Monday, June 11, 2012
4-25-12 I am in my second week in my new job with MSF in Port au Prince. I am so tired, and overwhelmed, that I have been on the verge of tears a lot of the time. It is really hard. I have never worked with MSF before, so there are a lot of details that I must learn in order to function within MSF. Plus, I am meeting like 200 new people whose names I am trying to learn…plus, the hospital is new to me, and I am responsible for supervising not one, but 7 areas within the hospital. This hospital takes only complicated maternity cases, and has strict admission criteria. There are experienced Haitian midwife supervisors in 3 of the areas that I am to oversee, which is a good thing. I am not responsible per se for direct coaching of staff, however once trust has been built, I will be trying to improve problem areas both through directly working with the midwives and also through collaborating with the 3 MW supervisors who run triage, delivery room, prepartum (antepartum) & postpartum, in order to make improvements. One way to do this is through creating a platform for continuing education in needed areas. There are many good practices and areas of strength and there are also areas of weakness that deserve attention. However, the first thing is to stand back and validate what is already happening, and build trust with the national (Haitian) staff. I have already been welcomed warmly by them, and have even felt like I am becoming part of a close, loving family. However, I strongly miss Blada, who instead of seeing every day, I will now see every 1-2 weeks—this is a huge adjustment for us. When I am lonely, I go and sit outside with the guards (at the house), instead of crying in my room. Another person I dearly miss is Marthonie. She is still in HInche, still teaching by herself. What I had with her was truly amazing—our collaboration and trust—and I don’t know if I will ever forge something this deep with another Haitian midwife. Marthonie was my ally, and I couldn’t have functioned at all without her collaboration & support. I miss her so much sometimes. We were such a good team, both in classes and in the hospital. Such trust. We both learned so much from eachother. The situation here, it is a much better situation to be starting off from than when I started in HInche. I am so much more prepared, I speak Creole, have had experience in public hospitals in Haiti, etc. But, it is still hard… The national staff is amazed that I speak Creole. I think I have never seen another group of people in Haiti who has been so delighted and appreciative of the fact that I speak Creole. It means so much to them. In fact, this is the most accepted I have ever felt by any group of people in Haiti. I still don’t know how I will perform my job satisfactorily, given that I have such a large area to cover. I just have to trust and keep going, and let it happen. 5-1-12 I was feeling a little less overwhelmed for a few days and now am back to feeling super overwhelmed. I am supposed to be supervising many areas of the hospital, but it seems like I will never have time to spend time in each area to assess the needs for improvement. There are 2 areas I have barely stepped foot in: postpartum pathology, which has 7 rooms with 6 beds in each, and OTP, which is postpartum appts for women with problems like post-op or high B/P. I have spent more time in triage, the delivery room, normal postpartum and antenatal pathology. Now, there is another area to supervise: Cholernity. It’s a unit for pregnant women with cholera. It opened yesterday. Today I helped the 1 midwife all day, who had 13 patients. It is nonstop work. Hopefully some of these areas I am supervising will need less help than others, but in triage and the delivery room, there are some definite problems that need to be addressed, and some of these problems will take time and multiple approaches to have any improvement. There are midwives here who are very competent, which makes things a lot easier, but despite that, there are still some very basic problems that need to be addressed. 5-8-12 So…this is halfway through the second week since the Cholernite opened. (Cholernite=pregnant women with cholera). Things are going a little smoother each day. However, it is still in the beginning stages and there aren’t any real systems in place yet, which means that I am running around searching for everything, each thing that comes up, all day long. But, things are slowly taking form. Each day a little more. I have been absent from the other services, because I have just been immersed in getting the Cholernite going. I have been so tired, since I arrived here. I am absorbing and learning and taking on SO MUCH all at once. A lot of it is stuff that I have never done before—like, more administrative stuff. I need to learn how to use Excel. And I am learning French. (I communicate with the national staff in Creole of course but all of the meetings—of which there are a lot—are in French.) I understand it well, but am just not used to speaking it, so when I need to speak it, I can’t communicate what I want to. Blada was allowed to come and spend this past weekend with me at the house. That was so nice. Unfortunately, I was so tired the whole time, we mostly just laid around while he comforted me and reassured me that everything is going to be ok. It turns out that I also have some kind of infection in one of my teeth…it suddenly has become acute—probably this is one reason why I have been so tired. I think the tooth is going to have to be pulled, because I think it is in a wisdom tooth that already had a root canal and a crown. I have an appointment tomorrow to have it checked. So, there is a lot going on at once. I am not able yet to step back and relax, and see the whole picture. I am still learning the small parts. And, there are two areas I have not even spent time in yet—postpartum pathology and OPD, where 2 midwives do postpartum checkups for moms/babies with problems that persisted after the birth. What else…I do feel very fortunate to have landed here, in this job, with this group of people…I feel very, very fortunate. I can learn a lot here, and the structure and support from the organization makes it possible to move forward with positive changes in the hospital. Also, with the national staff, I feel very comfortable. This goes for all of the staff—drivers, guards, cleaning people, midwives, etc. everyone. It feels like a family. It is a family, because many of these people have been working together for years. The expat staff comes and goes, but the national staff is constant. We moved houses 1 week ago. This place is better because it is really close to the hospital. Easier in the morning, more relaxed. It’s also nice for me because we are closer to Haitian life—you can hear sounds of people living their lives. There is a church close by and sometimes I can hear the beautiful hymns being sung. Haitians have a gift for singing in harmony. It is really beautiful. 11-may-12 So…I had my tooth extracted 2 days ago…I am feeling a lot better today than yesterday. Things have been nonstop since I arrived here and started this new job. Hopefully after this I will have more energy and things will continue to become easier. I think the infection (which was in fact below my root canal) was sucking all of my energy. Today has been a relaxed Saturday. Next weekend I get to go to Jacmel and visit my little house and the beach. So excited. Then right after this, I go to NY for a few days for this MSF thing called Information Days, which normally people attend before their first mission. I hope that I will learn some useful & practical things about the organization while I am there. It will probably take a few months to settle in and understand how to function within this job/hospital in my role and also how to function within MSF. There are so many things to learn. Anyway… Love to all of you, and thank you so much for all of your support… May 29th… There has been a lot to write about and many details that I’ve wanted to share but I have just been so tired…atleast before leaving Haiti for 1 week last week..i just got back today…I went to NY for an MSF informative event for new MSF workers…usually it happens before the first field position but in my case I had started working first…I stayed in Manhattan…in a hotel room with 2 other girls who were really fun…the experience was really good for me. I got to sit for 3 days and learn more background information about MSF—things I had already read about in some of the readings they sent me, but it is really different having someone explain it to you…everyone who talked had extensive experience working with MSF and so had many stories…stories to illustrate any example they wanted to make…it was really rich…I enjoyed this a lot…sitting back and listening to them…I also really enjoyed spending time with many of the people who participated in this event…many of them were really interesting, had already worked internationally, and already seemed to get some of the other levels that were on my mind, that I would have liked for the group to talk about more—things relating to cultural competency, but that’s not the right term actually…neocolonialism…a broader discussion of all of the implications that we have when we work globally…anyway, it was really uplifting overall and the icing on the cake for me was that at the end, I had the opportunity to sit down with a trained mental health professional, who specializes in working with aid workers, and I recounted to her in a timeline the entire experience (starting the second year) of what happened last year when things fell apart with Midwives for Haiti. Just explaining it to someone, like this, was something that I have been wishing I could do since last summer…actually since before I left MWH---there were already some really intense things to process…but I never had the opportunity to really sit down with someone like this…we talked for 2 hours…it was a huge relief…perhaps my raw feelings will always exist as I know them, but…perhaps time will also help me to achieve a distance from all of it as well. I have barely written about happened in this blog because I have wanted to keep things professional. But, it is quite an unbelievable story. Being in NY was also a very interesting experience for me because, as you all know, I have been living in Haiti for over 2 years now. NY is so, so different. I was just in awe, and walked around as much as I could in the evenings. The skyscrapers. The old buildings. All of the languages you hear as you pass people on the street. Absolutely fascinating. Something else was the impersonality of the people you pass on the street…I’ve always known NY to be this way, but, it’s just such the opposite in Haiti…sometimes you literally greet almost every person you pass on the street…like in Hinche…I remember this…Blada seemed to have a unique way of addressing each person we came across…always something a little different, and right for that person… After being in NY for 3 days, I spent 2 ½ days in NC with my family. I was there the day of my birthday. I didn’t tell anyone I was coming, because I knew I was only coming for 2 ½ days and I have already been so so exhausted the past month, learning the ropes of my new job…I just felt that talking to people would be too much for me. I am sorry to everyone that I didn’t call or write to before coming. I literally only saw my family, plus one friend, plus Emma, who is like a grandmother to me, and may not be around the next time I come. The good news is that hopefully I can come again for a week this summer, because MSF does give people breaks every 3 months. At first I thought I would stay in Haiti, but now I am not sure. I really miss my family. Having a moment to breathe in NC was very refreshing to me. I love it more than I used to. When I left 9 years ago and moved to the desert in El Paso, I was ready to leave. But now I am enchanted with NC. The smells…the earth…multilayered smells of nature…the gentle breeze…wild green grass and flowers everywhere…trees…birds singing…the only things missing when I am there is Blada…we have to get our visa this winter! In the meantime, I am so thankful to have this amazing new job…there is so much opportunity for growth and learning here…I feel very very lucky…and I like the people around me…I’m not best friends with everyone but there is no problem…things are good enough…most people are quite reasonable… Getting back to some of the things I had wanted to write about earlier, before I went to NY…basically what I had wanted to say was that I am humbled by the Haitian midwives who I have been working with in Cholernite (Cholera + Maternity= Cholernite—i.e. pregnant patients with cholera)--- These MW’s work tirelessly…with cholera you are constantly moving…never sitting…what impresses me the most about them is not their technical skills and their speed (which I am impressed by), but their kindness towards the patients. In general, my experience in Haiti has not shown me that Haitian midwives are especially compassionate or kind towards their patients (in fact they can be mean, even abusive). I have worked in 2 different public hospitals in Haiti and I saw some pretty heartbreaking things. These cholera midwives give me hope. I am pleasantly surprised again and again, when I see how they talk to people, how they don’t lose patience, how they don’t blame anyone for their illness…how they even use humor… Cholera is unfortunately still a very stigmatized illness in Haiti. People are deathly afraid of it. Perhaps because it is newer than other things, like tuberculosis, AIDS, Hepatitis, Syphilis, etc. it is scary to people. One amazing component of this MSF hospital is that they have a mental health component, and people from there actually come every morning and speak with the women/their families, and a lot of it is about not feeling ashamed for having gotten cholera. Peoples’ lives are so hard here…even here, in this hospital, which is probably as good as it gets, people still of course experience loss…there was this woman in the Cholernite, who was really dehydrated and not quite stable yet, and she also had 3 children in the normal cholera treatment center (CTC). Well, one of her children died there. They were waiting until she was more stable to tell her. This is so sad. It’s already such a hard thing to deal with, for your whole family to be on the edge of death with cholera, but then to lose a child, just like that…. There was another woman, who went into premature labor at 8 months gestation. (The dehydration from cholera causes a lot of abortions, premature labors and stillbirths). This woman had her baby (in Cholernite), the peds were there already in case we had a premature baby needing resuscitation, and they admitted the baby into neonatology because of the prematurity, although the baby really looked good and hadn’t even needed resuscitation. The next day, I saw the mother and father again, and they were very eager to hear news about the baby. The father was allowed to visit, and look at the baby through the glass. The baby was doing very well. The prognosis was good. Then, suddenly, about ½ hour later, the baby died. They resuscitated for a long time, but they couldn’t save him. This news was so hard for the parents to hear, after they had had hope. I again saw them the next day. (I learned about the baby death after returning home the day before). The mother looked at me as I came inside, and just put her hands up, as if saying, “there was nothing that could be done. There is nothing I can do about this, except accept it and move on”. She cried on my shoulder for a few minutes, and said these very things to me. She was resigning herself to moving on. She had another child at home. All of this because of cholera. There have been other women, other stories…because I have been so involved with Cholernite from day 1, I have also been close to the patients. The atmosphere in there, it is a small space with 13 cots crowded in, but people are making the best of it. They talk to each other, they make jokes, they laugh, they make fun of eachother. It becomes a sort of community. They tell on each other to the midwives, when someone tries to fake it because they want to go home. Once again, the instant intimacy and community that I have experienced time and time again in Haiti, in all sorts of circumstances. Mainly in tightly-crammed buses. People make the best of it and always seem to manage to have a good time, and to find things to argue about or laugh about. There is something so special about the people here. Maybe this is part of why I already felt so welcomed by the Haitian staff from the very beginning, because they are already like a family together. I feel as if I have been adopted into an extended family.