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…
Saturday, May 14, 2011
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.
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