dust on the road…it’s cooler…the insects sing more…(I still never hear birds sing…sad…there should be lots of birds here…)
I never got news about the lady with the severe abscess, who we transported to Cange. I think she’s probably at home and OK, however I don’t know if she continued BF her 1 month old baby…
Yesterday though, I did see the other lady we had transported that day…the 24-week pregnant lady with the strangulated hernia…she is OK….coming in every 3rd day for dressing changes on her bandage…so her life was saved, but her life sounds impossibly hard…she was talking to me yesterday, hoping that I could help her with some money…it’s so hard because SO many people have lives that are this hard and need the same help, and you can’t help everyone…I’m here to train midwives, and to provide healthcare…that’s all I can really do…but sometimes I do give people money when I see that that is the only way they’ll make it…anyway, here is her situation: she is staying in Hinche with one daughter, at someone else’s house. The husband of the friend letting her stay there is starting to be outraged at her presence. She’s from really far away in the country and she has 4 other kids out there, with no one taking care of them. They’re on their own. One of them Is 3 years old. Her husband is in the DR working and they have no communication and she doesn’t know when he’s coming back. She has no money, not even for paying to get on a truck to go home. She still needs to come in every 3 days for dressing changes and needs her stitches removed in 2 weeks. So she has to stay in Hinche for atleast that time.
Peoples’ lives are so impossibly hard here. You hear stories like this all the time. And most of them, they’re not exaggerated. That’s the real truth.
5-28-11
I had a really really happy, joyous, fun birthday. It was wonderful. Apparently the students and Marthonie had been planning a surprise party for me since last week. They came and made a party! They were so much fun. This group of women is really special. They are heartfelt, caring, sincere, loving, and FUN. There is one girl in our class who is HILARIOUS. She is one of those people who is always joking, always laughing, always making people laugh. She had me laughing throughout the whole party…some of the students danced together, and she was dancing too, but kind of in a joking way…I wish I had a video of it. I’ll never forget it. The most wonderful thing was that they all came together to show me their love and appreciation for me. It was so real, so unpretentious. One of the best birthdays I’ve ever had. It really is the happiest of them all because now, I’m not missing true love anymore. Blada and I are together, closer every day. So, because of that, I feel like my life is on track, even though sometimes I can barely stand living in Haiti and with the American volunteers.
The past few weeks with volunteers have been really good though. Really great folks who have come through, helped a lot, given us personal space, just been overall really easygoing. That’s been so nice. Now, we have 1 week with no volunteers. Such a blessing to have a little break. We should have a break regularly--it’s not normal to never have a break from people.
Anyway…
We had a really great birth yesterday…this poor lady had been being induced for a couple of days (for pre-eclampsia) and was exhausted…1st baby--finally was close to having her baby…pushing on a 3cm cervix, flailing around, screaming…it was almost time for us to leave…I stayed by her, and got her grandmother to come in too…just stayed there and massaged her and tried to slowly quietly soothe her fears and help her to calm down…well, during this time, of course there were other people standing around, watching, doing nothing to help, even laughing at her as she struggled…(these people are students in an auxilliare school--it’s like nurse’s aid school, 2 years long)…anyway, I usually talk to them about stuff and try to give them advice about how to treat people, but in this l=moment I just ignored them. Well, after awhile of struggling, this woman gave in and relaxed into her labor and let it happen…pretty soon she was complete…pushed her bb out fast, in hands and knees…had a really beautiful birth…I think she tore her cervix, because she was spurting blood at first (not from a vaginal tear), but then it stopped…so we let it be…I had thought that her bb was going to die right after birth, because of being so premature, but, the baby was more weeks than we had thought…maybe 32 or 33...was breathing on his own, and rooting…he looked like he was going to make it when I left…if he nurses a lot and stays warm…if not, he will not make it. So, hopefully.
6-5-11
The above baby DID make it! His mom was rally connected to him and breastfeeding him. I was so happy to hear this a few days ago!
Things here are better than they’ve ever been. Our living situation: the house: it is so much better because we have these new housemates, who we knew were coming and have been waiting for for months. Their names are Kirsty and Mackenzy. She is a Canadian MW and he is her Haitian fiance. They’re really down to earth, relaxed, cool, fun, nice, etc. they’re really into gardening and have already started gardens here. I feel like we can learn a lot from them. Having someone else here to help hold the space & who understands the realities here feels so good. They’re only been here for a week and we already feel so at home together. I feel like a layer of stress has been lifted off of me, because I don’t have to carry the house alone anymore, and interact with the visiting MW’s alone anymore. Thank god. The past few months here, until about a month ago, were really stressful. Getting the house going, starting a new class, having CONSTANT volunteers coming, each week, never ever having a break for ourselves.
There are things that are hard to address with people, such as people walking in here and taking pictures of everyone all the time. It’s a total underlying attitude…what do you say to them about that? Even if you ask someone’s permission to take their picture, and they say yes, that doesn’t mean that they’re really consenting to it…no matter what you do, there is a power differential when you come to a place like this and you have a camera and you are white…people don’t usually know how to say no. to me, it’s voyeuristic and exploitative to come to a place for a week and feel entitled to take all these pictures of people,,,in town, in the hospital…would you walk into a hospital in the US and take peoples’ pictures that you don’t know? I don’t think so. What makes you think that’s ok to do here? Because you paid your money and volunteered? Things like this that fucking drive me crazy sometimes…and I’m the one who’s here each day, seeing people come and go, seeing people repeat the same patterns…asking myself how the people here feel about having their pictures taken by all these white people who they’ll never see again…this is an example of why I’m glad Kirsty is here. To help hold things down and explain things to people so that hopefully they’ll think about it in a real way.
Anyway, like I said, everything has taken a turn for the better since about a month ago. The volunteers have been great, things have flowed more easily, and the house has been less stressful. The place you live shouldn’t be a source of stress in your life. It should be a place to relax and unwind from your work and outside life.
Even though the past month has been really great, I see that I am still processing the undue amount of stress that has been here in our house for the 1st several months of the new class (january-april).
Nothing too crazy at the hospital recently…let’s see…there was a lady who had had eclamptic seizures and was still there and I guess was in a coma the night before…well, she was the most agitated post-eclamptic person I’ve ever seen…she was talking NONSTOP, like a crazy person…going on and on about all kinds of crazy things…total drama about her aunt trying to kill her and just crazy stuff.
Then there was a woman who had a ruptured ectopic pregnancy (the fertilized ovum had embedded in the fallopian tube, which eventually burst, and then she was bleeding internally)---I didn’t see her myself but apparently, she was admitted the day before for abdominal pain,,,the OB did a sono and couldn’t see anything…only fluid…(it was blood)--well the next day apparently she was in more pain, and he did another sono, and still didn’t see anything…so what he did was insert a needle into her abdomen and withdrew to see if there was blood…yes, there was bright red blood…he rushed into the OR with her and operated on her ruptured ectopic pregnancy…she got a blood transfusion…after which her hemoglobin was 5...she really could have died…and would have if he hadn’t done surgery on her when he did…she had already lost a lot of blood…
Anyway…so, yes, things are good here…not too crazy, just moving along. The students are doing great. I taught NNR (neonatal resusitation) to them the other day, and we practiced a lot…they did great…I felt really good about the information I delivered to them…simple, complete, all the essentials.
Blada is great…I love all you guys…
Today is my birthday!
What a big difference from last year--last year I didn’t have anyone to celebrate with…had a good day, by myself…made the best of it…today, the students insist on coming over to sing to me…after we work at the hospital this morning…I made some cookies and sweet cornbread last night to share…I think it will be sweet…
The rainy season has begun…just about every day it starts raining sometime in the afternoon…sometimes it rains really hard, sometimes it rains slowly and for a long time…it makes everything more beautiful…the trees are greener…there is less dust on the road…it’s cooler…the insects sing more…(I still never hear birds sing…sad…there should be lots of birds here…)
I never got news about the lady with the severe abscess, who we transported to Cange. I think she’s probably at home and OK, however I don’t know if she continued BF her 1 month old baby…
Yesterday though, I did see the other lady we had transported that day…the 24-week pregnant lady with the strangulated hernia…she is OK….coming in every 3rd day for dressing changes on her bandage…so her life was saved, but her life sounds impossibly hard…she was talking to me yesterday, hoping that I could help her with some money…it’s so hard because SO many people have lives that are this hard and need the same help, and you can’t help everyone…I’m here to train midwives, and to provide healthcare…that’s all I can really do…but sometimes I do give people money when I see that that is the only way they’ll make it…anyway, here is her situation: she is staying in Hinche with one daughter, at someone else’s house. The husband of the friend letting her stay there is starting to be outraged at her presence. She’s from really far away in the country and she has 4 other kids out there, with no one taking care of them. They’re on their own. One of them Is 3 years old. Her husband is in the DR working and they have no communication and she doesn’t know when he’s coming back. She has no money, not even for paying to get on a truck to go home. She still needs to come in every 3 days for dressing changes and needs her stitches removed in 2 weeks. So she has to stay in Hinche for atleast that time.
Peoples’ lives are so impossibly hard here. You hear stories like this all the time. And most of them, they’re not exaggerated. That’s the real truth.
5-28-11
I had a really really happy, joyous, fun birthday. It was wonderful. Apparently the students and Marthonie had been planning a surprise party for me since last week. They came and made a party! They were so much fun. This group of women is really special. They are heartfelt, caring, sincere, loving, and FUN. There is one girl in our class who is HILARIOUS. She is one of those people who is always joking, always laughing, always making people laugh. She had me laughing throughout the whole party…some of the students danced together, and she was dancing too, but kind of in a joking way…I wish I had a video of it. I’ll never forget it. The most wonderful thing was that they all came together to show me their love and appreciation for me. It was so real, so unpretentious. One of the best birthdays I’ve ever had. It really is the happiest of them all because now, I’m not missing true love anymore. Blada and I are together, closer every day. So, because of that, I feel like my life is on track, even though sometimes I can barely stand living in Haiti and with the American volunteers.
The past few weeks with volunteers have been really good though. Really great folks who have come through, helped a lot, given us personal space, just been overall really easygoing. That’s been so nice. Now, we have 1 week with no volunteers. Such a blessing to have a little break. We should have a break regularly--it’s not normal to never have a break from people.
Anyway…
We had a really great birth yesterday…this poor lady had been being induced for a couple of days (for pre-eclampsia) and was exhausted…1st baby--finally was close to having her baby…pushing on a 3cm cervix, flailing around, screaming…it was almost time for us to leave…I stayed by her, and got her grandmother to come in too…just stayed there and massaged her and tried to slowly quietly soothe her fears and help her to calm down…well, during this time, of course there were other people standing around, watching, doing nothing to help, even laughing at her as she struggled…(these people are students in an auxilliare school--it’s like nurse’s aid school, 2 years long)…anyway, I usually talk to them about stuff and try to give them advice about how to treat people, but in this l=moment I just ignored them. Well, after awhile of struggling, this woman gave in and relaxed into her labor and let it happen…pretty soon she was complete…pushed her bb out fast, in hands and knees…had a really beautiful birth…I think she tore her cervix, because she was spurting blood at first (not from a vaginal tear), but then it stopped…so we let it be…I had thought that her bb was going to die right after birth, because of being so premature, but, the baby was more weeks than we had thought…maybe 32 or 33...was breathing on his own, and rooting…he looked like he was going to make it when I left…if he nurses a lot and stays warm…if not, he will not make it. So, hopefully.
6-5-11
The above baby DID make it! His mom was rally connected to him and breastfeeding him. I was so happy to hear this a few days ago!
Things here are better than they’ve ever been. Our living situation: the house: it is so much better because we have these new housemates, who we knew were coming and have been waiting for for months. Their names are Kirsty and Mackenzy. She is a Canadian MW and he is her Haitian fiance. They’re really down to earth, relaxed, cool, fun, nice, etc. they’re really into gardening and have already started gardens here. I feel like we can learn a lot from them. Having someone else here to help hold the space & who understands the realities here feels so good. They’re only been here for a week and we already feel so at home together. I feel like a layer of stress has been lifted off of me, because I don’t have to carry the house alone anymore, and interact with the visiting MW’s alone anymore. Thank god. The past few months here, until about a month ago, were really stressful. Getting the house going, starting a new class, having CONSTANT volunteers coming, each week, never ever having a break for ourselves.
There are things that are hard to address with people, such as people walking in here and taking pictures of everyone all the time. It’s a total underlying attitude…what do you say to them about that? Even if you ask someone’s permission to take their picture, and they say yes, that doesn’t mean that they’re really consenting to it…no matter what you do, there is a power differential when you come to a place like this and you have a camera and you are white…people don’t usually know how to say no. to me, it’s voyeuristic and exploitative to come to a place for a week and feel entitled to take all these pictures of people,,,in town, in the hospital…would you walk into a hospital in the US and take peoples’ pictures that you don’t know? I don’t think so. What makes you think that’s ok to do here? Because you paid your money and volunteered? Things like this that fucking drive me crazy sometimes…and I’m the one who’s here each day, seeing people come and go, seeing people repeat the same patterns…asking myself how the people here feel about having their pictures taken by all these white people who they’ll never see again…this is an example of why I’m glad Kirsty is here. To help hold things down and explain things to people so that hopefully they’ll think about it in a real way.
Anyway, like I said, everything has taken a turn for the better since about a month ago. The volunteers have been great, things have flowed more easily, and the house has been less stressful. The place you live shouldn’t be a source of stress in your life. It should be a place to relax and unwind from your work and outside life.
Even though the past month has been really great, I see that I am still processing the undue amount of stress that has been here in our house for the 1st several months of the new class (january-april).
Nothing too crazy at the hospital recently…let’s see…there was a lady who had had eclamptic seizures and was still there and I guess was in a coma the night before…well, she was the most agitated post-eclamptic person I’ve ever seen…she was talking NONSTOP, like a crazy person…going on and on about all kinds of crazy things…total drama about her aunt trying to kill her and just crazy stuff.
Then there was a woman who had a ruptured ectopic pregnancy (the fertilized ovum had embedded in the fallopian tube, which eventually burst, and then she was bleeding internally)---I didn’t see her myself but apparently, she was admitted the day before for abdominal pain,,,the OB did a sono and couldn’t see anything…only fluid…(it was blood)--well the next day apparently she was in more pain, and he did another sono, and still didn’t see anything…so what he did was insert a needle into her abdomen and withdrew to see if there was blood…yes, there was bright red blood…he rushed into the OR with her and operated on her ruptured ectopic pregnancy…she got a blood transfusion…after which her hemoglobin was 5...she really could have died…and would have if he hadn’t done surgery on her when he did…she had already lost a lot of blood…
Anyway…so, yes, things are good here…not too crazy, just moving along. The students are doing great. I taught NNR (neonatal resusitation) to them the other day, and we practiced a lot…they did great…I felt really good about the information I delivered to them…simple, complete, all the essentials.
Blada is great…I love all you guys…
Saturday, May 14, 2011
5-14-11
5/14/11
The last 2 weeks….prett busy. Always at the hospital, each week, there is some patient who stays in my mind over the weekend. Each week. There are so many different cases that we see.
The week before this week, there were 10 visitors in the house. I had been really worried about how this would be, and yes, I did lose sleep because some of them got up and made a lot of noise really early every morning. But, overall it was actually a really enjoyable week. I liked the people who were here. Several of them were with MWH, and the rest of them were doing their own thing--burses and doctors doing mobile primary health care clinics. There was this pediatrician who was heartbroken because he couldn’t save this 3 year-old kid’s life--the kid had pneumonia--the family wouldn’t let him treat the kid because they believed the sickness was caused by voudou. They wouldn’t participate. It was out of his hands.
Nadene and Steve, the directors of MWH, were here, and that was good--we talked about a lot of things and made some progress. Plus they are fun to be around. Really relaxed, with a good sense of humor.
There was another person who was here that week, who really touched me. Her name is Dr Alice. She is an OB with the heart of a midwife. Super loving and compassionate towards women. I was really taken aback by this, because that’s not usually what you expect from an OB. We had a situation that I will describe, where we worked together on this lady, and she was just so, so loving and compassionate and patient. It brings tears to my eyes to think about it. I’m just so thankful that there are OB’s like this out there. I met another female OB one time who also seemed super super nice--she actually had her kids with midwives, so that tells you something. But I didn’t ever work with her like this. Steve, he’s an OB, and he’s really great too, but he’s a guy. Anyway, I want to pay tribute to all the really cool doctors out there who are just as loving and gentle as midwives. I really am so ,so touched by what I saw. I will always remember those moments.
The woman I worked on together with Dr Alice was a 5/5, (5 pregnancies, 5 births) who was about 1 ½ months postpartum. She was from far away. She came in with a terrible, terrible breast abscess. She had probably stayed at home for a long time with it, and then she had gone to this other hospital, where she sat for 10 days without them doing anything for her. Then, her family brought her to St Therese. This was the worse breast abscess that either Dr Alice or this other MW had ever seen. The OB here, he incised it with a scalpal blade, and as soon as he did, pus just shot out with such force that it hit the wall. It kept coming out. All over the floor. He had put her to sleep for this--with ketamine. For about 10 min. After the pus stopped shooting out on its own, he dug around inside her breast with his fingers, in order to loosed up and remove any other pockets of pus. The abscess was involving a huge portion of her breast. When he had incised the abscess, the skin over it just burst open, and made a huge hole ( like 4cm) and also another little hole, going to another abscess, which was connected to the main one by a tract. All the skin above and around the abscess was already separated from the tissue beneath.
Dr Alice and I continued caring for this woman after this. We went to the hospital twice a day to clean out her abscess and re-bandage it. It was in one fo these moments when the mom was in a lot of pain, when Alice was cleaning our her wound, when Alice impressed me so much. She was saying to me “she’s working so hard” and just being so loving with the woman. Really compassionate, really feeling for her and validating this woman’s experience.
So, we continued doing this for a few days, and had to debride the inside of the abscess a few times, and do a lot of massage to get her engorgement down and work the pus out. She started improving. Alice left on sat, and by chance, another OB arrived that same day. So, I continued the wound care with her. Well, it started looking like each time we went, we needed to debride it, because there was still more dead tissure each time. Plus, it looked like she may have another abscess higher up in her breast, but we weren’t sureif it was that or engorgement. To add to the problem, for the 1st 2-3 days, the people at the hospital were neglecting her and not administering her IV antbiotices. As much as they overuse antibiotics, this woman really needed them and wasn’t getting them. Well, finally they got their act together and started doing that atleast.
So, the following Monday (this past Monday, 5 days after the woman had come in), we decided to transfer her to Cange, because there is a better hospital there (Paul Farmer’s place). As of right now, St Therese doesn’t have a general surgeon, so there was no one who could do surgery on her. (We thought she needed surgery at this point: more extensive debridement, etc.
So, the only way to get her there was to take her in the MWH jeep. Ronel, the driver, readily agreed and we prepared to TR. Well, this same day, in the morning, another woman had also come in to the hospital and was in grave danger. She had a hernia that had gotten trapped (a part of her intestines were protruding through her abdominal muscles and couldn’t be replaced back)--she was in A LOT of pain, and the danger was that after a number of hours, this part of the intestines wasn’t getting circulation and would die--which would cause other problems and eventually death. So, it ws hard to wrench her out of the hands at the hospital--people were insisting that we wait until one of her family members returned in order to send them with her. Yes, that would be good, but we didn’t know how long that would take, and her life was on the line. She had already been there all day, writhing in pain. Finally we left, and I called Blada and had him give someone money for a tap tap for when the family member showed up.
So we left the hospital, and then had to drive around Hinche and the market, looking for diesel fuel to fill the jeep engine. That took a long time. Finally we left Hinche…made it to Cange eventually--both women got admitted--the urgent one, she got into surgery within an hour. She was also 24 weeks pregnant. The breast abscess lady, Felice, she got surgery the next day. Thankfully, there was an American BREAST SURGEON there who did the surgery. He discovered another tract going to another abscess, probably the one we weren’t sure of. She got the care she needed. I am so thankful. Unfortunately I haven’t heard anything from either ladies, and I have no updates since the day after we TR them. The person I was in contact with, he went back to the US.
Hopefully I will hear from them.
Then, a couple days ago, we had a baby who was born with a defect called a meningocele. Basically a hole in his back overlying the spinal column. A hole, covered by a membrane. I covered it with sterile gauze and saline, and kept if wet, and tried to make arrangements to TR ASAP. It didn’t seem urgent to anyone else, and there really wasn’t a way to TR him anywhere anyway, until Ronel and the Jeep were free. Once again, Ronel readily agreed, and this time, took the bb to Port au Prince. To a hospital where they can do that surgery. I haven’t heard anything and don’t know if we ever will, but I’m just so thankful that atleast we were able to transfer the baby.
So, that has been the last couple of weeks.
I am making plans to return to the US this summer--first to EL Paso, for a final visit (for now) and to gather my stuff, and then drive to NC with it, because that is where we will land when we come on a fiancee visa (hopefully next summer). Then I will be in NC for a while too, and then come back.
We have another MW and her Haitian partner moving in here really soon--in about a week. I’m looking forward to having more continuity at the house and maybe more help with the volunteers.
That’s all for now…
The last 2 weeks….prett busy. Always at the hospital, each week, there is some patient who stays in my mind over the weekend. Each week. There are so many different cases that we see.
The week before this week, there were 10 visitors in the house. I had been really worried about how this would be, and yes, I did lose sleep because some of them got up and made a lot of noise really early every morning. But, overall it was actually a really enjoyable week. I liked the people who were here. Several of them were with MWH, and the rest of them were doing their own thing--burses and doctors doing mobile primary health care clinics. There was this pediatrician who was heartbroken because he couldn’t save this 3 year-old kid’s life--the kid had pneumonia--the family wouldn’t let him treat the kid because they believed the sickness was caused by voudou. They wouldn’t participate. It was out of his hands.
Nadene and Steve, the directors of MWH, were here, and that was good--we talked about a lot of things and made some progress. Plus they are fun to be around. Really relaxed, with a good sense of humor.
There was another person who was here that week, who really touched me. Her name is Dr Alice. She is an OB with the heart of a midwife. Super loving and compassionate towards women. I was really taken aback by this, because that’s not usually what you expect from an OB. We had a situation that I will describe, where we worked together on this lady, and she was just so, so loving and compassionate and patient. It brings tears to my eyes to think about it. I’m just so thankful that there are OB’s like this out there. I met another female OB one time who also seemed super super nice--she actually had her kids with midwives, so that tells you something. But I didn’t ever work with her like this. Steve, he’s an OB, and he’s really great too, but he’s a guy. Anyway, I want to pay tribute to all the really cool doctors out there who are just as loving and gentle as midwives. I really am so ,so touched by what I saw. I will always remember those moments.
The woman I worked on together with Dr Alice was a 5/5, (5 pregnancies, 5 births) who was about 1 ½ months postpartum. She was from far away. She came in with a terrible, terrible breast abscess. She had probably stayed at home for a long time with it, and then she had gone to this other hospital, where she sat for 10 days without them doing anything for her. Then, her family brought her to St Therese. This was the worse breast abscess that either Dr Alice or this other MW had ever seen. The OB here, he incised it with a scalpal blade, and as soon as he did, pus just shot out with such force that it hit the wall. It kept coming out. All over the floor. He had put her to sleep for this--with ketamine. For about 10 min. After the pus stopped shooting out on its own, he dug around inside her breast with his fingers, in order to loosed up and remove any other pockets of pus. The abscess was involving a huge portion of her breast. When he had incised the abscess, the skin over it just burst open, and made a huge hole ( like 4cm) and also another little hole, going to another abscess, which was connected to the main one by a tract. All the skin above and around the abscess was already separated from the tissue beneath.
Dr Alice and I continued caring for this woman after this. We went to the hospital twice a day to clean out her abscess and re-bandage it. It was in one fo these moments when the mom was in a lot of pain, when Alice was cleaning our her wound, when Alice impressed me so much. She was saying to me “she’s working so hard” and just being so loving with the woman. Really compassionate, really feeling for her and validating this woman’s experience.
So, we continued doing this for a few days, and had to debride the inside of the abscess a few times, and do a lot of massage to get her engorgement down and work the pus out. She started improving. Alice left on sat, and by chance, another OB arrived that same day. So, I continued the wound care with her. Well, it started looking like each time we went, we needed to debride it, because there was still more dead tissure each time. Plus, it looked like she may have another abscess higher up in her breast, but we weren’t sureif it was that or engorgement. To add to the problem, for the 1st 2-3 days, the people at the hospital were neglecting her and not administering her IV antbiotices. As much as they overuse antibiotics, this woman really needed them and wasn’t getting them. Well, finally they got their act together and started doing that atleast.
So, the following Monday (this past Monday, 5 days after the woman had come in), we decided to transfer her to Cange, because there is a better hospital there (Paul Farmer’s place). As of right now, St Therese doesn’t have a general surgeon, so there was no one who could do surgery on her. (We thought she needed surgery at this point: more extensive debridement, etc.
So, the only way to get her there was to take her in the MWH jeep. Ronel, the driver, readily agreed and we prepared to TR. Well, this same day, in the morning, another woman had also come in to the hospital and was in grave danger. She had a hernia that had gotten trapped (a part of her intestines were protruding through her abdominal muscles and couldn’t be replaced back)--she was in A LOT of pain, and the danger was that after a number of hours, this part of the intestines wasn’t getting circulation and would die--which would cause other problems and eventually death. So, it ws hard to wrench her out of the hands at the hospital--people were insisting that we wait until one of her family members returned in order to send them with her. Yes, that would be good, but we didn’t know how long that would take, and her life was on the line. She had already been there all day, writhing in pain. Finally we left, and I called Blada and had him give someone money for a tap tap for when the family member showed up.
So we left the hospital, and then had to drive around Hinche and the market, looking for diesel fuel to fill the jeep engine. That took a long time. Finally we left Hinche…made it to Cange eventually--both women got admitted--the urgent one, she got into surgery within an hour. She was also 24 weeks pregnant. The breast abscess lady, Felice, she got surgery the next day. Thankfully, there was an American BREAST SURGEON there who did the surgery. He discovered another tract going to another abscess, probably the one we weren’t sure of. She got the care she needed. I am so thankful. Unfortunately I haven’t heard anything from either ladies, and I have no updates since the day after we TR them. The person I was in contact with, he went back to the US.
Hopefully I will hear from them.
Then, a couple days ago, we had a baby who was born with a defect called a meningocele. Basically a hole in his back overlying the spinal column. A hole, covered by a membrane. I covered it with sterile gauze and saline, and kept if wet, and tried to make arrangements to TR ASAP. It didn’t seem urgent to anyone else, and there really wasn’t a way to TR him anywhere anyway, until Ronel and the Jeep were free. Once again, Ronel readily agreed, and this time, took the bb to Port au Prince. To a hospital where they can do that surgery. I haven’t heard anything and don’t know if we ever will, but I’m just so thankful that atleast we were able to transfer the baby.
So, that has been the last couple of weeks.
I am making plans to return to the US this summer--first to EL Paso, for a final visit (for now) and to gather my stuff, and then drive to NC with it, because that is where we will land when we come on a fiancee visa (hopefully next summer). Then I will be in NC for a while too, and then come back.
We have another MW and her Haitian partner moving in here really soon--in about a week. I’m looking forward to having more continuity at the house and maybe more help with the volunteers.
That’s all for now…
Sunday, May 1, 2011
4/20-5/1/11
4-20-11
This week and last week…
Today I had the honor of assisting in a stillbirth. Genette and I stayed a little late to be with this lady. She was an 8/7 (8th preg, 7 previous births). Probably she actually had been pregnant more times than that, and her admission just wasn’t correct, because most people here lose some of their babies.
She had a beautiful birth…her sister was next to her…she was supportive…luckily no one came in to kick her out…I also encouraged the other midwives to be cool about it…
So, she was “6 months” and preeclamptic. She had high B/P, but not that high. +4 proteinuria, and neurologic signs. We induced her with 200 mcg misoprostol in the morning. Around 10am. She birthed a little after 2pm. The baby came out in the bag, with the placenta. I was relieved to see the placenta come out right there because a lot of times with premature births, you have a retained placenta and have to do a manual removal, which is very painful for the mom. I think I knew when her placenta separated. Before she really started pushing. She had about a ½ cup clot, and I thought maybe her placenta was separating. So, she wanted to see and hold her baby. She held her little baby girl for about 5 minutes--I had assured her there was no rush; hold her baby, let herself cry, etc--and then a few minutes later, someone else was like: “ok, well let’s get you cleaned up.” Oh well. It was fine, that moment was good. She didn’t cry. I took the baby and weighed her--700 grams. Maybe she was like 26-28 weeks. She had just died. There had been heart tones on admission. But we had no choice about inducing her. If you don’t induce these severely pre-eclampic moms, they will die. The baby fit into a glove box. (medical gloves). I left her on the counter in a little box.
Today there was a lady who suddenly started crying, along with her family…in the ante partum room…it turns out that she had been eclamptic and lost consciousness and didn’t know anything that had happened, and didn’t know htat she had lost the baby until that moment when her family told her…
Last week…not too many things…the last day at the hospital, at one moment there were several things going on at once in the delivery room…2 births pretty close together, then an admission of a pre-eclamptic pregnant mom, plus an admission of a postpartum eclamptic mom who had birthed at home…plus, a woman who came in with her tiny premature baby who had just been born…maybe between 26-28 weeks…the baby started dying in her arms…I explained to her that her baby couldn’t be saved, etc…she got it…people get that pretty quick here. They accept it very quickly.
As all of this was happening in the delivery room, I was working in postpartum with the students. I worked all morning with this lady who when I arrived, her B/P was 190/140.
I had put her back on mag sulfate the day before, because she had started having a headache again and had +1 proteinuria, the day before--after having been diagnosed with pre-eclampsia and giving birth to a 7-month stillborn baby several days before. Anyway, I worked all day on her, giving her hydrolyzing IV to lower her B/P, figuring out with the other MW’s what PO meds she should be on for B/P…she is on 3 different B/P meds, plus phenobarbitol. A complicated case of a chronically hypertensive woman, who had PEC as well during the pregnancy…totally out of my scope in reality…however at the same time,
who else is there to take care of her? Who else was going to sit by her bedside all morning? No one.
4-27-11
This week for clinicals with the students it worked out that I was going to go on mobile clinics with the students. Today, tomorrow and Friday. Well, this morning, we left at 6am in order to drive about 2-3 hours to get to the community for the mobile clinic. There are 3 graduate midwives from our program who do the mobile clinics, and then we also accompany them with students in order to practice prenatal care with them. So, we leave Hinche and get to the next main town, and there is a roadblock. A group of people who are angry about the election results (not presidential, senator) have been putting up roadblocks in the mornings and making a big scene. Well, this morning it was really bad.
We arrived there, and there were trees across the road and 2 vans parked in the middle of the road. There was a group of people, some of them very angry and aggressive, who started hitting the jeep and yelling at Ronel, our driver. Then, they ordered all of us to get out of the Jeep. At that point, it was too late to try to turn around and leave. We had to get out. We got out, and stood by the side of the road. The ringleaders of this group were pacing around, yelling at people and being threatening. They had machetes, and one of them had a tank of gas (for burning a vehicle or a person). They seemed possessed, like totally crazy. They for sure had been up maybe all night or since early morning, either drinking or doing cocaine or both. There eyes were all glassed over--they looked totally crazy and out of their minds. It was really scary. We were completely at their mercy, all of us sticking together and acting cool, acting casual, not scared. But we were scared. Ronel was trying to talk to the guys, so that they would let us turn back. They took their machetes and slashed all of the tires on the 2 vans that were there--passenger vans on their way to port au prince. Everyone was stranded. They put a nail in one of the jeep tires and didn’t slash them but started taking the air out of them. This whole time, I was just trying to be invisible, as well as praying because our lives were totally in their hands, and they were not only angry, but totally deranged. They never said anything to me, except one person who was not really one of them but was there nevertheless---he started talking to me but I just ignored him. Eventually, the really bad guys paced away from where we were, and one of the midwives took me aside and told me to call Blada to have him send a motorcycle taxi to come and get me, because this was a really unsafe situation for me. Well, my phone was in the jeep. The midwife had 1 goud on her phone and called Manno instead, in order for him to send a couple of taxis to come and get us. In the meantime, I was supposed to start walking away, with one of the students. We were to walk away in pairs. Basically, lots of other people had already started slipping away and walking towards Hinche. So, I started walking away with the student. We got out of eyesight and kept walking. And kept walking. Apparently, the bad guys asked where I was when they strolled back. I was already gone, but the taxi never came. Manno didn’t understand the urgency of the situation. He didn’t send the taxis. But, the great thing was that they let Ronel and the midwives and the jeep to turn around. They came and picked us up on the road. They decided to let them go, and gave them “5 minutes” to be out of there. The tires were half flat, but we made it back to Hinche.
Everything was ok. I have been pretty upset today, just feeling the reality of what that situation was. Don’t worry, I don’t ever go through that area again at that time of day for the time being--and we are going to change the 3 mobile clinic locations that oblige us to drive through Thomond. Going through Thomond is totally inevitable though, if you are going to port au prince or many other places. So I can’t say that I won’t go through there again.
Of course, the UN and the police were nowhere in sight. Everyone knows what’s going on, and they’re nowhere in sight. Apparently, they let it go on until about noon, and then they come and break it up. There is obviously another agenda behind this violence--it makes me think about other places in the world where powerful groups manipulate people into turning against their own brothers and sisters. It’s the same thing--it’s not as simple as a group of angry people making a violent protest.
So, that was today. I feel more bonded to the mobile clinic midwives and Ronel, the driver, now. Because I really felt a super strong energy of love and protection between all of us. We were all psychically warding them off, and holding each other in the light.
5-1-11
I have considered taking out my last entry or re-writing it so as not to alarm and frighten everyone who reads the blog. But, what I wrote is what happened and it was a big deal. So, I am leaving it.
The next day, I went again on mobile clinic and this time, we had a normal, uneventful day. However, it did take us a long time to get to our destination because there were 2 roadblocks on the way--we had to search an alternate route to bypass them. We drove way off into the country down all these little roads, and then came out on the main road above the roadblocks. When we returned, on the main road, we could see where they had been. In one place, they had literally cut out sections of the road so that people couldn’t pass. People will do anything, and cause everyone else a lot of hardship, without caring. I just don’t understand how you could do something like this, without caring that you are making your fellow countrymen suffer. You’re angry with the gov’t, and then you make your brothers suffer because of it.
Today is Sunday. Nadene and Steve are coming today for one week; there are already 8 other people who arrived yesterday. They all seem really nice and eager to be conscientious houseguests. So that’s good. Still, no matter how considerate people are, this house makes a lot of noise, and with that many people, I know I will lose sleep this week.
The past few weeks leading up to now have been hard---with the house. I need to find some kind of balance with it all. The balance is protecting myself, so that I have some space and privacy, and also so that people understand how to help out in the house, and making people feel welcome and at ease here. It’s a group home, but it is also our home and day to day life. We have to keep some standards that enable our day to day life to be as normal and enjoyable as possible here. People don’t realize that--they come here for one week and then leave. For me, this is every day. I am trying to also just come to a place of accepting that this is my life for now. A more full acceptance. That will help.
This week and last week…
Today I had the honor of assisting in a stillbirth. Genette and I stayed a little late to be with this lady. She was an 8/7 (8th preg, 7 previous births). Probably she actually had been pregnant more times than that, and her admission just wasn’t correct, because most people here lose some of their babies.
She had a beautiful birth…her sister was next to her…she was supportive…luckily no one came in to kick her out…I also encouraged the other midwives to be cool about it…
So, she was “6 months” and preeclamptic. She had high B/P, but not that high. +4 proteinuria, and neurologic signs. We induced her with 200 mcg misoprostol in the morning. Around 10am. She birthed a little after 2pm. The baby came out in the bag, with the placenta. I was relieved to see the placenta come out right there because a lot of times with premature births, you have a retained placenta and have to do a manual removal, which is very painful for the mom. I think I knew when her placenta separated. Before she really started pushing. She had about a ½ cup clot, and I thought maybe her placenta was separating. So, she wanted to see and hold her baby. She held her little baby girl for about 5 minutes--I had assured her there was no rush; hold her baby, let herself cry, etc--and then a few minutes later, someone else was like: “ok, well let’s get you cleaned up.” Oh well. It was fine, that moment was good. She didn’t cry. I took the baby and weighed her--700 grams. Maybe she was like 26-28 weeks. She had just died. There had been heart tones on admission. But we had no choice about inducing her. If you don’t induce these severely pre-eclampic moms, they will die. The baby fit into a glove box. (medical gloves). I left her on the counter in a little box.
Today there was a lady who suddenly started crying, along with her family…in the ante partum room…it turns out that she had been eclamptic and lost consciousness and didn’t know anything that had happened, and didn’t know htat she had lost the baby until that moment when her family told her…
Last week…not too many things…the last day at the hospital, at one moment there were several things going on at once in the delivery room…2 births pretty close together, then an admission of a pre-eclamptic pregnant mom, plus an admission of a postpartum eclamptic mom who had birthed at home…plus, a woman who came in with her tiny premature baby who had just been born…maybe between 26-28 weeks…the baby started dying in her arms…I explained to her that her baby couldn’t be saved, etc…she got it…people get that pretty quick here. They accept it very quickly.
As all of this was happening in the delivery room, I was working in postpartum with the students. I worked all morning with this lady who when I arrived, her B/P was 190/140.
I had put her back on mag sulfate the day before, because she had started having a headache again and had +1 proteinuria, the day before--after having been diagnosed with pre-eclampsia and giving birth to a 7-month stillborn baby several days before. Anyway, I worked all day on her, giving her hydrolyzing IV to lower her B/P, figuring out with the other MW’s what PO meds she should be on for B/P…she is on 3 different B/P meds, plus phenobarbitol. A complicated case of a chronically hypertensive woman, who had PEC as well during the pregnancy…totally out of my scope in reality…however at the same time,
who else is there to take care of her? Who else was going to sit by her bedside all morning? No one.
4-27-11
This week for clinicals with the students it worked out that I was going to go on mobile clinics with the students. Today, tomorrow and Friday. Well, this morning, we left at 6am in order to drive about 2-3 hours to get to the community for the mobile clinic. There are 3 graduate midwives from our program who do the mobile clinics, and then we also accompany them with students in order to practice prenatal care with them. So, we leave Hinche and get to the next main town, and there is a roadblock. A group of people who are angry about the election results (not presidential, senator) have been putting up roadblocks in the mornings and making a big scene. Well, this morning it was really bad.
We arrived there, and there were trees across the road and 2 vans parked in the middle of the road. There was a group of people, some of them very angry and aggressive, who started hitting the jeep and yelling at Ronel, our driver. Then, they ordered all of us to get out of the Jeep. At that point, it was too late to try to turn around and leave. We had to get out. We got out, and stood by the side of the road. The ringleaders of this group were pacing around, yelling at people and being threatening. They had machetes, and one of them had a tank of gas (for burning a vehicle or a person). They seemed possessed, like totally crazy. They for sure had been up maybe all night or since early morning, either drinking or doing cocaine or both. There eyes were all glassed over--they looked totally crazy and out of their minds. It was really scary. We were completely at their mercy, all of us sticking together and acting cool, acting casual, not scared. But we were scared. Ronel was trying to talk to the guys, so that they would let us turn back. They took their machetes and slashed all of the tires on the 2 vans that were there--passenger vans on their way to port au prince. Everyone was stranded. They put a nail in one of the jeep tires and didn’t slash them but started taking the air out of them. This whole time, I was just trying to be invisible, as well as praying because our lives were totally in their hands, and they were not only angry, but totally deranged. They never said anything to me, except one person who was not really one of them but was there nevertheless---he started talking to me but I just ignored him. Eventually, the really bad guys paced away from where we were, and one of the midwives took me aside and told me to call Blada to have him send a motorcycle taxi to come and get me, because this was a really unsafe situation for me. Well, my phone was in the jeep. The midwife had 1 goud on her phone and called Manno instead, in order for him to send a couple of taxis to come and get us. In the meantime, I was supposed to start walking away, with one of the students. We were to walk away in pairs. Basically, lots of other people had already started slipping away and walking towards Hinche. So, I started walking away with the student. We got out of eyesight and kept walking. And kept walking. Apparently, the bad guys asked where I was when they strolled back. I was already gone, but the taxi never came. Manno didn’t understand the urgency of the situation. He didn’t send the taxis. But, the great thing was that they let Ronel and the midwives and the jeep to turn around. They came and picked us up on the road. They decided to let them go, and gave them “5 minutes” to be out of there. The tires were half flat, but we made it back to Hinche.
Everything was ok. I have been pretty upset today, just feeling the reality of what that situation was. Don’t worry, I don’t ever go through that area again at that time of day for the time being--and we are going to change the 3 mobile clinic locations that oblige us to drive through Thomond. Going through Thomond is totally inevitable though, if you are going to port au prince or many other places. So I can’t say that I won’t go through there again.
Of course, the UN and the police were nowhere in sight. Everyone knows what’s going on, and they’re nowhere in sight. Apparently, they let it go on until about noon, and then they come and break it up. There is obviously another agenda behind this violence--it makes me think about other places in the world where powerful groups manipulate people into turning against their own brothers and sisters. It’s the same thing--it’s not as simple as a group of angry people making a violent protest.
So, that was today. I feel more bonded to the mobile clinic midwives and Ronel, the driver, now. Because I really felt a super strong energy of love and protection between all of us. We were all psychically warding them off, and holding each other in the light.
5-1-11
I have considered taking out my last entry or re-writing it so as not to alarm and frighten everyone who reads the blog. But, what I wrote is what happened and it was a big deal. So, I am leaving it.
The next day, I went again on mobile clinic and this time, we had a normal, uneventful day. However, it did take us a long time to get to our destination because there were 2 roadblocks on the way--we had to search an alternate route to bypass them. We drove way off into the country down all these little roads, and then came out on the main road above the roadblocks. When we returned, on the main road, we could see where they had been. In one place, they had literally cut out sections of the road so that people couldn’t pass. People will do anything, and cause everyone else a lot of hardship, without caring. I just don’t understand how you could do something like this, without caring that you are making your fellow countrymen suffer. You’re angry with the gov’t, and then you make your brothers suffer because of it.
Today is Sunday. Nadene and Steve are coming today for one week; there are already 8 other people who arrived yesterday. They all seem really nice and eager to be conscientious houseguests. So that’s good. Still, no matter how considerate people are, this house makes a lot of noise, and with that many people, I know I will lose sleep this week.
The past few weeks leading up to now have been hard---with the house. I need to find some kind of balance with it all. The balance is protecting myself, so that I have some space and privacy, and also so that people understand how to help out in the house, and making people feel welcome and at ease here. It’s a group home, but it is also our home and day to day life. We have to keep some standards that enable our day to day life to be as normal and enjoyable as possible here. People don’t realize that--they come here for one week and then leave. For me, this is every day. I am trying to also just come to a place of accepting that this is my life for now. A more full acceptance. That will help.
Saturday, April 9, 2011
3/31-4/9/11
3/31/11
So…
The lady from last week, who had the 3 hemoglobin and then got the blood transfusion, she had a 5 hgb afterwards and was discharged. The day after the transfusion, she was up out of bed, bathing the baby, moving around--seemingly feeling a lot better. We did her hgb just to see, even though it was just 1 day after the transfusion--because it was a Friday and the lab is closed all weekend.
Today and yesterday I have been working with the students in post-op. It’s time to go for it--I have been more or less avoiding post-op all along because my skills aren’t so strong there. But I am seeing that it’s not such a big deal.
Thanks for peoples’ comments on FB and the emails regarding the maternal death that I wrote about last week. Thanks for everyone’s compassion and interest in following what I write. It helps me a lot to write about what I see here. It also really helps me to hear feedback and to know that people out there are in touch with my life here.
This isn’t the first maternal death I’ve seen here. It’s just the first person who I saw before my eyes who had just just died. We probably have one maternal death about every 2 months. I think we’ve already had 4 since the beginning of the year. Mostly women die here from eclampsia. I have been involved in the care of women who have died. I can recall several women who died last year, and a couple from this year.
There was a women who I had written about who died recently--she had sickling cell anemia and had a 2.3 hemoglobin. Moms and babies here die. Seeing these deaths has opened my eyes to how easy it really is to die. The fact that we’re all alive is amazing. We are walking such a thin line, all the time. Death is real. Seeing people here die, makes me think about the people I love who are close to me dying. When I think about that, I just feel sad, because I am not ready to let go of anyone yet. But I know that it is not my choice, when this will happen. It makes me want to come back to the US as soon as possible because I want to spend time with my family. I feel so far away from them. I don’t know when we will get up to the US. If things go smoothly, then maybe in the summer of 2012. Getting a visa for Blada is a process, with many parts. One part is that I need to find a co-sponsor, because I don’t make enough money to “sponsor” him myself. People are afraid to sign on for this, because there are too many “what if’s”. Yes, basically, whatever horrible and unlikely scenerio you can imagine, it could mean that the co-sponsor would be financially responsible. Like, if Blada had a heart attack and went to the hospital, and we didn’t pay the hospital bill. Any kind of government financial aid. Food stamps, a school grant, etc. If we used gov’t aid for him, then that’s where the co-sponsor would be pulled in. If anyone who knows the kind of person I am is reading this and sees the importance of this for me and is interested in being our co-sponsor, let me know. I can get more information about it too. It needs to be someone who is not afraid of all the “what if’s” and who sees life the same way I do: we all NEVER KNOW--we take risks all the time in our daily lives, and could have something unexpected happen at any moment. If I don’t have a co-sponsor, I can’t send the petition for our fiancee visa. I don’t want to be stuck in Haiti for my whole life. I want for Blada to meet my family and my community in NC and EP. I want to be pregnant and give birth in the US.
4-4-11
I went to the hospital today with the new MW’s do orient them to maternity, and one of the student asked me to check on a woman who she had worked on this past week. A 19 year-old woman, 1st pregnancy, recently married. This woman was preeclamptic, about 34 weeks pregnant, and also was anemic--her hgb was 6. Also, she had some kind of abdominal mass. I had seen her on wed and talked to her and she seemed ok--stable. They were waiting for the OB to do a sono on her to confirm if she had a mass or not, and also they were trying to get blood for a transfusion before inducing her for pre-eclampsia. Well, apparently she died on Sat. She gave birth, and I don’t know what else happened--if she had eclamptic seizures or just severe anemia plus postpartum hemorrhage. We are going to try and find out what we can when we return on Wed.
So many moms die here. This must be the 4th or 5th maternal death since the beginning of this year.
Marthonie and I talked about this woman’s case with the students this afternoon after I returned from the hospital. One of the main reasons people die here is because nothing happens quickly. Things take too long. Like, getting blood for a transfusion. The main reason is lack of materials and lack of infrastructure.
4-9-11
The woman I was describing above…from what I can tell, she died from pulmonary edema, secondary to pre-eclampsia. Not related to the anemia or the possible abdominal mass. 19 years old.
I am feeling a lot better--my spirits have lifted a lot during this week. Sometimes things here are just endlessly hard and overwhelming, and other times I am able to appreciate and enjoy what is, with greater ease.
This week in the hospital was satisfying. Usually I dread going there and working--the opposite of how I used to feel when I would go to work at MLL. But, atleast now, even if I dread going sometimes, often I end up having experiences with the patients that are really gratifying. Like, a deeper connection/ a bond after taking care of the same person for a couple of days. This week, Wed and Thur, I worked with the students in post-op. on the same people. I made friends with a few people, exchanged numbers with a couple…really nice. People really appreciate when they see you putting you heart into taking care of them or their family member. They notice the difference.
I got to do 2 births yesterday--both really great births. The first was a 1st timer, who went really fast from 4 cms to complete, and did great--the student who caught, it was her 1st time catching…the 3 students with me, they did a good job supporting the mom…I had to tell one of them one time, not to tell the mom to “cooperate”--that was the only glitch. I was like “she IS cooperating!! She is doing an amazing job! We don’t need to tell her to do anything different!” Geez. The students’ 1st response is always to tell people to cooperate and to tell them they shouldn’t cry. I always tell them that we are there to support the woman in any way, and if that means holding her while she cries, then great. Sometimes people need to cry. Especially when they’re going through labor, or just got abandoned by the father of the baby, or are having a miscairrage, or whatever.
The second birth was a 3rd timer, who had a really great spontaneous birth, with just me because it was busy and the students were leaving--in hands and knees. No one telling her what to do. Shirted the placenta semi sitting, kind of on one side, on the small exam table.
Being in births is uplifting for me, and is part of what is missing for me here. There are so many things here that make my reality so full and rich, and I have learned so much and continue to learn, but…I miss being in a lot of labors and births. Last year was busier with births.
There was someone in the hospital a few days ago, a father holding his maybe 2 year-old child in his arms. The child was severely malnourished. That was the 1st thing I noticed. He had brought the bb to the hospital because the bb apparently has something wrong with her leg--pain--it didn’t look deformed. Leg pain or foot pain.
Then he told us that they did an x-ray at the hospital, and discovered that there is a needle in the baby’s leg. On the inside of the theigh, straight across. A needle. Genette asked him if they (the parents) had put the needle in there. He looked down and said no. as we walked away, Genette said that for sure the parents had put the needle in there--they went to a sort of witch doctor that everyone goes to here, and that person put it in as a remedy. Genette said that one time she was putting in Norplant for someone, and the woman had a needle in her arm--inside her arm--as some kind of remedy or magical protection.
There was a postpartum patient yesterday morning who had birthed the night before, and hadn’t peed for 14 or 15 hours--her uterus was way up there--she was laying in a dirty bed, hadn’t eaten at all yet…and, she was this woman who Marthonie had evaluated the day before and who appeared PERHAPS lightly pre-eclamptic, but Marthonie wasn’t sure--she had +1 proteinuria and slightly elevated B/P, but no other signs…since we have no real lab tests to help us with diagnosing pre-eclampsia in it’s early stages/when it’s “mild”, that can be a hard dx sometimes. It’s obvious when someone is severely pre-eclamptic, but not always easy to dx when it’s light. So: the day before, she didn’t treat her for PEC. Well, the next morning, it was clear that she DID have PEC, because now her face was swollen. We cathed her because she hadn’t peed for so long, and then tested her pee for protein, and now it was +3. So, now we put her on mag sulfate. It was interesting to see the progression of her PEC. She hadn’t started getting better yet, after delivering. It was still worsening.
Also yesterday, not to come as a surprise, there was a woman who came in who has been bleeding for the past 6 days, but no cramps--13 weeks pregnant. Positive preg test. Her partner just kicked her out--when she started bleeding. The father of her 1st 3 kids, he died when she was pregnant with the last. She lives in the DR, working her ass off to support her kids here (like paying for school). She has no one to depend on. She broke down and just cried and cried in our arms. I made the students stay with her and hold her, and I did it with them. It was a calm moment in the delivery room, and we just held her and supported her while she cried and told us about her life. I see this so much. So many women, with so support whatsoever, with such hard lives. It is sad to see this pattern over and over, but it is also a privledge to sit with these women, and it is an obligation to involve the students in the act of having compassion for someone like this, and holding a loving space for her. We can’t fix her life, we can’t convince her partner to not kick her out, but what we can do, is spend this one moment with her, and give her our full attention, and hear her story, and give her validation.
Another person yesterday, she came in at 43+3 weeks, her 3rd pregnancy, a big baby--4-4.5 kilo--maybe twins but it more felt like a big baby to me--high blood pressure but no other signs of PEC--when I check her, the baby is also breech and high. We just put her on blood pressure medication to bring her B/P down a little and called the OB. I would have induced her for her high blood pressure and post dates, except that the baby was breech. A big cephalic baby I wouldn’t be so worried about.
Genette saved someone’s life a couple of weeks ago. This woman came in, with placenta previa, bleeding profusely. The OR was DOWN for about a week, because the anesthesiologist had gone to port au prince because he was sick. (The same people who work at this hospital, they go somewhere else when they’re sick!) ----so, anyone who actually needed a c/s, didn’t get one that week. Well, the only way to save this woman’s life was to somehow get her transported to Cange, about 45 minutes away, where ther is a better hospital (Paul Farmer’s hospital). Genette, who wasn’t on duty but had just come in to see someone, she did everything she could to transport this lady. She got in touch with the guy who drives the ambulance from the Cange hospital--yes, there is an ambulance--she called him, and he was far away, eventually made it, and picked up the lady. She made it to Cange, got a c/s, got a blood transfusion, and lived. It turned out that the ambulance driver, he knew this woman. Both he and the woman were so thankful to Genette. She literally saved this woman’s life. If she hadn’t walked into the hospital at that moment, the woman wh=ould have bled to death there. No one else who was there was going to go to such great lengths to save her life (making a phone call). It really shows you, how when you have no ambulances and no roads, people die. If there were basic services like this, a lot more people would survive.
Blada has been so supportive and accepting of me through my ups and downs here. Completely present, just full of love, always open, always compassionate. I am so thankful for him. I can’t even come close to describing how he really is. I just know it in my heart, and we both know how each other feel, and we both know that we can’t put our appreciation for each other into words. I am just so thankful for him.
So…
The lady from last week, who had the 3 hemoglobin and then got the blood transfusion, she had a 5 hgb afterwards and was discharged. The day after the transfusion, she was up out of bed, bathing the baby, moving around--seemingly feeling a lot better. We did her hgb just to see, even though it was just 1 day after the transfusion--because it was a Friday and the lab is closed all weekend.
Today and yesterday I have been working with the students in post-op. It’s time to go for it--I have been more or less avoiding post-op all along because my skills aren’t so strong there. But I am seeing that it’s not such a big deal.
Thanks for peoples’ comments on FB and the emails regarding the maternal death that I wrote about last week. Thanks for everyone’s compassion and interest in following what I write. It helps me a lot to write about what I see here. It also really helps me to hear feedback and to know that people out there are in touch with my life here.
This isn’t the first maternal death I’ve seen here. It’s just the first person who I saw before my eyes who had just just died. We probably have one maternal death about every 2 months. I think we’ve already had 4 since the beginning of the year. Mostly women die here from eclampsia. I have been involved in the care of women who have died. I can recall several women who died last year, and a couple from this year.
There was a women who I had written about who died recently--she had sickling cell anemia and had a 2.3 hemoglobin. Moms and babies here die. Seeing these deaths has opened my eyes to how easy it really is to die. The fact that we’re all alive is amazing. We are walking such a thin line, all the time. Death is real. Seeing people here die, makes me think about the people I love who are close to me dying. When I think about that, I just feel sad, because I am not ready to let go of anyone yet. But I know that it is not my choice, when this will happen. It makes me want to come back to the US as soon as possible because I want to spend time with my family. I feel so far away from them. I don’t know when we will get up to the US. If things go smoothly, then maybe in the summer of 2012. Getting a visa for Blada is a process, with many parts. One part is that I need to find a co-sponsor, because I don’t make enough money to “sponsor” him myself. People are afraid to sign on for this, because there are too many “what if’s”. Yes, basically, whatever horrible and unlikely scenerio you can imagine, it could mean that the co-sponsor would be financially responsible. Like, if Blada had a heart attack and went to the hospital, and we didn’t pay the hospital bill. Any kind of government financial aid. Food stamps, a school grant, etc. If we used gov’t aid for him, then that’s where the co-sponsor would be pulled in. If anyone who knows the kind of person I am is reading this and sees the importance of this for me and is interested in being our co-sponsor, let me know. I can get more information about it too. It needs to be someone who is not afraid of all the “what if’s” and who sees life the same way I do: we all NEVER KNOW--we take risks all the time in our daily lives, and could have something unexpected happen at any moment. If I don’t have a co-sponsor, I can’t send the petition for our fiancee visa. I don’t want to be stuck in Haiti for my whole life. I want for Blada to meet my family and my community in NC and EP. I want to be pregnant and give birth in the US.
4-4-11
I went to the hospital today with the new MW’s do orient them to maternity, and one of the student asked me to check on a woman who she had worked on this past week. A 19 year-old woman, 1st pregnancy, recently married. This woman was preeclamptic, about 34 weeks pregnant, and also was anemic--her hgb was 6. Also, she had some kind of abdominal mass. I had seen her on wed and talked to her and she seemed ok--stable. They were waiting for the OB to do a sono on her to confirm if she had a mass or not, and also they were trying to get blood for a transfusion before inducing her for pre-eclampsia. Well, apparently she died on Sat. She gave birth, and I don’t know what else happened--if she had eclamptic seizures or just severe anemia plus postpartum hemorrhage. We are going to try and find out what we can when we return on Wed.
So many moms die here. This must be the 4th or 5th maternal death since the beginning of this year.
Marthonie and I talked about this woman’s case with the students this afternoon after I returned from the hospital. One of the main reasons people die here is because nothing happens quickly. Things take too long. Like, getting blood for a transfusion. The main reason is lack of materials and lack of infrastructure.
4-9-11
The woman I was describing above…from what I can tell, she died from pulmonary edema, secondary to pre-eclampsia. Not related to the anemia or the possible abdominal mass. 19 years old.
I am feeling a lot better--my spirits have lifted a lot during this week. Sometimes things here are just endlessly hard and overwhelming, and other times I am able to appreciate and enjoy what is, with greater ease.
This week in the hospital was satisfying. Usually I dread going there and working--the opposite of how I used to feel when I would go to work at MLL. But, atleast now, even if I dread going sometimes, often I end up having experiences with the patients that are really gratifying. Like, a deeper connection/ a bond after taking care of the same person for a couple of days. This week, Wed and Thur, I worked with the students in post-op. on the same people. I made friends with a few people, exchanged numbers with a couple…really nice. People really appreciate when they see you putting you heart into taking care of them or their family member. They notice the difference.
I got to do 2 births yesterday--both really great births. The first was a 1st timer, who went really fast from 4 cms to complete, and did great--the student who caught, it was her 1st time catching…the 3 students with me, they did a good job supporting the mom…I had to tell one of them one time, not to tell the mom to “cooperate”--that was the only glitch. I was like “she IS cooperating!! She is doing an amazing job! We don’t need to tell her to do anything different!” Geez. The students’ 1st response is always to tell people to cooperate and to tell them they shouldn’t cry. I always tell them that we are there to support the woman in any way, and if that means holding her while she cries, then great. Sometimes people need to cry. Especially when they’re going through labor, or just got abandoned by the father of the baby, or are having a miscairrage, or whatever.
The second birth was a 3rd timer, who had a really great spontaneous birth, with just me because it was busy and the students were leaving--in hands and knees. No one telling her what to do. Shirted the placenta semi sitting, kind of on one side, on the small exam table.
Being in births is uplifting for me, and is part of what is missing for me here. There are so many things here that make my reality so full and rich, and I have learned so much and continue to learn, but…I miss being in a lot of labors and births. Last year was busier with births.
There was someone in the hospital a few days ago, a father holding his maybe 2 year-old child in his arms. The child was severely malnourished. That was the 1st thing I noticed. He had brought the bb to the hospital because the bb apparently has something wrong with her leg--pain--it didn’t look deformed. Leg pain or foot pain.
Then he told us that they did an x-ray at the hospital, and discovered that there is a needle in the baby’s leg. On the inside of the theigh, straight across. A needle. Genette asked him if they (the parents) had put the needle in there. He looked down and said no. as we walked away, Genette said that for sure the parents had put the needle in there--they went to a sort of witch doctor that everyone goes to here, and that person put it in as a remedy. Genette said that one time she was putting in Norplant for someone, and the woman had a needle in her arm--inside her arm--as some kind of remedy or magical protection.
There was a postpartum patient yesterday morning who had birthed the night before, and hadn’t peed for 14 or 15 hours--her uterus was way up there--she was laying in a dirty bed, hadn’t eaten at all yet…and, she was this woman who Marthonie had evaluated the day before and who appeared PERHAPS lightly pre-eclamptic, but Marthonie wasn’t sure--she had +1 proteinuria and slightly elevated B/P, but no other signs…since we have no real lab tests to help us with diagnosing pre-eclampsia in it’s early stages/when it’s “mild”, that can be a hard dx sometimes. It’s obvious when someone is severely pre-eclamptic, but not always easy to dx when it’s light. So: the day before, she didn’t treat her for PEC. Well, the next morning, it was clear that she DID have PEC, because now her face was swollen. We cathed her because she hadn’t peed for so long, and then tested her pee for protein, and now it was +3. So, now we put her on mag sulfate. It was interesting to see the progression of her PEC. She hadn’t started getting better yet, after delivering. It was still worsening.
Also yesterday, not to come as a surprise, there was a woman who came in who has been bleeding for the past 6 days, but no cramps--13 weeks pregnant. Positive preg test. Her partner just kicked her out--when she started bleeding. The father of her 1st 3 kids, he died when she was pregnant with the last. She lives in the DR, working her ass off to support her kids here (like paying for school). She has no one to depend on. She broke down and just cried and cried in our arms. I made the students stay with her and hold her, and I did it with them. It was a calm moment in the delivery room, and we just held her and supported her while she cried and told us about her life. I see this so much. So many women, with so support whatsoever, with such hard lives. It is sad to see this pattern over and over, but it is also a privledge to sit with these women, and it is an obligation to involve the students in the act of having compassion for someone like this, and holding a loving space for her. We can’t fix her life, we can’t convince her partner to not kick her out, but what we can do, is spend this one moment with her, and give her our full attention, and hear her story, and give her validation.
Another person yesterday, she came in at 43+3 weeks, her 3rd pregnancy, a big baby--4-4.5 kilo--maybe twins but it more felt like a big baby to me--high blood pressure but no other signs of PEC--when I check her, the baby is also breech and high. We just put her on blood pressure medication to bring her B/P down a little and called the OB. I would have induced her for her high blood pressure and post dates, except that the baby was breech. A big cephalic baby I wouldn’t be so worried about.
Genette saved someone’s life a couple of weeks ago. This woman came in, with placenta previa, bleeding profusely. The OR was DOWN for about a week, because the anesthesiologist had gone to port au prince because he was sick. (The same people who work at this hospital, they go somewhere else when they’re sick!) ----so, anyone who actually needed a c/s, didn’t get one that week. Well, the only way to save this woman’s life was to somehow get her transported to Cange, about 45 minutes away, where ther is a better hospital (Paul Farmer’s hospital). Genette, who wasn’t on duty but had just come in to see someone, she did everything she could to transport this lady. She got in touch with the guy who drives the ambulance from the Cange hospital--yes, there is an ambulance--she called him, and he was far away, eventually made it, and picked up the lady. She made it to Cange, got a c/s, got a blood transfusion, and lived. It turned out that the ambulance driver, he knew this woman. Both he and the woman were so thankful to Genette. She literally saved this woman’s life. If she hadn’t walked into the hospital at that moment, the woman wh=ould have bled to death there. No one else who was there was going to go to such great lengths to save her life (making a phone call). It really shows you, how when you have no ambulances and no roads, people die. If there were basic services like this, a lot more people would survive.
Blada has been so supportive and accepting of me through my ups and downs here. Completely present, just full of love, always open, always compassionate. I am so thankful for him. I can’t even come close to describing how he really is. I just know it in my heart, and we both know how each other feel, and we both know that we can’t put our appreciation for each other into words. I am just so thankful for him.
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