march 5th

3-2-11
At the hospital today…the woman from several days ago, who was unconscious and had had eclamptic seizures…well she was there. She had birthed, the same night after we induced her. She now looked like a totally different person. I didn’t recodnize her face. Her lips were still puffy and bruised and bloody from when she had had the seizures. Her blood pressure was still high—like 150/100 or so…she was on antihypertensive meds. She appeared anemic. They drew blood to check that. She needed to stay longer, but she was insisting to go. Her family had arranged a ride, and they lived far far away. Her baby, who miraculously had survived through all the seizures and high B/P, was small. She was ingoring him. She would lay down, and leave him at her feet on the bed. Or, she would leave him behind her back if she was laying on her side. She said, he’s going to die. She didn’t want to bond with him. If she were to breastfeed him and keep him close to her. He would make it. He breastfeeds well. He is skinny and small, definetly growth-restricted. But, as she is not breastfeeding or holding him, he will die.
They basically left AMA. Besides her hypertension and possible anemia and the baby, there is the issue of family planning. We talked to them a lot about this as well. If she gets pregnant again, she will probably die. I am surprised she didn’t die this time, after having 5 o so seizures and being unconscious for 2 days. If she were to stay one more week, the OB could tie her tubes next Wed. Hopefully she will do SOME kind of birth control in the meantime.
Also, in the normal pp room, there was another woman, who was eclamptic. She had had seizures at home on the 27th, came in, was induced, and finally had her bb this morning at 5am. She looked really bad. Her face was really really swollen; I didn’t check her out myself so I don’t know what other signs she still had—but the fact was, she had had eclamptic seizures. And she was getting normal care, being checked 3 times/day, just like everyone else. The American MW re-installed her fole.
Also, in the normal pp room, there was another woman, who was eclamptic. She had had seizures at home on the 27th, came in, was induced, and finally had her bb this morning at 5am. She looked really bad. Her face was really really swollen; I didn’t check her out myself so I don’t know what other signs she still had—but the fact was, she had had eclamptic seizures. And she was getting normal care, being checked 3 times/day, just like everyone else. The American MW re-installed her fole catheter (it stays in place and you can measure the urine output, in a bag that is attached) so that they could see if her kidneys are functioning well enough to start giving mag sulfate again (you are supposed to give it for 24 hours following delivery in pre-eclamptic women). I mentioned this to the staff MW who was going to be there after us—for her to check on her more and see about re-starting mag—and she said, “but she’s fine. Her blood pressure is fine.” This woman was so sick!!! She is not fine!!! Why do people neglect to treat pre-eclampsia and eclampsia??? There is a lag in inducing them, monitoring them, and continuing them on meds. I think it is partially because of misconceptions about PEC. People see it so often, but they don’t really understand what it is.
The group of students I worked with yesterday, it was challenging. I felt discouraged because they really didn’t have their shit together as far as having any idea how to talk to people, how to take a history, how to evaluate someone’s state of being, if the catheter (it stays in place and you can measure the urine output, in a bag that is attached) so that they could see if her kidneys are functioning well enough to start giving mag sulfate again (you are supposed to give it for 24 hours following delivery in pre-eclamptic women). I mentioned this to the staff MW who was going to be there after us—for her to check on her more and see about re-starting mag—and she said, “but she’s fine. Her blood pressure is fine.” This woman was so sick!!! She is not fine!!! Why do people neglect to treat pre-eclampsia and eclampsia??? There is a lag in inducing them, monitoring them, and continuing them on meds. I think it is partially because of misconceptions about PEC. People see it so often, but they don’t really understand what it is.
The group of students I worked with yesterday, it was challenging. I felt discouraged because they really didn’t have their shit together as far as having any idea how to talk to people, how to take a history, how to evaluate someone’s state of being, if they’ve eaten, etc…I remind myself, they are just starting out. Some of them are just starting out.

3-4-11
Well…a baby was born yesterday with an imperforate anus…no hole at all where the anus should be…also the penis was weird-red and inflamed, wide…it looked like it had been circumcised…some people thought it looked like the genitals were ambiguous but I didn’t think so…the testicles weren’t descended yet…anyway, the head of the hospital, who is a surgeon, did a colostomy on the beby, put in a tube and colostomy bag…they are going to do the surgery to make an anus at “6 years old”…the mom hasn’t wanted to see the baby because she thinks the bb is not going to make it…
I worked in post-op today with the students…I am trying to conquer my fear of post-op---to conquer my reluctance to work there…it’s not my expertise, but I need to learn the ropes…I am learning…
I am so tired today…the house is sooo loud…sometimes I feel really fed up with running the house…also with having people and noise here constantly…it is so beneficial to us to live here, and we don’t have another option also, and I understand that and appreciate staying here…but at the same time, it’s like having another job on top of teaching…plus there is no privacy or break from noise…people always in and out…sometimes the guests, they don’t understand how to be quiet in the mornings…the doors all make a lot of noise and are easy to slam…I am a very light sleeper…not a good combination…

3-5-11
I still have a cold from over a week ago. There is so so much dust here--every time you go into the street.
We have a few days off--everyone--because of Kanaval--a national holiday. Each town has kanaval. We are going to go to Okap (Cap Haitien) tomorrow morning, to spend a couple of days with Blada's family there and hopefully go to Kanaval there as well. I am so glad to have a few days off. Things never end here. I have a ton of stuff to do today before we leave. Class planning, looking at a test that Lara wrote that is probably too hard and needs to be simplified and translated into Creole...I could easily stay here and work. But I am going to leave.
Love you guys...