5-26-11
Today is my birthday!
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…
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…)
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…
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.
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.
5-28-11
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.
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.
Anyway…
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.
6-5-11
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!
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.
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.
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.
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).
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.
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…
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.
Blada is great…I love all you guys…
Sunday, June 5, 2011
Saturday, May 14, 2011
5-14-11
5/14/11
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hopefully I will hear from them.
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.
So, that has been the last couple of weeks.
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.
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.
That’s all for now…
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hopefully I will hear from them.
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.
So, that has been the last couple of weeks.
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.
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.
That’s all for now…
Sunday, May 1, 2011
4/20-5/1/11
4-20-11
This week and last week…
Today I had the honor of assisting in a stillbirth. Genette and I stayed a little late to be with this lady. She was an 8/7 (8th preg, 7 previous births). Probably she actually had been pregnant more times than that, and her admission just wasn’t correct, because most people here lose some of their babies.
She had a beautiful birth…her sister was next to her…she was supportive…luckily no one came in to kick her out…I also encouraged the other midwives to be cool about it…
So, she was “6 months” and preeclamptic. She had high B/P, but not that high. +4 proteinuria, and neurologic signs. We induced her with 200 mcg misoprostol in the morning. Around 10am. She birthed a little after 2pm. The baby came out in the bag, with the placenta. I was relieved to see the placenta come out right there because a lot of times with premature births, you have a retained placenta and have to do a manual removal, which is very painful for the mom. I think I knew when her placenta separated. Before she really started pushing. She had about a ½ cup clot, and I thought maybe her placenta was separating. So, she wanted to see and hold her baby. She held her little baby girl for about 5 minutes--I had assured her there was no rush; hold her baby, let herself cry, etc--and then a few minutes later, someone else was like: “ok, well let’s get you cleaned up.” Oh well. It was fine, that moment was good. She didn’t cry. I took the baby and weighed her--700 grams. Maybe she was like 26-28 weeks. She had just died. There had been heart tones on admission. But we had no choice about inducing her. If you don’t induce these severely pre-eclampic moms, they will die. The baby fit into a glove box. (medical gloves). I left her on the counter in a little box.
Today there was a lady who suddenly started crying, along with her family…in the ante partum room…it turns out that she had been eclamptic and lost consciousness and didn’t know anything that had happened, and didn’t know htat she had lost the baby until that moment when her family told her…
Last week…not too many things…the last day at the hospital, at one moment there were several things going on at once in the delivery room…2 births pretty close together, then an admission of a pre-eclamptic pregnant mom, plus an admission of a postpartum eclamptic mom who had birthed at home…plus, a woman who came in with her tiny premature baby who had just been born…maybe between 26-28 weeks…the baby started dying in her arms…I explained to her that her baby couldn’t be saved, etc…she got it…people get that pretty quick here. They accept it very quickly.
As all of this was happening in the delivery room, I was working in postpartum with the students. I worked all morning with this lady who when I arrived, her B/P was 190/140.
I had put her back on mag sulfate the day before, because she had started having a headache again and had +1 proteinuria, the day before--after having been diagnosed with pre-eclampsia and giving birth to a 7-month stillborn baby several days before. Anyway, I worked all day on her, giving her hydrolyzing IV to lower her B/P, figuring out with the other MW’s what PO meds she should be on for B/P…she is on 3 different B/P meds, plus phenobarbitol. A complicated case of a chronically hypertensive woman, who had PEC as well during the pregnancy…totally out of my scope in reality…however at the same time,
who else is there to take care of her? Who else was going to sit by her bedside all morning? No one.
4-27-11
This week for clinicals with the students it worked out that I was going to go on mobile clinics with the students. Today, tomorrow and Friday. Well, this morning, we left at 6am in order to drive about 2-3 hours to get to the community for the mobile clinic. There are 3 graduate midwives from our program who do the mobile clinics, and then we also accompany them with students in order to practice prenatal care with them. So, we leave Hinche and get to the next main town, and there is a roadblock. A group of people who are angry about the election results (not presidential, senator) have been putting up roadblocks in the mornings and making a big scene. Well, this morning it was really bad.
We arrived there, and there were trees across the road and 2 vans parked in the middle of the road. There was a group of people, some of them very angry and aggressive, who started hitting the jeep and yelling at Ronel, our driver. Then, they ordered all of us to get out of the Jeep. At that point, it was too late to try to turn around and leave. We had to get out. We got out, and stood by the side of the road. The ringleaders of this group were pacing around, yelling at people and being threatening. They had machetes, and one of them had a tank of gas (for burning a vehicle or a person). They seemed possessed, like totally crazy. They for sure had been up maybe all night or since early morning, either drinking or doing cocaine or both. There eyes were all glassed over--they looked totally crazy and out of their minds. It was really scary. We were completely at their mercy, all of us sticking together and acting cool, acting casual, not scared. But we were scared. Ronel was trying to talk to the guys, so that they would let us turn back. They took their machetes and slashed all of the tires on the 2 vans that were there--passenger vans on their way to port au prince. Everyone was stranded. They put a nail in one of the jeep tires and didn’t slash them but started taking the air out of them. This whole time, I was just trying to be invisible, as well as praying because our lives were totally in their hands, and they were not only angry, but totally deranged. They never said anything to me, except one person who was not really one of them but was there nevertheless---he started talking to me but I just ignored him. Eventually, the really bad guys paced away from where we were, and one of the midwives took me aside and told me to call Blada to have him send a motorcycle taxi to come and get me, because this was a really unsafe situation for me. Well, my phone was in the jeep. The midwife had 1 goud on her phone and called Manno instead, in order for him to send a couple of taxis to come and get us. In the meantime, I was supposed to start walking away, with one of the students. We were to walk away in pairs. Basically, lots of other people had already started slipping away and walking towards Hinche. So, I started walking away with the student. We got out of eyesight and kept walking. And kept walking. Apparently, the bad guys asked where I was when they strolled back. I was already gone, but the taxi never came. Manno didn’t understand the urgency of the situation. He didn’t send the taxis. But, the great thing was that they let Ronel and the midwives and the jeep to turn around. They came and picked us up on the road. They decided to let them go, and gave them “5 minutes” to be out of there. The tires were half flat, but we made it back to Hinche.
Everything was ok. I have been pretty upset today, just feeling the reality of what that situation was. Don’t worry, I don’t ever go through that area again at that time of day for the time being--and we are going to change the 3 mobile clinic locations that oblige us to drive through Thomond. Going through Thomond is totally inevitable though, if you are going to port au prince or many other places. So I can’t say that I won’t go through there again.
Of course, the UN and the police were nowhere in sight. Everyone knows what’s going on, and they’re nowhere in sight. Apparently, they let it go on until about noon, and then they come and break it up. There is obviously another agenda behind this violence--it makes me think about other places in the world where powerful groups manipulate people into turning against their own brothers and sisters. It’s the same thing--it’s not as simple as a group of angry people making a violent protest.
So, that was today. I feel more bonded to the mobile clinic midwives and Ronel, the driver, now. Because I really felt a super strong energy of love and protection between all of us. We were all psychically warding them off, and holding each other in the light.
5-1-11
I have considered taking out my last entry or re-writing it so as not to alarm and frighten everyone who reads the blog. But, what I wrote is what happened and it was a big deal. So, I am leaving it.
The next day, I went again on mobile clinic and this time, we had a normal, uneventful day. However, it did take us a long time to get to our destination because there were 2 roadblocks on the way--we had to search an alternate route to bypass them. We drove way off into the country down all these little roads, and then came out on the main road above the roadblocks. When we returned, on the main road, we could see where they had been. In one place, they had literally cut out sections of the road so that people couldn’t pass. People will do anything, and cause everyone else a lot of hardship, without caring. I just don’t understand how you could do something like this, without caring that you are making your fellow countrymen suffer. You’re angry with the gov’t, and then you make your brothers suffer because of it.
Today is Sunday. Nadene and Steve are coming today for one week; there are already 8 other people who arrived yesterday. They all seem really nice and eager to be conscientious houseguests. So that’s good. Still, no matter how considerate people are, this house makes a lot of noise, and with that many people, I know I will lose sleep this week.
The past few weeks leading up to now have been hard---with the house. I need to find some kind of balance with it all. The balance is protecting myself, so that I have some space and privacy, and also so that people understand how to help out in the house, and making people feel welcome and at ease here. It’s a group home, but it is also our home and day to day life. We have to keep some standards that enable our day to day life to be as normal and enjoyable as possible here. People don’t realize that--they come here for one week and then leave. For me, this is every day. I am trying to also just come to a place of accepting that this is my life for now. A more full acceptance. That will help.
This week and last week…
Today I had the honor of assisting in a stillbirth. Genette and I stayed a little late to be with this lady. She was an 8/7 (8th preg, 7 previous births). Probably she actually had been pregnant more times than that, and her admission just wasn’t correct, because most people here lose some of their babies.
She had a beautiful birth…her sister was next to her…she was supportive…luckily no one came in to kick her out…I also encouraged the other midwives to be cool about it…
So, she was “6 months” and preeclamptic. She had high B/P, but not that high. +4 proteinuria, and neurologic signs. We induced her with 200 mcg misoprostol in the morning. Around 10am. She birthed a little after 2pm. The baby came out in the bag, with the placenta. I was relieved to see the placenta come out right there because a lot of times with premature births, you have a retained placenta and have to do a manual removal, which is very painful for the mom. I think I knew when her placenta separated. Before she really started pushing. She had about a ½ cup clot, and I thought maybe her placenta was separating. So, she wanted to see and hold her baby. She held her little baby girl for about 5 minutes--I had assured her there was no rush; hold her baby, let herself cry, etc--and then a few minutes later, someone else was like: “ok, well let’s get you cleaned up.” Oh well. It was fine, that moment was good. She didn’t cry. I took the baby and weighed her--700 grams. Maybe she was like 26-28 weeks. She had just died. There had been heart tones on admission. But we had no choice about inducing her. If you don’t induce these severely pre-eclampic moms, they will die. The baby fit into a glove box. (medical gloves). I left her on the counter in a little box.
Today there was a lady who suddenly started crying, along with her family…in the ante partum room…it turns out that she had been eclamptic and lost consciousness and didn’t know anything that had happened, and didn’t know htat she had lost the baby until that moment when her family told her…
Last week…not too many things…the last day at the hospital, at one moment there were several things going on at once in the delivery room…2 births pretty close together, then an admission of a pre-eclamptic pregnant mom, plus an admission of a postpartum eclamptic mom who had birthed at home…plus, a woman who came in with her tiny premature baby who had just been born…maybe between 26-28 weeks…the baby started dying in her arms…I explained to her that her baby couldn’t be saved, etc…she got it…people get that pretty quick here. They accept it very quickly.
As all of this was happening in the delivery room, I was working in postpartum with the students. I worked all morning with this lady who when I arrived, her B/P was 190/140.
I had put her back on mag sulfate the day before, because she had started having a headache again and had +1 proteinuria, the day before--after having been diagnosed with pre-eclampsia and giving birth to a 7-month stillborn baby several days before. Anyway, I worked all day on her, giving her hydrolyzing IV to lower her B/P, figuring out with the other MW’s what PO meds she should be on for B/P…she is on 3 different B/P meds, plus phenobarbitol. A complicated case of a chronically hypertensive woman, who had PEC as well during the pregnancy…totally out of my scope in reality…however at the same time,
who else is there to take care of her? Who else was going to sit by her bedside all morning? No one.
4-27-11
This week for clinicals with the students it worked out that I was going to go on mobile clinics with the students. Today, tomorrow and Friday. Well, this morning, we left at 6am in order to drive about 2-3 hours to get to the community for the mobile clinic. There are 3 graduate midwives from our program who do the mobile clinics, and then we also accompany them with students in order to practice prenatal care with them. So, we leave Hinche and get to the next main town, and there is a roadblock. A group of people who are angry about the election results (not presidential, senator) have been putting up roadblocks in the mornings and making a big scene. Well, this morning it was really bad.
We arrived there, and there were trees across the road and 2 vans parked in the middle of the road. There was a group of people, some of them very angry and aggressive, who started hitting the jeep and yelling at Ronel, our driver. Then, they ordered all of us to get out of the Jeep. At that point, it was too late to try to turn around and leave. We had to get out. We got out, and stood by the side of the road. The ringleaders of this group were pacing around, yelling at people and being threatening. They had machetes, and one of them had a tank of gas (for burning a vehicle or a person). They seemed possessed, like totally crazy. They for sure had been up maybe all night or since early morning, either drinking or doing cocaine or both. There eyes were all glassed over--they looked totally crazy and out of their minds. It was really scary. We were completely at their mercy, all of us sticking together and acting cool, acting casual, not scared. But we were scared. Ronel was trying to talk to the guys, so that they would let us turn back. They took their machetes and slashed all of the tires on the 2 vans that were there--passenger vans on their way to port au prince. Everyone was stranded. They put a nail in one of the jeep tires and didn’t slash them but started taking the air out of them. This whole time, I was just trying to be invisible, as well as praying because our lives were totally in their hands, and they were not only angry, but totally deranged. They never said anything to me, except one person who was not really one of them but was there nevertheless---he started talking to me but I just ignored him. Eventually, the really bad guys paced away from where we were, and one of the midwives took me aside and told me to call Blada to have him send a motorcycle taxi to come and get me, because this was a really unsafe situation for me. Well, my phone was in the jeep. The midwife had 1 goud on her phone and called Manno instead, in order for him to send a couple of taxis to come and get us. In the meantime, I was supposed to start walking away, with one of the students. We were to walk away in pairs. Basically, lots of other people had already started slipping away and walking towards Hinche. So, I started walking away with the student. We got out of eyesight and kept walking. And kept walking. Apparently, the bad guys asked where I was when they strolled back. I was already gone, but the taxi never came. Manno didn’t understand the urgency of the situation. He didn’t send the taxis. But, the great thing was that they let Ronel and the midwives and the jeep to turn around. They came and picked us up on the road. They decided to let them go, and gave them “5 minutes” to be out of there. The tires were half flat, but we made it back to Hinche.
Everything was ok. I have been pretty upset today, just feeling the reality of what that situation was. Don’t worry, I don’t ever go through that area again at that time of day for the time being--and we are going to change the 3 mobile clinic locations that oblige us to drive through Thomond. Going through Thomond is totally inevitable though, if you are going to port au prince or many other places. So I can’t say that I won’t go through there again.
Of course, the UN and the police were nowhere in sight. Everyone knows what’s going on, and they’re nowhere in sight. Apparently, they let it go on until about noon, and then they come and break it up. There is obviously another agenda behind this violence--it makes me think about other places in the world where powerful groups manipulate people into turning against their own brothers and sisters. It’s the same thing--it’s not as simple as a group of angry people making a violent protest.
So, that was today. I feel more bonded to the mobile clinic midwives and Ronel, the driver, now. Because I really felt a super strong energy of love and protection between all of us. We were all psychically warding them off, and holding each other in the light.
5-1-11
I have considered taking out my last entry or re-writing it so as not to alarm and frighten everyone who reads the blog. But, what I wrote is what happened and it was a big deal. So, I am leaving it.
The next day, I went again on mobile clinic and this time, we had a normal, uneventful day. However, it did take us a long time to get to our destination because there were 2 roadblocks on the way--we had to search an alternate route to bypass them. We drove way off into the country down all these little roads, and then came out on the main road above the roadblocks. When we returned, on the main road, we could see where they had been. In one place, they had literally cut out sections of the road so that people couldn’t pass. People will do anything, and cause everyone else a lot of hardship, without caring. I just don’t understand how you could do something like this, without caring that you are making your fellow countrymen suffer. You’re angry with the gov’t, and then you make your brothers suffer because of it.
Today is Sunday. Nadene and Steve are coming today for one week; there are already 8 other people who arrived yesterday. They all seem really nice and eager to be conscientious houseguests. So that’s good. Still, no matter how considerate people are, this house makes a lot of noise, and with that many people, I know I will lose sleep this week.
The past few weeks leading up to now have been hard---with the house. I need to find some kind of balance with it all. The balance is protecting myself, so that I have some space and privacy, and also so that people understand how to help out in the house, and making people feel welcome and at ease here. It’s a group home, but it is also our home and day to day life. We have to keep some standards that enable our day to day life to be as normal and enjoyable as possible here. People don’t realize that--they come here for one week and then leave. For me, this is every day. I am trying to also just come to a place of accepting that this is my life for now. A more full acceptance. That will help.
Saturday, April 9, 2011
3/31-4/9/11
3/31/11
So…
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.
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.
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.
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.
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.
4-4-11
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.
So many moms die here. This must be the 4th or 5th maternal death since the beginning of this year.
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.
4-9-11
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
So…
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.
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.
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.
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.
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.
4-4-11
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.
So many moms die here. This must be the 4th or 5th maternal death since the beginning of this year.
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.
4-9-11
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Thursday, March 24, 2011
3/17-3/24/11
3-17-11
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….
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.
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.
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).
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.
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.
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.
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?
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??
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.
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.
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.
3-19-11
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.
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.
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.
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.
3-24-11
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.
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.
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.
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.
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.
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.
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.
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.
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….
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.
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.
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).
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.
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.
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.
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?
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??
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.
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.
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.
3-19-11
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.
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.
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.
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.
3-24-11
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.
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.
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.
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.
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.
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.
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.
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.
Wednesday, March 9, 2011
Trip to Okap
March 9th 2011
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.
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…
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…
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.
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.
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.
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.
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.
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.
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.
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.
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.
That is all for now…
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.
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…
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…
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.
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.
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.
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.
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.
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.
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.
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.
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.
That is all for now…
Saturday, March 5, 2011
march 5th
3-2-11
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.
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.
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.
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.
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.
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.
3-4-11
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…
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…
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…
3-5-11
I still have a cold from over a week ago. There is so so much dust here--every time you go into the street.
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.
Love you guys...
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.
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.
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.
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.
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.
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.
3-4-11
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…
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…
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…
3-5-11
I still have a cold from over a week ago. There is so so much dust here--every time you go into the street.
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.
Love you guys...
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