Welcome to my blog!

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

Saturday, February 19, 2011

saturday, 19 feb 2011

so, this is a continuation of what i was writing a couple of days ago. i am going to continue telling the story of a couple of our patients this week at the hospital and then keep this blog open before publishing it and keep adding things that happen here. there are always so many things!
so, our 8/7 mama who has severe pre-eclampsia...we had induced her and put her back on meds to prevent seizures and lower her B/P, on thursday. friday morning, yesterday, we found that she had birthed at about 8pm on thursday night. after birthing, her IV's were discontinued and nothing was done to her all night. so, when we arrived, we once again re-installed her IV and put her back on the meds she needs. so, her baby is a little fighter. i thought we would find her with no baby, but her little 32 week baby was there by her side, doing fine, just getting cold and needing to be kept warm. he was having no respiratory distress at all. however, he was too premature and small to be able to breastfeed, and had not fed at all the whole night. so, one of the volunteer midwives worked on teaching the woman's teenage daughter how to feed the baby milk, by dropping drops into the mouth. the mother, she is too sick to take care of her baby. she is still all swollen (body, belly, face, eyelids...) and her B/P is still really high, and she is still having all the neurological complaints of pre-eclampsia.
the problem with just relying on the daughter to feed the baby is that...she just isn't going to be able to do it sufficiently to keep the baby alive. as the day progressed yesterday, the midwives had returned to check on them--the baby was having a harder time keeping warm, and was starting to lose some of his rosy color and get a little cyanotic. the midwives ended up offering the mom to help get the baby to a different hospital about 45 min away , where they have a NICU and will actually be able to keep the baby fed until he can suck on his own. he may be more than 32 weeks also, just with really severe growth restriction. anyway, i found out today that the baby had been sent--and i am glad that they did it and also glad that they didn't ask me to help to make that decision. i think the baby has a really good chance.
my mama who i have been working with...the one who was assaulted...i have been thinking about her alot today...i will probably go see if she's still there today and check on her again...i gave her a little money yesterday...it was the 1st time i saw her smile...the people who assaulted her and her husband, they also stole about $50 that they were carrying, as well as their bicycle.
i am concerned about her not staying nourished enough and hydrated enough, and her going into premature labor and losing her baby. she's already been through enough.

friday feb 25th

well, my lady from last week, the one i was writing about, she was gone when i came back to the hospital 2 days ago. i hope she's doing ok and her husband is out of jail.
today, i worked on a mom who was eclamptic and a mom with high blood pressure. the eclamptic woman, she had had 5 seizures at home. then she was unconscious after that until now--today--she still is. they came from a few hours away to get to the hospital. she's pregnant with her 4th baby. she has 3 kids at home.
i am getting more comfortable with the management of pre-eclampsia and eclampsia--with giving meds and taking care of these patients.
that's all for now...

Friday, February 18, 2011

feb 18th 2011

a few things...

apparantly last weekend a 17 year-old girl died at teh hospital...she had had eclamptic seizures at home after giving birth, and then eventually made it to the hospital...i don't know if when she came in, she was already in a coma and would have died anyway, or if there was lack of care at the hospital...

we have a very sick woman at the hospital right now...an 8/7 (8th pregnancy, 7 previous births) who was brought in from a mobile prenatal clinic that MWH was doing in a community around here...her blood pressure was 240/170--she had all the signs of pre-eclampsia...she was admitted and put on meds but never induced...when we arrived yesterday morning, NOTHING had been done on her since 9pm the night before...her IV lines were dry, no rounds done on her, nothing. so so dissappointing and maddening. so, marthonie and i worked on her all day yesterday, getting meds back in, monitoring her with the students, and inducing her. dopefully, when we arrive this morning, she will have birthed and she will STILL be on B/P meds and anticonvulsive meds (magnesium sulfate).

i have been taking care for the past couple of days of a woman who was beat up in the street by her husband's ex-girlfriend and some man (her brother?). they waited for her as she was coming out of the market. they beat her with a stick and then when she was on the ground they kicked her in teh stomach. she is 30 weeks pregnant.
when she came in to the hospital 3 days ago, she was covered in dirt and sticks and was having contractions. she is totally depressed and not eating or drinking. i gave her an IV and then the next morning, yesterday morning, i see that the IV is dry and no one ever replaced it. so she only got 500 cc's of fluid. she started having contractions again yesterday afternoon as i was leaving the hospital, and i asked a staff MW to check on her and start an IV again...when i came back 2 hours later, no IV was in, but they HAD given her amoxicillin. why? so, i put in an IV. have been talking alot with her and her family about eating drinking resting to prevent preterm labor. her baby won't make it here if it is born now. she is just totally depressed. they arrested her husband, instead of the people who beat her up, and now it will be hard to get him out of jail, even though he's not guilty.
i offered her to listen to the FHT's (bb's heartbeat) yesterday with my fetoscope. she listened. i sat there holding it in place for her for like 20 minutes, and then put her hand on it to hold it so i could go do something else. she must have listened for like 45 minutes total. that was good.

i feel so much empathy for ehr. i feel so bad for her, that she was attacked and beaten by these fucked up people. she will probably be there today when we go. i may give her some money. i don't think she really has money to eat, because her husband is in jail.

i guess that's all for now. there's alot more of stuff that goes on at the hospital but i can't write everything.

in general things here are going well. in the household. however it's alot of work also, to manage and maintain everything.

love you guys...

Sunday, February 13, 2011

a maternal death from anemia

today is february 13th. before i tell the story i want to tell, let me just say that in general , my life here is going really well, and that blada and i are so happy together and really appreciating eachother. running the household, interacting with volunteers, managing everything here, has sometimes been really stressful and hard. there is a woman named lara who has been here for a month, here for 2 more, who is very helpful with house and especially volunteer stuff. nevertheless, it gets stressful. but all the work we are doing is good and important and is paving the way for things to get easier.

blada and i had our 8 month anniversary yesterday. it was lovely; we kept getting wrapped up in house stuff, and then reminding ourselves that "this is our day". oh yeah, try not to talk about the house stuff. we had a beautiful day though. really sweet.

a woman died several nights ago at the hospital. she was pregnant and had 2 kids at home. i will call her marlene. marlene had come in 3 weeks ago having difficulty breathing (air hungry) and feeling really bad and unable to stand up. she was 10 weeks pregnant at this time. her hemoglobin was 4.6. (hgb measures the ability of our red blood cells to carry oxygen around the body--normal levels are 12-16; in pregnancy 10-12 is still considered normal; under 10 in pregnancy is considered anemic). her hgb was 4.6--we made a requisition for blood from the red cross, and the blood didn't come that day. perhaps the next day, she got the blood--only one bag--which is about 1 cup--250ml. i had written about her on my last blog entry.
so, marlene got the one bag of blood and was sent home. supposedly her hgb was around 9, but that's impossible if you had a 4.6 and got one bag of blood. anyway, she went home, and then presented to teh emergency room 3 weeks later, in really bad shape. once again, having a hard time breathing--breathing fast, shallow, sweating, uncomfortable, groaning...so, she was admitted to the hospital. the NEXT DAY, her labs were drawn to see how anemic she was. there is no way to get someone's labs done at night--the hospital lab closes at like 4pm. well, this next day, and i was there--the result of her hemoglobin was 2.3. her hematocrit (percentage of red blood cells in blood) was 7. (normal ahct is 30-40 something). she was really doing bad. when the nurses saw this result, everyone started working fast to get a blood transfusion for her. i looked for oxygen in the ICU--there was no oxygen to give her.

well, one bag of blood arrived. i didn't return in the afternoon as normal, so i heard from the volunteer midwives when they returned after the afternoon shift, about how marlene was doing. they said that she was dying. her body was shutting down. her oxygen levels were so low, that her organs were literally shutting down. you could already see from when i was there in the morning, that her brain was being affected by the lack of oxygen, because of the way she was behaving.
apparantly, in the evening, marlene wasw moved into the ICU, given an IV, put on oxygen (they found some), and given 2 more bags of blood. but she died at 2:30 in the morning. she left 2 children at home without a mother.
she had tried to save her own life by coming into the hospital when she felt bad, but the hospital was unable to save her life because there was not enough blood to transfuse her and there was not access to oxygen to give her. those were the 2 things she needed the most, besides all of the other interventions that would have been done noramally, in a hospital, to treat someone this sick.
marlene had sickle cell disease. this condition causes the red blood cells to assume a crescent moon shape, which causes them to not circulate well and actually get stuck at certain points in the body--mainly the joints--and apparantly this is an extrememly painful event. this is called sickle cell crisis. when more of the RBC's assume this abnormal shape, and then can't circulate around the body--causing destruction of the RBC's (leading to anemia), causing oxygen deprivation to the tissues and organs, and causing pain where the abnormally-shaped RBC's conglomerate.
i don't know if marlene's 2.3 hgb was precipitated by a crisis. but her condition, sickle cell disease, definetly played a role in her severe anemia. this condition is not uncommon here. also, the night that marlene had come into the hospital, to the emergency room, she had witnessed her cousin being shot and killed before her eyes.

i share her story because it makes me so sad that she died--knowing that in pther places in the world, someone like her would have been treated correctly and saved. this death is an example of the capacity of the healthcare system here.
i have seen people here with like 3.4 hgb's who have survived. imagine seeing someone this anemic and them surviving. peoples' lives here are so hard.

Thursday, February 3, 2011

february 3rd 2011

Each day has been so full and with its own unique stories. I don't know where to start. Maybe with yesterday at the hospital, and then I will ret to recapture some of what happened last week as well.
Well, in genereal also, life here is going really well. Running the house has been a big job. But it is going more smoothly with time, as we figure out systems that work for things. Blada and I are doing great. He is so awesome! I can't wait for all of you to meet him. He's so positive and easygoing. We have been sprouting and making kimchi (fermented cabbage and other vegetables). He loves kimchi! We eat it every day. It is so good to be able to do this. Having a real refrigerator makes so many things possible. I used to take all of this for granted. It's amazing how all of us are so used to having something like a refrigerator. Having one again is such a blessing.
The internet has been really really unreliable. Sometimes there are days and days where I can't sign into hotmail. and FB also, it doesn't let me open and respond to my messages. I guess it's too slow. But sometimes it works and that's great. Like right now.
On this past Sunday, I went to a funeral with Blada. It was so so interesting. The ceremnoy was at the big Catholic cathedral. There was some weeping and wailing there, from a couple of ladies...then, we walked in the funeral procession to the graveyard. I had seen other funeral processions but never been in one. It felt really significant to me that I was part of it--I felt like, this means that I am part of this community. Really significant. When we got to the graveyard, everyone had to walk through the weeds and over tombstones to get to the tombstone for the guy thery were burying. Here, they bury people in these cement boxes above the ground. Maybe they don't all do this, but maybe most people do. They put the coffin in the cement box thing, above the ground. The thing is though, they don't biuld a new one each time. They leave someone in there for awhile, then when they need it for someone else, they take that person's body out and burn it or bury it. So, we got to the tombstone for them to put the coffin in , and when they opened up the cement box, there was someone else's decomposing body in there. They pulled it out--it was mostly just bones--the skull and the other bones--and the clothes were still on him...I didn't realize it at first, but Blada unflinchingly pointed it out to me. Then there was some heated discussion about twhat to do with the bones of this guy--leave them there, burn them, etc--well they ended up putting them back in after the coffin. Into the cement box tombstone.
This same evening, I had another super interesting and intense cultural experience with Blada. We went down to the plaza to see Carnaval, which is starting since late January...each Sunday, a Rara band plays and everyone goes and dances in the street...so, we went, and it was CRAZY. There were so many people, and it was so so chaotic and there was all this movement...like bikes going in and out of the crowd, some cars, and a huge crowd following the Rara band around the square, everyone dancing and singing...well, after awhile, apparantly a fight broke out somewhere in the thick of the crowd, and then everyone started running...then someone started throwing ROCKS and bottles...we left. Blada was very protective of me...yet he was also amazingly calm and unflinching during the whole thing...I wish I could really describe what it was like...just a little slice of Haitian culture...also, by the way, with all of this, there is no lighting...no streetlights...
So, the hospital...busy, interesting, crazy. Yesterday I was in 3 births...the 1st, was a 4th timer who had a great birth but then had a retained placenta...we waited an hour and tried everything but then I ended up doing a manual removal of her placenta...thank god, a current MW volunteer brought a med called Katorolac...a pain med...we give it for manual removals...
Then yesterday afternoon, we arrive and there is this 1st timer in labor, with a reference from a different hospital for a CORD PROLAPSE...but she's just laying there...I ask and the staff say that it's not a cord, it's a hand, next to the head...2 people had checked her...so I say to the students: Well, the first thing for us to do RIGHT NOW is listen to fetal heart tones...we start listening and there are deep decelerations with each contraction...like from 120 BPM to 60...so we check her, and indeed yes, there is a cord right there...there is the head, a hand, and the cord...so then, I stayed inside pushing up the head off the cord, while we prepared her for a cesarean--luckily the Dr came quickly and we got her in for the c-section maybe within 1 hour (sometimes it can take 3-4 hours). The decels resolved after a little while of holding the head up off the cord. So, I went in with her for the c/s...and when we were in the OR, it seemed like everyone was getting ready and moving so slowly...it always ffeels like that with emergencies here...so, at one moment, I felt that the cord wasn't pulsing...I didn't want to squeeze it either so I just waited and then after a little while, I felt it again lightly, and I could feel it was pulsing normally...so, they got the bb out, and the bb was a little shocky and cyanotic but was fine...just needed stimulation...thank god...I brought the bb back to the delivery room, to do the weight measurements vitamin K etc, and the one of the students ran iin with this OTHER baby, who had just been born in the other room--in the antepartum room--to this lady who had been eclamptic, who Marthonie had been working on all morning...the baby was extremely premature...maybe 24 weeks, maybe more,...definetly way premature--red translucent skin, all the stuff. No way of saving this baby.
Last week, there were also alot of crazy things...there were 4 manual removals (of the placenta--you separate it with your hand--in the uterus--then come out with it)--of which I did 2--one of these was on this lady who had just birthed a stillborn baby in the cholera tents...she was like 5 months pregnant...you see more retained placentas with premature births...so, we tried for a little while and then I went ahead and did the manual removal...for some reason I always get these...Marthonie always gets eclamptic ladies...
marthonie worked the other night because she had gone and it was so crazy that she stayed to help...they had alot of births, and 3 of these ladies had severe preeclampsia. Well, one of these ladies, she died. She maybe had a heart attack. It sounds like maybe she had a heart condition, because what happened was that she just suddenly laid down and died...she never had had seizures or anything...Marthonie told me the whole story...she was really bummed...she has seen alot of people die...so she had worked the night before class, and needed to sleep, so I taught class the next morning...it was good to do it by myself...I feel like my Creole isn't really good enought to really really do a good job teaching classes and explaining physiology...but I did a pretty good job, and felt proud of myself...usually we do the classes together and kind of share the teaching and add things to eachother's teaching...
Last week also, while we had a few births and one lady who had a retained placenta, at the same time, there was this other lady who was only 10 weeks pregnant and severely anemic...her hemoglobin was 4.6...she couldn't stand up...we did her admission and did a requisition for 2 units of blood from the red cross, and....they were out of blood. Maybe out of her type of blood. They had her family looking for someone to donate blood for her.
I feel like there were other stories from the hospital last week but maybe I've highlighted some of the main ones...
Each day is so interesting...I am really enjoying living here and learning more and more Creole...the hospital is super interesting but also super frusturating...because there is nothing, often not even charts to write on...it's crazy...MWH is trying to establish a formal relationship with Zanmi Lasante (Partners in Health)--for referring people to them and also to get meds and supplies...but apparantly, this action is offensive to some people...because they don't want everyone to know the truth about the hospital...they act like they care and want to help Maternity access materials and meds, but it's all a show and I know they're just cursing us under their breath...there was a lady last week who was there for 6 days and couldn't breath because her lungs were full of fluid...she had some kind of lunf infection probably but also had had severe preeclampsia...we had done her birth...her baby was premature (maybe 32 weeks?) and did after about 1 day...anyway, she wasn't on oxygen or anything...finally, we tried to transfer her to the PIH hospital in Cange...they came and got her...she would have died if we didn't do this...well apparantly this made some people really mad, that we took it upon ourselves to refer her...
Unbelievable stuff...
Ok I love you guys...hopefully will keep being able to write every week or two...