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.