tag:blogger.com,1999:blog-34627926415773764532023-07-17T22:04:59.667-07:00reina's midwifery adventuresI have been living & working in Haiti as a midwife since February 2010.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.comBlogger59125tag:blogger.com,1999:blog-3462792641577376453.post-86173197196942164292013-01-14T12:34:00.000-08:002013-01-14T12:34:05.983-08:00October 2012 to January 201323 October 2012
Yesterday I caught a baby with only my right hand. A woman was wheeled into the delivery room who was already pushing . As she came through the door, the head was coming out. I followed her in—the midwife who had been with her in labor was also by her side, but no one was doing anything to prepare for the birth. The midwife was yelling at her not to push, and even threatening that her baby could die and if so it would be her fault (for pushing in the wheelchair instead of on the table). The head was out, and I got ready to catch the body, which I had a feeling was going to fly out. The only thing was that I was holding a stack of papers in my left hand—in the fastness of the moment, I didn’t think of letting the papers drop to the floor—but instead, as the baby flew out of her as she sat on the edge of the wheelchair, I caught the flying baby with only my right hand. For a moment I thought that this would be my first baby to ever fall on the floor, but instead what happened was that my finger hooked inside the baby’s mouth and this helped me to keep the baby straddled on my right arm, while I kept holding the papers with my left hand. I told the mother that she didn’t need to worry—everything was okay, and I also gently told the midwife that it was not the mother’s fault for pushing—in fact her body was pushing on its own, without her effort. Actually, perhaps she was wheeled into the delivery room a little too late. It was a fun catch—my first one-handed catch (usually even if you were to have a one-handed catch, you would probably have a surface close by where the baby could gently land—like for instance if the mom was squatting on the floor).
27 October
This month has gone by very fast. Each week flies by. Things are going okay, not great but definitely better than they were a few months ago. The arrival of Devon, the expat nurse, was a huge blessing for me. She has been helping me to implement things, like the temperature protocol in the delivery room, and is supportive and spends time with me in the wards; we do births together and she’s someone I can talk to…finally…
I wouldn’t say that things are going so well with all of the national staff midwives but they are a little better than they were a few months ago. I feel that I have been in an impossible position, stretched between 2 worlds, always the person in front of the staff who receives the blows of their frustration, which is rooted long before my arrival.
This week, I was so happy to have some cooler, cloudy and rainy days…but the rain, which was light and lasted 3 days, completely paralyzed the transportation system in Port au Prince…the roads have no canals which drain the water, and many of them are dirt roads…this light rain created a disaster—we had to work for 3 days straight organizing pickups of MSF staff by the MSF trucks, so that people could come to work…finally today the sun is out, and I am actually relieved and happy to see it, because now I can relax and know that people will come to work with no major problem…
We find out about the date for our visa interview in a few days…
1 November
Well, our interview was set for the 4th of December. So, another month away. This is somewhat disappointing for me because I am really ready to be finished with the whole process, which has taken the past 1 ½ years. But, it is okay. Blada and I are going to visit his family in Cap Haitian for about a week starting next weekend. It has been over a year since I’ve seen them. It will be so nice for me to have a break from the current situation of living in a way that feels segregated from the Haitian population. I am a homebody and don’t mind so much being closed in all the time at the house—I’m not really interested in going out to restaurants like everyone else here—since I’m not allowed to walk anywhere, there’s nothing I can do except work and hang out at home. Blada has been around here more because we were preparing for the visa interview, which we thought would be really soon, not the 4th of December.
3 November
Luckily, this week had 2 holidays (Day of the dead) in which I was able to rest and recuperate a little. I was going to go in to work the first day, but instead I ended up working at home, working on these 2 reports I wanted to write, mostly to get some things out of my head and onto paper, which has always helped me. The first one, about the history of the problem of neonatal hypothermia in the hospital and the development & implementation of the strict temperature protocol, I wanted to do so that the new expat or few expats would hopefully not undo the work I have done in this area and would be able to see the complexity of something so simple as protecting newborns from getting cold. It was more straightforward and is mostly finished. The other one, it is about the complexities of working with the national staff here. This one has a long way to go, and it is mostly for myself, to get some of these absurd stories and events out of my head so I can stop thinking about them. It would be too long and detailed to give anyone else…it is more for me, something cathartic.
This week I had no tolerance for the expats and felt I barely had the energy to interact with them at all. There is this one person who I like and is really nice, but who talks a lot and who requires a lot of energy to interact with. I think she took it personally that I could not interact with her but at the same time, when I am around someone who is giving me signs that they are not interested in talking with me, I follow the signs and go my way. This person, she never follows peoples signs but always has the exact same, long-winded, needing to have the last word kinds of conversations. This is not so bad though—I really like her, I just couldn’t spare any energy to interact with her. The bad part is that I am super fed up with some of the expats in the house, because they are completely unaware of others and are complete slobs. It is unbelievable. These are adults! I just don’t understand this mentality. Group living is hard, when you are living with people you would have not chosen ever to live with, who has completely different values from you. Mostly I am very tolerant, but there is one guy who really grates on my nerves, because he is so arrogant, he just does whatever he wants all the time, since he first arrived. And, he is unapproachable.
Luckily, my vacation is coming up, in one week. Blade and I are going to Cap Haitian for 1 week to visit with his family. It has been over a year since I’ve seen them. I am so excited to be out, to be free, to be able to walk in the street, to be in a normal Haitian house, etc. I can’t wait.
2 December 2012
The month of November went by fast. I now have only 2 ½ months left!!! I know it will go by fast. Our fiancé visa interview is in 3 days. Once we are finished with this and have the visa in our hands, we will truly be in the last phase of our existence here. I am still enjoying parts of being in Haiti, of the Haitian people, which I know I will miss later on. But, in general, I am really ready for a change. It will have been 3 years for me here once we leave in February. I can’t wait to experience a totally different climate, to experience changing seasons, to eat other kinds of food, to reintegrate into my old community which supported me 10 years ago when I was preparing to go to midwifery school, and to be with my family again. I can’t wait to experience different things with Blada, like visiting NYC. I think about these things all the time.
Work has been a lot better and easier the past couple of months. People have been a lot easier on me and seemingly more accepting of me. I also stopped vocalizing my observations, which was what they wanted in the first place (for me to leave them alone). But, nevertheless, things have been moving in the right direction because most of them now believe in the necessity of having a temperature protocol in the delivery room to protect the newborn babies, and I have been able to furnish all of the midwives and auxilliares with good quality reading material which supports my points. I found an excellent WHO booklet which talks scientifically and quantitatively about the short-term and long-term benefits for mother AND baby of immediate skin to skin contact, immediate breastfeeding, and delayed cord clamping (this one, I wasn’t pushing at all but now that I have a really good reference to back me up, I can talk to the midwives about it). Anyway, in general things are a lot better and less dramatic—also because one person who was really horrible to me has been gone for almost 3 months, but she is coming back in 2 weeks and will be here for my last 2 months. Maybe since many other people are more on board with me, she will be easier on me too. We will see. Either way, it is not an uphill battle anymore—I am now on a flat plateau—no new changes—just following up with the same things as before, finishing things up, and moving towards having closure.
Our trip to Okay (Cap Haitian)/Hinche was great. Just getting away from the reality here…I was feeling really fed up with everything, and just needed a break…well, being in normal Haiti for 1 week was enough for me to forget all the stresses of work…This is how our trip went:
We took a schoolbus from PAP to Okap. We got seats in the way back of the bus, right over the back wheel. We arrived at 6:30am and waited for 3 hours for the bus to fill up so we could leave. I thought it would be a good idea to pee before taking off, so we went to the only place we could find in the “ station” to pee: in a trash pile behind some vendors’ stands. There were flies everywhere and it smelled like poop. There were old tires, trash, and oily black mud. It was really gross but there was nowhere else to go. I kept thinking that someone was going to see my white feet from below the vendor stand, and call me out, as usual in my life here, and so then I couldn’t relax enough to pee. Finally, I was able to pee and we then went back to the bus. There was another white guy on the bus now, in the row next to us. He was backpacking through Haiti for 3 weeks, and spoke not a word of Creole. Wow. He was nice though.
We got going. Things were going well. We went on the road along the west coast, through Gonaives. The trip took probably about 7 hours. Each row of seats has 3 people crammed onto one seat. The last 1/3 or so of the trip though was horrible. This bus obviously had no shocks, and we were sitting in the back. The driver was driving over all the potholes, not slowing down for them, and everyone in the back was bouncing all around. The road apparently had been good once, but like everything else here, was not maintained and is in ruins. I started getting pissed, just thinking about how this is one of the MAIN ROADS between 2 MAIN TOWNS in Haiti, and it is in this shape. And people are subjected to this, as if they do not deserve any better. How is this possible? To not even have normal roads? So, we were bouncing so much that our heads were hitting the metal grate thing above, where you put your bags, and then some people in the back started cursing at the choffeur. This part was really funny. Since he was not paying any attention to them, they started cursing him and making fun of him, calling him an animal, a pig, and saying that he eats shit, not real food. Then, we stopped somewhere along the way and he loaded onto the top of the bus a bunch of huge sacks of stuff. We started going again, and then suddenly we noticed that there was this weird liquid dripping onto us through the window from above. It wasn’t water. I couldn’t figure out what it was. It had a chemical smell. Finally I realized that it was ammonia. Liquid ammonia. They call it “ kanpe lwen”—stand far away. They use it for people who faint and for headaches. We tried to close the window, but it was broken and wouldn’t close. Then, a little while later, it started raining and all the rain was coming through the windows on our side, but again nothing could be done because the windows couldn’t close. Once again, typical Haiti. I didn’t mind too much because I was so relieved to be away from my closed in existence in PAP.
So, we arrived to Blada’s mother’s house. This time it was a lot easier for me to stay there because they have built another room onto the house, so we had a room with a mat on the floor, which I had requested them to get for us in advance, instead of sleeping on a damp mattress. So, having the mat, which was made of some kind of tall dried reed/grass (they make them from other materials as well), was amazing. My body was sore though for 3 days after that bus ride. Luckily we had bought some tiger balm while waiting for the bus to fill up, from someone who came onto the bus selling different things like this, for 50 cents and so Blada massaged my back and neck with this and also we got some for his mother.
This trip to Okap was really sweet. His family was just so sweet, his younger sisters were more into me than they had been before, I understood everyone’s Creole with no problem this time (the Creole in Okap is a lot different). It was great. We just made food together every day, and hung out. We didn’t go anywhere. The place where the house is, you can hear sounds from all over, from other houses. Maybe because there is a lot of cement. Each morning, I could hear children screaming while their parents beat them. I’m serious. There is no escaping the reality here. It’s all over. Being in Okap was great, seeing his family and really enjoying them, but also because I was so much in touch with the real reality of Haiti, it was also discouraging. Okap is so, so dirty. As soon as you go out into the street, you are in a cloud of dust. Most of the roads, even in town, are unpaved. People look at you like you’re an alien. I went to the market with Blada’s mom and sisters and it was unbelievable. People act like they’ve never seen a white person before. Someone asked his mom: “ ou gen blan nan fami a?” You have a blan in the family? When we were leaving Okap, the way to the station is over a bridge which goes over a bay. The bay is lined with shacks, pieced together with rusted pieces of tin. The banks are piled with trash, and the water is black and oily. With trash floating in it. I just kept thinking of how it could be. How beautiful and amazing it could be.
Yes, leaving Okap, I felt discouraged about living in Haiti, and all I could think of, despite how wonderful of a visit I had had with Blada’s family, was how I can’t wait to leave. So, we got to the bus station. We were going to go through Hinche (a different route than on the way up) and spend a few days in HInche). There are pickup trucks that make this route. The road is not good enough for the minivans or the schoolbuses. So, we got seats in the cab of the truck, with a driver who always makes this route, who everyone knows, named Pisket. As we waited for the truck to fill up, we ate sugarcane that Blada had bought. I felt happy.
So, we left Okap and before taking the road to Hinche, took an hour-long detour, to a little place in the country closeby, because Pisket was going to load a bunch of sacks of pottery onto the truck to make extra money (he didn’t tell any of us beforehand, we just went there.) This was actually really nice, because in contrast to Okap, the countryside was really beautiful, and this was encouraging to me. And, another thing that was really encouraging was seeing the people actually being industrious in something. Making pottery. This was very encouraging.
So, finally we made the trip to HInche, and it was uneventful. Being in Hinche was great. We saw old friends, and had enough time to visit with people. We had to leave one day early because MSF called me and was concerned about us coming back on Sunday because there were planned protests in PAP over the shooting of a student. So, we didn’t get to see Jamlex, our baby (when we lived in the MW4H house, Jamlex came everyday with his mother, Diunney, the cook, and we grew very attached to him). We also didn’t get to see Blada’s godmother, who is a Catholic nun. It really would have been good to see them both. But, oh well. Overall, the trip was full and very satisfying.
If I don’t go back to Hinche or Okap before we leave Haiti, that is fine. I also don’t know if I’ll make it back to Ti Trou or Jacmel. We’ll see. I was satisfied with my exposure to real Haitian life. It felt totally normal and natural, as if I had never left.
Coming back to PAP was fine. I had been feeling really apprehensive about returning to work but things have been smooth and I know I will make it through these last months fine.
December 16th
So…exactly 2 more months left. That is 8 weeks. Each week passes quickly. I am really anticipating this change. I have been ready for so long! 8 weeks is perfect…now I am just wrapping up things at work…I need to write my end of mission report, I need to revise the obstetric protocols…I will be very bust until the end…which is fine….I am so thankful that I am at this point….
We don’t have our visa yet…Blada has an appointment to pick it up this week….I can’t let my guard down and rejoice until we have it in our hands…it has been so long since I have been working on this and feeling trapped in Haiti…now it is almost over…we think and hope…I wish I could just buy our tickets right now, but we are supposed to wait until we actually have the visa…
The house is kind of quiet…it’s really nice…people are on holiday…I’m listening to music in my room, fully enjoying being in my own reality…
Blada is in Okap visiting his family…
It seems that every day things get worse in Port au Prince. Every week you hear of killings, usually robberies that end with shootings…honestly I don’t know if I’ll ever come back here…when you think about the reality here, how as soon as people leave the airport, they may have someone following them, ready to rob and kill them…just last week, there was a very sad story…a very kind woman, a patient at the hospital whom I had had the chance to get to know a little. I had talked with her the day before, it was her birthday. She was pregnant with her 4th child. Well, the next day I heard that her husband had been murdered. He was on a public bus in Port au Prince, and there was an armed robbery, and the robbers made everyone empty their pockets. When he emptied his, they saw that he was a police officer. They shot and killed him. I heard the news, and of her reaction-- instant intense mourning, as everyone does here when they first hear that someone has died. I went to see her later that day, to sit with her , but she wasn’t in her bed. I returned the next day, and she was in her bed, smiling and cheerful. We talked matter-of-factly about the fact that her husband had just been murdered, that she has 3 kids at home and one more coming, and she told me that they had been married for 13 years. She asked me about myself, when I was going to have children, if I was married. She seemed completely “ normal”. This is the thing that I have seen in Haiti time and time again: people mourn outwardly and strongly in the first moments, and then they immediately carry on with their lives and act as if everything is okay. They are unbelievably stoic. I cannot interpret it or explain it, but I have seen it time and time again. It’s like a switch is turned on and off. Maybe it’s because people don’t have the luxury to mourn for long periods and get depressed, because they have to survive. There is a culturally-accepted time for mourning, people do it and then continue on. This lady was also Christian, she mentioned this to me, and I think in times like these, this is something that really helps people to get through the tragic events of life that are so common here. That’s another thing: the amount of trauma that people experience throughout their lives…trauma like this is not a once in a lifetime event. It is part of life.
December 23, 2012
We are doing well. The waiting, the certain amount of uncertainty, the dragging on of our visa process was somewhat excruciating for me. But, we made it happen, we got everything in order, we had the last missing form FedEx’d from the US for $86, Blada brought it to the embassy, they gave him a return appt. in 8 days, and each day of the 8 days was an eternity for me. Finally, the 20th of Dec. arrived, and he went, and…HE GOT HIS VISA. This is the closing of a chapter which has lasted almost 2 years, from start to finish. Finally, we are moving through the threshold of waiting and wondering, to knowing. This is a huge transition for me, because I have had to keep my guard up and survive here for a long time, never knowing for sure if the visa would work out or not. I am so relieved, I can’t express it. At the same time, I am still here, in the reality of my work, still surviving in my own way. We have about 8 weeks left till the day that we leave. I just want to forget everything and leave…I feel impatient…all I can think about is leaving, arriving in NC, seeing everyone, reuniting with everyone, bringing Blada into the family…
12/25/12
Can’t sleep..last night, I got woken up at midnight to the loudest music I have ever heard, from one of our neighbors’ houses…it was horrible DJ/mix music…it was so so loud…it went on for hours…I get it, people are celebrating, 24 Dec is a big deal, basically the whole month of December is a huge party, leading up to 1 + 2 January, when they celebrate their independence, then soon after that Carnaval starts, which lasts a couple of months…I get it, and I accept that in Haiti people make lots of noise and no one cares, but last night I was pissed, because the volume was so exaggerated…and of course I was tired all day today..Christmas day…quiet and somber…imagining next year, being with my family…
Now that I’ve passed the 8 weeks left mark, and we are almost in January, I think the time will go really fast…January will be super busy, at work and at home, finishing up everything…that’s good. My replacement arrives Feb 2nd. I will spend the last 2 weeks here doing a handover with her, which means that everything else must be done before then.
2 days ago I was able to attend a Christmas dinner at my friend Beth’s house…it was so nice…I ate traditional American food…a welcome break…we sang Christmas carols...I am so glad I could go. Beth and her husband, John, have been living and working in Port au Prince for 22 or 23 years. They do really good work. Beth is a midwife and has a birth center where she provides excellent prenatal, intrapartum and postpartum care..parenting classes, lots of other services. Anyone who is interested in helping Haiti I welcome you to check out HEARTLINE MINISTRIES. I can personally vouch for them. They are grassroots and their work directly affects peoples’ lives in their community. They are extremely generous and despite all their years here, I have never ever gotten the impression that they are bitter or desensitized. They really care about people. Beth, despite being super busy with all of the work she already does helping people, has been coming to the MSF hospital every 3 months and donating blood. I mean, these people are hard-core, and they really walk the talk.
There was something that hit me while I was at Beth’s house…there were 2 other interracial couples there…they were so in love, sitting close together, just glowing with their love for each other and apparently so open and uninhibited. Seeing this, I thought about me and Blada…how we used to be at the MW4H house in Hinche…how we were comfortable, because we thought it was our home and it was safe…and how the whole time, (white) people (visitors) were uncomfortable with our relationship, talking behind our backs, and how in the end it all exploded out into the open…I experienced a lot of trauma when things fell apart in this way and we chose to leave Hinche, because we did not feel safe anymore with the organization, after the all the lies and betrayel…it is a long and unbelievable story, and in the end, I know that I have unresolved trauma around losing the safety that we had trusted to exist there for us, in our own home…now, living in the MSF house, it is very different in some ways because the people here I would say are a lot more cultured and international than most of the volunteers who used to come to HInche…my housemates accept Blada and don’t seem to mind his presence…they’re not shocked or offended by us together…but at the same time, this is not our house and we do have to be extremely careful. Watching these other couples at Beth’s house the other day, it reflected to me how guarded I have had to become. I look forward to living in a place where my home is safe for me, for Blada, and for our relationship. Where people like us and accept us for who we are. I appreciate the safety that I have felt here, with MSF, in this sense…but I have never been able to trust it fully or let my guard down, after what happened in Hinche. I hope that in NC, we will feel free and open, completely.
Don’t be fooled by all of the “do-gooders” who travel to poor countries like Haiti to “help”. Most of them are looking for an experience, or to prove something to themselves, their friends, their coworkers. I have had so many people come up to me when I am visiting the US who don’t even know me, who thank me for the “amazing work” that I am doing in Haiti…(they assume that if you would come and work in Haiti, that you must be doing “amazing work”).
Don’t be fooled. There are plenty of demented people who come to places like Haiti precisely because these populations are vulnerable and anything that you do will look like help. Or because they have specific scenarios that they need to play out in order to feel good about themselves, and they can do that here…in the meantime, often taking advantage of the population or stepping all over those who are already there…I have seen multiple variations of these scenarios myself and have heard stories of people who have come here and done even worse things.
6 January 2013
I am so happy about the new year. The year of 2013…it brings many long-awaited for transformations. It was a fun time to be here as well…a very special time in Haiti…when their independence is celebrated…people are happy…luckily I slept well the night of the 31st…I thought there would be al of noise…it was the most wonderful thing: there is this little church right next to our house. People gather there, and sing and pray, both Sunday mornings and Friday evenings, in the dark…well, the night of the 31st, they sang beautiful slow hymns all night long…I could hear them in my sleep…it was so, so wonderful. I felt so happy the next day.
Things are changing…we are getting ready…wrapping things up here…soon we will be in the US, starting a whole new chapter…I look forward to seeing those of you I can…and I thank all of you for your continual support over the past 3 years.
This might be it…my last blog…those of you who would like to keep in touch with me, please email me at parterachida@hotmail.com. Again I thank all of you for your immense support over the past 3 years.
parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com2tag:blogger.com,1999:blog-3462792641577376453.post-30341917680198611162012-10-23T13:35:00.003-07:002012-10-23T13:35:52.628-07:00August-October 20122 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….
parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com0tag:blogger.com,1999:blog-3462792641577376453.post-91511015645904547882012-06-26T16:00:00.000-07:002012-06-26T16:02:09.991-07:006-11-12 to 6-25-12June 11th 2012
I am reading about hypothermia and hypoglycemia in the newborn, in order to be better-equipped to explain these things to the midwives here as I try to improve the conditions meeting newborn babies in the MSF hospital. Actually, there have already been small improvements since I first started talking about this (hypothermia—haven’t tackled hypoglycemia yet) with the 2 MW supervisors who oversee triage/delivery room/antenatal/normal postpartum. This is great. I will be starting to teach neonatal resuscitation (it will be a review for many of them) to all of the midwives and auxilliares very soon, and I also wanted to use this opportunity to talk about cold stress and hypoglycemia in the newborn. (The delivery room actually has an air conditioner and it used to always be super cold in there, plus the other issue is lack of early breastfeeding. Babies are having a hard start in life here.
I need to remember not to get into the expat mentality of being in a rush and trying to accomplish a million things in 6 months-- I see some people doing this around me, which makes me doubt myself sometimes, but I also know myself and know that I need to be realistic and pace myself. AND, another huge reason for not being super crazy and in a huge rush is because the Haitian staff are not like this at all, and it won’t help me in my work AT ALL if I act crazy and stress them out. So, I have to stay relaxed and combine speeds—a combination of expat speed and national staff speed.
We had a woman die in Cholernite on Thursday night. It is sad…it is always sad and strange when people die…something that Haitian people have had to deal with their whole lives…this woman was 22 years old…her case was complicated, and in the end, no one knows for sure what the main cause of her demise was…several of us worked very hard to save her on Thursday, during the day—but at that point, she was already in a coma and was getting worse and worse…when I left, I knew that she was dying.
The saddest part for me of this situation, was witnessing her husband as he had to deal with the reality of her death…the thing is that here, people are struggling to get the money together to even have the body picked up and buried. So, the day after Delia died, her husband of 7 years was in the street, running around, from here to there, trying to borrow money so that he could have her body picked up (we don’t have a refrigerated morgue) so that he could have his beloved wife buried. He had no time to grieve, or to hold his 4 year-old daughter who was also realizing the fact that her mother was not coming home…he had to be matter-of-fact, and tend to the nitty gritty details of having his wife’s body picked up…not just any ambulance will pick them up, because people who have died with cholera are still infectious, even after the disinfection process that is carried out after the death…(which is why MSF additionally provides a body bag and coffin to reduce the contamination risks).
Friday afternoon, he had been out all day, trying to make necessary arrangements, hadn’t eaten, hadn’t sat down…I was present in the discussions between him/his sister (who were both by Delia’s bedside for 3 days until her death) and the staff who are in charge of dealing with the dead bodies as they discussed logistics…it was so sad…towards the end of the conversation, someone showed compassion and solidarity by saying something like, “It’s something you grow up your whole life with, but you never get used to it (death).” Then, the sister said something like, “yeah, you never can get used to it, but it will always be in your blood”—what she meant by this was that it is something you cannot escape. Unnecessary death, such as children dying from malnutrition or diarrhea—moms dying from eclampsia—things like this, if you’re Haitian and live in Haiti, you will always be exposed to it, and it will continue to happen. It’s in your blood, as in, you cannot get away from it.
As we were walking away after this final conversation, I felt so incredibly humbled before this man and his sister, who were dealing with the reality of Delia’s death because they had no other choice. I was so incredibly humbled, and wishing to give some kind of consolation to them, wishing that I could somehow offer some support, besides my presence and my patience. I had no words to offer, no blessing to give that could possibly compare to their courage. I felt so inadequate, although I knew too that simply being present and compassionate meant a lot to them. Still, I could see myself there in such a priveledged position, having a window into their suffering, watching them and learning from them, as I have done in with so many other people here. Not one word could I give them that would possibly suffice. As we parted ways, the only thing I could think of that was encouraging and that would make sense to them was, “I’ll pray for you.” That was all I could say.
I will never be able to understand or quantify the strength of the Haitian people. People notice it, but so many people overlook it. I remember in Hinche, people would always notice the “lack of compassion” of the Haitian care providers at the hospital. It was shocking to me in the beginning as well. It was hard to understand how midwives and other healthcare workers could be so cold and callous. But, I came to see many things in my time there, and one of them was the realization that there were many other acts of compassion that I had initially overlooked, because I didn’t perceive them as such. I didn’t understand the culture enough to see them.
People in Hinche (short-term volunteers) always used to try to ask me to analyze with them “why” there was such a “lack of compassion”—perhaps because people see so much death and suffering on a regular basis that they are powerless to fix—that was one hypotheses…I always remained neutral and not really willing to agree upon a certain analysis, because in reality, who am I to give a reason for anything? What do I know? Al I know is from my own observation, which is shaded by my own cultural assumptions. I didn’t grow up here. How could I possibly be an authority on the Haitian mentality?
It makes you think of all of our own mortality, of how we are constantly walking such a thin line between life and death…I try not to think about it too much…those of us who are living are so lucky…
Blada came here this weekend…he left this morning…we hadn’t seen each other for about 3 weeks, and I was really starting to miss him a lot…it was such a relief to see him and be with him…so joyous…so so full of joy. I miss being around him. I feel so balanced, centered, and happy when we are together. This is good, what we are doing now…we are both accomplishing important things…working on our own…but, we are going to try to see each other more often, because 2-3 weeks each time is really hard for us.
He has been cultivating our little piece of land in Ti Trou. Planting trees, and making gardens. For instance, he has planted like 40 coconut trees all along the perimeter of the land. He is planting mango, cashew, almond, soursap, breadfruit, things like that.
We started a little garden here too. With seeds that my mother sent down with someone for me. Basil, tomato, tomatillo, chile peppers, melon, cucumber, sunflower. So exciting!!
June 16th
So…this was a pretty good week at work…the people I work with (both expat and national) and the work itself (everything it entails) is so interesting…sometimes I find myself in the moment, while at work, just savoring the moment and feeling so content and optimistic, knowing that I both have a lot to contribute and also a lot to learn…and knowing that both of these things will happen….and are happening…other times, sometimes, I still feel overwhelmed, both at the massiveness of all the work that still needs to happen in all the different services I am involved in overseeing, and then sometimes feeling really inadequate, and then sometimes comparing myself to other people who appear to be accomplishing big things/making huge steps…then wondering how people see me…but in reality I know that people trust me and respect me, and that part of this insecurity I have is because I am still new and figuring out the ropes…I can see the problems, the hard part is figuring out multiple strategies to approach the problems. I am accustomed to working directly with midwives and teaching/coaching as I work together with them…but, I can’t just have this one approach…I can do this too, and in fact must do this, in order to improve some of the care, but I also need to do research, plan continuing education modules, and be more of an administrator. I see all this, but the pieces are still falling into place for me, as far as how to work within the structure of MSF and use the tools available to me.
I am starting neonatal resuscitation classes on Monday. I have a feeling that this is an area that needs improvement in the delivery room. I am going to keep it really basic and practical—what to do and how to do it effectively.
Blada is here this weekend again! Some of our little seedlings that we planted last weekend are coming up. Last night we had a really fun time, we went out with 2 people I live with, Charles and Adriana, to a little party at the house of an old friend of mine, who is now living in Haiti for the next 2 years. My friend is named Elisha, and we both grew up in Saxapahaw, and used to play in the woods together all day with our other friends, when we were like 9-10 years old. Then I didn’t’ see her again for like 20 years, and now suddenly she is living in Haiti. She is a really fun, exuberant person. It was really great last night because she got to meet Blada, and also my friend Charles, is from DRC, where Elisha lived for 3 years. So, really great. At the end, before we left, we were all dancing in the living room—so, yes, my kind of party.
Blada brought me 12 green coconuts from Ti Trou. I was literally in heaven earlier today as I drank the sweet coconut water from 3 fresh coconuts. And then eating the flesh…soft, sweet…coconuts are amazing.
June 18th
Back to work today…I was sad to let Blada leave this morning…it was easier last week because I knew I would see him the next weekend…it’s hard trying to cram everything into 2 days…
This morning I did my first neonatal resuscitation class here at CRUO (the MSF hospital: Centre de Reference des Urgences Obstetricales)----doing the class was really fun—really natural and enjoyable for me—I guess I miss teaching…it was partially a review for the midwives but partially new, because I really focused on doing each thing correctly…so, I think the result was good…simple, practical…how to do ventilation and chest compressions: correctly.
I wanna give a big shout out to Maternidad La Luz, where I trained and worked for 6 ½ years before coming to Haiti…I got such a good grounding in midwifery skills (such as neonatal resuscitation)—and in birth, suturing, prenatal care, newborn exam, so many other things. I am eternally thankful to MLL for the opportunity I had to learn and practice what I did during that time. And MLL is still so much within my consciousness (or subconscious) that it really embodies/represents many of my ideas and feelings around midwifery…
For instance, the other night I had a dream, in which I was in the rose room (one of the birth rooms) at MLL, and there was a beautiful laboring woman in there who was doing amazing, handling her own labor and taking care of herself, changing positions intuitively…I was just watching her, holding the space…she starts pushing, and soon the head starts emerging…well, next to me is a Haitian midwife (who I know in reality), who, once the head is coming, starts telling the woman to stop pushing so she can get her hands in there and pull the baby out for her. I gently tell her to wait and just watch, without interfering. The woman catches her own baby in front of us, with no interference.
In reality, it is really hard to watch sometimes how the midwives practice, because it seems as if most of them have one single way to handle birth especially. One of the things that annoys me (since forever) is how people always make the mom stop pushing after the head is out, and then they proceed to pull the baby out by the head, with no help from the mother. It doesn’t make sense to me. But, it’s the one way that everyone learned at the one midwifery school.
I’m not complaining…I’m just being honest about one of the many zillion tiny things that have been challenging for me, for the past 2 ½ years since being in Haiti. I think that I have done well accepting Haitian culture and reality and realizing that I am a guest here anyway, so why get all bent out of shape…but still, it can be hard. And I think that the dream I described above embodies some of this frusturation. The thing is that here, it’s not like at MLL where all of us held the basic principles and understanding around the way we treat pregnant & birthing women. I feel very alone sometimes. I remember in Hinche, when I first arrived, what torture it was. But, as Marthonie came to trust me and became my ally, I wasn’t alone anymore. She was amazing. I have said this before—I don’t know if I will ever find someone else like her again in Haiti.
Another little dream from this same night that is kind of funny and again embodies some unspoken feelings was that I was in a group of people and everyone was speaking French, which I understood perfectly, and then one person turns to me and translates the whole conversation over again in English. In the dream I am like, “God! You don’t have to do that! I UNDERSTAND FRENCH!” In reality something like this had just happened that day, and I wanted to be polite so I didn’t say anything. Remembering the dream was funny.
One thing that I really like about my house is that I get to hear people speaking German and French a lot…it is so interesting…just listening to the sounds…the French is fine, I understand it very well and am starting to speak it more and more…the German, I don’t understand it but I love hearing it.
If is finally cool (for Haiti) and cloudy for the past couple of days…so so wonderful…I miss weather like this…I wish it could be like this more often. Cool and cloudy, instead of hot and really sunny. It is really nice.
I have been missing my old girlfriends from MLL. Old midwife sisters, from years ago. Those who spanned the 6 ½ years that I was at Maternidad La Luz. I wrote to many of them this past weekend, (after wanting to for a long time), and I have received some responses that have been so touching and helpful to me after the almost 2½ years that I have been in Haiti. One of them was from a classmate of mine when I was a student…she is in Canada and we never saw each other again or wrote very often but she was one of those who wrote me back with enthusiasm…it helps so much, to feel that you are part of a global network of people who believe in and work towards the same thing….
Thank you, to all of you who have been with me during this time, who have been present with me, who have posted comments and feedback to me during this time…friends and midwives sisters alike….
6-25-12
Blada spent this weekend with me—he left this morning. It was so good to unwind with him. He has come each weekend for the past few weeks. This weekend, I felt satisfied. Last weekend, I was really sad to see him go, and I felt like we didn’t have enough time to do everything we needed to. Like, simply spending time together, embracing or whatever. I was really sad when he left. 2 days is not really long enough. And it is not really feasible to do every weekend, because he comes from far away. When he left, I missed him so much, and I couldn’t talk with him for long enough on the phone either, because phone cards here are sooo expensive. That’s why Haitians have really short, direct conversations usually, like, “Did you get the thing? Eh? Ok Ok.” Anyway…this weekend was wonderful. We had a really fun going away party for one of the expats, with drinking, socializing, and dancing, national and expat staff together. This woman, who the party is for, is usually to total hardass (but is also pretty funny a lot of the time), but she really loves her national staff, and as soon as everyone left, she sat down by herself and started crying (hard). It was really sweet.
Yesterday, I was tired, but I wanted to practice some salsa dancing with Blada. So, we went up to the rooftop terrace of the house, which is all covered with tile, and is very nice, and we danced up there. It felt magical. I felt so happy. There was a constant breeze….palm trees…mountains all around…gliding around together, dancing salsa…it was one of those moments.
Things at the hospital are going well. Today was a good day….the sessions with the midwives for neonatal resuscitation (NNR) are going well…they all seem to know the theory well, but it’s the actual technique/practice that they are weak in…so, it has been good to work with them.
I am talking with the one of the Haitian midwife supervisors to get her interested in helping me to improve the NNR area of the delivery room, so that it’s more functional and organized, and I have also been working with her on the issue of keeping the room warmer. When I first arrived it was always really cold. The temperature issue has already improved a lot. Which is really encouraging. This needs to be continued and encouraged continually---another big area to improve is the maternal-infant separation that happens and the lack of early breastfeeding. So, hopefully these areas will be possible to really improve as well. Instead of having hypothermic infants that are separated from their mothers and not BF early, we can have babies staying on their moms, breastfeeding early, and not getting cold. This will make a huge difference in the outcomes of these babies.
So, things are possible and promising…it’s just hard to have patience sometimes, because you have to go so slow with people and really take time to talk with them…there’s a certain kind of etiquette in a way…I get it, I accept it, but like many things about Haiti and Haitian culture, I also get frusturated again from time to time again and really annoyed, about things that I had thought I had already accepted pretty well.
One good thing for me is that the 3 SF (sage-femme, midwife) supervisors who I work with, they are not hard people to get along with, or communicate with, or work with, etc. I just have to remember to follow the etiquette and not lose patience. But, for instance in the delivery room, there has already been a huge improvement in the temperature. I got ahold of this awesome WHO publication all about cold stress and how/why to avoid it in newborns, and got it printed out (in French!), and one of the SF supervisors asked me to borrow a copy to take home and read. This is so great.
Another good sign was this morning, one of the SF in the NNR session told me afterwards that I should give them continuing education sessions every month. That was great because she had initially seemed somewhat uninterested in the class. So…my next big subject to address with all of the SF (not only the supervisors) is cold stress and hypoglycemia (which can both be avoided by not separating moms and babies and helping with early BF).
There are many other things I see especially in the delivery room that I would love to help the SF to change—but, I have to pace myself, give them time to digest what I am putting forth, have patience, and choose my battles wisely. I understand perfectly well that there are many things that I will have to completely ignore because there are more important problems to address, but at the same time, being a midwife myself, witnessing how some people manage birth can be very frusturating. It’s frusturating when it’s things that are being done that are completely unnecessary or even harmful, and then other things that should be done that arecompletely ignored. It’s like, a lot of times, things are done in the wrong order, or the priorities are wrong. This is probably since midwifery school. The nursing aspect is strong, but the midwifery aspect is weak.
It’s interesting that I am getting so involved in noticing the details of how the SF manage birth too, because I am already used to seeing how birth is managed in Haitian hospitals. I don’t think that I’m losing the greater perspective though. I am “overseeing” and participating in many areas of the hospital, and each has weak points and strong points, that I am coming to understand and coming to see paths I can take to address them.
My friend Kirsty, who I met and became close friends with last year when I lived in HInche, is coming to visit with me this weekend. I am so excited. She is a MW who also worked with MWH and we lived in the same house together for several months last summer. She is married to a Haitian man named Mackenzy; Blada lives with them in Ti Trou and is doing agriculture with Mackenzy and his team. So, I’m really excited to see Kirsty again…she had a baby in March…so cute…she’s coming with him….
The next weekend, hopefully I will be getting a ride on a MSF truck that is bringing people to Jacmel. I will visit my house, see friends there, get stuff to bring back here (since I live here now, not there), and maybe even go to the beach.
So, that’s what’s going on right now. Some days, I have a lot of energy, like today, and I can write and enjoy my time at home in the evenings…other days, I am just so tired….i lay down at like 7pm….
Up and down energy-wise, but in general feeling good about the job and myself…doing what I can…it’s hard not to compare myself to others though…not that I actually want to be like them…there is this one expat, who is always so busy, always kind of in a frenzy to get things accomplished…if I want to talk to her about something at work, I feel like I can't approach her...there's always some big crisis she is dealing with….that’s fine for her, and I think the service she works in has needed a strong push…but, I don’t want to be in a frenzy myself. I want to be calm and at a speed that makes sense for the people I am working with (even though this is a struggle sometimes)---I am doing my best to remember to follow the Haitian etiquette of communication, however annoying it can sometimes be (that you have to be this way all the time, each time…) And I also need to remember not to think that I am being compared to others and that it’s not like we’re in a factory or something. I know that if I continue building trust and following the etiquette, things will have the possibility of improving from the inside out.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com5tag:blogger.com,1999:blog-3462792641577376453.post-28462096042274095022012-06-11T14:56:00.001-07:002012-06-11T14:56:03.961-07:004/25-5/29/124-25-12
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.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com2tag:blogger.com,1999:blog-3462792641577376453.post-60547803136045278532012-04-10T10:10:00.000-07:002012-04-10T10:11:45.664-07:003/31/12-4/10/123-31-12<br />Just a couple of observations/situations that I couldn’t help but think were interesting and telling…<br />The first, I have noticed a couple of times: when we go into our bank, Fonkoze...in a couple of places on the wall there is a tattered piece of paper taped there…I didn’t pay attention to it at first, but then one time I started reading it…it is instructions on how to bury someone who died from cholera. It describes how one must put the body in a plastic bag, and also stuff all of the orifices with something. It gives examples of orifices that would need to be stuffed: ears, mouth, butt…<br />This is just taped nonchalantly on the wall at the bank, in front of the tellers…on a tattered, faded, typed page…<br />Interesting and sad…that cholera is so common still that they have to put up signs at banks explaining how one should bury their dead…<br />Today, we went to the photocopy place…a very interesting place, each time I go…I have been going a lot recently because I was making copies and handouts for a class I will be teaching sometime soon at Help Nursing School in Leogone, on neonatal resuscitation…so, anyway, each time I go, it is an interesting experience, culturally—even something so small as going to a photocopy place here is quite different than in the US, and you see those differences clearly…you have to go with a lot of time on your hands…no one is in a hurry, and in a way this is good because the people working there, they focus on one task at a time without getting stressed out about all the people waiting—no running around frantically multitasking. So, it is always like this—people are having conversations while they make the copies—there are lots of pauses in the work…that’s fine. What was funny today was that when I arrived, the place was packed! Blade went with me…we soon saw that the reason it was packed, was that people had gone there to watch the soccer match…they have a TV there…so people were standing at the counter and sitting on boxes of paper—crowded in—watching the game—not only watching, but having animated conversations across the room about the game and the players…a group conversation…really fun. The guy who was scanning my papers for me was also watching the game…so, starting and stopping with the scanning….it’s just such a good lesson in being relaxed! It’s so easy in the US to get so caught up in being busy and multitasking all the time, and being as efficient with our time as possible…always on to the next project…<br />Here, you have to take a step back, relax, and slow down…<br /><br />The past few days, I have been super busy (and enjoying it) basically organizing my stuff into different categories and packing for Port au Prince. I am trying to get all my papers for MSF in order as well…hence the scanning of forms today…it’s been busy but good…<br />Blada and I are doing great…both mentally preparing for our upcoming separation…we both feel that this is the right move for us right now…I can’t pass this up with MSF, it’s such an amazing opportunity (to he hired in-country for a specific position). I probably cry about 4 times a day when I think about not living with him…about being separated from him…it has been such a blessing having our little house in Jacmel…living together, having privacy (we have been living together since summer 2010 but not with privacy)…having our little kitchen…it has been a huge blessing, and was totally facilitated by our friend Sarah, whose clinic and house are on the same compound as our house…thanks to her we got the house, and have internet, water and electricity…<br />Anyway, this will be a new chapter for us…we will each be learning things on our own this year…<br />Blada is going to be living mostly in Ti Trou, with Mackenzy and Kirsty…Kirsty recently returned from Canada with their 2-month old baby…they are still building their house and Mackenzy has massive gardens that he maintains and sells produce from…so, Blada will be learning agronomy with Mackenzy….<br />We are also buying a little piece of land, right in front of Kirsty & Mackenzy…so, this year, Blada will be working on our land, planting trees especially….<br />Currently the land is treeless…well it does have one tree, which Blada thinks is an olive tree…apparently olive tree leaves are very nutritious…<br />He will be planting mango, cashew, almond, papaya, soursap, breadfruit, orange…things like this.<br />So, there is a lot of work to be done…and a lot of skills to be learned….<br /><br />4-5-12<br />This is my last week in Jacmel before moving to Port au Prince and starting my new life, working with MSF. I have been savoring all of the little aspects of daily life in Haiti as well as aspects of personal freedom that I know I won’t have after I start working. <br /><br />We went to a beautiful beach a couple of days ago…oh, it was just so so beautiful…the water, the mountains in the background…I spent hours collecting rocks to bring to our land in Ti Trou (which doesn’t have round rocks—only sharp rocks) to one day do a project…<br />I have made hot chocolate with local cacao a couple of times this week…and sat there are grated coconut to make coconut milk to put in…like gathering the rocks, I felt no hurry, just a peace of mind, knowing that I can spend my last days here doing even the most tedious or slow of tasks and that it’s okay…there’s no rush for anything…there is time for everything…<br /><br />4-10-12<br />Well…I am starting my life with MSF in 4 days. It’s hard to believe even though I know that it is about to happen and it makes sense. It feels kind of like a dream, like an idea, that is a good idea and will be amazing, but perhaps will never materialize. Saturday the 14th, Blada is going to escort me to Port au Prince, to the house where I will be living with other expats. Shortly after arriving I will be taken to a different MSF place-an office I guess—where I will spend the next 2 days having briefings about the project, security, etc. <br />I have been enjoying the slowness of my life here, in Jacmel…making good food…we are making bouyon today—it is a kind of soup—<br />I have been making hot chocolate with the local cacao…and grating coconut to make coconut milk to add to the cacao…oh, it is so amazing…an energizing drink with lots of good fat from the cacao and coconut…I have been doing things like this, while reading documents sent to me by MSF and preparing myself and packing…<br /><br />I was reading one of their documents yesterday—a briefing document about Haiti—its history, politics, health situation, etc. I started thinking about what it was like working in HInche, at the public hospital there…the beautiful things and the heartbreaking things…the stark reality of being grossly, unimaginably understocked, understaffed…all of the severe and classic manifestations of disease that you see in settings where people have had no access to any kind of preventative healthcare, for their whole lives…<br />I started thinking about this one woman, who I will never forget…she was around 20 years old, in her second pregnancy…28 weeks (7 months) pregnant. She had severe preeclampsia, with really high B/P, facial swelling, protein in her urine, etc. I was talking to her, explaining to her why our only choice right now was to induce her labor and cause her to give birth—to a 7-month baby who will definetly not live. But that if we didn’t do this, she was only going to get sicker, would probably end up having eclamptic seizures, and could die. Women dying from eclampsia was commonplace at St Therese hospital. <br />Well, this woman, she was willing to make this choice to save her own life, but she was so torn and so sad, because she wanted to have a baby so badly. She was attached to this baby already and from time to time kept saying how she could feel the baby moving in her belly. She was wavering between the logic of saving her own life and the feelings and love she had already developed towards this baby. Then she started saying, “Why am I incapable of having a baby? I just want to have a baby.“—In her last pregnancy, the same things had happened: she was preeclamptic and lost her pregnancy around 7 months.<br />This experience of sitting with her through her grief and acceptance of the need to save her own life by getting rid of the pregnancy was heartbreaking for me. I cried and cried yesterday as I remembered this. The choices women have to make here…she had 2 options, and either one of them entailed either herself or her baby dying. There were no special (routine in any 1st world country) tests to give us an idea of how severe her preeclampsia really was—we had to rely on gross evaluation of her outward symptoms. There was nowhere we could send her that would most likely be able to save her 7-month baby. There was no system to transport someone like her in case there was a place to send her. <br />Now that I know of the MSF hospital where I will be working, I know that if we had been able to get her there, they most likely would have been able to save her premature baby.<br /><br />Peoples’ lives are so hard. You see it in so many children…stress. They are not carefree and innocent. They are hungry. They carry water everyday. They sell gum in the street instead of going to school. They work as indentured servants. <br /><br />Blada and I were in the market the other day (where people sell produce, clothing etc. on the street), and it hit me that I will miss going to the market…the experience of it is a microcosm of Haiti in some ways…it is so interesting….going with him is interesting too because of the etiquette he has while buying, which I have not quite mastered…there is an etiquette of buyers and sellers…a lot of bluffing while debating on prices…arguing, debating the price or quantity, walking away if not satisfied, getting called back, buying the thing at the price you wanted…<br />Flies everywhere…meat sitting out all day (people have a special way of washing meat here which neutralizes the fact that it was sitting out all day with flies on it)<br />As we were leaving, we were looking at sunglasses and for like 10 minutes could hear this guy who sounded really annoyed, speaking in English…demanding to buy something for 5 dollars. After like 10 minutes or 15 minutes, we ended up standing right next to him and I realized what was happening...he was being SO RUDE to the merchant…speaking in English, demanding to buy a watch for $5, and then demanding that the merchant GIVE HIM CHANGE IN US DOLLARS. He is standing there, arguing with the merchant, who is doing his best to communicate with this person who is practically yelling at him, in a language he doesn’t even speak. I decided to try and help. When I got close, I saw that the guy who was being super rude and disrespectful was someone with a UN uniform. Oh, big surprise. It all fell into place. He was from somewhere like Sri Lanka or Nepal. Yelling his broken English at this poor merchant. Many if not most of the UN soldiers here, they feel completely entitled—to everything. You can see it manifested in all kinds of circumstances. Anyway, I tried to explain to this guy that the merchant DOESN”T HAVE change in US dollars. It should have been so obvious to him. But it wasn’t. <br />Many people here feel that they are living under an occupation. To top it off, there have been child rapes ( Blada even knows of a boy this happened to in Hinche---his parents had to take him out of school because people constantly tease and taunt him, calling him “Madanm Minusta”---<br />Then as we are walking away from the market, we see this group of white people, who obviously are going to the market for a purely touristic and voyaristic experience…one of them has a big nice camera around her neck…I should have said something to them…who do people think they are, just walking in and taking pictures of people as they go through the motions of their daily lives…without even asking permission? Even if they did ask permission, as I used to see in HInche with the short-term volunteers who wanted to take pictures of patients they had helped, THERE IS A HUGE POWER DIFFERENTIAL that exists, and many people will not feel EMPOWERED TO SAY NO. This is such a basic reality—yet people walk into Haiti so blind to it.<br /><br />So…I feel optimistic about this year, about working in Port au Prince with MSF…I am so thankful, so so so thankful for this opportunity…it is amazing that this was possible…<br />Any situation, any blessing, always entails sacrifice. I have been immersed in midwifery since 2003, and consequently have had to live apart from my family for the past 9 years. I have learned so much and grown so much as a midwife, and am so thankful that this path was possible for me to embark upon. Likewise, working with MSF is a huge blessing, that entails a huge sacrifice: living apart from Blada. I know that this is going to be really hard for me.<br />My beacon of light, my hope, is the vision of obtaining our fiancé visa without problems, and moving to NC in the spring of 2013, and being reunited with my family and community there, while also finally being able to start a family of our own. This is the goal. There has to be a goal in order to make it through.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com0tag:blogger.com,1999:blog-3462792641577376453.post-82542269640303786402012-03-26T09:44:00.000-07:002012-03-26T09:45:45.223-07:003/20-3/26/123/20/12<br />Things have been going well. Better and better. There have been some recent events that were interesting and I thought I would share.<br /><br />I went to HInche a couple of weeks ago and visited with everyone there. It was wonderful. I spent every day with Marthonie (who I used to teach with), and visited a lot with Genette, the other midwives, the MWH house staff, etc. Jamlex, who we used to spend every day with when we lived in Hinche, was really fun to be around again. He has changed so much in 6 months. He is about 2 years old now! The first moment he saw me, the first thing he said was “Blada”. He is used to seeing us together! He knew my name, but the whole time I was there, he always called me Blada. It was funny. I went to their house and spent a day there, with him and Diunney, his mother (the cook at the MWH house). It was so nice having time to sit with people. Marthonie and I miss eachother a lot. She is doing the classes mostly on her own now, with some “help” from the American volunteers.<br /><br />Visiting the hospital was very interesting, as always. Man, I really miss working there. I got to see all the people I used to work with—the OB, the head ofmaternity, the midwives, some of my old students, etc. The first day I went, I just hung out and socialized. The second day, there was no one working in the prepartum room (antepartum) so I worked in there by myself all morning. Almost every single person in there was either preeclamptic or eclamptic. I couldn’t work on everyone so I chose the 3 worst cases, who needed the most immediate attention. It was 2 women who had already had eclamptic seizures, and one preeclamptic woman with a splitting headache (bad sign) who needed her labor induced and had super high blood pressure (like 190/130). I got all their IV’s and meds going, and just kept going between them checking their B/P, making sure the IV’s were running correctly, etc. I induced the preeclamptic woman. I also spent most of the morning running around, looking for the materials I needed to work on these very sick women. I went between 3 or 4 places all morning, getting things as I needed them. It is ridiculous! It’s just as bad if not worse—the access to materials and the porganization of materials—as when I used to be there. Yes, there are some more things that seem to be more in abundance now than before (because of the new director of the hospital), but the organization and access isn’t any better. This lack of access to basic supplies and medications is why preeclamptic women don’t get induced and then go on to have eclamptic seizures.<br /><br />The new director of the hospital seems to be very proactive and forward-thinking. He is also very accessible and not a sociopath, like the last person. I like him a lot. However, there are people who DON’T like him, or the order and progress he represents (he has also been cracking down on hospital staff when they are lazy and apathetic about performing their jobs), and there has actually been a subversive wave of propaganda against him. No one actually knows who is behind it. But, there have been death threats, things on the radio, and there is red graffiti spray painted on some of the hospital walls. When I saw him and asked him how things are going, he smiled and calmly replied that there have been some “ti pwoblem”—“small problems”, that are always to be expected in a situation like this, but that things are going well. When he first arrived to Hinche last October or so, he used to always have these 4 large bodyguards with him—everywhere he went. Now, it doesn’t seem that he does. I guess he anticipated trouble before he came, I guess this is normal. People like to create chaos and impede progress. The last person who had his job, everyone was just too scared of him to ever try to intimidate him or speak out against him in any way.<br /><br />The day I travelled from Hinche back to Jacmel was also pretty memorable. It was just another pretty normal day in Haiti, especially travelling such a great distance. Shortly after leaving HInche, one of the tires on the papadap (like a minivan—faster than a tap tap, which is a pickup truck) exploded, so we all had to get out and wait for another machine (general term for different kinds of vehicles) to pick us up. When the next machine came, everyone trampeded in, pushing and shoving (totally normal), and since I didn’t want to take part in that, I just waited and then got in. Well, my seat was now occupied—I didn’t say anything, and just started unfolding the little side seat with no back support that was now to be mine. As I was doing this, the metal support attached to the seat slammed down onto my big toe like a hammer (I am used to the seats just unfolding easily, not forcefully). So, I had a pretty severe injury to my toe, and was in great pain the whole way to Port au Prince. <br /><br />I hadn’t planned to take a moto taxi in Port au Prince to the Jacmel station (you get dropped off in one place and have to traverse the city to get to the place where you can board a machine for wherever you are going)---I was planning on taking a tap tap, but now I couldn’t walk and I had 2 backpacks with me. So, I took a taxi. I chose the guy with the most innocent-looking face. He was nice enough, but was incessantly flirting with me the whole time, in a way that was really annoying. Like, “I may as well just die if I can never see you again.” Stuff like that. We drove past the national palace, which is still in ruins, all fallen and crumbled. People living in tents all around. The president doesn’t live there—he lives in Petionville, a part of Port au Prince where the rich people live. Anyway, the other thing was that this guy’s motorcycle must have stalled out like 4 or 5 times along the ride. One time I had to get off and walk across the street, which was hard because I couldn’t walk at all. Another time, we stalled out right as we were driving through a stream of muddy sewage water that smelled like shit. I had my injured tow, and really didn’t want to expose my injury to sewage water. He kept pushing the moto, trying to make it restart. He took one of his sandals off, his foot now in the sewage water, trying to give his moto a push start. Well, finally we got out of there. <br /><br />Like I said, just another day in Haiti. It seems like it would have been stressful, but it wasn’t. Everything was normal. Just that I had a bad injury and couldn’t walk. Even the scenery in PAP is seeming more and more normal. I am pretty used to Haiti, but PAP is pretty bad. Most people who haven’t lived here wouldn’t be able to imagine it at all. And I don’t want to make it sound bad—this is peoples’ daily reality and daily lives. But, to an outsider who has not been forced to accept this as their life, I perceive Port au Prince as a hellish place to live. What I see is trash everywhere, piles and piles that people have to walk over, piles of trash burning while people are picking through it, tires burning, air pollution, sewage water in the streets, beautiful well-groomed schoolchildren carefully and nimble stepping through the dirty water and trash and mud as they walk to school…huge traffic jams…loud noises…decaying buildings…<br />Once again, this is not to say that this IS how it is. This is how I perceive it. I am less affected by it now. It used to depress me more.<br /><br />Blada made a wonderful traditional Haitian food today: bouyon (boullion). It is a kind of soup, with starchy root vegetables, amaranth greens, meat…really special. We don’t know when I will get called to start working in Port au Prince, but I am just enjoying the present moment, living our little life here, making food together in our little house, going to the market and getting produce, negotiating prices, stopping and talking with people in the street…<br /><br />3-26-12<br /><br />So, things are moving fast now. We are packing up our house because I did get the job with MSF and will be starting on April 15th. We will still have our little house here but will hardly ever be here—it will be more like a storage room. Hopefully, I will be able to leave once in awhile and we can come here for a weekend. Blada is going to be living mostly in Ti Trou, apprenticing with Mackenzy (organic farming)—he is also probably going to start holding dance classes twice a week in Ti Trou.<br /><br />We have a lot of organizing to do before we move. When I start with MSF, I will have to follow their security protocol, although they are willing to be somewhat flexible with me about leaving once in awhile. Normally, expats can only leave the residence in an MSF vehicle, to go to work. No walking around Port au Prince, no taking public transportation. This will be very different than how I have lived in Haiti, but it will be a new experience and I accept it. It is part of the new situation, and this new situation is such a blessing and I am so thankful. Blada will be able to visit me at the house on weekends, as long as my housemates and coworkers are not too jealous and upset about it (they don’t get the same flexibility). So, we will play it by ear. I am savoring my time with him, trying not to think about missing him later on.<br /><br />We went to PAP a few days ago for a final meeting with MSF—I met with the head of mission there. We recently bought a motorcycle—we will sell it before we leave Haiti—now that we will be split between 3 places, it’s more of a necessity. So, we took the moto to PAP. Oh my god, driving in PAP is a nightmare. It is unbelievable. Motos there simply weave between all the other vehicles—huge trucks, cars, other motos, etc. They weave in and out, between vehicles—black smoke everywhere, people darting in and out between lanes—vendors—so much activity. It was stressful but we made it. We got stopped by the police on the way and had to bribe them to get away. Totally normal for here. The whole reason they were stopping people was to fine them—they don’t care if people don’t have all their papers in order or their drivers license or a license place—they make a big deal just to make you pay money so you can go. We had to stand there for like 30 minutes while things worked themselves out. (we don’t have all the papers in order yet for the motorcycle). At first, they were like, “madanm, misye arête”—like, “madam, he is under arrest.” Then it went from that to “you have to leave the motorcycle with us until you get all your papers in order” to Blada talking with one of them over to the side (what they had been waiting for the whole time) and offering a bribe of 300 goudes (about 7-8 USD). The guy was like, “come on, there are 3 of us (3 police sharing the bribe)—so then Blada gave him 500g (about 12.50 USD). After this, their whole demeanor changed, they were friendly, they were understanding, they even gave him their phone numbers in case we got stopped by someone else down the road. So funny. About halfway through PAP, I wiped my face and it was just covered with black soot. Luckily I was travelling with a rag and water, so when we arrived I wiped my face down. Black city grime. Blada’s beard was white from all the dust.<br /><br />So…yes, things are suddenly moving forward…I am so grateful for this…this means that we will be putting off ourvisa interview until a little later than we thought—I am signing a 9 month contract with MSF—this means we will hopefully be coming up to NC next spring. If all goes well with the visa interview, which I hope and pray it will.<br /><br />Thank you to all of you for your support and love!parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com1tag:blogger.com,1999:blog-3462792641577376453.post-6287605647162903242012-03-01T04:50:00.000-08:002012-03-01T04:52:02.989-08:002/4-3/1/122-4-12<br />Time is passing! I can’t believe we’re already in to February.<br />Things are getting better, life is happening. Around mid-January I believe is when I started coming out of my depression. It has been slowly receding--still there are moments where I feel really sad about it and when I reflect on the actual reasons and events that led up to this, it can be upsetting, because it is really just so ridiculous--all stemming from lack of communication and misperceptions--it all feels so wrong sometimes--like, this was all a huge mistake--but, nevertheless I want to be happy and appreciate my life for what it is, so I have been trying to move on and look for other things to do.<br />What have I /we been doing? Here in Jacmel, I am helping at Olive Tree Projects with structural improvements and writing of protocols for the clinic. So, I have been reading a lot which has been good. Also, recently I started going to Leogone (a town south of Port au Prince, it was the epicenter of the earthquake but looks pretty good now)--because a friend of mine named Angela who was a volunteer last year with MWH is there now laying the groundwork for MWH to expand their program there. In Leogone they have these health cluster meetings every 2 weeks where different NGO’s meet & discuss the work they’re doing in effort to coordinate efforts/avoid duplicating each other’s work…the reason I’m going to these is to start putting myself out there, to meet people, in hopes of landing some teaching jobs. I visited a nursing school/hospital with Angela and met with the administrators, who once they knew what I had been doing the past 2 years (teaching Hatiian auxilliares), asked me to come and teach a few classes for their nursing students. This is great--it’s a step in the right direction--but I need to find paying jobs too. All of it is good.<br />Kanaval has been good…apparently it lasts 1-2 months…we went on the first day and ended up getting painted with black sugar syrup and parading through the streets in a large group of people who were all painted this way…at the end, we arrived at the beach and everyone jumped into the ocean and bathed…so fun! <br />The people in Jacmel are very easygoing…a lot more friendly and less suspicious than the people in Hinche (in general)…even at Kanaval, no one cared that I was white…it was nice to feel like part of the group…<br /><br />2-16-12<br />Things are going well. Kanaval has been interesting. Blada has been out of town for 2 weeks, working with Mackenzie (Kirsty’s partner) on their land in Ti Trou (in the southern part of Haiti). Kirsty is in Canada; she birthed her baby 2 weeks ago and is doing well and hopefully returning soon.<br />I am lined up to teach a few classes at this hospital & nursing school called Help, in Leogone. Another prospect is that I may be getting a job with MSF Holland, in Port Au Prince (MSF=Medecins sans Frontieres=Doctors without Borders). I met this MSF person at the health cluster meeting a couple of weeks ago and got a contact from her and I actually interviewed 2 days ago in PAP. It would be for an administrative/managerial role, which is somewhat new for me, so it would teach me some things I’m sure. The problem with possible working for them is that Blada and I will have to live apart. For atleast 6 months. I would be able to see him sometimes, like maybe every 2 weeks. This is a huge sacrifice that is really difficult for me to imagine, but at the same time, this seems like an amazing opportunity that I shouldn’t pass up. We will see.<br /><br />Other good news: our fiance visa petition has been approved, which means that now we are moving into the next phase of the process. The next phase is gathering necessary documents and preparing for the interview at the US embassy in PAP. We are hoping to do the interview around May. After this, if we get the visa, we have to leave Haiti within 6 months. Hopefully getting the visa and working with MSF can both coincide timing-wise. <br /><br />I have been thinking about what one of the days at Kanaval was like. I never take pictures here--I have very few pictures I’ve ever taken, although believe me all the time I see things that I wish I could record and share with people back home to show what life is like here. I have never felt comfortable taking pictures--I stand out enough as it is, people see me as different enough as it is, they see me as rich and provledged enough as it is…to then be snapping fotos in front of them, it just feels like something someone would do out of complete ignorance or indifference to the situation and power dynamics here. So, this one day at Kanaval, I knew a lot of people would be taking pictures, and I convinced myself to try and take some as well. Jacmel is an historic town, old architecture…Kanaval is interesting…the parade…huge painted paper mache puppets and marionnets and things…I found Kanaval here to be very very touristy…it was clear that a lot of people had come to Jacmel only for Kanaval…lots of white people…just a different scene than I am used to. Well, I took pictures during the day, and then later, during the next few days, was reflecting to myself how I felt about that…actually, it was like I was carrying around a guilty feeling, like I had betrayed something…that was what made me think about it so much…I kind of feel like I missed part fo the spirit of Kanaval because I was taking pictures…and not that anything is so wrong with taking pictures, especially on a day like this, where everyone knows it is a touristy occasion…just food for thought…<br />Then a few days later I was in a tap tap (public transportation) and there was actually this discussion going on in the tap tap about how NGO’s and white people come here and take pictures of poor people, without asking permission or anything…this guy was talking about it…a lot of people here think that the people who come here and take pictures go back and make money off of them…in some cases that’s true…in some cases they don’t make money but they still are taking something back with them that doesn’t belong to them…and using these images to promote themselves in some way…I have seen people come in with the most entitled attitudes, it is unbelievable…a couple months ago Blada and I were on the beach, and this white guy arrived, and he had a big camera in his hands…he didn’t look at anyone or say hi to anyone, except after a few minutes he came right up to me and shook my hand and started asking me questions….he was a journalist, doing a piece about “tourism in Haiti”--I was feeling uncomfortable because he hadn’t Agno ledged anyone else who was there, just me…I didn’t want to be a part of that…so, he walked away, and then…without saying anything, just started snapping fotos of the kids on the beach who were practicing flips on the sand…we left. <br />Anyway…just something to think about…<br />When I was in Port au Prince I saw an image that will never leave my mind--it was the kind of image that would have made a very compelling photo. In a tap tap, crossing an intersection. The road intersecting us was Martin Luther King Blvd. Right next to the road sign, was a very old woman holding a bowl (asking for money) in one hand…the other arm was horribly disfigured…it looked like it had been completely twisted around--and broken--from above her elbow--and never fixed. It was just hanging there, with the palm of her hand facing the wrong direction. We want to think that we have come so far past racism, but seeing an image as ironic as this, seeing such raw suffering right next to the name of someone who brought the movement forward so far and is remembered and honored for that…it is ironic. We have so far to go. The people here are still in chains. Poverty is a form of violence. <br /><br />3-1-12<br />February went by so fast. Things are going better now than they were in Dec-Jan. Those were hard months! Finally, things seem to really be picking up and new opportunities are arising.<br />It has been nice visiting with an old schoolmate from Maternidad La Luz--for about the past month. Her name is Olivia, and we were in midwifery school together like 9 years ago. She is in Jacmel with her beautiful baby, Zora. Strong lady, coming to Haiti by herself with her baby! She has an organization called Earth Birth that is partnering with Mother Health International, which is the org that has been running the other birth center in Jacmel (there are 2). So, they moved locations and Olivia has been working really hard for the past month to make lots of things happen. We’ve been visiting and sharing lots of stories, and it’s been so great. It’s really cool seeing how drastically we both have grown and changed since we knew each other in midwifery school. <br />She has been hoping that I could work for their birth center--they have 4-5 Haitian midwifery apprentices who need more attention & training…it is nice to be wanted! But I do have my sights set right now on working with MSF in Port au Prince, and it is still uncertain but seems to be in the works. This would be such a good opportunity for me and I feel I can’t pass it by. Of course, I have mixed feelings because living apart from Blada will be hard…and we will have to put off starting a family still…but also, this feels like it will be so god for each of us, because we each will grow & develop ourselves in ways that are important (Blada will hopefully be apprenticing with Mackenzy, Kirsty’s partner, who is a master agronomist).<br /><br />I taught my first class at Help nursing school a few days ago. It was on breech birth. It went really, really well. The staff was so happy with it (the head of nursing sat in on the class--I think they were already interested in me but wanted to verify if I could actually do a good job teaching)--that they started talking with me about becoming an integral part of their faculty! Teaching more classes, helping with clinical training of their students, attending events, etc. I dropped by yesterday before the Health Cluster meeting, to give them my CV, which they had requested, and the director officially introduced me to people there as a new staff member! They are making a file for me, an ID badge, etc. It is amazing, because all I had done originally was offer to teach 2 classes for them, and everything else from there has been their effort. It is very encouraging. <br />I really like Help, because it is well-organized and all Haitian-run. It’s awesome!! They have partner NGO’s and they receive funding from them, but, on the ground, it is all Haitian run. They do a wide array of community health services. They do health education, mental health services, rape crisis, community education, among others. Very impressive.<br /><br />Another wonderful event that has left me in greater peace than before is that I finally met with the directors of MWH face-to-face this week. The reason they met with me was because it was strongly recommended to them by a volunteer who was laying groundwork/networking for MWH in Leogone (they will be replicating the training program there starting this September) that after she leaves, they contract with me to attend Health Cluster meetings as their representative, so that other NGO’s there (who MWH hopes to partner with) will see a continued presence and interest. So, this is happening now and I am glad. Meeting with them, for me, was helpful because I have been longing for resolution and closure. This happened to the extent that was possible. And, the fact that I am contracted to represent them in Leogone is good because it shows that we are not burning bridges.<br /><br />I am finally going to visit Hinche! Next week. So so excited. Everyone there is too. I will get to see Marthonie and everyone else!parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com1tag:blogger.com,1999:blog-3462792641577376453.post-57947542412731332642012-01-10T17:08:00.001-08:002012-01-10T17:09:43.569-08:0012/18/11-1/10/1112/18/11<br /><br />I have not been able to sit down and start writing for awhile. The month of October was quick, and things have been tumultuous since my return. I don’t really want to go into great detail here but basically, when I returned to Haiti in late September, after having been in the US to get my affairs straight so that I could come back and stay for longer, and after having 2 successful fundraisers for my work in Hinche and the work of Midwives for Haiti, I found out that there was a very deep rift that had grown between those of us living and working on the ground, and those who live and manage the organization from the US. This misunderstanding had already transformed into something so complicated and perverse, without my knowledge of its existence at all, that by the time I found out about it, it was too late. Very sadly, for everyone, the way the situation came down was that there was irrevocable damage done and I left Hinche. This was devastating for me, and I am still recovering from the shock of it, and still missing people a lot, such as Marthonie, who was my loved and trusted co-teacher. I had grown so used to working with her, and we had such an amazing, collaborative, tolerant, and trusting relationship. She is not the only one, but the main one.<br /><br />I haven’t been able to say anything or write anything, because I have just been in shock about how abruptly my life changed, and have been mourning a great, great loss. I had not foreseen this happening, but in a way something like this is not surprising, given the overall situation that the organization was functioning within (such as the fact that I was living full-time with all the short-term volunteers with no personal space/boundaries/privacy, lack of communication between myself and the directors about issues…it‘s complex).<br /><br />I have wanted to let all of you know that I am ok, and Blada is ok. But, so far I haven’t been able to say anything, because I have just been in a state of perpetual mourning. I am trying to move forward and move through this transition and accept the loss and also the blessings that will inevitably come out of this. I am starting to see it more in this light, although the truth of what happened and the feelings of betrayel and loss that go along with it will always inevitably stand out in my memory and emotional landscape. Perhaps there will be a way in the future to work with MWH, perhaps in a different context or setting, although I miss the people in Hinche so much and had spent 2 years literally building bridges and trust through working daily with the people there.<br /><br />Often I have felt like I am dragging my feet, and like I should just get over it and continue and have faith, because that is what I see Blada doing. He is doing fine. This has been sad for him too--we lost our community, and he witnessed my sorrow and held me through it since the beginning of this change. So, he is very strong and resilient, and adaptable. One main reason for this is that he is Haitian. Haitians, most of them, have spent their whole lives having to accept many injustices and hardships as normal life events, and have even cultivated an amazing capacity for joy and humor, which they exercise all of the time (they can laugh and have a great time doing anything…) so, as Blada put it to me, so honestly, he has never had the luxury of escaping the reality here (he can’t just take a vacation from it like I can if I want), and for his whole life he has had to accept hardship and if he allowed himself to dwell on things as much as I do, he would have gone crazy by now. It’s really true. Maybe part of the difference is that I’m a woman too, and I process things differently and definetly live more in the realm of my emotions than he does…but I think it’s not just that, it’s also part of my upbringing and life experience as a North American…you have the luxury to ponder and process your feelings….<br /><br />To illustrate this difference even more, I will give 2 examples of people I know who recently experienced great loss and nevertheless are living their normal lives…a Haitian midwife I know, before we left Hinche, I heard from someone else that her father had just been murdered--hacked apart by someone with a machete--over something that had to do with land rights/ownership. Yes--her father was murdered. I saw her the same week or the next week, and never would have known if someone elsehadn’t told me. She seemed normal, and was working every day. Haitians have a way of compartmentalizing their grief, so that they can continue functioning and living. I think part of this could be the fact that when someone dies, there is definetly an acceptable time and place for intense grieving, with no restraint. People grieve intensely when someone dies. But somehow after this, they move on, and at least seem to be ok. Another time, shortly before we left, we had a friend who was in the house who suddenly we all could hear she was crying--weeping--and calling out to her father over and over. Finally I approached her to ask her what was wrong. She told me that today marked the 10 year anniversary since her father went missing, in Port au Prince. After this day, no one ever heard from him again. Probably on this same day, every year, she grieves this way for him. Maybe this way she is able to function normally the rest of the days. I don’t know, and I’m not attempting to analyze or name anything about Haitians or Haitian culture--I have tremendous respect and humility towards it--I’m just citing a couple of examples of my experience here that gives rise to my small sliver of understanding of the people here.<br /><br />So, I can’t and shouldn’t compare myself with Blada, because we come from such different cultures and life experiences. Things will work out and I do realize how very lucky and privileged I am, to still have so many choices, in reality, and such a good standard of living…we have a little house, which we love…it’s private, peaceful…just the 2 of us…it has a kitchen, a bedroom, and a bathroom. But it is big enough. It is lovely. We have water, part-time electricity, and even a stove and fridge!!! It is on the same compound and right behind a little birth center, started by a friend of ours named Sarah--she’s a Canadian MW who’s been living in Haiti for about 4 years, and has an organization called Olive Tree Projects. The situation here is pretty relaxed and slow-paced. I am helping her out in the birth center and hoping to make improvements to its functionality. I am also teaching classes for a group of women who she would like to train as MW assistants for her clinic. <br /><br />In addition to this, I am volunteering part-time at the public hospital here. I miss the hospital in Hinche too much…I don’t want to be completely isolated from what I came to know as my work in Haiti. So, I have started going. The problem is, I am starting over completely from scratch--no one knows me or trusts me yet--it took me a long time to establish trust with the staff at St Therese in Hinche, and now I am starting over completely with a whole new group of people at St Michel in Jacmel…some of them are nicer than others…things could change but there is definetly one Dr, a female OB, who is very angry and hostile (towards everyone--especially the patients)--that’s kind of her reputation overall, so I don’t have any hope of her warming up to me…but, maybe I can make allies with some of the other people…there are a couple of male OB’s, and several nurses…they are much more well-staffed and well-equipped with materials than St Therese…it’s very different…similar but different…I assisted in 2 births there yesterday…I guess I have been partially hardened to the sadness of seeing women mistreated in the most vulnerable moment of their life (labor/birth)--so, I wasn’t surprised by what I saw and am doing my best to remain neutral, nonjudgmental, and hopeful as well…but, I couldn’t help but notice the hostility towards the 2 women and even yelling and hitting of the second…the first one got an episiotomy and fundal pressure (with normal fetal heart tones and the head still not through the bones)…anyway, it is what it is and I am very honored that I am allowed to enter into the space at the public hospital and witness in, participate in, peoples’ care there…it is a new challenge; I have no delusions about changing anything there, but it will be interesting for me…maybe there will be a few meaningful things that can be exchanged, once trust has been established…we will see…<br />What else is different about Jacmel…I feel like I left part of my family in Hinche…especially the hospital staff and my co-teachers in MWH…Marthonie, Genette…I miss them so much…I have learned so much from them…they are remarkable beacons of light and knowledge…I have so much respect for them and for everyone back there, working in such a hard situation at the hospital…<br /><br />Here in Jacmel, it is apparent not only in the hospital but everywhere on the street: the standard of living is a lot better than in Hinche. For one, there is electricity. People have their little shops that have lights on at night. People just seem more at ease, like they are struggling less. People have a different attitude towards me on the street as well--they don’t seem to notice me too much. This may sound like nothing but this is huge to me. It is such a relief. I am learning that I don’t have to be so on guard emotionally. It is so nice. <br /><br />The beach is close, which is a huge blessing and so therapeutic. I love it. <br />Another gem here is the gay community--yes, that’s right. Jacmel is kind of hip. I was introduced to this art collective--that’s right--where they have these free dance classes (Haitian folklore (vodou) dance--similar to African dancing)--yes, that’s right--free dance practice sessions with most of the participants being flamboyant gay guys--who are so, so sweet and accepting and welcoming--it’s a community that I had missed--and it is here in Jacmel. So refreshing. The atmosphere is all about acceptance. They have art classes there too--all kinds of art--it’s a really really cool place--an old building--funky--like the way a lot of cafes and art studios in the US try to look--this place just is--you go up an ancient staircase (there’s a lot of old French architecture here) to the top level, which lost its back wall in the earthquake…<br /><br />What else…yes, just trying to be hopeful about things working out, finding my niche, having true resolution and healing with MWH, etc. Since I have more free time on my hands, I am starting again to study French a little (mostly by listening to RFI online)--the internet here is faster so more things are possible…also I’ve been doing a lot of reading and research online, about midwifery and anatomy & physiology…I am learning a lot and it’s exciting--I’m not retaining everything but I’m hoping that some of the concepts will remain and that maybe they’ll be more familiar if someday I am able to go to nursing school…so, I’m doing what I can to make good use of my time…<br />Blada is making good use of his time…he found an artist to apprentice with and is learning how to paint and helping with other projects…it’s all useful…it’s all progressive…<br />That’s about all for now. Loving all of you and thanking you for your love and support. <br /><br />12-31-11<br /><br />We had a quiet Christmas--very, very quiet. Now, we just got back a couple of days ago from visiting our friends Kirsty and Mackenzy who have land way out in the country (well, next to a small town) in southern Haiti…it was beautiful there…so refreshing…beautiful black earth, sweet air and sweet earth smells…more trees…beautiful. Now we’re back in Jacmel, relaxing and continuing with our activities here. I stayed up all night helping in a difficult labor and birth the day we got back--it was good--good outcome in the end, after a long, hard labor…it’s amazing what some women go through in their labors…I haven’t been going to the hospital as much as I’d like to--I’m too tired sometimes, and also it’s not easy, because like I said I’m brand new there and I’m all alone with no allies…it’s hard.<br /><br />Working in the birth center is interesting. It is so different than what I had been doing in Hinche. There are things about it that are nice and also things that are hard. Some of the differences are kind of funny, and I don’t mind adapting to them. Each of the births have been interesting and beautiful, and sometimes they remind me of what births used to be like at Maternidad La Luz, where I trained and worked for 6 ½ years before coming to Haiti. In the sense that we know the women, the clients, and it is personal, and they are supported with kindness, and their families are welcomed and encouraged to participate. There is something so special about this.<br /><br />1-10-12<br /><br />However, I have not settled into being here, working here--it’s not an automatic thing, and I don’t feel so at ease. I don’t have anyone I can really relate to on the same level as a MW. I miss my people in Hinche. I miss the meaningful work that I was participating in. I still can’t believe that it is all suddenly gone. It doesn’t feel right at all. I feel like I should be there, working and teaching alongside Marthonie and Genette. I don’t have a community here yet. It takes time to find your place and build trust. Plus, the overall approach to the model of care provided is not congruent with who I am as a MW based on my knowledge and experience, so…I am just trying to do what I can to help, reminding myself that this is someone else’s project and I am not responsible for anything more than what I can do. Hopefully I can help to initiate lots of growth and improvement in different areas. <br /><br />I am publishing this because I know that many of you want to know what’s going on here. Unfortunately I don’t have any better news to give--it is what it is. All I can do is continue on, hope for the best, do my best.<br /><br />We don’t know what will happen this year and next year--with work, with our life…when our visa will come through…anything…once again I compare my uncertainty and stress with that of the people here, and it looks like nothing…but it is something, it is my experience.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com5tag:blogger.com,1999:blog-3462792641577376453.post-78565331479050275572011-11-05T11:59:00.000-07:002011-11-05T12:02:59.308-07:00Blog 10/24/-10/29/1110/24/11<br /><br />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. <br /><br />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.<br /><br />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:<br />--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.<br />--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.<br />--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.<br />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.<br />--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. <br />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.<br />--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. <br /><br />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.<br /><br />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.<br />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.<br /><br />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…<br />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.<br /><br />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…<br />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.<br /><br />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.<br /><br />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. <br />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.<br /><br />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. <br />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.<br />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. <br />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. <br />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. <br />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. <br />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. <br />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. <br /><br />10-26-11<br />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.<br />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. <br /><br />10-29-11<br /><br />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. <br />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.” <br />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. <br />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…<br />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. <br />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…<br /><br />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. <br /><br />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.<br /><br />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. <br />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.<br /><br />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. <br /><br />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…<br />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.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com0tag:blogger.com,1999:blog-3462792641577376453.post-62049687178078016282011-07-16T09:00:00.000-07:002011-07-16T09:02:13.937-07:007-1 to 7-16-117-1-11<br /><br />So…so many things to write about always…it would be easier if I could tell these stories face to face…<br />Today we had 2 births…one was a super easy spontaneous fast labor/birth with a 3rd-timer…the other was a 6/5 with pre-eclampsia who they wanted to do a c/s on because her cervix was swollen because she had been pushing on it for awhile at 5cms and a few other reasons…anyway, we helped her to birth…when we arrived, she was laying on her back (with a swollen ANTERIOR cervix) and she was 6cms and her ctx were weak…we started pit on her and put her forward-leaning and then hands and knees…then I simply held back her cervix she pushed and the baby almost flew out.<br />When we arrived they had stopped her mag sulfate drip because her urine output was scant and very bloody (really BAD sign)…she was ok though and after she birthed she started peeing a lot and it was clear…huge relief…we put her back on mag and everything was great…<br />That’s a summary of it…<br />Last week we had 3 really great births too…the students really have their hearts in the right place…they are doing so well supporting women in labor, doing labor monitoring, etc…I am so proud of them…this year is a lot different than last year…we really started off on the right foot with this group…<br />5 babies who died this week…2 apparently were stillbirths…one was yesterday, a 25-week baby born alive who died in my arms over the next while…it was with that or let the baby die by herself on the counter…<br />One died yesterday--I’m sure this baby had aspirated mec…born in the morning, died in the afternoon…<br />Anyway…there’s always a lot of this…<br /><br />So I have been trying to get a kind of visa called permis de sejours…it allows you to live here for 1 year, and you renew it each year…it has been so hard…I can’t even explain it in writing…imagine in a country with no infrastructure, no real systems for anything…you have to make a long trip in person each time, only to find out that you are missing more documents or their fingerprinting machine is broken so you’ll have to return…<br />Well the 3rd and final time I went (to PAP to finish the permis stuff), I went with Blada. We had the most interesting ride up there. You ride there in either a tap-tap, which is a pickup truck, or a papadap, which is a minivan…either way everyone is super crammed in there, sitting on one buttcheek…well, this time, we had the luck of having a very entertaining crazy person in the papadap with us…it was hilarious…someday I will tell some of you who are interested in hearing about it…I will be able to explain it better…not only did we have the crazy person, we also had a woman sho in the middle fo the ride suddenly started screaming and writhing in pain…she was on her period…it was like she was having an abortion or in labor…so everyone supported her, and then after her pain started dying down and she was sleeping between the contractions, everyone started talking about how their labors were and about how boy babies hurt more than girl babies…it was really interesting…<br />One thing here is that people talk about everything in a group…like, you’re in the minivan and the whole group of people is having a conversation or an argument about something…people don’t hold back their comments…no one is immune to criticism…I don’t know how to describe it…it’s almost communal in a way…like, people keep each other in line in the street…everyone disciplines each others’ kids…<br /><br />I feel like I’m riding the crest of a wave with the creole language…like, learning at a fast pace…catching more and more little things…<br /><br />7-11-11<br />Today is Monday, a class day…the students are taking a test right now…<br />This past Friday…each day at the hospital this past week was very interesting and good with the students…we did some labors and births together…too many things to describe but one that has been on my mind was on Friday….<br />We had this woman who was in active labor, 6cms in the morning. When the student checked her, she popped the bag of waters accidentaly and there was very thick <br />me conium. But, the fetal heart tones were great. Well, her labor never went anywhere all day and although the FHT’s were always good, there was just something wrong, something that was preventing her labor from progressing. Her cervix had been 5-6 cms in the morning and in the afternoon was 4-5 cms and less soft. She didn’t have signs of infection but that could be a reason for the reverse dilation. Her contractions were strong but farther and farther apart. We tried a lot of things, and nothing helped. We had advised the Dr in the morning about her and he had actually decided to do a c/s since 9:30am. Then, for the next 4 hours, he was running around trying to get them to fix the generator, because apparently the generator was broken and so there was no power and no possibility of doing a c/s. well, after 4 hours of trying, it was clear that it couldn’t be fixed. He resigned himself to telling her: “ there is nothing I can do for you.” that is literally what he said. He left. He works all the time, gets called in all the time….he went home to eat something. You wouldn’t believe how hard people work here.<br />In the meantime, we had also been trying to find a way to transport her to a different howpital. In Cange--about 30-45 minutes away between Hinche and Port au Prince. Well, Cange does have an “ambulnce” which they send here sometimes for really grave cases…we thought they were coming and then they called and said they couldn’t come. Our jeep, the Midwives for Haiti jeep, that is used for mobile clinics, was broken down, but in the process of being fixed. By the afternoon, around 3pm or so, the jeep was fixed and Ronel (the driver) brought her to Cange. A graduate MW went with her. <br />It was hard--it was like, she was stuck there with this dysfunctional labor and thick mec getting more and more exhausted. Eventually we actually gave her mag sulfate to tocolyze her (to slow down the ctx) because we had already tried augmenting her with pit, and then when I checked her again and saw that she was reverse dilating and also was pushing on her cervix and tearing it and bleeding, we stopped the pit and tocolyzed her instead. <br />It was a team effort between myself, Genette, the students, the other graduate MW Bienaime, our driver…I imagine that things turned out ok for her and the baby because the baby had been stable all along and she was also not super compromised yet. <br />The most striking thing to me of the whole situation was when Dr C, the OB, said to her: “there’s nothing I can do for you.” I mean, for an OB to have to say that to someone--for an OB to have to tell a woman this--for an OB to have their hands tied like this and to have to simply tell a woman that there’s nothing else they can do for them---that is really sad. That is a reflection on the entire eituation here--the act that we had to wait all day to transport this lady to a hospital 45 MINUTES away--and that there are no public services like ambulances…<br /><br />There was another really intense situation this week….a birth on Wednesday…a 5th-timer (5/4) who was diagnosed with “CPD” (it is the largest reason they do cesareans here)--(CPD means that the baby’s head can’t fit through the mom’s pelvis)---<br />Anyway I advocated for us trying for a vaginal birth and got a lot of hell for it but eventually she progressed to complete (she had been 9cms with an anterior lip only, laying on her back--when we arrived)….this lady was really out of her mind--wouldn’t let us help her at all, wouldn’t cooperate at all…had it in her mind that she was going to die if she didn’t get a c/s….it was really chaotic and crazy---her yelling, her family yelling, everyone upset and scared, them mad at her for not cooperating with us, her mad at me for saying she didn’t need a c/s--anyway it was really crazy until she started pushing…then, she calmed down and started focusing and pushing and working with us…she was on the floor, almost outside of the L&D area…her dad, who had been praying over her, stayed there and held her as she pushed…<br />Pushing stage proved very difficult…probably her other babies had been smaller than this baby…very hard with fetal heart tones that started getting bad (around 70-80, staying there, with the head still not through the bones)…I called in help from another American MW who was there at the hospital too because I knew she could help me get the baby out…we were doing everything and finally the baby came and was ok after a few minutes of artificial respiration…<br />The whole thing was intense too because besides the birth being hard, besides the possibility of having a damaged or dead baby, and all the grief that would cause, there was the other reality that I had been the one who opposed the c/s earlier, so if we had a bad outcome, it would have been my fault, in everyone’s eyes. That would have been really bad. As it was, with everything ok, the mom was so so happy and so thankful etc during the postpartum, and so was her family…she had lost her voice from all the screaming so she just kept whispering “thank you so much, thank you so much…” and her family was like “you should always stay here and save mothers”…I was happy for their happiness but I also knew that if the outcome had been different, and it could have been, it would have been the opposite…<br />The thing is, earlier on, she really didn’t have any real indication for a c/s. one reason for it was that people didn’t want to deal with her crazy screaming anymore.<br />I’ve had lots of births here where they were headed for a c/s for “CPD” and I helped them birth vaginally…the week before I had another 5th timer with “CPD” who just needed some pit augmentation, a change in position from flat on her back to hands and knees, and then to push back her swollen anterior cervix--then the baby flew out.<br />Anyway….writing about something never captures the reality in full but atleast it can give an idea.<br />The students, I am so proud of them. They are doing so well in the hospital. Last week I was able to suture with on eof them and do PPV 2 times with her as well. (PPV=artificial respirations for a baby who needs help to start breathing). It is so satisfying to help someone else do something, to put your hands over theirs and feel them do it with their own hands.<br /><br />The time here has been flying by. The energy in the house has been easier than in the first several months, which has been so great, because after the first 5 months or so, I was really really FRIED, and the volunteers could see that, and that made some of them feel unwelcome, but there was nothing I could do about that because it was our living situation that was really really unbalanced…the last 2 months have been better--with some breaks from visitors (volunteers) and with Kirsty and Mackenxy moving in a month ago…<br /><br />Anyway, time is flying and in less than a month, I am leaving Haiti to go to the US for almost 2 months…first I’m going to El Paso for 3 weeks, then to NC for 4 weeks. One of the big reasons for my trip is to go through all my stuff in EL Paso and pack up what I’m keeping and ship it all to NC. So that, when our fiance visa petition gets approved next year hopefully, we can go to NC directly. I feel sad about rapping up my life in El Paso, even though I know I have to and I know that life changes. It was just such a big part of my life for so long, and I feel really connected to the midwives there still. And to the people of Ep Paso/Juarez. I had many friends who birthed in my hands 3-4 times and whose sisters’ and cousins’ births I attended…<br />I will be so happy to see everyone there again, and relieved to deal with my stuff and move it, but also sad to be wrapping up things there…I would love to visit MLL & El Paso one day with Blada…would love for him to see where I was and for my friends there to meet him…<br />Also really excited about going to NC and being there with family and friends…<br />Another part of my trip besides moving my stuff is doing things like renewing my CPR and IV certifications in order to be able to renew my midwifery license when that comes up…hopefully I can do everything I need to on this trip so that I don’t need to leave Haiti again until I leave with Blada…whenever that is…(we hope next year but you never know with stuff like this). And of course the other big thing I am going to do while in EP is to send off our visa petition. That will be such a relief! <br /><br />This past week at the hospital also, I enlisted the participation of a group of auxilliare students who are in their maternity rotation. The last groups we’ve had, they’ve been awful, so we mostly ignore them. They just sit there all day, not trying to help or learn, playing with their phones…well, the group that started this week is a different story. They are helpful and get their hands in there. I’ve had them come and do massage for laboring moms…I’ve taken time to show them things like explain things to them while I’m suturing…so, we had one birth on Friday where the mom pushed and had her baby on the floor (on a sheet)---and there is a guy in the group, who is really open and had already been doing massage for the laboring mom. So, while she was pushing, I had him squatting behind her supporting her. For like 45 minutes. It was great. This is the only time in their training they will ever see something like this. I talk to them about how to talk to patients. How to be gentle with them and show them that they can trust you. So, it was really great that they could help us in this birth--actually the guy student, he was more positive and helpful than the females. I joked that we will pick him for our next MW class. <br /><br />7-16-11<br />So, it has been 2 weeks that the hospital has been without power. The midwives do births at night with their headlamps. There is no functional OR. We’ve had to transport women who needed c-sections to a different hospital in Cange, about 45 min away. If we didn’t have the MWH jeep, some of these transports would have not been possible. Like the woman I wrote about last time, who we transported a week ago, who was stuck at 5cms all day, with thick mec. If the jeep hadn’t been available, she would have eventually lost the baby and if her labor didn’t progress she would have ended up with a ruptured uterus (and would have died).<br />Not only does the hospital have no power (the whole town of Hinche has no power. Anyone who has power has either solar panels or a generator))---but now, the Red Cross, down the road form the hospital, had all of their 8 solar panels STOLEN a week ago. Which means that all the stored blood was lost, and there is NO blood available for transfusions. There are 2 ladies at the hospital with 4 hemoglobins. There are people worse off than them, I’m sure. Ayway, whoever stole the solar panels is going to cost people their lives. If the town finds out who did it, they will probably kill him. I’m serious. Thieves are punished severely here. One time, Blada witnessed a thief get tied up, beaten and dragged through town, and then burned to death.<br />Anyway, so the hospital is pretty bad off right now. Sometimes I give some of the patients who are really bad off a little money. Like, a woman in post-op with a 4 hgb whose family is only feeding her some crackers and juice every day, and who doesn’t have money to buy iron injections. One of the students has taken on making food for her and told me about her situation, so I gave her the money to buy the iron. Out of leftover house food money. Sometimes you just have to, people are so bad off.<br />We had a 15 day postpartum woman come in on Wednesday, having eclamptic seizures. Her parents came with her….she had been seizing all day…we had to restrain her to give her anti-seizure meds because after you’ve been seizing, your brain is abnormal and you are really deranged and out of it---she was trying to bite me and scratch me…the next day, she was a lot better and has been better each day. But she’s not totally here yet. She can’t really speak yet. But, she is holding and BF her baby. Her parents are so dedicated to her…they came from far away, with nothing…nothing to wrap the baby in…everything was dirty…bloody and smelly…so so sad…they didn’t even have a sheet to put down on her bed…I looked through our stuff at the hospital and neither did we…sometimes we have stuff, like baby blankets, baby clothes, etc, but they get used and then there’s nothing…anyway, I gave them some money so they could eat and feed her…really humble and caring people…I talked to them a lot about keeping the baby on the breast, about giving their daughter good food once they get home…<br />We had another pre-eclamptic woman yesterday, who is 7 months pregnant, 21 years old, who lost her 1st baby at 7 months due to the same condition. I talked with her for a long time yesterday about the fact that right now, her pre-eclampsia appears “light”--it’s not severe/full blown yet, but that that can change at any moment--we had a woman a few weeks ago who had been seen at the hospital 3 days before with a B/P of 90/60 and everything appearing fine, who then came in seizing 3 days later…anyway, I was talking to this woman about the fact that we reall yneed to induce her labor, and that yes, her 7-month old baby probably won’t make it…it was so heart-wrenching because this woman really, really wants her baby…she is still sad about losing the last one…she kept saying that she feels the baby moving in her belly…she kept asking me what I thought were the chances of her baby surviving…at the same time, understanding and resigning herself to the induction, in order to save her own life…<br />And in talking to her, I just kept coming back to this: that this is so unfair…that in the US, we would be monitoring her condition continuously with blood tests, to know how much longer we could wait to deliver her, to balance the risks for both her and baby and she most likely would not die…it is so unfair that women here have to make this choice…this woman yesterday, she is an intelligent, normal woman, who deserves the options and choices of any other woman…the women here are no less, and they deserve no less.<br />Yesterday in case studies class with the students, we were talking about eclampsia. I was asking them if they have known women who have had eclamptic seizures, who have either been normal afterwards or been kind of off mentally, or even crazy. (years later). I just wonder, because obviously, you can suffer brain damage from an event like this. Well, almost half of them have had cousins, aunts, sisters, etc who have had eclampsia. This is shocing. This shows how common it is here. All of them said that the people have been normal afterwards. I know that there is different research about how PEC starts, like with placental attachment in the 1st trimester, genetics, etc. but to me, the most obvious cause is malnutrition and dehydration. People here do have chronic dehydration and malnutrition. A pregnant woman needs more of everything, and needs to expand her blood volume by 50% over what it was, by 28 weeks pregnant. These women are HYPOVOLEMIC. They have a thick, contracted blood volume. This leads to placental insufficiency, fetal growth restriction, high blood pressure, kidney damage, etc. the body responds to the hypovolemia the same way it does to a big hemorrhage: the kidneys release renin, to raise to the blood pressure, in order to keep circulating blood through the body, and to the placenta. They also start reabsorbing water, in order to keep the blood volume out. Lack of adequate protein and salt causes plasma (the fluid part of the blood) to leak out of the blood circulation, which causes pathological swelling. This is a simplified explanation of a multifaceted syndrome. There are surely other factors that can exaserbate the process or augment someone’s risk. But, I really feel that this is the underlying cause. It is so clear. When you see it here, it is so clear. When you read about it and put all the pieces together, it is so clear.<br /><br />The choice that ended up being made, in light of her fervent desire to save her baby if possible, was to bring her to Cange the next morning (this morning), because at least there they have the capacity to care for premature infants…I don’t know if a 7-month baby will make it there, but it’s her only chance.<br /><br />We only have 3 weeks left of classes, until we start the last 10 weeks of the program, which is almost all clinical. I regret that I will be gone for 2 months of that. I feel really attached to this group of students and will miss them so much and also be sad to miss out on a big part of their learning. There is never a convenient time to leave Haiti. Even though I am excited to come home, to see everyone…it is also hard to leave and I will really miss people here…<br /><br />What else…the weeks are passing fast.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com4tag:blogger.com,1999:blog-3462792641577376453.post-72551588633692895682011-06-20T18:29:00.000-07:002011-06-20T18:31:41.797-07:006-20 june, 20116-11-11<br /><br />Things here are going really well. This is the easiest time so far this year. The students are doing great; we’re over halfway through the class year. The house is way more relaxed--for the 1st 5 months of this class year, starting in January, we had volunteers every single week, with no break. For 5 months. Now, we have had a couple of breaks, and, for over the past month, we have had all really great, really easy (low maintenance) and fun volunteers. And, Kirsty and Mackenzy have now been here for 2 weeks, and this has added a wonderful element to the household. It feels like more of a community now. We’re living with people who we share a lot of things in common with, even just with our lifestyles and overall beliefs…we get along really really well. It is so good. I like Kirsty so much. Also, with them here, and knowing their vision for their life here, it makes living in Haiti more appealing. They have land in the south…they have lots of gardens…<br /><br />What a blessing. Blada and I are great, just more and more connected and in love with each passage of time. He is so wonderful, I just can’t wait for those of you who can, to meet him when we come to the US. This weekend is our one year anniversary. A year ago, there was a day that marked a change in the course of our friendship. We had already been getting together for awhile, on and off for 1-2 months, to dance. To practice. Well this one day, we had finished practicing, and then their was a huge downpour of rain. A thunderstorm, with lightning, wind…and 2 full arc rainbows in the sky. A beautiful storm, a sign from nature. This day, we danced in the rain. And then sat down and talked for awhile, in the rain. This day, the energy began to shift. This was the beginning of us dating. <br /><br />Anyway I could go on about that but I’ll leave it there. <br /><br />Nothing else too spectacular to report…well, one sad event, which repeats itself every 1-2 months without fail: a woman died at the hospital. She was a small woman, who was very pale and weak from anemia. She came in with a hemoglobin of 5, not as low as some people who make it here--got a transfusion after days of waiting for blood, and then was at the hospital still for about 2 weeks. I spent some time with her, talking to her about her ailment (to her it was a sickness that someone had sent upon her with black magic, someone who was jealous of her…)…talking to her about nutrition and all the thing sshe could eat at home for iron…<br />Well, this came as a surprise to me because I had just seen her 2 days before, but yesterday I heard that she had died. Apparently she started having diarrhea and vomiting. I don’t know if it was cholera--but it definetly could have been, and I think she should have been rushed over to the cholera tents (in front of the hospital) for treatment. Anyway, I guess she got really dehydrated and died. I don’t know more info about it except for that. She had one child.<br /><br />6-20-11<br />Well, this week was crazier than last week. Another woman died at the hospital--this time from a placental abruption. I wasn’t there--apparently she had the classic signs--her belly was hard and full of blood (but no external bleeding). Anyway, they didn’t do a c/s--they don’t always do them for abruptions, if the mom isn’t bleeding a lot and she’s stable--but, in this case, she had already lost so much blood when she showed up, it may have been too late anyway even with a c/s (they don’t have blood available in the hospital)…so, she birthed (a dead baby), and then died 1 hour later.<br />The next day, there 2 eclamptic women--one of them was 16 years old and came in seizing. She was in labor, 6cms. We got her on mag sulfate…I had to leave before she had her baby, but she was pushing when I left. Most of the time when I was there, she was unconscious, after the seizure. She started coming around a little, getting a little responsive…but really out of it, thrashing her body around, really agitated…when she was unconscious, you could still tell when she had a contraction…she would moan and kind of thrash around..it was still hurting her..<br />Well, she had her baby after I left (the FHT’s were great the whole time I was there, and we were listening often). I guess the baby wasn’t OK when he was born, and needed to be recessed, and then they gave him to the “ped unit”…(it’s not a real ped unit…)…anyway, he died the next day..there were 2 or 3 babies who died this week…1-2 days after they were born…the hospital just doesn’t have any means of giving care to babies who need anything more than IV antibiotics…they don’t even have oxygen to give them…anyway…this mom, I’m not sure how well she’s doing…I haven’t heard any really bad news, but, I heard that the next day, after her birth, she was unconscious again…I guess she seized again….I don’t know if they were monitoring her appropriately and keeping her or mag sulfate to prevent more seizures…<br />Well, the same day that she birthed, there was another woman, who had a previa. (the placenta is situated over the cervix…so when the cervix starts to open, the placenta separates and the mom bleeds a lot and both mom and bb can die). This woman, at one moment, I thought she was dying in my hands. She was waiting to be wheeled into the OR for a c/s, and I was doing vitals on her. She was bleeding A LOT, and a few times said that she was going to die right there. Well, she lost consciousness at one point, and I opened her eye and looked into it and it looked like it was flat, fixed. I took her B/P, and it sounded like either 40-20 or nothing at all…it was faint. Well, she was still alive and when I took her B/P again, it was actually 80-40. She got her c/s and a blood transfusion and was OK. I don’t know if her baby made it though. <br />The next day after the 16 year-old eclamptic woman and the placenta previa woman, there was another woman who came in with an abruption, but birthed and was ok, and another woman who was eclamptic, and, to top it off, there was another woman, who had a bowel obstruction and was vomiting shit. I’m not kidding. Thank god, she was transported to Cange and hopefully had her operation STAT and hopefully was ok. <br />So, this week was crazy. The students see so much here. They are like 6 months into the program and they’re working on super super high risk sick women. Being a midwife in Haiti means that you will work with a high-risk population, no matter what. You will see death, and severe pathology that midwives (and doctors) in the states would never see. People here become midwives because they want to save peoples’ lives. If you ask anyone here why they wanted to be a MW, that is what they say.<br /><br />Our new housemates, Kirsty and Mackenzy, we are really enjoying them. We flow super easily, enjoy hanging out together, etc. it’s great. We always had a sort of community here at the house, but now, it’s on a totally different level. They’ve started gardens, compost…he’s an agronomist. He’ll be bringing his little daughter here soon too, which will be nice for the house…we already have Jamlex, our cook’s baby, who comes here with here all the time and is SOO much fun (he’s 14 months old…), so this will make it even more like…a family. Really cool.<br /><br />What else…I’m still trying to figure out in my mind some way to not be affected by the way people can often be in the street…comments all the time about the white girl…I’ve written about this before…anyway, I haven’t found a way to filter it out yet…but it must be possible, because in order to survive at the hospital, I have had to convert myself to not being devastated every time I see birth rape…somehow, as a survival mechanism, I did that, without even realizing it…so it must be possible to filter this out as well…the thing is that with this, the way people make me feel is that I will never fit in, I will always be strange, different…anyway, still working on that…in the meantime it still hurts my feelings all the time, and Blada has spent countless nights holding me in his arms while I cried about it…there has to be a better way…<br /><br />We visited Blada’s family this weekend in Okap…(Cap Haitian)…it was so nice to be with them…but traveling there and back is exhausting…plus we went on eday and returned the next…it’s a 4-5 hour ride jam-packed in an old pickup truck, that they have to push start…seriously, the whole road is just rocks…you’re bottoming out the whole time, bouncing so hard that you feel like your organs are just slamming against each other constantly…seriously, this is the reality of traveling in Haiti. Since there’s no actual real government that provides any kind of services to its citizens, such as mail service, it’s the chauffeurs who deliver packages and letters for people along the way…part of the way, it was raining, and the road was just all mud…going up and down hills…this guy, the driver, he is so experienced at driving those hills, he was fishtailing on purpose just to get the heavily-loaded truck up and down those hills…you have to cross a few rivers too…(drive through the river)…one time the water was deep enough that it came into the cab of the truck…<br />All of this is just another day for people here, who, that has always been the way you travel…you have no other option. I don’t mind it, it is interesting, but also very tiring.<br /><br />The students are doing great. I am really proud of them. They have the right attitude. They really care about the women they serve. It shines through in the ways they talk to the women, and the energy that keeps them on their feet all day instead of sitting down and yelling at patients from across the room…<br /><br />Well I guess that’s all for now…<br />Love all fo you…thank you to all fo you for reading my blog and staying current on my life…parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com0tag:blogger.com,1999:blog-3462792641577376453.post-39424779574115533282011-06-05T07:23:00.000-07:002011-06-05T07:25:08.910-07:005/26-6/5/115-26-11<br /><br />Today is my birthday!<br />What a big difference from last year--last year I didn’t have anyone to celebrate with…had a good day, by myself…made the best of it…today, the students insist on coming over to sing to me…after we work at the hospital this morning…I made some cookies and sweet cornbread last night to share…I think it will be sweet…<br />The rainy season has begun…just about every day it starts raining sometime in the afternoon…sometimes it rains really hard, sometimes it rains slowly and for a long time…it makes everything more beautiful…the trees are greener…there is less dust on the road…it’s cooler…the insects sing more…(I still never hear birds sing…sad…there should be lots of birds here…)<br /><br />I never got news about the lady with the severe abscess, who we transported to Cange. I think she’s probably at home and OK, however I don’t know if she continued BF her 1 month old baby…<br />Yesterday though, I did see the other lady we had transported that day…the 24-week pregnant lady with the strangulated hernia…she is OK….coming in every 3rd day for dressing changes on her bandage…so her life was saved, but her life sounds impossibly hard…she was talking to me yesterday, hoping that I could help her with some money…it’s so hard because SO many people have lives that are this hard and need the same help, and you can’t help everyone…I’m here to train midwives, and to provide healthcare…that’s all I can really do…but sometimes I do give people money when I see that that is the only way they’ll make it…anyway, here is her situation: she is staying in Hinche with one daughter, at someone else’s house. The husband of the friend letting her stay there is starting to be outraged at her presence. She’s from really far away in the country and she has 4 other kids out there, with no one taking care of them. They’re on their own. One of them Is 3 years old. Her husband is in the DR working and they have no communication and she doesn’t know when he’s coming back. She has no money, not even for paying to get on a truck to go home. She still needs to come in every 3 days for dressing changes and needs her stitches removed in 2 weeks. So she has to stay in Hinche for atleast that time.<br />Peoples’ lives are so impossibly hard here. You hear stories like this all the time. And most of them, they’re not exaggerated. That’s the real truth.<br /><br />5-28-11<br /><br />I had a really really happy, joyous, fun birthday. It was wonderful. Apparently the students and Marthonie had been planning a surprise party for me since last week. They came and made a party! They were so much fun. This group of women is really special. They are heartfelt, caring, sincere, loving, and FUN. There is one girl in our class who is HILARIOUS. She is one of those people who is always joking, always laughing, always making people laugh. She had me laughing throughout the whole party…some of the students danced together, and she was dancing too, but kind of in a joking way…I wish I had a video of it. I’ll never forget it. The most wonderful thing was that they all came together to show me their love and appreciation for me. It was so real, so unpretentious. One of the best birthdays I’ve ever had. It really is the happiest of them all because now, I’m not missing true love anymore. Blada and I are together, closer every day. So, because of that, I feel like my life is on track, even though sometimes I can barely stand living in Haiti and with the American volunteers.<br />The past few weeks with volunteers have been really good though. Really great folks who have come through, helped a lot, given us personal space, just been overall really easygoing. That’s been so nice. Now, we have 1 week with no volunteers. Such a blessing to have a little break. We should have a break regularly--it’s not normal to never have a break from people. <br />Anyway…<br />We had a really great birth yesterday…this poor lady had been being induced for a couple of days (for pre-eclampsia) and was exhausted…1st baby--finally was close to having her baby…pushing on a 3cm cervix, flailing around, screaming…it was almost time for us to leave…I stayed by her, and got her grandmother to come in too…just stayed there and massaged her and tried to slowly quietly soothe her fears and help her to calm down…well, during this time, of course there were other people standing around, watching, doing nothing to help, even laughing at her as she struggled…(these people are students in an auxilliare school--it’s like nurse’s aid school, 2 years long)…anyway, I usually talk to them about stuff and try to give them advice about how to treat people, but in this l=moment I just ignored them. Well, after awhile of struggling, this woman gave in and relaxed into her labor and let it happen…pretty soon she was complete…pushed her bb out fast, in hands and knees…had a really beautiful birth…I think she tore her cervix, because she was spurting blood at first (not from a vaginal tear), but then it stopped…so we let it be…I had thought that her bb was going to die right after birth, because of being so premature, but, the baby was more weeks than we had thought…maybe 32 or 33...was breathing on his own, and rooting…he looked like he was going to make it when I left…if he nurses a lot and stays warm…if not, he will not make it. So, hopefully.<br /><br />6-5-11<br /><br />The above baby DID make it! His mom was rally connected to him and breastfeeding him. I was so happy to hear this a few days ago!<br /><br />Things here are better than they’ve ever been. Our living situation: the house: it is so much better because we have these new housemates, who we knew were coming and have been waiting for for months. Their names are Kirsty and Mackenzy. She is a Canadian MW and he is her Haitian fiance. They’re really down to earth, relaxed, cool, fun, nice, etc. they’re really into gardening and have already started gardens here. I feel like we can learn a lot from them. Having someone else here to help hold the space & who understands the realities here feels so good. They’re only been here for a week and we already feel so at home together. I feel like a layer of stress has been lifted off of me, because I don’t have to carry the house alone anymore, and interact with the visiting MW’s alone anymore. Thank god. The past few months here, until about a month ago, were really stressful. Getting the house going, starting a new class, having CONSTANT volunteers coming, each week, never ever having a break for ourselves. <br /><br />There are things that are hard to address with people, such as people walking in here and taking pictures of everyone all the time. It’s a total underlying attitude…what do you say to them about that? Even if you ask someone’s permission to take their picture, and they say yes, that doesn’t mean that they’re really consenting to it…no matter what you do, there is a power differential when you come to a place like this and you have a camera and you are white…people don’t usually know how to say no. to me, it’s voyeuristic and exploitative to come to a place for a week and feel entitled to take all these pictures of people,,,in town, in the hospital…would you walk into a hospital in the US and take peoples’ pictures that you don’t know? I don’t think so. What makes you think that’s ok to do here? Because you paid your money and volunteered? Things like this that fucking drive me crazy sometimes…and I’m the one who’s here each day, seeing people come and go, seeing people repeat the same patterns…asking myself how the people here feel about having their pictures taken by all these white people who they’ll never see again…this is an example of why I’m glad Kirsty is here. To help hold things down and explain things to people so that hopefully they’ll think about it in a real way.<br /><br />Anyway, like I said, everything has taken a turn for the better since about a month ago. The volunteers have been great, things have flowed more easily, and the house has been less stressful. The place you live shouldn’t be a source of stress in your life. It should be a place to relax and unwind from your work and outside life.<br />Even though the past month has been really great, I see that I am still processing the undue amount of stress that has been here in our house for the 1st several months of the new class (january-april). <br /><br />Nothing too crazy at the hospital recently…let’s see…there was a lady who had had eclamptic seizures and was still there and I guess was in a coma the night before…well, she was the most agitated post-eclamptic person I’ve ever seen…she was talking NONSTOP, like a crazy person…going on and on about all kinds of crazy things…total drama about her aunt trying to kill her and just crazy stuff. <br /><br />Then there was a woman who had a ruptured ectopic pregnancy (the fertilized ovum had embedded in the fallopian tube, which eventually burst, and then she was bleeding internally)---I didn’t see her myself but apparently, she was admitted the day before for abdominal pain,,,the OB did a sono and couldn’t see anything…only fluid…(it was blood)--well the next day apparently she was in more pain, and he did another sono, and still didn’t see anything…so what he did was insert a needle into her abdomen and withdrew to see if there was blood…yes, there was bright red blood…he rushed into the OR with her and operated on her ruptured ectopic pregnancy…she got a blood transfusion…after which her hemoglobin was 5...she really could have died…and would have if he hadn’t done surgery on her when he did…she had already lost a lot of blood…<br /><br />Anyway…so, yes, things are good here…not too crazy, just moving along. The students are doing great. I taught NNR (neonatal resusitation) to them the other day, and we practiced a lot…they did great…I felt really good about the information I delivered to them…simple, complete, all the essentials.<br /><br />Blada is great…I love all you guys…parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com0tag:blogger.com,1999:blog-3462792641577376453.post-91157898739376947132011-05-14T09:11:00.000-07:002011-05-14T09:12:14.442-07:005-14-115/14/11<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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. <br /><br />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.<br /><br />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.<br /><br />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. <br /><br />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.<br /><br />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.<br />Hopefully I will hear from them.<br /><br />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. <br /><br />So, that has been the last couple of weeks. <br /><br />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.<br /><br />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.<br /><br />That’s all for now…parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com0tag:blogger.com,1999:blog-3462792641577376453.post-16082551883223672522011-05-01T05:42:00.000-07:002011-05-01T05:44:50.976-07:004/20-5/1/114-20-11<br /><br />This week and last week…<br />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.<br />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…<br />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.<br /><br />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…<br /><br />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.<br />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.<br />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, <br />who else is there to take care of her? Who else was going to sit by her bedside all morning? No one.<br /><br />4-27-11<br />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.<br />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.<br />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.<br />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.<br />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.<br /><br />5-1-11<br /><br />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. <br />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. <br /><br />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. <br />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.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com2tag:blogger.com,1999:blog-3462792641577376453.post-87311042097125672162011-04-09T09:25:00.001-07:002011-04-09T09:28:51.649-07:003/31-4/9/113/31/11<br /><br />So…<br /><br />The lady from last week, who had the 3 hemoglobin and then got the blood transfusion, she had a 5 hgb afterwards and was discharged. The day after the transfusion, she was up out of bed, bathing the baby, moving around--seemingly feeling a lot better. We did her hgb just to see, even though it was just 1 day after the transfusion--because it was a Friday and the lab is closed all weekend. <br /><br />Today and yesterday I have been working with the students in post-op. It’s time to go for it--I have been more or less avoiding post-op all along because my skills aren’t so strong there. But I am seeing that it’s not such a big deal. <br /><br />Thanks for peoples’ comments on FB and the emails regarding the maternal death that I wrote about last week. Thanks for everyone’s compassion and interest in following what I write. It helps me a lot to write about what I see here. It also really helps me to hear feedback and to know that people out there are in touch with my life here.<br />This isn’t the first maternal death I’ve seen here. It’s just the first person who I saw before my eyes who had just just died. We probably have one maternal death about every 2 months. I think we’ve already had 4 since the beginning of the year. Mostly women die here from eclampsia. I have been involved in the care of women who have died. I can recall several women who died last year, and a couple from this year. <br /><br />There was a women who I had written about who died recently--she had sickling cell anemia and had a 2.3 hemoglobin. Moms and babies here die. Seeing these deaths has opened my eyes to how easy it really is to die. The fact that we’re all alive is amazing. We are walking such a thin line, all the time. Death is real. Seeing people here die, makes me think about the people I love who are close to me dying. When I think about that, I just feel sad, because I am not ready to let go of anyone yet. But I know that it is not my choice, when this will happen. It makes me want to come back to the US as soon as possible because I want to spend time with my family. I feel so far away from them. I don’t know when we will get up to the US. If things go smoothly, then maybe in the summer of 2012. Getting a visa for Blada is a process, with many parts. One part is that I need to find a co-sponsor, because I don’t make enough money to “sponsor” him myself. People are afraid to sign on for this, because there are too many “what if’s”. Yes, basically, whatever horrible and unlikely scenerio you can imagine, it could mean that the co-sponsor would be financially responsible. Like, if Blada had a heart attack and went to the hospital, and we didn’t pay the hospital bill. Any kind of government financial aid. Food stamps, a school grant, etc. If we used gov’t aid for him, then that’s where the co-sponsor would be pulled in. If anyone who knows the kind of person I am is reading this and sees the importance of this for me and is interested in being our co-sponsor, let me know. I can get more information about it too. It needs to be someone who is not afraid of all the “what if’s” and who sees life the same way I do: we all NEVER KNOW--we take risks all the time in our daily lives, and could have something unexpected happen at any moment. If I don’t have a co-sponsor, I can’t send the petition for our fiancee visa. I don’t want to be stuck in Haiti for my whole life. I want for Blada to meet my family and my community in NC and EP. I want to be pregnant and give birth in the US.<br /><br />4-4-11<br /><br />I went to the hospital today with the new MW’s do orient them to maternity, and one of the student asked me to check on a woman who she had worked on this past week. A 19 year-old woman, 1st pregnancy, recently married. This woman was preeclamptic, about 34 weeks pregnant, and also was anemic--her hgb was 6. Also, she had some kind of abdominal mass. I had seen her on wed and talked to her and she seemed ok--stable. They were waiting for the OB to do a sono on her to confirm if she had a mass or not, and also they were trying to get blood for a transfusion before inducing her for pre-eclampsia. Well, apparently she died on Sat. She gave birth, and I don’t know what else happened--if she had eclamptic seizures or just severe anemia plus postpartum hemorrhage. We are going to try and find out what we can when we return on Wed. <br />So many moms die here. This must be the 4th or 5th maternal death since the beginning of this year. <br />Marthonie and I talked about this woman’s case with the students this afternoon after I returned from the hospital. One of the main reasons people die here is because nothing happens quickly. Things take too long. Like, getting blood for a transfusion. The main reason is lack of materials and lack of infrastructure.<br /><br /><br />4-9-11<br /><br />The woman I was describing above…from what I can tell, she died from pulmonary edema, secondary to pre-eclampsia. Not related to the anemia or the possible abdominal mass. 19 years old.<br /><br />I am feeling a lot better--my spirits have lifted a lot during this week. Sometimes things here are just endlessly hard and overwhelming, and other times I am able to appreciate and enjoy what is, with greater ease.<br /><br />This week in the hospital was satisfying. Usually I dread going there and working--the opposite of how I used to feel when I would go to work at MLL. But, atleast now, even if I dread going sometimes, often I end up having experiences with the patients that are really gratifying. Like, a deeper connection/ a bond after taking care of the same person for a couple of days. This week, Wed and Thur, I worked with the students in post-op. on the same people. I made friends with a few people, exchanged numbers with a couple…really nice. People really appreciate when they see you putting you heart into taking care of them or their family member. They notice the difference. <br /><br />I got to do 2 births yesterday--both really great births. The first was a 1st timer, who went really fast from 4 cms to complete, and did great--the student who caught, it was her 1st time catching…the 3 students with me, they did a good job supporting the mom…I had to tell one of them one time, not to tell the mom to “cooperate”--that was the only glitch. I was like “she IS cooperating!! She is doing an amazing job! We don’t need to tell her to do anything different!” Geez. The students’ 1st response is always to tell people to cooperate and to tell them they shouldn’t cry. I always tell them that we are there to support the woman in any way, and if that means holding her while she cries, then great. Sometimes people need to cry. Especially when they’re going through labor, or just got abandoned by the father of the baby, or are having a miscairrage, or whatever.<br />The second birth was a 3rd timer, who had a really great spontaneous birth, with just me because it was busy and the students were leaving--in hands and knees. No one telling her what to do. Shirted the placenta semi sitting, kind of on one side, on the small exam table. <br />Being in births is uplifting for me, and is part of what is missing for me here. There are so many things here that make my reality so full and rich, and I have learned so much and continue to learn, but…I miss being in a lot of labors and births. Last year was busier with births. <br /><br />There was someone in the hospital a few days ago, a father holding his maybe 2 year-old child in his arms. The child was severely malnourished. That was the 1st thing I noticed. He had brought the bb to the hospital because the bb apparently has something wrong with her leg--pain--it didn’t look deformed. Leg pain or foot pain.<br />Then he told us that they did an x-ray at the hospital, and discovered that there is a needle in the baby’s leg. On the inside of the theigh, straight across. A needle. Genette asked him if they (the parents) had put the needle in there. He looked down and said no. as we walked away, Genette said that for sure the parents had put the needle in there--they went to a sort of witch doctor that everyone goes to here, and that person put it in as a remedy. Genette said that one time she was putting in Norplant for someone, and the woman had a needle in her arm--inside her arm--as some kind of remedy or magical protection.<br /><br />There was a postpartum patient yesterday morning who had birthed the night before, and hadn’t peed for 14 or 15 hours--her uterus was way up there--she was laying in a dirty bed, hadn’t eaten at all yet…and, she was this woman who Marthonie had evaluated the day before and who appeared PERHAPS lightly pre-eclamptic, but Marthonie wasn’t sure--she had +1 proteinuria and slightly elevated B/P, but no other signs…since we have no real lab tests to help us with diagnosing pre-eclampsia in it’s early stages/when it’s “mild”, that can be a hard dx sometimes. It’s obvious when someone is severely pre-eclamptic, but not always easy to dx when it’s light. So: the day before, she didn’t treat her for PEC. Well, the next morning, it was clear that she DID have PEC, because now her face was swollen. We cathed her because she hadn’t peed for so long, and then tested her pee for protein, and now it was +3. So, now we put her on mag sulfate. It was interesting to see the progression of her PEC. She hadn’t started getting better yet, after delivering. It was still worsening. <br /><br />Also yesterday, not to come as a surprise, there was a woman who came in who has been bleeding for the past 6 days, but no cramps--13 weeks pregnant. Positive preg test. Her partner just kicked her out--when she started bleeding. The father of her 1st 3 kids, he died when she was pregnant with the last. She lives in the DR, working her ass off to support her kids here (like paying for school). She has no one to depend on. She broke down and just cried and cried in our arms. I made the students stay with her and hold her, and I did it with them. It was a calm moment in the delivery room, and we just held her and supported her while she cried and told us about her life. I see this so much. So many women, with so support whatsoever, with such hard lives. It is sad to see this pattern over and over, but it is also a privledge to sit with these women, and it is an obligation to involve the students in the act of having compassion for someone like this, and holding a loving space for her. We can’t fix her life, we can’t convince her partner to not kick her out, but what we can do, is spend this one moment with her, and give her our full attention, and hear her story, and give her validation.<br /><br />Another person yesterday, she came in at 43+3 weeks, her 3rd pregnancy, a big baby--4-4.5 kilo--maybe twins but it more felt like a big baby to me--high blood pressure but no other signs of PEC--when I check her, the baby is also breech and high. We just put her on blood pressure medication to bring her B/P down a little and called the OB. I would have induced her for her high blood pressure and post dates, except that the baby was breech. A big cephalic baby I wouldn’t be so worried about.<br /><br />Genette saved someone’s life a couple of weeks ago. This woman came in, with placenta previa, bleeding profusely. The OR was DOWN for about a week, because the anesthesiologist had gone to port au prince because he was sick. (The same people who work at this hospital, they go somewhere else when they’re sick!) ----so, anyone who actually needed a c/s, didn’t get one that week. Well, the only way to save this woman’s life was to somehow get her transported to Cange, about 45 minutes away, where ther is a better hospital (Paul Farmer’s hospital). Genette, who wasn’t on duty but had just come in to see someone, she did everything she could to transport this lady. She got in touch with the guy who drives the ambulance from the Cange hospital--yes, there is an ambulance--she called him, and he was far away, eventually made it, and picked up the lady. She made it to Cange, got a c/s, got a blood transfusion, and lived. It turned out that the ambulance driver, he knew this woman. Both he and the woman were so thankful to Genette. She literally saved this woman’s life. If she hadn’t walked into the hospital at that moment, the woman wh=ould have bled to death there. No one else who was there was going to go to such great lengths to save her life (making a phone call). It really shows you, how when you have no ambulances and no roads, people die. If there were basic services like this, a lot more people would survive.<br /><br />Blada has been so supportive and accepting of me through my ups and downs here. Completely present, just full of love, always open, always compassionate. I am so thankful for him. I can’t even come close to describing how he really is. I just know it in my heart, and we both know how each other feel, and we both know that we can’t put our appreciation for each other into words. I am just so thankful for him.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com3tag:blogger.com,1999:blog-3462792641577376453.post-71066179734017478692011-03-24T16:51:00.000-07:002011-03-24T17:03:23.903-07:003/17-3/24/113-17-11<br /><br />Things are so unbelievable here, if there was any way to really describe it to all of you, it would be a big relief to me. If there was any way to really capture all of the different pieces, as well as the big picture. Things are crazy here, in so many ways. Everything: activity level at the house, with people coming and going, noise levels; coordinating the people who work at the house in order for everything to run smoothly; the street: how do you make peace with the fact that 15 people a day yell something out at you in the street? Something that has to do with the fact that you’re white, and therefore different. The hospital: the level of knowledge and the level of apathy of the people who work there, the almost complete lack of materials to work….<br />I have been feeling really frustrated with everything here recently. It is really hard to live here. At the house, there is never really a quiet time or a time where someone doesn’t need to engage with you. There has been a volunteer here for 2 months, Lara, who helps tremendously with the volunteers. She talks with them a lot and spells things out for them. I feel like I don’t have the energy to do this, even though it is supposed to be part of my job. I already manage the house, prepare classes, teach, work at the hospital…but the thing is, Lara also does a lot of extra work around here, and I have been comparing myself to her a lot and wondering why I can’t also do all of this extra shit all the time---I can’t and I also don’t want to--I don’t want to put myself through that, always working, always talking with the volunteers, taking all of these other jobs on…is it that some people are just more capable than others?? To step into a situation as overwhelming as this and just take on all of these different responsibilities?? Is it that at this time of my life, I need to be more inward and focused on myself, on my growing relationship with Blada? Is there anything wrong with that? I just don’t see how it would be possible for me to be as engaged with so many different aspects of the work here, when I already live here, and am doing the work that is mine to do. I know this in my mind, I know what I am capable of, and don’t want to put more than that onto myself, but I also can’t help but feel that in the eyes of MWH I am not doing enough. <br />Sometimes the reality here in Haiti, in the street and in the hospital, is so depressing…I just get depressed, and feel like I can’t enjoy it at all. It has been up and down for the past year. It has never been easy, even though I have learned to love and appreciate many things about the culture and people here. I really do enjoy a lot of things about Haiti…some things here, they are lacking in the US…but sometimes the hard things about being here are just so overpowering…and going back and forth between this place and the US, which are starkly different, it is hard to assimilate. Even months later after traveling, the differences stand out in your head, in your experience. <br />In the hospital, you see things that are really frustrating. So many little things that you just can’t believe. Such as: I was talking to someone’s mother yesterday, in the hospital. This lady had had 10 babies. Then she told me that one of them was a c-section. I asked her which one: it was the 10th. Why? Because the baby was “too big”. someone’s 10th birth!! She had already birthed vaginally 9 times!! How is it possible that someone would think this is possible? There are so many c-sections done here for “CPD”. So many. It’s the easiest diagnosis to do a c/s for. They take it so lightly. They do a c/s for a reason that’s not real, and then the post-op care is not good. Sometimes people don’t ambulate for 2 days. These people are really at risk for thrombosis. Plus a lot of them already have high B/P. (Thrombosis is when you have a clot that develops in a vein, usually in the leg. If it detaches, it can travel to the lung or heart or brain).<br />Yesterday, there was a woman who had a dry IV in her arm--that’s almost everyone--so I asked her how long it had been dry, and she waid for 2 days. And I looked in the chart, and it was true. She had the same dry IV in her arm for 2 DAYS. Why?? And each person who checked her, 3 times a day, they just wrote in her chart, the IV that ran out is in place with the IV tubing closed. But no one looked back to see how long it had been dry for? If they needed to give her IV fluids, they would have had to re-stick her anyway. <br />Today, there was someone with a 4.6 hemoglobin who needed a blood transfusion. We did the requisition for the Red Cross, and one of the students walked over there to deliver it to them. Well, she knocked on all the doors and no one was there. Someone finally came and told her: the Dr isn’t here--go back to the hospital and call the Dr. So she came back, and we found someone who had the Dr’s number in their phone, but then no one had minutes on their phone. Ok, so then we found someone with minutes on their phone, and we called. They said they will send someone over to pick up the blood specimen (so that they can match her blood type). Hopefully that will happen today.<br />At the hospital, in order to get materials to work on the patients, for example to give someone an IV, you have to write a prescription on a special prescription paper, and then send the family to the in-hospital pharmacy, to get the materials, like IV fluids, IV tubing, etc. When the pharmacy is out, then the family goes to a pharmacy on the street and buys it. (Most of the time). Well, sometimes at the hospital you don’t even have the little prescription papers. Like today, they were using regular paper (which they actually had) and tearing them and putting a Maternite stamp in it, in order to use it for a prescription paper. <br />The sharps boxes are stuffed full, because people throw the needles and syringes into them. Instead of detaching the needle from the syringe. So I was talking about this to the head of maternity today, and she was like, “well, this is just how we do it.” then she shows me how she does it-- she takes the protective covering OFF of the needle, and then throws the needle and syringe into the sharps box. Seriously? I don’t know if she was doing this just to say like: “I have my own way of doing it“, or what. Does that make sense at all? <br />Things are just so fucked up at the hospital. Another thing is that working with Haitians, there are major cultural obstacles. Ways we are raised as children, that are so different. I have been feeling discouraged about the new class--I remember feeling this way last year too--I just don’t know if they’ll ever be capable of grasping the real underlying concepts. Will they be good enough? How good is good enough? In a country where 76% of women give birth without a trained birth assistant, and many of these women and babies die?? <br />And these things I am describing are just tiny, tiny slivers of the reality here. It is so big, you just wouldn’t believe it. Some day I will tell some of you more stories in person. If you want to know. When I come to the US, and hang our with people, and they don’t ask me questions about my experience here, I don’t feel compelled to talk about it, because I don’t know who is actually interested in hearing about it.<br />Oh, and Aristide is returning to the country today or tomorrow, for the 1st to=ime after his exile. Baby Doc is in the country as well, as of atleast a month ago. And, elections are Sunday. The second election--the re-vote--after the vote in November. It is really very strange. Something big is going to happen. The volunteers from this week are evacuating though the DR--not through Port au Prince--tomorrow morning. Hopefully no new volunteers will try to come this weekend. Not a good idea.<br />There must be a bigger plan for the manipulation of Haiti, which is why both Baby Doc and Aristide are going to be here for the election. There has to be. For some reason, Haiti needs to be kept in darkness and chaos and poverty. <br /><br />3-19-11<br /><br />So…I am feeling a lot better than I had been feeling this week. I am really trying to figure out ways to reduce my level of stress here. I have to come to a place of greater acceptance of the reality here. The realities here, the mentalities here, etc. everything that I was writing about a couple of days ago. If I can somehow turn it around and use humor…this has definetly helped over this whole year--like, the rediculousness of some things that happen here…just try to laugh it off, just try to see it as interesting and ridiculous and therefore funny…I don’t mean laughing off the hardship of peoples’ lives here--I mean laughing off the stress of my job here, the fucked up things I see over and over again at the hospital….things like that. The poverty and suffering that you see here is something that gets burned into your heart. You can’t forget it, and you can’t not compare it to other places, where peoples’ basic quality of life is sooo much better. Here, people are denied the right to a basic, normal quality of life. I don’t mean just the fact that they’re poor. It’s so much more than that, and there’s no way I will ever really be able to explain it to someone who hasn’t spent time here or somewhere like here.<br /><br />I am feeling more at peace and happy here though. Blada is a solid support. So understanding of my difficulties here. So patient. I think if we can make it here we can make it anywhere. And everywhere will have its own particular challenges.<br /><br />Yesterday at the hospital, there was this woman who had had eclamptic seizures the day before, and they had decided to do a cesarean because she was not in labor at all, her cervix wasn’t ripe at all, she was 41 weeks, plus she had already had seizures. Ok, I agree. The only problem was, the OR team never arrived that night and so she still hadn’t gotten the c/s yet (the next morning). So, we started working on her, making sure she was getting the right meds and stuff. Well, according to her chart, no one had done any rounds on her at all since sometime the night before (they don’t usually write the times in the charts--just AM, PM, and NIGHT). So, then we saw that her IV drip with blood pressure medication was dry. Since who knows when. Then, we also saw that her IV had infiltrated----that means that the little catheter that stays in the vein, it wasn’t in the vein anymore and the fluid was all just going into the interstitial space (basically just into the tissue). So, it was so infiltrated (for so long) that her whole arm was swollen. Not only was her ARM swollen, the swelling spread all the way to the midline of her chest. No kidding. When they took the adhesive off (they keep IV’s in place here with really poor quality adhesive that’s almost impossible to rip and really sticky)--the adhesive tore off patches of skin on her arm. This is the second time I’ve seen this with peoples’ IV’s that were neglected and had infiltrated into their tissue.<br /><br />So, it’s been quiet--I don’t know if things will blow at any moment or what will happen. The vote is tomorrow. Both ex-presidents are here. It feels like something big could happen. I felt like it was a really horrible idea for any volunteers to arrive in port au prince today and I strongly urged MWH to not let them come. The worst time to come here. I am relieved, no one is coming. We just really don’t know what’s going to happen. I’m going to lay low here in Hinche. <br /><br />3-24-11<br />Wow…so we work with the students each wed, thur and fri in the hospital…in just that small window of time each week, you get involved with patients, you see a lot of things. Yesterday, when we started, I was pleased with the students ability to take care of people, talk to people, stay with them, follow through with their care, etc. I was really pleased with them. This was the first time I’ve really felt that way. Because in class, I usually feel so bewildered and frustrated with their level of understanding. So, there have been many cases in these past 2 days, but today was especially interesting and also sad. The main situations are these: there is a woman who had given birth at home and then was admitted to the hospital for a retained placenta--somewhere between 14-24 hours later--it’s not clear in the chart. She said she had lost a lot of blood at home. So, the next day after she was admitted, they did a hemoglobin and hematocrit on her--her hemo was 3. They sent a sample of her blood to the Red Cross close to the hospital, for them to match her blood group, and they said that they didn’t have any O negative blood. They said for her husband to gather 4 family members to come and donate blood for her. They are from a town called Maissade. So, today--the next day--all the 4 people were here, so they went and donated blood. This afternoon, we got the blood for the transfusion. Just one bag. She needs more than that. Anyway, we gave her the blood transfusion. I am still learning about some things like giving blood transfusions--luckily, one of the students in the class, Magaly, is very experienced and already worked at the hospital here for 5 years, in maternity, before starting the program. She ran the blood transfusion and me and the other student helped. At one point, the blood clotted in the IV tubing, because it was flowing too slowly, and she flushed the tubing with a different IV fluid that we had there. She really knows how to solve all the problems you can run into with an IV. Anyway, this woman, with the 3 Hgb, she is really with it. You wouldn’t think she had a 3 hemoglobin. Her pulse is very high--130--but her other vitals are basically normal, and she’s present and responsive. Her conjunctiva are totally white though. And she gets dizzy if she stands up, and she “sees black”. Seeing black is a scary sign. The last person who was severely anemic (hgb 2.3) was seeing black too, and she died. But, this woman, she also doesn’t have any problem breathing. Hopefully tomorrow morning we can do a requisition for blood from a different hospital in Cange. I gave her husband some money this morning to buy inject able iron for her. He doesn’t have any money on him…then, it became apparent today that her baby definetly isn’t getting enough milk at all from her. Of course--that goes along with anemia. We started giving the baby glucose water in a syringe--but the baby needs more than that. At 4pm, I tried going to the Partners in Health storehouse, behind the hospital, to see if they could give me a little formula. They were closed. But, the weirdest thing happened. As I was walking away, this man approached me--the guy who works for ZL (Zanmi Lasante--Partners in Health)--he’s in charge of supplying the hospital--and he showed great concern and gave me money to give the husband to buy formula for the baby. That was like a divine intervention. In only wish this guy would come by maternity once a week and ask us what meds we need, if he was really that concerned. Anyway, that was great luck for today.<br />As all of this was going on, Genette (a grad from last year--one of our clinical instructors for class 4--) came up to me and brought me into the delivery room, where a 31 year-old woman had just died. She had just arrived about 15 minutes before--a reference from another hospital in another town, for severe anemia. Hemoglobin of 5. Apparantly her vitals were not super abnormal, but her temp was really low (93 degrees)--which can be a sign of infection. Severe anemia and infection can go hand in hand, and Marthonie thinks that she died from septicemia--infection in the blood. Once an infection gets into your blood, you die quickly. The infection circulates to all of your organs and your body shuts down. When I came in, they had already tried CPR and now they gave her adrenaline IV--she was also on oxygen. There was no heartbeat, no breathing, no papillary reaction to light--nothing. 34 weeks pregnant with her first baby. She didn’t look dead, except if you looked into her eyes. How could this be possible? For the veil between life and death to be so thin. It’s hard to understand, even though you know that it’s true, for all of us.<br />Genette had me go outside with her to deliver the news to the family. She has done this so many times, she asked me to, she didn’t want to this time. So, I did. Her brother started crying. Her mother marched inside to see her, and looked at her, and then said: “I will be calm.” she said some other things I didn’t understand, and talked to her daughter some, and then said: “ I am not going to yell.” (yell/cry. Here, people mourn together and loudly. They cry, yell, fall down on the ground, etc.). “I’m not going to yell/cry now, or next year, or the next year…“she counted all the way up to 2015. When she was saying this, this made me cry. To me, it seemed like she was saying that she wasn’t going to let this destroy her. <br />I told this story to Blada, who gave me another interpretation of what she was saying. That here, people very often attribute death and sickness to other people putting spells on them/using voudou. So, that what she was saying was that she wasn’t going to take revenge on anyone yet. And, also, that if she doesn’t cry yet and doesn’t take revenge yet, that in a way, that is like saying that her daughter isn’t dead yet.<br />I wondered if maybe we could take the oxygen she had and put it on the lady with the 3 hgb. I asked Genette, and she said that unfortunately int eh postpartum room, there is no electricity. (It’s an O2 concentrator and requires being plugged in). There are so many layers to the reasons why people don’t obtain the care they need. Such as no electricity in the pp room. <br />The other lady, with the 3 hgb, her husband took me aside to talk to me. This was before the other woman came in and died. He said: “Do you think my wife is going to make it? Because if not, I would like for you guys to hand her over to me to return home and for me to make arrangements for her funeral. Please tell me if she’s not going to make it. I don’t have any money on me. I can’t afford for her to die here.” This was so sad, that in reality, he doesn’t know at all what is wrong with her. He doesn’t know what anemia is, what hemoglobin is, etc. I mean, even though we have explained it to him. So, basically, he doesn’t know what’s going on, and it’s all in our ‘hands--he doesn’t even have money in his pocket to but inject able iron for her. He is totally powerless to help her. This is so sad. He doesn’t know if she will live or not, and he just needs to know the truth. I assured him that I think she looks pretty good--I’m surprised that she has a 3 hgb--she is handling it really well--and that we are trying to get more blood for her etc. and I assured him that we will tell him the truth about her state.<br />Some days, the hospital and life here really discourages me and depresses me. Other days, like today, even though all of this happened, a 31 year-old woman dying--I don’t feel as sad. Maybe it will hit me later--sometimes it does. One time this year when I was in the US at my mom’s house, we watched this documentary about Afganistan and maternal health etc. it reminded me so much of Haiti, I just cried and cried as I watched it. <br />Anyway, so that is a summary of a couple of situations that occurred over the past couple of days at the hospital. There have been others…there always are so many unbelievable situations that are actually peoples’ real lives.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com3tag:blogger.com,1999:blog-3462792641577376453.post-23553415107253754262011-03-09T17:55:00.000-08:002011-03-09T17:59:34.344-08:00Trip to OkapMarch 9th 2011<br /><br />We went to Okap (Cap Haitien) on Sunday morning, in a tap tap. A tap tap is a pickup truck which has about 25 people piled on. There are 2 rows of seats in the cab, with 7 people packed in, then the back is packed really tight, with peoples’ bags and huge baskets of stuff tied onto the sides…usually there are 2 or 3 people sitting on the top as well. So, we rode to Okap--about a 5 hour ride, to go a distance of maybe 50 miles--I don’t know the exact mileage but it is short. But over mountains, on a dirt road--the most rocky, bumpy dirt road that you can imagine. Up and down hills, through several rivers (you just drive right through--it’s shallow)….we were sitting next to a lady with a 3 month old baby, and we got to hold her for awhile because of how the sun was coming into the cab--we held the baby out of the sun. It was nice. We passed through a lot of really small towns. So, so desolate. It’s the dry season...the landscape is so barren…you look up at the mountains from afar, and they look bare…with small shrubs maybe…they just look brown…you look up at the mountains and then down outside the window of the tap tap, and what you see is complete desolation…these small towns, with maybe the remnants of a town square…everything looks like it’s in ruins…people walking around with no shoes…it looks like something you would see in an article about a really poor place in Africa…I have images burned into my mind that I cannot put into words…if I had taken pictures, maybe people would catch a glimpse of it…but I can’t take pictures…I never take pictures…I just can’t imagine pulling a camera out of my pocket and taking a picture of peoples’ lives--this is their life--and what would they think of that…I already stand out so starkly…they already think I’m so rich and privileged…which is true, in comparison to them, so true.<br /><br />We got to Okap, and got to Blada’s mother’s house. We spent Sunday and part of Monday there. It was wonderful to be with his family…they really accept me and love me…his mom is so affectionate, so sweet…but when I’m there, it’s kind of hard too, because we’re basically closed up in a small space, because there’s no shade outside, and the sun is sooo strong…<br /><br />So, we went to the beach Sunday afternoon, and then just hung out at the house…the beach…it is full of trash…just full…even the water has trash floating in it…there is black oily water running into the water from a pipe…it’s incredible…I didn’t feel comfortable getting into the water this time…so I just got in up to my waist…Blada could sense that I was not at ease and kept offering for us to leave…the next morning, Monday morning, he could still sense that I was feeling down, and he persisted in asking me what was going on…I hadn’t wanted to hurt his feelings by telling him how the scenery in Haiti really depresses me sometimes…but I started telling him now, because he genuinely wanted to know, and as soon as I started telling him, I just started weeping…just seeing the scenes in my mind from the tap tap ride the day before…the extreme poverty, the barrenness of the landscape…this is the majority of the population, that is barely holding on…imagine a country where a large part of the population has chronic headaches, stomachaches, high blood pressure, general malaise…imagine why…when you see the extreme poverty here, you understand why. People don’t have enough to eat, they have to depend on the rain to water their crops, they are chronically dehydrated…<br /><br />Being in Okap is also usually depressing for me, because Okap is so filthy. Gray water (smells like sewage) running through streets and walkways…open canals with sewage and trash everywhere (here too), huge piles of trash everywhere, smoke, dust, etc.<br /><br />Blada was really sweet and understanding of my feelings, and he didn’t feel judged by them. That was great. We decided to come back to Hinche a day early--Monday afternoon. If was too late to get a tap tap, so his brother, who is a taxi driver (motorcycle taxi), was willing to take us. We left Okap on the motorcycle. As we were leaving Okap, we had to cross paths with some guys who were blocking the road with a rope, making people stop and pay them a toll. They were a little sinister and intimidating, to me. Blada kind of laughed it off--they do this every mardi gras. They had put black motor oil all over their bodies, and had these weird sinister masks on--like Halloween masks. We got through that, and then drove for 3 ½ hours on the motorcycle to get home. It was the most bumpy ride you can imagine. Not that I am complaining, it’s just incredible to me that this is the reality here. I was scared--I don’t like traveling by motorcycle. I feel too vulnerable. A dirt road, with gravel, sand, mud if it’s been raining, rocks…anything could happen. How is it possible that in this country, between 2 main towns, there is a DIRT road, that’s full of ruts and potholes, and rocks…how is this possible??? I think about all of the pregnant women, who come to St Therese hospital for one reason or another…who come from hours away, by motorcycle, on these roads. This is peoples’ normal lives.<br /><br />I was so relieved to get back, take a shower, eat some vegetables, and get a good night’s sleep. We did a lot of stuff yesterday and today. Washed clothes and sheets, did other house stuff, lots of stuff. Last night was the last night of Kanaval. We went to the plaza, and there was a Rara band playing--it’s the most amazing music…everything about it…homemade horns, that have this beautiful soft sound…drumming, singing…the songs are always about the history here, how the people are still being fucked over by the gov’t, how they need to be united and continue the struggle for freedom, etc. Really positive, heartfelt, prideful songs. So, we arrive and get right into the crowd, which is in rows, dancing and marching, with the band. Of course, just like all the time, wherever I am, whatever I’m doing here, however I’m dressed, etc, I am a spectacle for everyone, it was of course this way at Kanaval. But, in a way it was less. In a way I felt more a part of the crowd. Because we were all dancing. Dancing and walking, around the plaza. Getting down. People LOVED seeing me get down with Blada, dancing with him. It was a spectacle for them, inevitably, but I could also see that they were really happy to see this. It was really really fun. A few fights broke out--there are always people who want to create fights, because that’s fun for them…we were walking a thin line the whole time, trusting in the crowd to react wisely if there was a big fight…trusting them not to trample us completely…Blada was on top of it, and was very protective of me and careful…but it definetly was a thin line. <br /> <br />The Kanaval experience was really satisfying and joyful for both of us. For me, it was like being slightly closer in to the group than I am usually, and that felt good.<br />Here, people will always see me as different and perhaps strange, no matter how long I’m here or what I do. It grates on me, the constant, nonstop reactions from people, just from seeing me. The comments. The staring, the preconceptions. I’ll never be able to be a full member of this society. All of this, as a collective reality--this layer plus the reality of the hospital, the death, the lack of supplies, the poverty here, everything--all of this exists and I know has changed me. <br /><br />I came here because I needed to change my reality, to learn how to be adaptable and flexible again, to be immersed in a new language and culture, and to expand my scope of midwifery experience, including seeing death. All of these things have come true.<br />I also left El Paso because I felt that I needed to make a big life change in order to meet my partner, who was out there somewhere. I thought that even if I just came to Haiti for 6 months, that would set me on the path to meeting him. I had waited and waited, visualized and visualized. Now I had this opportunity to come here, and it was scary, but I had to trust and walk through that door, which was wide open.<br />The first months here was the hardest experience of my life. It broke me down. I didn’t think I would stay past 6 months, I was so unhappy. However, when I started seeing Blada, it was like he scooped me out of that gloom, out of that darkness, swept me up. And up and up.<br /><br />Everything that is hard here, it has a counterpart which is positive. Like, the beauty of dancing Rara with all those people last night. And, overall, the biggest positive influence in ly life right now, which enables me to stay here and also like/love being here most of the time, is my relationship with Blada. He is exemplary. <br /><br />That is all for now…parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com3tag:blogger.com,1999:blog-3462792641577376453.post-6845325884417483822011-03-05T03:38:00.000-08:002011-03-05T04:02:13.004-08:00march 5th3-2-11<br />At the hospital today…the woman from several days ago, who was unconscious and had had eclamptic seizures…well she was there. She had birthed, the same night after we induced her. She now looked like a totally different person. I didn’t recodnize her face. Her lips were still puffy and bruised and bloody from when she had had the seizures. Her blood pressure was still high—like 150/100 or so…she was on antihypertensive meds. She appeared anemic. They drew blood to check that. She needed to stay longer, but she was insisting to go. Her family had arranged a ride, and they lived far far away. Her baby, who miraculously had survived through all the seizures and high B/P, was small. She was ingoring him. She would lay down, and leave him at her feet on the bed. Or, she would leave him behind her back if she was laying on her side. She said, he’s going to die. She didn’t want to bond with him. If she were to breastfeed him and keep him close to her. He would make it. He breastfeeds well. He is skinny and small, definetly growth-restricted. But, as she is not breastfeeding or holding him, he will die. <br />They basically left AMA. Besides her hypertension and possible anemia and the baby, there is the issue of family planning. We talked to them a lot about this as well. If she gets pregnant again, she will probably die. I am surprised she didn’t die this time, after having 5 o so seizures and being unconscious for 2 days. If she were to stay one more week, the OB could tie her tubes next Wed. Hopefully she will do SOME kind of birth control in the meantime.<br />Also, in the normal pp room, there was another woman, who was eclamptic. She had had seizures at home on the 27th, came in, was induced, and finally had her bb this morning at 5am. She looked really bad. Her face was really really swollen; I didn’t check her out myself so I don’t know what other signs she still had—but the fact was, she had had eclamptic seizures. And she was getting normal care, being checked 3 times/day, just like everyone else. The American MW re-installed her fole.<br />Also, in the normal pp room, there was another woman, who was eclamptic. She had had seizures at home on the 27th, came in, was induced, and finally had her bb this morning at 5am. She looked really bad. Her face was really really swollen; I didn’t check her out myself so I don’t know what other signs she still had—but the fact was, she had had eclamptic seizures. And she was getting normal care, being checked 3 times/day, just like everyone else. The American MW re-installed her fole catheter (it stays in place and you can measure the urine output, in a bag that is attached) so that they could see if her kidneys are functioning well enough to start giving mag sulfate again (you are supposed to give it for 24 hours following delivery in pre-eclamptic women). I mentioned this to the staff MW who was going to be there after us—for her to check on her more and see about re-starting mag—and she said, “but she’s fine. Her blood pressure is fine.” This woman was so sick!!! She is not fine!!! Why do people neglect to treat pre-eclampsia and eclampsia??? There is a lag in inducing them, monitoring them, and continuing them on meds. I think it is partially because of misconceptions about PEC. People see it so often, but they don’t really understand what it is. <br />The group of students I worked with yesterday, it was challenging. I felt discouraged because they really didn’t have their shit together as far as having any idea how to talk to people, how to take a history, how to evaluate someone’s state of being, if the catheter (it stays in place and you can measure the urine output, in a bag that is attached) so that they could see if her kidneys are functioning well enough to start giving mag sulfate again (you are supposed to give it for 24 hours following delivery in pre-eclamptic women). I mentioned this to the staff MW who was going to be there after us—for her to check on her more and see about re-starting mag—and she said, “but she’s fine. Her blood pressure is fine.” This woman was so sick!!! She is not fine!!! Why do people neglect to treat pre-eclampsia and eclampsia??? There is a lag in inducing them, monitoring them, and continuing them on meds. I think it is partially because of misconceptions about PEC. People see it so often, but they don’t really understand what it is. <br />The group of students I worked with yesterday, it was challenging. I felt discouraged because they really didn’t have their shit together as far as having any idea how to talk to people, how to take a history, how to evaluate someone’s state of being, if they’ve eaten, etc…I remind myself, they are just starting out. Some of them are just starting out. <br /><br />3-4-11<br />Well…a baby was born yesterday with an imperforate anus…no hole at all where the anus should be…also the penis was weird-red and inflamed, wide…it looked like it had been circumcised…some people thought it looked like the genitals were ambiguous but I didn’t think so…the testicles weren’t descended yet…anyway, the head of the hospital, who is a surgeon, did a colostomy on the beby, put in a tube and colostomy bag…they are going to do the surgery to make an anus at “6 years old”…the mom hasn’t wanted to see the baby because she thinks the bb is not going to make it…<br />I worked in post-op today with the students…I am trying to conquer my fear of post-op---to conquer my reluctance to work there…it’s not my expertise, but I need to learn the ropes…I am learning…<br />I am so tired today…the house is sooo loud…sometimes I feel really fed up with running the house…also with having people and noise here constantly…it is so beneficial to us to live here, and we don’t have another option also, and I understand that and appreciate staying here…but at the same time, it’s like having another job on top of teaching…plus there is no privacy or break from noise…people always in and out…sometimes the guests, they don’t understand how to be quiet in the mornings…the doors all make a lot of noise and are easy to slam…I am a very light sleeper…not a good combination…<br /><br />3-5-11<br />I still have a cold from over a week ago. There is so so much dust here--every time you go into the street. <br />We have a few days off--everyone--because of Kanaval--a national holiday. Each town has kanaval. We are going to go to Okap (Cap Haitien) tomorrow morning, to spend a couple of days with Blada's family there and hopefully go to Kanaval there as well. I am so glad to have a few days off. Things never end here. I have a ton of stuff to do today before we leave. Class planning, looking at a test that Lara wrote that is probably too hard and needs to be simplified and translated into Creole...I could easily stay here and work. But I am going to leave.<br />Love you guys...parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com2tag:blogger.com,1999:blog-3462792641577376453.post-33919038006696908562011-02-19T11:12:00.000-08:002011-02-25T10:42:27.237-08:00saturday, 19 feb 2011so, this is a continuation of what i was writing a couple of days ago. i am going to continue telling the story of a couple of our patients this week at the hospital and then keep this blog open before publishing it and keep adding things that happen here. there are always so many things!<br />so, our 8/7 mama who has severe pre-eclampsia...we had induced her and put her back on meds to prevent seizures and lower her B/P, on thursday. friday morning, yesterday, we found that she had birthed at about 8pm on thursday night. after birthing, her IV's were discontinued and nothing was done to her all night. so, when we arrived, we once again re-installed her IV and put her back on the meds she needs. so, her baby is a little fighter. i thought we would find her with no baby, but her little 32 week baby was there by her side, doing fine, just getting cold and needing to be kept warm. he was having no respiratory distress at all. however, he was too premature and small to be able to breastfeed, and had not fed at all the whole night. so, one of the volunteer midwives worked on teaching the woman's teenage daughter how to feed the baby milk, by dropping drops into the mouth. the mother, she is too sick to take care of her baby. she is still all swollen (body, belly, face, eyelids...) and her B/P is still really high, and she is still having all the neurological complaints of pre-eclampsia. <br />the problem with just relying on the daughter to feed the baby is that...she just isn't going to be able to do it sufficiently to keep the baby alive. as the day progressed yesterday, the midwives had returned to check on them--the baby was having a harder time keeping warm, and was starting to lose some of his rosy color and get a little cyanotic. the midwives ended up offering the mom to help get the baby to a different hospital about 45 min away , where they have a NICU and will actually be able to keep the baby fed until he can suck on his own. he may be more than 32 weeks also, just with really severe growth restriction. anyway, i found out today that the baby had been sent--and i am glad that they did it and also glad that they didn't ask me to help to make that decision. i think the baby has a really good chance. <br />my mama who i have been working with...the one who was assaulted...i have been thinking about her alot today...i will probably go see if she's still there today and check on her again...i gave her a little money yesterday...it was the 1st time i saw her smile...the people who assaulted her and her husband, they also stole about $50 that they were carrying, as well as their bicycle. <br />i am concerned about her not staying nourished enough and hydrated enough, and her going into premature labor and losing her baby. she's already been through enough.<br /><br />friday feb 25th<br /><br />well, my lady from last week, the one i was writing about, she was gone when i came back to the hospital 2 days ago. i hope she's doing ok and her husband is out of jail.<br />today, i worked on a mom who was eclamptic and a mom with high blood pressure. the eclamptic woman, she had had 5 seizures at home. then she was unconscious after that until now--today--she still is. they came from a few hours away to get to the hospital. she's pregnant with her 4th baby. she has 3 kids at home.<br />i am getting more comfortable with the management of pre-eclampsia and eclampsia--with giving meds and taking care of these patients. <br />that's all for now...parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com1tag:blogger.com,1999:blog-3462792641577376453.post-35384004831522600252011-02-18T03:47:00.000-08:002011-02-18T04:05:10.494-08:00feb 18th 2011a few things...<br /><br />apparantly last weekend a 17 year-old girl died at teh hospital...she had had eclamptic seizures at home after giving birth, and then eventually made it to the hospital...i don't know if when she came in, she was already in a coma and would have died anyway, or if there was lack of care at the hospital...<br /><br />we have a very sick woman at the hospital right now...an 8/7 (8th pregnancy, 7 previous births) who was brought in from a mobile prenatal clinic that MWH was doing in a community around here...her blood pressure was 240/170--she had all the signs of pre-eclampsia...she was admitted and put on meds but never induced...when we arrived yesterday morning, NOTHING had been done on her since 9pm the night before...her IV lines were dry, no rounds done on her, nothing. so so dissappointing and maddening. so, marthonie and i worked on her all day yesterday, getting meds back in, monitoring her with the students, and inducing her. dopefully, when we arrive this morning, she will have birthed and she will STILL be on B/P meds and anticonvulsive meds (magnesium sulfate). <br /> <br />i have been taking care for the past couple of days of a woman who was beat up in the street by her husband's ex-girlfriend and some man (her brother?). they waited for her as she was coming out of the market. they beat her with a stick and then when she was on the ground they kicked her in teh stomach. she is 30 weeks pregnant.<br />when she came in to the hospital 3 days ago, she was covered in dirt and sticks and was having contractions. she is totally depressed and not eating or drinking. i gave her an IV and then the next morning, yesterday morning, i see that the IV is dry and no one ever replaced it. so she only got 500 cc's of fluid. she started having contractions again yesterday afternoon as i was leaving the hospital, and i asked a staff MW to check on her and start an IV again...when i came back 2 hours later, no IV was in, but they HAD given her amoxicillin. why? so, i put in an IV. have been talking alot with her and her family about eating drinking resting to prevent preterm labor. her baby won't make it here if it is born now. she is just totally depressed. they arrested her husband, instead of the people who beat her up, and now it will be hard to get him out of jail, even though he's not guilty. <br />i offered her to listen to the FHT's (bb's heartbeat) yesterday with my fetoscope. she listened. i sat there holding it in place for her for like 20 minutes, and then put her hand on it to hold it so i could go do something else. she must have listened for like 45 minutes total. that was good.<br /><br />i feel so much empathy for ehr. i feel so bad for her, that she was attacked and beaten by these fucked up people. she will probably be there today when we go. i may give her some money. i don't think she really has money to eat, because her husband is in jail.<br /><br />i guess that's all for now. there's alot more of stuff that goes on at the hospital but i can't write everything.<br /><br />in general things here are going well. in the household. however it's alot of work also, to manage and maintain everything. <br /><br />love you guys...<br />reinaparterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com2tag:blogger.com,1999:blog-3462792641577376453.post-81865057938347817162011-02-13T03:45:00.001-08:002011-02-13T04:16:38.120-08:00a maternal death from anemiatoday is february 13th. before i tell the story i want to tell, let me just say that in general , my life here is going really well, and that blada and i are so happy together and really appreciating eachother. running the household, interacting with volunteers, managing everything here, has sometimes been really stressful and hard. there is a woman named lara who has been here for a month, here for 2 more, who is very helpful with house and especially volunteer stuff. nevertheless, it gets stressful. but all the work we are doing is good and important and is paving the way for things to get easier.<br /><br />blada and i had our 8 month anniversary yesterday. it was lovely; we kept getting wrapped up in house stuff, and then reminding ourselves that "this is our day". oh yeah, try not to talk about the house stuff. we had a beautiful day though. really sweet. <br /> <br />a woman died several nights ago at the hospital. she was pregnant and had 2 kids at home. i will call her marlene. marlene had come in 3 weeks ago having difficulty breathing (air hungry) and feeling really bad and unable to stand up. she was 10 weeks pregnant at this time. her hemoglobin was 4.6. (hgb measures the ability of our red blood cells to carry oxygen around the body--normal levels are 12-16; in pregnancy 10-12 is still considered normal; under 10 in pregnancy is considered anemic). her hgb was 4.6--we made a requisition for blood from the red cross, and the blood didn't come that day. perhaps the next day, she got the blood--only one bag--which is about 1 cup--250ml. i had written about her on my last blog entry. <br />so, marlene got the one bag of blood and was sent home. supposedly her hgb was around 9, but that's impossible if you had a 4.6 and got one bag of blood. anyway, she went home, and then presented to teh emergency room 3 weeks later, in really bad shape. once again, having a hard time breathing--breathing fast, shallow, sweating, uncomfortable, groaning...so, she was admitted to the hospital. the NEXT DAY, her labs were drawn to see how anemic she was. there is no way to get someone's labs done at night--the hospital lab closes at like 4pm. well, this next day, and i was there--the result of her hemoglobin was 2.3. her hematocrit (percentage of red blood cells in blood) was 7. (normal ahct is 30-40 something). she was really doing bad. when the nurses saw this result, everyone started working fast to get a blood transfusion for her. i looked for oxygen in the ICU--there was no oxygen to give her. <br /><br />well, one bag of blood arrived. i didn't return in the afternoon as normal, so i heard from the volunteer midwives when they returned after the afternoon shift, about how marlene was doing. they said that she was dying. her body was shutting down. her oxygen levels were so low, that her organs were literally shutting down. you could already see from when i was there in the morning, that her brain was being affected by the lack of oxygen, because of the way she was behaving. <br />apparantly, in the evening, marlene wasw moved into the ICU, given an IV, put on oxygen (they found some), and given 2 more bags of blood. but she died at 2:30 in the morning. she left 2 children at home without a mother. <br />she had tried to save her own life by coming into the hospital when she felt bad, but the hospital was unable to save her life because there was not enough blood to transfuse her and there was not access to oxygen to give her. those were the 2 things she needed the most, besides all of the other interventions that would have been done noramally, in a hospital, to treat someone this sick.<br />marlene had sickle cell disease. this condition causes the red blood cells to assume a crescent moon shape, which causes them to not circulate well and actually get stuck at certain points in the body--mainly the joints--and apparantly this is an extrememly painful event. this is called sickle cell crisis. when more of the RBC's assume this abnormal shape, and then can't circulate around the body--causing destruction of the RBC's (leading to anemia), causing oxygen deprivation to the tissues and organs, and causing pain where the abnormally-shaped RBC's conglomerate.<br />i don't know if marlene's 2.3 hgb was precipitated by a crisis. but her condition, sickle cell disease, definetly played a role in her severe anemia. this condition is not uncommon here. also, the night that marlene had come into the hospital, to the emergency room, she had witnessed her cousin being shot and killed before her eyes. <br /><br />i share her story because it makes me so sad that she died--knowing that in pther places in the world, someone like her would have been treated correctly and saved. this death is an example of the capacity of the healthcare system here.<br />i have seen people here with like 3.4 hgb's who have survived. imagine seeing someone this anemic and them surviving. peoples' lives here are so hard.parterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com2tag:blogger.com,1999:blog-3462792641577376453.post-528501121734837142011-02-03T03:23:00.000-08:002011-02-03T04:10:04.013-08:00february 3rd 2011Each day has been so full and with its own unique stories. I don't know where to start. Maybe with yesterday at the hospital, and then I will ret to recapture some of what happened last week as well.<br />Well, in genereal also, life here is going really well. Running the house has been a big job. But it is going more smoothly with time, as we figure out systems that work for things. Blada and I are doing great. He is so awesome! I can't wait for all of you to meet him. He's so positive and easygoing. We have been sprouting and making kimchi (fermented cabbage and other vegetables). He loves kimchi! We eat it every day. It is so good to be able to do this. Having a real refrigerator makes so many things possible. I used to take all of this for granted. It's amazing how all of us are so used to having something like a refrigerator. Having one again is such a blessing.<br />The internet has been really really unreliable. Sometimes there are days and days where I can't sign into hotmail. and FB also, it doesn't let me open and respond to my messages. I guess it's too slow. But sometimes it works and that's great. Like right now.<br />On this past Sunday, I went to a funeral with Blada. It was so so interesting. The ceremnoy was at the big Catholic cathedral. There was some weeping and wailing there, from a couple of ladies...then, we walked in the funeral procession to the graveyard. I had seen other funeral processions but never been in one. It felt really significant to me that I was part of it--I felt like, this means that I am part of this community. Really significant. When we got to the graveyard, everyone had to walk through the weeds and over tombstones to get to the tombstone for the guy thery were burying. Here, they bury people in these cement boxes above the ground. Maybe they don't all do this, but maybe most people do. They put the coffin in the cement box thing, above the ground. The thing is though, they don't biuld a new one each time. They leave someone in there for awhile, then when they need it for someone else, they take that person's body out and burn it or bury it. So, we got to the tombstone for them to put the coffin in , and when they opened up the cement box, there was someone else's decomposing body in there. They pulled it out--it was mostly just bones--the skull and the other bones--and the clothes were still on him...I didn't realize it at first, but Blada unflinchingly pointed it out to me. Then there was some heated discussion about twhat to do with the bones of this guy--leave them there, burn them, etc--well they ended up putting them back in after the coffin. Into the cement box tombstone.<br />This same evening, I had another super interesting and intense cultural experience with Blada. We went down to the plaza to see Carnaval, which is starting since late January...each Sunday, a Rara band plays and everyone goes and dances in the street...so, we went, and it was CRAZY. There were so many people, and it was so so chaotic and there was all this movement...like bikes going in and out of the crowd, some cars, and a huge crowd following the Rara band around the square, everyone dancing and singing...well, after awhile, apparantly a fight broke out somewhere in the thick of the crowd, and then everyone started running...then someone started throwing ROCKS and bottles...we left. Blada was very protective of me...yet he was also amazingly calm and unflinching during the whole thing...I wish I could really describe what it was like...just a little slice of Haitian culture...also, by the way, with all of this, there is no lighting...no streetlights...<br />So, the hospital...busy, interesting, crazy. Yesterday I was in 3 births...the 1st, was a 4th timer who had a great birth but then had a retained placenta...we waited an hour and tried everything but then I ended up doing a manual removal of her placenta...thank god, a current MW volunteer brought a med called Katorolac...a pain med...we give it for manual removals...<br />Then yesterday afternoon, we arrive and there is this 1st timer in labor, with a reference from a different hospital for a CORD PROLAPSE...but she's just laying there...I ask and the staff say that it's not a cord, it's a hand, next to the head...2 people had checked her...so I say to the students: Well, the first thing for us to do RIGHT NOW is listen to fetal heart tones...we start listening and there are deep decelerations with each contraction...like from 120 BPM to 60...so we check her, and indeed yes, there is a cord right there...there is the head, a hand, and the cord...so then, I stayed inside pushing up the head off the cord, while we prepared her for a cesarean--luckily the Dr came quickly and we got her in for the c-section maybe within 1 hour (sometimes it can take 3-4 hours). The decels resolved after a little while of holding the head up off the cord. So, I went in with her for the c/s...and when we were in the OR, it seemed like everyone was getting ready and moving so slowly...it always ffeels like that with emergencies here...so, at one moment, I felt that the cord wasn't pulsing...I didn't want to squeeze it either so I just waited and then after a little while, I felt it again lightly, and I could feel it was pulsing normally...so, they got the bb out, and the bb was a little shocky and cyanotic but was fine...just needed stimulation...thank god...I brought the bb back to the delivery room, to do the weight measurements vitamin K etc, and the one of the students ran iin with this OTHER baby, who had just been born in the other room--in the antepartum room--to this lady who had been eclamptic, who Marthonie had been working on all morning...the baby was extremely premature...maybe 24 weeks, maybe more,...definetly way premature--red translucent skin, all the stuff. No way of saving this baby. <br />Last week, there were also alot of crazy things...there were 4 manual removals (of the placenta--you separate it with your hand--in the uterus--then come out with it)--of which I did 2--one of these was on this lady who had just birthed a stillborn baby in the cholera tents...she was like 5 months pregnant...you see more retained placentas with premature births...so, we tried for a little while and then I went ahead and did the manual removal...for some reason I always get these...Marthonie always gets eclamptic ladies...<br />marthonie worked the other night because she had gone and it was so crazy that she stayed to help...they had alot of births, and 3 of these ladies had severe preeclampsia. Well, one of these ladies, she died. She maybe had a heart attack. It sounds like maybe she had a heart condition, because what happened was that she just suddenly laid down and died...she never had had seizures or anything...Marthonie told me the whole story...she was really bummed...she has seen alot of people die...so she had worked the night before class, and needed to sleep, so I taught class the next morning...it was good to do it by myself...I feel like my Creole isn't really good enought to really really do a good job teaching classes and explaining physiology...but I did a pretty good job, and felt proud of myself...usually we do the classes together and kind of share the teaching and add things to eachother's teaching...<br />Last week also, while we had a few births and one lady who had a retained placenta, at the same time, there was this other lady who was only 10 weeks pregnant and severely anemic...her hemoglobin was 4.6...she couldn't stand up...we did her admission and did a requisition for 2 units of blood from the red cross, and....they were out of blood. Maybe out of her type of blood. They had her family looking for someone to donate blood for her. <br />I feel like there were other stories from the hospital last week but maybe I've highlighted some of the main ones...<br />Each day is so interesting...I am really enjoying living here and learning more and more Creole...the hospital is super interesting but also super frusturating...because there is nothing, often not even charts to write on...it's crazy...MWH is trying to establish a formal relationship with Zanmi Lasante (Partners in Health)--for referring people to them and also to get meds and supplies...but apparantly, this action is offensive to some people...because they don't want everyone to know the truth about the hospital...they act like they care and want to help Maternity access materials and meds, but it's all a show and I know they're just cursing us under their breath...there was a lady last week who was there for 6 days and couldn't breath because her lungs were full of fluid...she had some kind of lunf infection probably but also had had severe preeclampsia...we had done her birth...her baby was premature (maybe 32 weeks?) and did after about 1 day...anyway, she wasn't on oxygen or anything...finally, we tried to transfer her to the PIH hospital in Cange...they came and got her...she would have died if we didn't do this...well apparantly this made some people really mad, that we took it upon ourselves to refer her...<br />Unbelievable stuff...<br />Ok I love you guys...hopefully will keep being able to write every week or two...<br />Reinaparterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com4tag:blogger.com,1999:blog-3462792641577376453.post-89496490216189393132011-01-26T09:26:00.000-08:002011-01-26T09:54:42.098-08:00great birth this AM!so...we are into our 2nd week of clinicals with the students at St Therese hospital, and our 3rd week of classes. this morning we had a beautiful birth! i feel so happy. this was how it went: a first timer, 19 years old, who came in in active labor and then soon started pushing...she was tired--hadn't slept or eaten for 2 days, and was pushing weakly and not making much progress. she pushed only for about 1 1/2 hours maybe--maybe a little longer--and at the end of her push, we gave her an IV with pitocin in it to help her contractions get closer together so she could push her baby out--it really worked. we also got her squatting on the floor, and she pushed there for awhile and brought her baby down. i caught her baby; she had the placenta there on the floor too. everything was good. she had a small laceration that i sutured...the students tight now, they are more observing, and practicing their basic skills, but they're not catching babies yet or suturing, for example. what i really loved about this birth was that we were such a team! i had one person documenting everything--every fetal heart tone count we got, everything--and one person assisting--listening to FHT's after each contraction--it really felt like a team, plus, we were able to get her onto the floor which helped her so much. she did a really good job, even though she was so exhausted. it was a nice slow birth where i was really able to explain alot of things to the students and get them involved in supporting her.<br />last week: it was a little crazier. there was one day where we had a woman who was only 10 weeks pregnant--severely anemic--her hemoglobin was 4.6--maybe it was 3.6--she was having a hard time--we were going to do a blood transfusion but the red cross had no blood. i don't know what happened with her. at the same time as she was there, i was catching this lady's baby who had died inside of her--an IUFD (intrauterine fetal demise)--she was "8 months" pregnant but the baby looked more like 20 or 22 weeks (5 months)--so i caught her baby, and really tried to get the students right there by her side supporting her, stroking her, massaging her...we had induced her that morning with 100 mcg misoprostol (cytotec)--she had her baby like 5 hours later--a footling breech--so, she had cried some, i thad told the students not to tell her not to cry--to encourage her to let herself cry and that we were there with her--so she had cried some before, and now too, and then now, with this bring her 1st baby, and being 18 years old, after all of this hardship, there was another problem: her placenta was partially separated and she was bleeding...we decided to do a manual removal (after trying uterine massage and giving pit)--so i had to do that. we had no anesthesia to give her. she did her best to cooperate but she was up the wall and i had to follow her up the bed. it was excruciatingly painful for her. as soon as i was done i looked at the placenta, which was complete, and showed it to her and everyone else, and then got up right next to her and agnowledged that this had been really traumatic for her and that i was sorry...i am really trying to model compassionate behavior for the students...also for these other students who are at the hospital...they have no supervisor...they don't know anything...they just watch and sometimes help with something...these other students are in an auxialliare school (like nurse's aid)....<br />besides this IUFD, there was a twin birth maybe the day before, or maybe it was the same day...an 8th timer...with polyhydramnios (too much amniotic fluid)...the babies were premature (24-26 weeks?) and didn't make it...there was a midwife here last week, Jill, who just so happened to be the one who held all the babies as they were dying...there were the twins, then there was another baby that died who was premature, who she held as he was dying...she used this opportunity to model behavior to everyone that basically was showing love to a dying baby....counting babies born already dead as well as those who died after birth last week, there were 6. <br />the premature baby i just mentioned was born to a very sick mom the day before. she was severely preeclamptic, to the point of having pulmonary edema. she had very labored breathing and also was coughing alot and appeared to have something else going on with her lungs. she also ended up with a manual removal of her placenta---really hard---she is still sick and was also very anemic. i am going oto check on her today when we return to the hospital. <br />the household here is going pretty well. alot of things to orchestrate all the time and lalot of communication to do with the volunteers. but it is going well. we have also finally 'more or less planned our upcoming classes, so that is a relief. <br />blada and i are doing great. i love living with him and spending time with him. there are so many things we want to do together. little by little we do them.<br />i am really enjoying being back in haiti and feeling that my comprehension of creole is on a new plateau. really exciting to see the progression. languages are so interesting. seeing where words and expressions come from...it is endlessly interesting.<br />i love all you guys...<br />reinaparterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com1tag:blogger.com,1999:blog-3462792641577376453.post-19869969886339735862011-01-16T04:57:00.000-08:002011-01-16T05:21:05.705-08:00Back in Haiti! January 2011I am back in Haiti after being in the US for 6 weeks. It feels so so good to be back! Although I was so ready for a break from Haiti when I left, I actually missed Haiti alot while I was gone. Not only did I really really miss Blada, but I also did miss Haiti: walking everywhere you need, having time to do each task, like washing your clothes by hand, the music and people in the street....lots of things. <br />I got back to Hinche on Jan 3rd, and had 5 days with Blada, and then on Saturday the 8th, the MW4H leaders came and were here for 1 week, and they just left yesterday. This past week was so so crazy...now that they're gone I'm realizing how stressful it actually was. Nonstop activity, meetings, talking, coordinating, problem solving...it was really important and great and amazing to be a part of this group of people who are undertaking these monumental tasks and pulling it off with such a positive attitude, but even with that, it was stressful. <br />I am really impressed by these people and love knowing them and working in their organization. Right now is a time of amazing growth and expansion in the organization. They are finding places to put our graduates, putting them out in the country all around, making alliances with parishes and communities...<br />The mobile clinics are expanding also...they go 4 days a week, each place they go is once a month...so that makes about 20 different communities where they goa nd do prenatal care...we JUST got our new Jeep which is for the mobile clinics...this whole week was also revolving around getting the Jeep out of customs...unbelievably difficult....the Jeep is here now, and it is PINK with the MW4H logo on it...really awesome...<br />We started classes last Monday, the 10th. Our new class has 15 students, and they all seem really bright and eager...so exciting...I am so so excited to be working again with Marthonie, my co-teacher...she is so fun, so interesting and compelling...<br />We are going to start having classes out here at the house starting tomorrow...it will be alot more comfortable here than at the hospital...we have electricity, we have all out teaching aids here...it will be good. We are basically going to be with the students from M-F 8am-5pm, either teaching classes or doing clinical teaching in the hospital or in mobile clinics.<br />We have one student from Port au Prince who will be living at the house here, and she is moving in this evening. I like her alot and I am happy there will be another Haitian living in the house. <br />I will try to blog as often as possible and may actually start writing more often and then posting like once every 1-2 weeks. I like keeping people up on my life here. There is this woman who has a blod--her name is Wendy Dotson--she's a midwife who's a big part of <br />MW4H, and maybe her blog is more descriptive than mine--it would be a good thing to read--maybe someday I'll be a more descriptive writer and be able to explain things more about daily life here.<br />We have a baby in the house now too...our cook is bringing her 9 month old baby M-Sat so she can breastfeel him during the day...it is so so much fun...he was so playful yesterday...Blada and I both like to hold him and carry him around alot...that's fun...<br />Ok I love all you guys...it was so wonderful to see everyone when I was back...I miss all of you and love you...<br />Reinaparterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com1tag:blogger.com,1999:blog-3462792641577376453.post-56797811195479155392010-11-19T12:36:00.001-08:002010-11-19T13:09:05.583-08:00post graduation, 11-19-10it has been a long time since i blogged! <br />i haven't had internet for...months.<br />one day that will be remedied. i would like to blog more often.<br />so...i am sitting at teh airport in fort lauderdale. on my way to el paso for a few days, to visit and take care of stuff like relicensing, renewing car registration, etc...then headed to NC for thanksgiving and the whole month of december!!! i have been looking forward to this time off for months. although as the time got closer, i also felt apprehensive about leaving haiti, especially about being separated from blada for 6 weeks. but, this is important and i will be back soon.<br />so looking forward to the holidays in NC! seeing my family and friends!<br />let's see...yes, cholera is in hinche; i don't know how many people have died there yet, but they've probably seen a few hundred cases there (in hinche) already...it's all over the radio...people are pissed because it most likely came from the UN, who they kind of resent anyway, fand yes there have been riots...nothing severe in hinche, yet...some throwing of bottles and burning of tires on the street...some people kind of joke about cholera...the cholera handshake (touching elbows)...people who sell candy in the market, calling out that the candy is good for the prevention of cholera...stuff like that.<br />this year has been relentless for haiti.<br />blada and i have been camping out at the new house for the past month. it is going to be really nice, once it's all set up. it will be where we live, plus where the midwife volunteers stay, plus probably 2 students from port au prince will live there, plus this canadian midwife and her haitian partner...they are coming in april...everyone was in hinche this past week for graduation...yes, graduation was special. i even got up and did an improvised speech in creole. everyone was really happy that i spoke in creole, even if it wasn't totally fluid and perfect. i took my time, paused before i thought of what to say, and just basically tried to express my appreciation for being part of this project. it was good. i have a video of the speech...if i could ever upload videos to FB...<br />the canadian midwife coming in april, i really like her. she will be helping marthonie and i with curriculum development and classes. i am really excited that she is coming; they are definetly cool. her partner is super into organic farming, and is planning for us to have lots of gardens. i feel like i will be returning to a home that is nourishing for me. having this midwife there, who seems like a kindred spirit, and having gardens, compost...imagine! it's also really exciting because blada and i will be able to learn alot about growing food in haiti. a very useful skill!!!<br />i am returning to hinche on january 3rd. the new class will start jan 10th.<br />we had graduation on the 14th. it was really great. really enjoyable. it was so good to have several days of fellowship with nadene and steve, the directors of midwives for haiti (nadene is also the founder). they are so, so appreciative of all of our work in haiti, all of us, and they are so heartfelt, just really great people. each time i see them i like them more and am more excited about working in their organization.<br />there is still alot to be done in the house, but it is starting to happen. blada and i have been living there well, it has gotten better and better. we pump all of the water we use; there's no electricity yet, so we use an oil lamp; and we cook on an old kerosene stove that makes lots of smoke. fun, and funny. every day, we make basically the same thing: salad (grated beet, onion, garlic, avocado, cabbage...) and boiled maniok (yucca) and/or green bananas, pumpkin, potatoes, malanga (another root vegetable), yam...we have been making these fresh beans too...we eat really well. we could be eating white rice 2 times a day.<br />we did interviews for the new class each morning for the 3 days following graduation. we saw 35 people! one crazy lady, who didn't pass--she was there bright and early, and met us outside the hospital, before we even started. <br />we definetly have an apparantly excellent group of new students. the majority of them seemed to have a bright interest in midwifery, and a tendency towards compassion. yes! that will make my job easier. we had this one question that we asked all of them, that embodies many other questions: imagine you have a 14 or 15 year old patient, who is in labor, and is out of her mind, screaming, writhing around, really scared. won't let anyone do an IV or vaginal exam or anything. what do you do for her? how do you help her? well, some people answered that they would take her blood pressure and give her an injection. some people added that if she wasn't able to birth and needed a c/s, they would call the Dr in. the response we were looking for was that they would show her compassion. some people said that they would massage her, some people said that they would stay by her side and talk to her. well, about 5 people said that if they had another person there with them, they would have that person HOLD HER DOWN, while they did whatever care was necessary. and that if they were alone, they would TIE HER DOWN to the bed, and then do whatever care was necessary. well, we were appauled by the first few responses like this, and then after 4 or 5, we realized that this is what these ladies have seen done to people, when they were in school and did their hospital rotation in maternity. we realized that we can't hold this against them 100%. they don't know. this is literally what they have seen. one person even started out answering the question well, saying she would massage the girl and talk to her, but then ended by saying that if she had to, she would tie her down. well, guess what. she ended up in out "possible candidates" list, and we ended up choosing her for the class!!! it's funny to me. it will all be fine, as long as people are open. she seemed open to us.<br />so, it was a sad goodbye with blada this morning. he accompanied me to port au prince yesterday, and we spent the night there at my friend beth's house. this morning they brought me to the airport. it's harder for him because he will be in the same place, and i am in a different place, with lots of people, and lots of activity.<br />so...ok, i will prob start blogging again in january, once the new class starts...love all of you guys! thanks for your continued interest!<br />reinaparterachidahttp://www.blogger.com/profile/00693453847694606608noreply@blogger.com5