August-October 2012

2 Sept 2012 Things have been really, really tough for me in my work here. I have found myself getting to the place of just wishing to leave, because I have felt so hopeless. I have felt this way from time to time before, in my time living in Haiti. I remember feeling this way in Hinche for at least the first several months after I arrived, having a language barrier and witnessing the care that birthing women received. I remember seeing a woman get slapped because she was squirming and screaming too much while getting a D&C(dilation & curettage) with no pain medication, and having an argument afterwards with the person who slapped her. We disagreed on this, but continued to work together, and nothing ever festered. The next year, there was one day when I walked into the delivery room only to see this same person slowly rocking together with a laboring woman, the woman’s head on her chest, her stroking the woman’s hair lovingly. I would have never believed that this was ever possible, the year before. This same person has become one of the people that I most love, respect, trust, and miss the most in Hinche. I came to accept many things about Haiti, and about the hospital where I worked, and the people I worked with. I came to appreciate many things. Acceptance was the key, after a long period of adjustment. Since being in Port au Prince, I have seen that the acceptance I had cultivated for Haiti, and for Haitian healthcare professionals, was not as everlasting as I had thought. I have seen that it actually comes in waves. Sometimes it is easier to be completely calm and accepting, and other times, I feel unhappy, isolated and frustrated. My experience in the project here in Port au Prince has not been as smooth as I had hoped for. There have been a combination of factors that have made it feel even excruciating at times. These have been: the workload (I am spread too thin—too many areas for one person to cover), and the relationship with national staff, the history and collective memory of the national staff in this project, as well as their overall resentment of white people, NGO’s, etc (which is justified). The relationship with national staff: there are reasons why this has been hard. I am used to working with Haitians and love working with Haitians. But I have never worked with a group of people like this. I have come to see a different side of the Haitian people up close. The proud, defensive, angry, passive-aggressive side. I have tried to be the perfect communicator, humble, kind, gentle…and it has seemed that nothing has ever been good enough, because some (not all) of the people in this project, are not interested in communicating if it has to do with improving things, which means that their work may be altered slightly. The whole point is for me to work together with the people here, who already have a long history in this project, in order to make sustainable improvements in the quality of care. But, it is hard to have normal communication about this when people see you as a representation of everything that they have come to resent about MSF. There is a long history for many of these people (6 years), and this is great, but it also has its downside, because many people are burned out—they have given up—and here I am, coming in, and trying to communicate about ways to improve the services, which is annoying to them because they have a comfortable routine. It is not such an easy thing to balance. I am an “expat”, but I speak Creole and live here already. It’s not like I’m sweeping in for 6-9 months and then leaving, never to return . I DO care what people here think about me—the key to my survival in Haiti has been building trust with Haitians. But what am I to do, when there is already such an intense distrust? People see you as a spy. They see you as a blan. This situation has been a painful reminder of the ever-present reality in Haiti: no matter what I do, I will always be seen as a blan, which represents many things to the people here. I will never be fully accepted or seen as a normal person. The problem with this is that I am tied to Haiti—Blada is Haitian—and, I still don’t even know when we will be leaving, because we are not yet finished with the visa application process. I really hit rock bottom with these realities, especially after receiving a lot of anger and aggression from some of the staff, despite all of my attempts to mold myself to their needs, to be slow, to communicate well, etc. It felt like no matter what I did, people were angry with me. It is draining. It is exhausting. People do not take responsibility for their own attitudes or actions—they even blatantly lie about things they have said or done. But, they will easily blame me—I am the representative of everything they have come to hate about their job. It goes even deeper than this. People see everything through the eyes of their history with slavery/colonization, and then the long fight for freedom. So, they are not afraid to fight, and it’s like some of them are reliving a perpetual battle. It is very complex. I feel caught in a complicated web of history and peoples’ personal and collective anger, which they themselves are not even willing to agnowledge or take responsibility for. It is intense. I am hoping for an easier time, hoping to step back a little from the intensity—it is just too stressful. Too much stress. There was finally a breakthrough, a couple of days after I had really lost all hope. I am hoping that this breakthrough will carry through and that things really will get and stay on the right track, a tleast with the person concerned. I can’t make everything perfect with every person who already resents what I represent, but if this one can continue on a better track, I will be very relieved. I have felt like I am suffocating with the stress. It’s not good to live like this. I just want to live somewhere where I am accepted and seen as a normal person. I am tired of having to prove myself all the time. I am tired of having to be ultra-positive and upbeat in every single moment, in the face of anger and hostility. I am tired of it. I just want to live. 11 sept 2012 Things seem to be continuing on a tentatively better path than they were. Relations are positive with the national staff supervisor I was having problems with, and this is wonderful, but it also feels tentative, because the layer of trust here is so fragile. It is so hard to weigh the importance of speaking up about problems that I see, both directly to the staff and to the supervisors, even when to me these are very important problems, because you must balance this thin layer of trust and tolerance. There is a new expat nurse. I like her a lot—she speaks Creole and has lived in Haiti before. She will be helping me and the pediatrician with some of our work. I am so so so happy for this, and I really think that this will enable me to have more time to focus on the problems that are the most urgent. She is going to take over 2 of the postpartum services that I am responsible for, which I have not had much time to work in because of all the things I’ve been working on in the other services. This is such a relief for me. She is also going to help me to come up with continuing education for staff in needed areas and to streamline postpartum education in the whole hospital. I am really happy for the help and the collaboration at work---this is HUGE. But, apart from this, I am also really happy that I will have a friend at the house. I get along well with everyone at the house, but I have never felt close to anyone here. But with her, I just feel at ease, and like I can be myself and talk without feeling like I need to be formal or polite in a certain way which fits with other peoples’ expectations or cultural backgrounds. All of this hopefully means that the second half of my mission here will be more fulfilling, less frustrating, and smoother than the first half. I have been spread so thin this whole time, I have felt like I have all of these unfinished projects with no real accomplishments to show for my work and the stress I’ve been through. There have been some improvements though. There definetly is more of a tendency now to leave babies with moms and initiate breastfeeding in the delivery room. I have organized an area for neonatal resuscitation with a daily checklist of the supplies, which is being followed. My national staff supervisor is also making more of an effort to participate with me in the follow up of these changes. There are others too. Small steps. I visited Hinche this past weekend. I spent some time at the hospital where I used to work…watched the way the midwives there interact with patients…it was so different there when I first arrived 2 ½ years ago. I remember feeling like a knife was stabbing into my heart every time I would walk in and see the way the women were being treated—slapped, yelled at, made to labor on the tiny delivery tables… Now, it is so different. I felt like I was surrounded by a community of like-minded midwives, for the first time in a long time. They were encouraging women to walk around in labor, were talking gently with them, were doing labor support, were encouraging moms to breastfeed. I don’t take all the credit by any means!!! But, seeing changes like this gives you hope. If I had 2 years to invest in this project, I know that I would be able to build trust as I did in Hinche, and that I would be able to steadily address all of the major problems, and to follow up the implementation of changes, and to mentor the national staff and support them in their growth as midwives. But, I don’t have 2 years to give here. I feel that I don’t have sufficient time to address the problems and create deep relationships with the staff here which would support our working relationship. It is unfortunate. I will do what I can. Perhaps what I am able to do will be more far-reaching than it appears at the present moment. 21 October There’s not much new to report. Things have been going slightly better—for the first time one of my national staff supervisors is standing behind something I am working for and is defending it—it is a solid, spelled out protocol for the temperature in the delivery room, which became necessary because after months and months of talking about the risks of hypothermia in the newborn and people still putting the A/C unit on really low, to make themselves comfortable. Miraculously, one of the supervisors I work with finally bought into the idea that hypothermia of the newborn is a real medical problem at our hospital. I finally this week started feeling somewhat satisfied and happy in my job. But, this happiness was short lived when there was some drama that went down with one of the midwives…nothing is simple here....something as simple as implementing a temperature protocol can be interpreted in so many different ways..I am tired…I want to push forward but part of me also just wants to withdraw and not say anything about anything, because whatever you say to people here, no matter what you say and how you say it, inevitably gets turned into something else and transforms into a huge dramatic thing… Only 4 more months. I am trying to stay strong. I have never worked with a group of Haitian midwives quite like this one. The group of people in this project is very angry. I feel like I am caught in the crossfire, simply by being in the position I am and by doing my job, which involves correcting problems. So, like I said, nothing really new to report. Just doing my job, getting through each day and each week, trying to hold my head up despite the challenges, the cross cultural misunderstandings which given the fact that I’ve already lived and worked in Haiti for almost 3 years, is disappointing and disheartening…it is like there is this rift of distrust that will never be bridged, no matter what you do… Trying not to think about work so much…I just want to enjoy my last months in Haiti…I wish I could be carefree and just enjoy the things I love about the people here…unfortunately I am faced with living in a reality that I don’t want to be a part of…being part of a group of people who resent my presence because I am white…that’s always how it’s been in Haiti though…it just plays out in slightly different ways… On a brighter side…really, aside from the shattering reality that the midwives here don’t like me or trust me, let’s see…aside from that, things are going well I guess. Things are good at the house…everyone is making effort to get along and compromise....there are about 10 of us…from different countries…it’s quite interesting…. I hope to have more interesting stories to tell next time…unfortunately, the way I am describing my work here is the reality that I have been living in now for many months…but, I am still trying to have hope that things can improve, and am counting on those at work who are silently supportive of me, and who don’t buy in to the drama and accusations…these allies certainly do exist among the national staff… Blada and I are doing great, staying strong together, getting closer and closer to having our interview at the embassy for his visa…hopefully this will take place in the next 2 weeks or so…our plan is then to move to NC in March of 2013… Sending love to all of you and thanking all of you for your constant presence and support….