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, November 5, 2011

Blog 10/24/-10/29/11


Each week, there are more things that get added onto the list of things I wanted to write about in my next blog. I have been so busy, and there have been so many changes since the time I departed from Haiti and returned, that I don’t even know how to start.

I was gone for 7 weeks. It was important to go--I had a lot to do--but so hard to be away from Haiti, my students, Marthonie, Genette, Blada…everyone. I have felt so relieved since I returned, a few weeks ago. The students are preparing for graduation. They are now coming over every afternoon (M-F) after working at the hospital to practice their singing and dancing, for graduation. 10 months is a very short time to prepare midwives to work competently. Most of them can’t suture on their own, for example. But, I am very proud of them and what they have accomplished. The first week I returned, at Case Studies class, which we have every Friday afternoon, I just stood back to hear them talk about cases from the week…I was so impressed and pleased to hear how they were discussing between themselves different births and situations they’d dealt with, sharing information…it was really a joy to see this upon first returning, and made me feel so proud of them and hopeful for them.

The money that the community in NC helped me to raise has already begun to be distributed into the hands of many. I can’t even remember everyone so far, but there are always people who are in an urgent situation and just need 5-10 dollars to make it out safely. I’ve never had this luxury before, of being able to help anyone who needs it, and of being more liberal with the amount. A few examples of people I’ve been able to help:
--a 14th-timer, who came in drenched in blood, who had a placenta previa (where the placenta is located right upon the cervix, instead of higher up in the uterus)--luckily, everyone was there when she came in, and we ran around and prepared her for a cesarean really fast…we even got a requisition for blood delivered to the Red Cross…she went into surgery and got a blood transfusion before coming out of the OR…well, she had come from far away and her family didn’t even have 1 clean sheet to put on her bed in the Post-op room. Not even a sheet. Her mother took all the blood-drenched sheets and clothes that they had and walked to the rive to wash them. I gave them some money so they could buy food for the patient and for themselves. It was so clear that they had come with nothing. Thank god, the OR is functioning now. Before I left Haiti, there was no electricity at all and no OR. If this had happened 3 months ago, she would have died in our arms. She knew this. She and her family were very very thankful for the care that was given to her.
--there was a woman who approached me as I was leaving the hospital maybe 2 weeks ago…she is living with AIDS. Her legs were covered with sores that weren’t healing. She is in the HIV program that’s run by Zanmi Asante (Partners in Health)--but she said that they haven’t renewed her card that gives her an allowance for free food. She has children that she takes care of at home. She was so destitute, so poor. In the past, I would have rejected her because she was not in an acute, life-threatening situation. I would have chosen to wait for someone who was more urgent. But, I was able to give her some money for food. Probably about 10 dollars US. She was very thankful. I told her that people in the US had put money together, because when I showed them pictures of the hospital and explained how it was, they cried and wanted to help.
--Right after this, there was an old man in a wheelchair who was skinny and sick--I don’t kn ow with what, but he had a foley catheter in place because he had some kind of urinary obstruction and couldn’t pee on his own and was getting swollen in his abdomwn--he is probably about 70 years old. He didn’t ask me for money, but I could tell he was destitute--I was asking him if he had family in town, who took care of him--he said he has no one. No one to take care of him, to bring him food…he’s just suffering on his own.
People at the hospital, some of them give him food when they bring food for their own family members. So, I gave him some money. He was so so appreciative.
--After this, there were 2 other people who wanted to ask me for money (they hadn’t seen me give him money but I think they knew I had given the HIV+ woman money) and I just had to go after that. I’m not down with people lining up asking me for money. One woman, she was maybe 60 years old, and just wanted a few dollars to buy a new pair of sandals. Hers were totally broken, her toes sticking out. This is most people here though. I didn’t give her any money. Later, I thought maybe I should have.
I don’t want to give people money myself. I want to let the students give people money. I don’t want to reinforce the example of white people always having a lot of money and giving handouts, but so far, I have given some people money myself. I have tried to explain to them that it’s not my money--that lots of people in the US put small amounts of money together to send down to help individual people. I have tried to let people know that Americans are concerned and compassionate and want to help.
--There was another woman who came up to me about a week or so ago…maybe longer ago…she was telling me that she has 5 children, and is behind on her rent as of several months, and has no way to feed them…she started crying as she was talking to me…she said she was embarrassed at having to ask, and that she came to me because “white people have more patience than Haitians” and will listen to you. Well, if this had been before the fundraisers, I would have told her at the beginning of the conversation that I couldn’t help her. But, I listened to her and talked to her and eventually gave her some money, around 10 dlls or so…we talked about her trying to put her kids in the orphanage here, Maison Fortunae…it’s a really good orphanage…the kinds are happy…they provide school, food, community…it’s a good place. But, they don’t take everyone who comes to their door.

So, thank you so much to everyone who stepped forth and contributed so generously to help the people I work with here in Hinche, Haiti. Thank you so so so much, for being touched and stepping forth with such willingness. I appreciate this so much. This gives me the chance to help people make it through when there would be no other way.

Since I returned, I have had good experiences with the volunteers. When people are kind, humble, and approachable, it is always so much more possible to have a mutually good experience. The first 2 weeks I was back, we had a volunteer named Julie, who is a very kind person and very experienced practitioner. I asked her all kinds of questions, the whole time she was here. She could explain anything! I learned a lot from her. For the first time since the very beginning of my time here (February will make 2 years), I visited the Eziel. The Eziel is a place run by Mother Theresa nuns, where they feed malnourished babies and kids in order to give them back to their families, here in Hinche. I hadn’t been back this whole time, because the reality there is so intense, and because I live here and already witness death and extreme poverty on a regular basis, I just never could bring myself to go back. The short-term volunteers usually go. They hold babies, feed them, change them, give them human contact. Well, I walked over there with Julie, and went into the room with the babies. The room is full of metal cribs, with babies of different ages, who look so forlorn and neglected--the sadness is etched into their faces. Their eyes are big, and sad. You look at their little bodies, and you see how starved they are. They are all congested and coughing. There was one little girl, apparently she was at least 2 years old, because she had a full set of teeth. But, her body was so skinny…her head was too big for her body. She was just whimpering. I picked her up to give her a bottle. She could hardly figure out how to suck on it. She had a fungal infection on her skin, around her neck, and also a little infection or stye under one of her eyes. Very fragile health. I just went from baby to baby, holding them for a little while, offering some human contact, stroking their faces, talking to them. Is this doing more harm than good? They are so used to lack of human contact (the sisters are wonderful and take great care of them but don’t have time to hold them). Is this giving these babies some kind of false hope? I really don’t know. There are so many questions I have, that I will never be able to answer.
The whole time Julie and I were with these babies, I was either crying or fighting back tears. It was a huge dose of reality that I hadn’t been ready to face. I felt safe with Julie, like emotionally I could be on the same level with her.

After this, Julie and I decided to walk to the hospital, to check on a baby who we had been helping to feed--helping the mom to hand-express her milk--the baby had suffered some neurological damage probably, around the time fo birth or beforehand--anyway, we walked up there and on the way, there was this group of kids who of course yelled out to us “Blan!! Blan!!” So I stopped to talk to them, and just took my time and made conversation and explained that I am a person who has a name, etc--then one of them said that I had delivered her cousin’s baby…that was good…a lot of people in this community know me now--they may have a family member who I was present at their birth…
So, anyway, the point is that in order for people to recognize me as a real person, I have to stop and talk to them and not be in a rush. Then, they learn my name and next time they call out to me by my name. I have many names here--all are variations of “Reina”--no one really calls me Reina, but some of the other names they call me by are Lena, Klena, Melena, Plena, Pelina, and other such variations. It suits me just fine, because they are making an effort to recognize me as a person.

There was a little boy at the hospital, who was a very bright and also very sweet and wise little 8year-old boy. He said that his father had dropped him off at the hospital back in May, and had never returned to get him. He knew where he was from, but not how to get home, and had no one he could call. Somehow, he was making it at the hospital--people had taken a liking to him. He had broken his leg back in May. He would scoot around on a wheelchair all day…we all noticed him and started interacting with him and helping him and encouraging him to practice walking on his own…he really needed physical therapy…the first day I met him, I told him that with practice and dedication (walking on it) he would regain use of his leg, and his response was: “Yes, with God’s grace/blessing I will regain us eof my leg”--it was like something an adult would say…
Well, Julie was going to try to get him into the orphanage here, so that he would have the opportunity to go to school. He seemed so intelligent, so genuine, like a bright star who had so much potential. Well, we don’t really know what happened to him, because the day before Julie was going to go with him to the orphanage to talk to the director, he was picked up by the mayor. Apparently the nurses who were taking care of him were not happy about this. So, this made us wonder if maybe he was taken to be put to work, as a child servant, somewhere. We don’t know. I hope he is ok.

Schools here, they are so corrupt…for instance where Blada went last year, everyone knew that the director of the school was having sex with 14, 15, etc. year-olds in order to let them pass…this was well-known, and not really hidden. The teachers too. Schools are for making money, which is why most people fail the end-of-year tests in high school. Probably like 75% of people don’t pass. There are people who try year after year. Some people commit suicide when they don’t pass, because they think school is their only way for improving their lives and helping their families, and it is impossible to achieve.

Today, in the Prepartum room (ante partum), there were 8 women. Of these 8, 5 of them were morbidly hypertensive and on IV meds for their B/P. 3 of them were pre-eclamptic. Of these 3, one of them had a B/P of 200/130. Another one, she had such a splitting headache (caused by the pre-eclampsia) that she was moaning and swaying with the pain. I was really really worried about her. She also had facial swelling, high B/P, protein in her urine, etc. The thing that upsets me about her case is that she was admitted since Friday (3 days ago), and her labor never was induced. Until she births, her PEC will only get worse, and she could go into eclamptic seizures. She is 29 weeks--her baby won’t make it. But if we don’t induce her, she won’t make it. Her first baby. We induced her today with Misoprostol (Cytotec). It will need to be renewed every 4-6 hours until she’s in active labor. I hope the midwives do this. She was never induced since Friday, but, she has been receiving regular doses of 2 antibiotics, even though she has never had a high temp.
Besides the 3 PEC ladies, there is another woman who was admitted 5 days ago--last Wednesday--who has been in a coma/unconscious since the time she was admitted. She had given birth the day before, and immediately started having eclamptic seizures. She’s 18 years old, and it was her first baby (she lost the baby). Her mother and brother-in-law have been by her side this whole time. Last week, she seemed so bad, I idn’t think she would live. Her face was so swollen and distorted--even her eyelids were huge. Her eyes were empty and fixed. Her breathing was labored and it sounded like she was snoring. She was on oxygen. Well, today, she is a little better. Her facial swelling has gone down A LOT. And, she’s still unconscious, but she seems closer now to being conscious, like, she’s not as far away. Even her eyes look better, like her life force is returning. I really thought she was going to die this weekend. I am so happy to see her still there, and even better than she was. Hopefully she will continue to get better and better.

Last week, on Friday morning, there was a first-timer who had had a placental abruption (the placenta had prematurely separated from the uterus) and her baby had died and she was now birthing. She pushed her baby out, maybe it took about 2 hours of pushing. She was stoic and strong. A couple of times during this, one of the OB’s came in and wanted to cut an episiotomy. I gently refused to let him do it--the second time he came in, he said that if she didn’t birth within 5-6 minutes, he was going to cut an epis. (He does this routinely; also he thought that she would hemorrhage if she took too long pushing). I really didn’t want her to have to recover from this as well as losing her baby. We helped her to get the baby out before the 6-minute deadline, and then I showed the Dr that she had birthed with no tear, and he was so happy, he hugged me. As soon as she birthed, she started crying and mourning her baby. It was really really sad--I was trying not to cry at all but I did a little.
She was crying out, “my baby, my baby, my baby…” and “when I go back home, people will see me in the street and know I lost my baby…” and even “everyone else, they have their baby, but my baby is going to get thrown away”…(at the hospital, babies literally do get dumped somewhere behind the hospital in a pile of trash…I have told people they can take their babies hole with them and bury them, but they are reluctant to…I don’t want to put it to them like this: “If you don’t take your baby home, your baby will be left in a cardboard box on the counter and then thrown out with the trash and then eaten by dogs”--but that is the truth. But, if I told them that, that would be horrible. Whatever choice they make, they deserve to be in peace with their decision.
She was really sad and really mourning the loss of her first baby. Who knows why she’d had the abruption. The placenta had a huge clot on it, covering most of it. It was a large abruption. Her family was all there coming in and out, also very concerned and sad, some of them crying.
The other OB (not the first one who wanted to cut the epis), came in and told her not to cry, that if she cried her blood pressure would go up and that wouldn’t be good for her. She really needed to cry though. I gently came up to him and said, “She needs to cry--she is really sad because she just lost her first baby. She needs to empty her heart--if she doesn’t do this, she could go crazy”. Well, the next day I saw him and he thanked me for what I had said to him, and he said that I was right, that she needed to let herself cry, and that he had never thought of this aspect of it before. That was really nice that he told me that.
I try really hard to be careful about what I say to people, because I want them to know that I respect them, that I’m not coming in here to tell them what to do. We are all learning from each other. I really do have deep respect for all the people here, even though in the past I have thought that many of them lacked compassion. I can’t judge anyone here. Sometimes, I can help them in ways that I see are possible for me to help, but I am careful about when I bring things up.
This enters into the whole issue too of how do you enter into another culture and help out and not impose your own values upon that culture. Each culture and society has developed ways to deal with problems that exist within their own community. In the past and perhaps still, I have judged and been perplexed by the Haitians’ universal reaction to someone who is suffering, to tell them “don’t cry”. the longer I live here, the more I understand that this is a gesture of compassion, even if at times, it appears so misguided or off (to me). I can’t judge this universal reaction, however counter-intuitive it is to me.
I am a guest in their culture. This is why, I do know that I have a lot to offer, and to take as an example the relationship between myself and Marthonie: each person compliments the other’s experience. We have learned a lot from each other and our diverse backgrounds are the perfect combination and this offers the students a much more well-rounded education. It’s great.
However, even though I know this, I also know that just my mere presence here, although there are many positive sides to it, it also has negative effects on people here, because it reinforces the white savior model. This people has such an intense history with colonialization and white supremacy, and now with the multitude of NGO’s who offer handouts and help to maintain their position of helplessness….it’s not a simple equation. People want to come here and understand everything in one week, and have answers to their questions…there are no concise answers. I don’t have the answers.

Of the 3 pre-eclamptic ladies in the repartee room, one of them birthed last night and had a postpartum hemorrhage and was getting a transfusion this morning (and her baby was born dead), one of them is still not in active labor and is being induced with pitocin (she’s only 29 weeks and it would be better not to do a cesarean--), and one of them died today.
The woman who died today, this was her 4th pregnancy, and she had 3 kids at home. I worked on her 2 days ago and was trying to get all her meds going and get her blood pressure controlled--it was 190/120--and trying to convinvce her to let me induce her labor. Yesterday, she was worse--a really bad headache and swollen face--she still refused to let me induce her, so I got the OB to come in and talk to her and just induce her anyway. He did. Well, the misoprostol wasn’t renewed 4-6 hours later and she never went into labor, but this morning, she was very agitated and uncomfortable. She had a high fever. We did a malaria test on her--it was positive. We started treating her for that, and I didn’t pay much attention to her after that. Well, this afternoon, a couple of hours after I left the hospital, she died. Genette thinks she had an a placental abruption. And just bled to death from inside her uterus from where the placenta had separated. Often people with high blood pressure have abruptions.


Yesterday was our last day at the hospital with the students. I have been feeling very nostalgic about the hospital. It is so special, such a privledge, to be with people there while they are going through the most intense moments of their life.
The day after the woman died--her name was Marie--well, everyone in the prepartum room had seen her die. They saw the whole thing. In Haiti, death is not hidden from people. Everyone has seen it. People have experiences and the community is involved, and everyone talks about it. Well, there was another woman with pre-eclampsia in the repartee room, who saw Marie die. The next day, she was worse, and they had decided to do a cesarean, even though it was her 1st baby and she was 30 weeks. When we arrived int eh morning, her family was praying over her. She was doing worse than the day before. Her B/P was still high, and her face was even more swollen, and now she was also breathing fast, like she wasn’t getting enough air. I listened to her lungs, and they were clear. Well, I stayed by her side for awhile, because her family and she were obviously scared that she was going to die. It was so sad. Some of them were crying. I was standing next to her, and she said to me, “I’m not going to die, am I?” this just broke my heart. Here was this young, promising, valuable woman, who because of where she was born, has not had fair access to ways to stay in health, and now, she is sick enough that she could die very easily, and she has done everything in her power to save her own life--she has been at the hospital for 6 days, in our care…she is slipping through the cracks, getting worse..and it’s not her fault, it is our fault, it is the hospital’s fault, it is the fact that there is no infrastructure here to support our efforts to save peoples’ lives…I wasn’t sure if she was going to live or die, but I told her, “No, you aren’t going to die. We are taking care of you. You’re going to get a cesarean. You’re going to be OK.”
After awhile, she got her cesarean. Her baby was more than 30 weeks. He was maybe 33 weeks. He was pink an looking good, except having respiratory distress. Genette was able to get oxygen for him (our oxygen concentrator only works in the delivery room when there‘s electricity, which there wasn‘t at this moment. Anyway, after I left, one of the Haitian midwives helped the family send the baby to the hospital in Cange. This is such good news. This is the baby’s chance at survival.
Right after this, after this woman had been afraid for her life, waiting to get a cesarean, I walked over to the ICU area to check on someone who was in a diabetic coma whose family had asked me to help them get a doctor to see her, and when I arrived, someone had just died there. An old woman. Her children were middle-aged. She had just died, and they were just starting to weep and mourn her, throwing themselves on the ground, wailing, saying “my mother is dead, my mother is dead…” and I just couldn’t hold my tears back any longer. I always try not to cry in front of patients--but at this moment, there had already been so many reminders of how fragile peoples’ lives are in Haiti, and how powerless they are to change that…I just walked away and leaned over the railing and put my head in my hands, and cried for a few minutes…this is the first time this has happened to me like this at the hospital, and I just couldn’t stop it. Peoples’ grief here is contagious sometimes. When I returned to maternity, there was a 22 year-old woman, whose 7-month baby had stopped moving since the day before and she was now pushing him out. I stayed for the birth, one of our students, Magaly, who has really flourished in our program because she was already very experienced but had lacked sweetness and compassion, and now really really has this in her heart…she caught the baby. Once again, such an honor to be there, witnessing this…to witness a woman having a stillbirth, and a midwife helping her…to see them dealing with this situation in their way…sometimes I think I’m useless here, and I’m more of a witness and learner…I know there are deep changes that I have initiated and followed up with, that I do see…such as the general moral and treatment of women in maternity, by the midwives and the doctors…but, I also feel so helpless and useless sometimes…
The eclamptic woman who was in a coma for over a week, she is a little better each day. She is semi-conscious. She is eating and drinking. She still can’t answer peoples’ questions, but she can say things like “water” if she wants water. I am going to go check on her today.
People at the hospital, they touch me so much…it’s like every week, there is a new group of people who I fall in love with…

Yesterday afternoon Marthonie, Genette and I sat down with the students and each person talked about how this year has been for them. This group of women has been a group of sisters. We are all so proud of them and happy to see them moving on, but it is so hard to let people go too…you think your life is defined by a certain place or group of people, and then it suddenly changes…sometimes you don’t know when that change will come.

This year has given me several experiences that have stripped layers of my identity away from me, unexpectedly. I don’t know why, but I have to trust and move forward. Blada is the one constant, at this point. When I went to El Paso, none of my old friends had room for me to stay with them. I felt pushed away by my old community. MLL was warm and welcoming, thank god. Nevertheless, this was very hard for me. I worked every day in the August heat, going through my stuff and packing it and getting rid of it, so that I can make a smooth transition with Blada to North Carolina, whenever we get our fiance visa.

In NC, I was very busy as well. It was a really good trip, in many ways. I saw my old community through new eyes. I saw things that gave me hope for when I move back. I was very busy with 2 fundraisers that we had in order to raise money so that I could come back to Haiti and help people more. It was intense having to think so much about Haiti while I was gone, because there are parts of it that are painful to think about. But, I did it.
The fundraisers, after all the stress and running around that went into them, were successful, and I was really touched by the fact that people were so interested and willing to help.

Three days before leaving to come back to Haiti, I found out that my life in Haiti was about to change. After everything I have put into the community here and the organization MWH, I am suddenly faced with having to let it all go. Instead of feeling triumphant after such a successful year with the students, I am now mourning the loss of everything I have come to know here. I can’t explain it all here, but someday I will tell some of you the story. I am devastated but all I can do is move on, and try to have faith that things are falling into place exactly as they should. Our life will continue, and the most important thing is that we have each other. This year has been a lot about letting go. Sometimes you get used to your life, and you see yourself as defined by certain parameters of your life. Then, suddenly it changes and what you are left with is yourself. This is how I feel. Maybe it’s not normal for this to happen. I think a lot of peoples’ lives are predictable and stable. Maybe that is what’s normal. I don’t really know anymore.

This is the concise version of what our life has been like recently. Working in Haiti means that you see really intense parts of peoples’ lives. There are very joyous and beautiful parts of living here too. I am just sometimes more focused on the sadness because I encounter it everyday in my work. The beauty here is the strength of the people that shines through all the loss. The natural joy of people, the way people are relaxed, the way people always find a way to make things humorous and laugh about so many things…people simply have a good time and make all kinds of things into jokes. People help each other out--people in the hospital share water and food with others who don’t have…
The students who are about to graduate…I am so proud of them…I love them so much…it has been a huge labor of love, on everyone’s part, each person contributing in the ways they specifically could, to pull this off. The students really care about the women and families they care for. This comes through so clearly in the way they relate to and talk to people. They have compassion. They talk to people with kindness and respect. Sometimes when I have thought of the love I see in their hearts, and the willingness they have to work and the desire they have to save peoples’ lives, I just cry…I wish that they could have more…that they could have better access to the tools they need to save these womens’ lives…but, it is what it is and compared to the alternative of giving up, there is no choice. This is so much better. These women are amazing. They will make a difference.