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.