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.
Thursday, March 24, 2011
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...
Saturday, February 19, 2011
saturday, 19 feb 2011
so, this is a continuation of what i was writing a couple of days ago. i am going to continue telling the story of a couple of our patients this week at the hospital and then keep this blog open before publishing it and keep adding things that happen here. there are always so many things!
so, our 8/7 mama who has severe pre-eclampsia...we had induced her and put her back on meds to prevent seizures and lower her B/P, on thursday. friday morning, yesterday, we found that she had birthed at about 8pm on thursday night. after birthing, her IV's were discontinued and nothing was done to her all night. so, when we arrived, we once again re-installed her IV and put her back on the meds she needs. so, her baby is a little fighter. i thought we would find her with no baby, but her little 32 week baby was there by her side, doing fine, just getting cold and needing to be kept warm. he was having no respiratory distress at all. however, he was too premature and small to be able to breastfeed, and had not fed at all the whole night. so, one of the volunteer midwives worked on teaching the woman's teenage daughter how to feed the baby milk, by dropping drops into the mouth. the mother, she is too sick to take care of her baby. she is still all swollen (body, belly, face, eyelids...) and her B/P is still really high, and she is still having all the neurological complaints of pre-eclampsia.
the problem with just relying on the daughter to feed the baby is that...she just isn't going to be able to do it sufficiently to keep the baby alive. as the day progressed yesterday, the midwives had returned to check on them--the baby was having a harder time keeping warm, and was starting to lose some of his rosy color and get a little cyanotic. the midwives ended up offering the mom to help get the baby to a different hospital about 45 min away , where they have a NICU and will actually be able to keep the baby fed until he can suck on his own. he may be more than 32 weeks also, just with really severe growth restriction. anyway, i found out today that the baby had been sent--and i am glad that they did it and also glad that they didn't ask me to help to make that decision. i think the baby has a really good chance.
my mama who i have been working with...the one who was assaulted...i have been thinking about her alot today...i will probably go see if she's still there today and check on her again...i gave her a little money yesterday...it was the 1st time i saw her smile...the people who assaulted her and her husband, they also stole about $50 that they were carrying, as well as their bicycle.
i am concerned about her not staying nourished enough and hydrated enough, and her going into premature labor and losing her baby. she's already been through enough.
friday feb 25th
well, my lady from last week, the one i was writing about, she was gone when i came back to the hospital 2 days ago. i hope she's doing ok and her husband is out of jail.
today, i worked on a mom who was eclamptic and a mom with high blood pressure. the eclamptic woman, she had had 5 seizures at home. then she was unconscious after that until now--today--she still is. they came from a few hours away to get to the hospital. she's pregnant with her 4th baby. she has 3 kids at home.
i am getting more comfortable with the management of pre-eclampsia and eclampsia--with giving meds and taking care of these patients.
that's all for now...
so, our 8/7 mama who has severe pre-eclampsia...we had induced her and put her back on meds to prevent seizures and lower her B/P, on thursday. friday morning, yesterday, we found that she had birthed at about 8pm on thursday night. after birthing, her IV's were discontinued and nothing was done to her all night. so, when we arrived, we once again re-installed her IV and put her back on the meds she needs. so, her baby is a little fighter. i thought we would find her with no baby, but her little 32 week baby was there by her side, doing fine, just getting cold and needing to be kept warm. he was having no respiratory distress at all. however, he was too premature and small to be able to breastfeed, and had not fed at all the whole night. so, one of the volunteer midwives worked on teaching the woman's teenage daughter how to feed the baby milk, by dropping drops into the mouth. the mother, she is too sick to take care of her baby. she is still all swollen (body, belly, face, eyelids...) and her B/P is still really high, and she is still having all the neurological complaints of pre-eclampsia.
the problem with just relying on the daughter to feed the baby is that...she just isn't going to be able to do it sufficiently to keep the baby alive. as the day progressed yesterday, the midwives had returned to check on them--the baby was having a harder time keeping warm, and was starting to lose some of his rosy color and get a little cyanotic. the midwives ended up offering the mom to help get the baby to a different hospital about 45 min away , where they have a NICU and will actually be able to keep the baby fed until he can suck on his own. he may be more than 32 weeks also, just with really severe growth restriction. anyway, i found out today that the baby had been sent--and i am glad that they did it and also glad that they didn't ask me to help to make that decision. i think the baby has a really good chance.
my mama who i have been working with...the one who was assaulted...i have been thinking about her alot today...i will probably go see if she's still there today and check on her again...i gave her a little money yesterday...it was the 1st time i saw her smile...the people who assaulted her and her husband, they also stole about $50 that they were carrying, as well as their bicycle.
i am concerned about her not staying nourished enough and hydrated enough, and her going into premature labor and losing her baby. she's already been through enough.
friday feb 25th
well, my lady from last week, the one i was writing about, she was gone when i came back to the hospital 2 days ago. i hope she's doing ok and her husband is out of jail.
today, i worked on a mom who was eclamptic and a mom with high blood pressure. the eclamptic woman, she had had 5 seizures at home. then she was unconscious after that until now--today--she still is. they came from a few hours away to get to the hospital. she's pregnant with her 4th baby. she has 3 kids at home.
i am getting more comfortable with the management of pre-eclampsia and eclampsia--with giving meds and taking care of these patients.
that's all for now...
Friday, February 18, 2011
feb 18th 2011
a few things...
apparantly last weekend a 17 year-old girl died at teh hospital...she had had eclamptic seizures at home after giving birth, and then eventually made it to the hospital...i don't know if when she came in, she was already in a coma and would have died anyway, or if there was lack of care at the hospital...
we have a very sick woman at the hospital right now...an 8/7 (8th pregnancy, 7 previous births) who was brought in from a mobile prenatal clinic that MWH was doing in a community around here...her blood pressure was 240/170--she had all the signs of pre-eclampsia...she was admitted and put on meds but never induced...when we arrived yesterday morning, NOTHING had been done on her since 9pm the night before...her IV lines were dry, no rounds done on her, nothing. so so dissappointing and maddening. so, marthonie and i worked on her all day yesterday, getting meds back in, monitoring her with the students, and inducing her. dopefully, when we arrive this morning, she will have birthed and she will STILL be on B/P meds and anticonvulsive meds (magnesium sulfate).
i have been taking care for the past couple of days of a woman who was beat up in the street by her husband's ex-girlfriend and some man (her brother?). they waited for her as she was coming out of the market. they beat her with a stick and then when she was on the ground they kicked her in teh stomach. she is 30 weeks pregnant.
when she came in to the hospital 3 days ago, she was covered in dirt and sticks and was having contractions. she is totally depressed and not eating or drinking. i gave her an IV and then the next morning, yesterday morning, i see that the IV is dry and no one ever replaced it. so she only got 500 cc's of fluid. she started having contractions again yesterday afternoon as i was leaving the hospital, and i asked a staff MW to check on her and start an IV again...when i came back 2 hours later, no IV was in, but they HAD given her amoxicillin. why? so, i put in an IV. have been talking alot with her and her family about eating drinking resting to prevent preterm labor. her baby won't make it here if it is born now. she is just totally depressed. they arrested her husband, instead of the people who beat her up, and now it will be hard to get him out of jail, even though he's not guilty.
i offered her to listen to the FHT's (bb's heartbeat) yesterday with my fetoscope. she listened. i sat there holding it in place for her for like 20 minutes, and then put her hand on it to hold it so i could go do something else. she must have listened for like 45 minutes total. that was good.
i feel so much empathy for ehr. i feel so bad for her, that she was attacked and beaten by these fucked up people. she will probably be there today when we go. i may give her some money. i don't think she really has money to eat, because her husband is in jail.
i guess that's all for now. there's alot more of stuff that goes on at the hospital but i can't write everything.
in general things here are going well. in the household. however it's alot of work also, to manage and maintain everything.
love you guys...
reina
apparantly last weekend a 17 year-old girl died at teh hospital...she had had eclamptic seizures at home after giving birth, and then eventually made it to the hospital...i don't know if when she came in, she was already in a coma and would have died anyway, or if there was lack of care at the hospital...
we have a very sick woman at the hospital right now...an 8/7 (8th pregnancy, 7 previous births) who was brought in from a mobile prenatal clinic that MWH was doing in a community around here...her blood pressure was 240/170--she had all the signs of pre-eclampsia...she was admitted and put on meds but never induced...when we arrived yesterday morning, NOTHING had been done on her since 9pm the night before...her IV lines were dry, no rounds done on her, nothing. so so dissappointing and maddening. so, marthonie and i worked on her all day yesterday, getting meds back in, monitoring her with the students, and inducing her. dopefully, when we arrive this morning, she will have birthed and she will STILL be on B/P meds and anticonvulsive meds (magnesium sulfate).
i have been taking care for the past couple of days of a woman who was beat up in the street by her husband's ex-girlfriend and some man (her brother?). they waited for her as she was coming out of the market. they beat her with a stick and then when she was on the ground they kicked her in teh stomach. she is 30 weeks pregnant.
when she came in to the hospital 3 days ago, she was covered in dirt and sticks and was having contractions. she is totally depressed and not eating or drinking. i gave her an IV and then the next morning, yesterday morning, i see that the IV is dry and no one ever replaced it. so she only got 500 cc's of fluid. she started having contractions again yesterday afternoon as i was leaving the hospital, and i asked a staff MW to check on her and start an IV again...when i came back 2 hours later, no IV was in, but they HAD given her amoxicillin. why? so, i put in an IV. have been talking alot with her and her family about eating drinking resting to prevent preterm labor. her baby won't make it here if it is born now. she is just totally depressed. they arrested her husband, instead of the people who beat her up, and now it will be hard to get him out of jail, even though he's not guilty.
i offered her to listen to the FHT's (bb's heartbeat) yesterday with my fetoscope. she listened. i sat there holding it in place for her for like 20 minutes, and then put her hand on it to hold it so i could go do something else. she must have listened for like 45 minutes total. that was good.
i feel so much empathy for ehr. i feel so bad for her, that she was attacked and beaten by these fucked up people. she will probably be there today when we go. i may give her some money. i don't think she really has money to eat, because her husband is in jail.
i guess that's all for now. there's alot more of stuff that goes on at the hospital but i can't write everything.
in general things here are going well. in the household. however it's alot of work also, to manage and maintain everything.
love you guys...
reina
Sunday, February 13, 2011
a maternal death from anemia
today is february 13th. before i tell the story i want to tell, let me just say that in general , my life here is going really well, and that blada and i are so happy together and really appreciating eachother. running the household, interacting with volunteers, managing everything here, has sometimes been really stressful and hard. there is a woman named lara who has been here for a month, here for 2 more, who is very helpful with house and especially volunteer stuff. nevertheless, it gets stressful. but all the work we are doing is good and important and is paving the way for things to get easier.
blada and i had our 8 month anniversary yesterday. it was lovely; we kept getting wrapped up in house stuff, and then reminding ourselves that "this is our day". oh yeah, try not to talk about the house stuff. we had a beautiful day though. really sweet.
a woman died several nights ago at the hospital. she was pregnant and had 2 kids at home. i will call her marlene. marlene had come in 3 weeks ago having difficulty breathing (air hungry) and feeling really bad and unable to stand up. she was 10 weeks pregnant at this time. her hemoglobin was 4.6. (hgb measures the ability of our red blood cells to carry oxygen around the body--normal levels are 12-16; in pregnancy 10-12 is still considered normal; under 10 in pregnancy is considered anemic). her hgb was 4.6--we made a requisition for blood from the red cross, and the blood didn't come that day. perhaps the next day, she got the blood--only one bag--which is about 1 cup--250ml. i had written about her on my last blog entry.
so, marlene got the one bag of blood and was sent home. supposedly her hgb was around 9, but that's impossible if you had a 4.6 and got one bag of blood. anyway, she went home, and then presented to teh emergency room 3 weeks later, in really bad shape. once again, having a hard time breathing--breathing fast, shallow, sweating, uncomfortable, groaning...so, she was admitted to the hospital. the NEXT DAY, her labs were drawn to see how anemic she was. there is no way to get someone's labs done at night--the hospital lab closes at like 4pm. well, this next day, and i was there--the result of her hemoglobin was 2.3. her hematocrit (percentage of red blood cells in blood) was 7. (normal ahct is 30-40 something). she was really doing bad. when the nurses saw this result, everyone started working fast to get a blood transfusion for her. i looked for oxygen in the ICU--there was no oxygen to give her.
well, one bag of blood arrived. i didn't return in the afternoon as normal, so i heard from the volunteer midwives when they returned after the afternoon shift, about how marlene was doing. they said that she was dying. her body was shutting down. her oxygen levels were so low, that her organs were literally shutting down. you could already see from when i was there in the morning, that her brain was being affected by the lack of oxygen, because of the way she was behaving.
apparantly, in the evening, marlene wasw moved into the ICU, given an IV, put on oxygen (they found some), and given 2 more bags of blood. but she died at 2:30 in the morning. she left 2 children at home without a mother.
she had tried to save her own life by coming into the hospital when she felt bad, but the hospital was unable to save her life because there was not enough blood to transfuse her and there was not access to oxygen to give her. those were the 2 things she needed the most, besides all of the other interventions that would have been done noramally, in a hospital, to treat someone this sick.
marlene had sickle cell disease. this condition causes the red blood cells to assume a crescent moon shape, which causes them to not circulate well and actually get stuck at certain points in the body--mainly the joints--and apparantly this is an extrememly painful event. this is called sickle cell crisis. when more of the RBC's assume this abnormal shape, and then can't circulate around the body--causing destruction of the RBC's (leading to anemia), causing oxygen deprivation to the tissues and organs, and causing pain where the abnormally-shaped RBC's conglomerate.
i don't know if marlene's 2.3 hgb was precipitated by a crisis. but her condition, sickle cell disease, definetly played a role in her severe anemia. this condition is not uncommon here. also, the night that marlene had come into the hospital, to the emergency room, she had witnessed her cousin being shot and killed before her eyes.
i share her story because it makes me so sad that she died--knowing that in pther places in the world, someone like her would have been treated correctly and saved. this death is an example of the capacity of the healthcare system here.
i have seen people here with like 3.4 hgb's who have survived. imagine seeing someone this anemic and them surviving. peoples' lives here are so hard.
blada and i had our 8 month anniversary yesterday. it was lovely; we kept getting wrapped up in house stuff, and then reminding ourselves that "this is our day". oh yeah, try not to talk about the house stuff. we had a beautiful day though. really sweet.
a woman died several nights ago at the hospital. she was pregnant and had 2 kids at home. i will call her marlene. marlene had come in 3 weeks ago having difficulty breathing (air hungry) and feeling really bad and unable to stand up. she was 10 weeks pregnant at this time. her hemoglobin was 4.6. (hgb measures the ability of our red blood cells to carry oxygen around the body--normal levels are 12-16; in pregnancy 10-12 is still considered normal; under 10 in pregnancy is considered anemic). her hgb was 4.6--we made a requisition for blood from the red cross, and the blood didn't come that day. perhaps the next day, she got the blood--only one bag--which is about 1 cup--250ml. i had written about her on my last blog entry.
so, marlene got the one bag of blood and was sent home. supposedly her hgb was around 9, but that's impossible if you had a 4.6 and got one bag of blood. anyway, she went home, and then presented to teh emergency room 3 weeks later, in really bad shape. once again, having a hard time breathing--breathing fast, shallow, sweating, uncomfortable, groaning...so, she was admitted to the hospital. the NEXT DAY, her labs were drawn to see how anemic she was. there is no way to get someone's labs done at night--the hospital lab closes at like 4pm. well, this next day, and i was there--the result of her hemoglobin was 2.3. her hematocrit (percentage of red blood cells in blood) was 7. (normal ahct is 30-40 something). she was really doing bad. when the nurses saw this result, everyone started working fast to get a blood transfusion for her. i looked for oxygen in the ICU--there was no oxygen to give her.
well, one bag of blood arrived. i didn't return in the afternoon as normal, so i heard from the volunteer midwives when they returned after the afternoon shift, about how marlene was doing. they said that she was dying. her body was shutting down. her oxygen levels were so low, that her organs were literally shutting down. you could already see from when i was there in the morning, that her brain was being affected by the lack of oxygen, because of the way she was behaving.
apparantly, in the evening, marlene wasw moved into the ICU, given an IV, put on oxygen (they found some), and given 2 more bags of blood. but she died at 2:30 in the morning. she left 2 children at home without a mother.
she had tried to save her own life by coming into the hospital when she felt bad, but the hospital was unable to save her life because there was not enough blood to transfuse her and there was not access to oxygen to give her. those were the 2 things she needed the most, besides all of the other interventions that would have been done noramally, in a hospital, to treat someone this sick.
marlene had sickle cell disease. this condition causes the red blood cells to assume a crescent moon shape, which causes them to not circulate well and actually get stuck at certain points in the body--mainly the joints--and apparantly this is an extrememly painful event. this is called sickle cell crisis. when more of the RBC's assume this abnormal shape, and then can't circulate around the body--causing destruction of the RBC's (leading to anemia), causing oxygen deprivation to the tissues and organs, and causing pain where the abnormally-shaped RBC's conglomerate.
i don't know if marlene's 2.3 hgb was precipitated by a crisis. but her condition, sickle cell disease, definetly played a role in her severe anemia. this condition is not uncommon here. also, the night that marlene had come into the hospital, to the emergency room, she had witnessed her cousin being shot and killed before her eyes.
i share her story because it makes me so sad that she died--knowing that in pther places in the world, someone like her would have been treated correctly and saved. this death is an example of the capacity of the healthcare system here.
i have seen people here with like 3.4 hgb's who have survived. imagine seeing someone this anemic and them surviving. peoples' lives here are so hard.
Thursday, February 3, 2011
february 3rd 2011
Each day has been so full and with its own unique stories. I don't know where to start. Maybe with yesterday at the hospital, and then I will ret to recapture some of what happened last week as well.
Well, in genereal also, life here is going really well. Running the house has been a big job. But it is going more smoothly with time, as we figure out systems that work for things. Blada and I are doing great. He is so awesome! I can't wait for all of you to meet him. He's so positive and easygoing. We have been sprouting and making kimchi (fermented cabbage and other vegetables). He loves kimchi! We eat it every day. It is so good to be able to do this. Having a real refrigerator makes so many things possible. I used to take all of this for granted. It's amazing how all of us are so used to having something like a refrigerator. Having one again is such a blessing.
The internet has been really really unreliable. Sometimes there are days and days where I can't sign into hotmail. and FB also, it doesn't let me open and respond to my messages. I guess it's too slow. But sometimes it works and that's great. Like right now.
On this past Sunday, I went to a funeral with Blada. It was so so interesting. The ceremnoy was at the big Catholic cathedral. There was some weeping and wailing there, from a couple of ladies...then, we walked in the funeral procession to the graveyard. I had seen other funeral processions but never been in one. It felt really significant to me that I was part of it--I felt like, this means that I am part of this community. Really significant. When we got to the graveyard, everyone had to walk through the weeds and over tombstones to get to the tombstone for the guy thery were burying. Here, they bury people in these cement boxes above the ground. Maybe they don't all do this, but maybe most people do. They put the coffin in the cement box thing, above the ground. The thing is though, they don't biuld a new one each time. They leave someone in there for awhile, then when they need it for someone else, they take that person's body out and burn it or bury it. So, we got to the tombstone for them to put the coffin in , and when they opened up the cement box, there was someone else's decomposing body in there. They pulled it out--it was mostly just bones--the skull and the other bones--and the clothes were still on him...I didn't realize it at first, but Blada unflinchingly pointed it out to me. Then there was some heated discussion about twhat to do with the bones of this guy--leave them there, burn them, etc--well they ended up putting them back in after the coffin. Into the cement box tombstone.
This same evening, I had another super interesting and intense cultural experience with Blada. We went down to the plaza to see Carnaval, which is starting since late January...each Sunday, a Rara band plays and everyone goes and dances in the street...so, we went, and it was CRAZY. There were so many people, and it was so so chaotic and there was all this movement...like bikes going in and out of the crowd, some cars, and a huge crowd following the Rara band around the square, everyone dancing and singing...well, after awhile, apparantly a fight broke out somewhere in the thick of the crowd, and then everyone started running...then someone started throwing ROCKS and bottles...we left. Blada was very protective of me...yet he was also amazingly calm and unflinching during the whole thing...I wish I could really describe what it was like...just a little slice of Haitian culture...also, by the way, with all of this, there is no lighting...no streetlights...
So, the hospital...busy, interesting, crazy. Yesterday I was in 3 births...the 1st, was a 4th timer who had a great birth but then had a retained placenta...we waited an hour and tried everything but then I ended up doing a manual removal of her placenta...thank god, a current MW volunteer brought a med called Katorolac...a pain med...we give it for manual removals...
Then yesterday afternoon, we arrive and there is this 1st timer in labor, with a reference from a different hospital for a CORD PROLAPSE...but she's just laying there...I ask and the staff say that it's not a cord, it's a hand, next to the head...2 people had checked her...so I say to the students: Well, the first thing for us to do RIGHT NOW is listen to fetal heart tones...we start listening and there are deep decelerations with each contraction...like from 120 BPM to 60...so we check her, and indeed yes, there is a cord right there...there is the head, a hand, and the cord...so then, I stayed inside pushing up the head off the cord, while we prepared her for a cesarean--luckily the Dr came quickly and we got her in for the c-section maybe within 1 hour (sometimes it can take 3-4 hours). The decels resolved after a little while of holding the head up off the cord. So, I went in with her for the c/s...and when we were in the OR, it seemed like everyone was getting ready and moving so slowly...it always ffeels like that with emergencies here...so, at one moment, I felt that the cord wasn't pulsing...I didn't want to squeeze it either so I just waited and then after a little while, I felt it again lightly, and I could feel it was pulsing normally...so, they got the bb out, and the bb was a little shocky and cyanotic but was fine...just needed stimulation...thank god...I brought the bb back to the delivery room, to do the weight measurements vitamin K etc, and the one of the students ran iin with this OTHER baby, who had just been born in the other room--in the antepartum room--to this lady who had been eclamptic, who Marthonie had been working on all morning...the baby was extremely premature...maybe 24 weeks, maybe more,...definetly way premature--red translucent skin, all the stuff. No way of saving this baby.
Last week, there were also alot of crazy things...there were 4 manual removals (of the placenta--you separate it with your hand--in the uterus--then come out with it)--of which I did 2--one of these was on this lady who had just birthed a stillborn baby in the cholera tents...she was like 5 months pregnant...you see more retained placentas with premature births...so, we tried for a little while and then I went ahead and did the manual removal...for some reason I always get these...Marthonie always gets eclamptic ladies...
marthonie worked the other night because she had gone and it was so crazy that she stayed to help...they had alot of births, and 3 of these ladies had severe preeclampsia. Well, one of these ladies, she died. She maybe had a heart attack. It sounds like maybe she had a heart condition, because what happened was that she just suddenly laid down and died...she never had had seizures or anything...Marthonie told me the whole story...she was really bummed...she has seen alot of people die...so she had worked the night before class, and needed to sleep, so I taught class the next morning...it was good to do it by myself...I feel like my Creole isn't really good enought to really really do a good job teaching classes and explaining physiology...but I did a pretty good job, and felt proud of myself...usually we do the classes together and kind of share the teaching and add things to eachother's teaching...
Last week also, while we had a few births and one lady who had a retained placenta, at the same time, there was this other lady who was only 10 weeks pregnant and severely anemic...her hemoglobin was 4.6...she couldn't stand up...we did her admission and did a requisition for 2 units of blood from the red cross, and....they were out of blood. Maybe out of her type of blood. They had her family looking for someone to donate blood for her.
I feel like there were other stories from the hospital last week but maybe I've highlighted some of the main ones...
Each day is so interesting...I am really enjoying living here and learning more and more Creole...the hospital is super interesting but also super frusturating...because there is nothing, often not even charts to write on...it's crazy...MWH is trying to establish a formal relationship with Zanmi Lasante (Partners in Health)--for referring people to them and also to get meds and supplies...but apparantly, this action is offensive to some people...because they don't want everyone to know the truth about the hospital...they act like they care and want to help Maternity access materials and meds, but it's all a show and I know they're just cursing us under their breath...there was a lady last week who was there for 6 days and couldn't breath because her lungs were full of fluid...she had some kind of lunf infection probably but also had had severe preeclampsia...we had done her birth...her baby was premature (maybe 32 weeks?) and did after about 1 day...anyway, she wasn't on oxygen or anything...finally, we tried to transfer her to the PIH hospital in Cange...they came and got her...she would have died if we didn't do this...well apparantly this made some people really mad, that we took it upon ourselves to refer her...
Unbelievable stuff...
Ok I love you guys...hopefully will keep being able to write every week or two...
Reina
Well, in genereal also, life here is going really well. Running the house has been a big job. But it is going more smoothly with time, as we figure out systems that work for things. Blada and I are doing great. He is so awesome! I can't wait for all of you to meet him. He's so positive and easygoing. We have been sprouting and making kimchi (fermented cabbage and other vegetables). He loves kimchi! We eat it every day. It is so good to be able to do this. Having a real refrigerator makes so many things possible. I used to take all of this for granted. It's amazing how all of us are so used to having something like a refrigerator. Having one again is such a blessing.
The internet has been really really unreliable. Sometimes there are days and days where I can't sign into hotmail. and FB also, it doesn't let me open and respond to my messages. I guess it's too slow. But sometimes it works and that's great. Like right now.
On this past Sunday, I went to a funeral with Blada. It was so so interesting. The ceremnoy was at the big Catholic cathedral. There was some weeping and wailing there, from a couple of ladies...then, we walked in the funeral procession to the graveyard. I had seen other funeral processions but never been in one. It felt really significant to me that I was part of it--I felt like, this means that I am part of this community. Really significant. When we got to the graveyard, everyone had to walk through the weeds and over tombstones to get to the tombstone for the guy thery were burying. Here, they bury people in these cement boxes above the ground. Maybe they don't all do this, but maybe most people do. They put the coffin in the cement box thing, above the ground. The thing is though, they don't biuld a new one each time. They leave someone in there for awhile, then when they need it for someone else, they take that person's body out and burn it or bury it. So, we got to the tombstone for them to put the coffin in , and when they opened up the cement box, there was someone else's decomposing body in there. They pulled it out--it was mostly just bones--the skull and the other bones--and the clothes were still on him...I didn't realize it at first, but Blada unflinchingly pointed it out to me. Then there was some heated discussion about twhat to do with the bones of this guy--leave them there, burn them, etc--well they ended up putting them back in after the coffin. Into the cement box tombstone.
This same evening, I had another super interesting and intense cultural experience with Blada. We went down to the plaza to see Carnaval, which is starting since late January...each Sunday, a Rara band plays and everyone goes and dances in the street...so, we went, and it was CRAZY. There were so many people, and it was so so chaotic and there was all this movement...like bikes going in and out of the crowd, some cars, and a huge crowd following the Rara band around the square, everyone dancing and singing...well, after awhile, apparantly a fight broke out somewhere in the thick of the crowd, and then everyone started running...then someone started throwing ROCKS and bottles...we left. Blada was very protective of me...yet he was also amazingly calm and unflinching during the whole thing...I wish I could really describe what it was like...just a little slice of Haitian culture...also, by the way, with all of this, there is no lighting...no streetlights...
So, the hospital...busy, interesting, crazy. Yesterday I was in 3 births...the 1st, was a 4th timer who had a great birth but then had a retained placenta...we waited an hour and tried everything but then I ended up doing a manual removal of her placenta...thank god, a current MW volunteer brought a med called Katorolac...a pain med...we give it for manual removals...
Then yesterday afternoon, we arrive and there is this 1st timer in labor, with a reference from a different hospital for a CORD PROLAPSE...but she's just laying there...I ask and the staff say that it's not a cord, it's a hand, next to the head...2 people had checked her...so I say to the students: Well, the first thing for us to do RIGHT NOW is listen to fetal heart tones...we start listening and there are deep decelerations with each contraction...like from 120 BPM to 60...so we check her, and indeed yes, there is a cord right there...there is the head, a hand, and the cord...so then, I stayed inside pushing up the head off the cord, while we prepared her for a cesarean--luckily the Dr came quickly and we got her in for the c-section maybe within 1 hour (sometimes it can take 3-4 hours). The decels resolved after a little while of holding the head up off the cord. So, I went in with her for the c/s...and when we were in the OR, it seemed like everyone was getting ready and moving so slowly...it always ffeels like that with emergencies here...so, at one moment, I felt that the cord wasn't pulsing...I didn't want to squeeze it either so I just waited and then after a little while, I felt it again lightly, and I could feel it was pulsing normally...so, they got the bb out, and the bb was a little shocky and cyanotic but was fine...just needed stimulation...thank god...I brought the bb back to the delivery room, to do the weight measurements vitamin K etc, and the one of the students ran iin with this OTHER baby, who had just been born in the other room--in the antepartum room--to this lady who had been eclamptic, who Marthonie had been working on all morning...the baby was extremely premature...maybe 24 weeks, maybe more,...definetly way premature--red translucent skin, all the stuff. No way of saving this baby.
Last week, there were also alot of crazy things...there were 4 manual removals (of the placenta--you separate it with your hand--in the uterus--then come out with it)--of which I did 2--one of these was on this lady who had just birthed a stillborn baby in the cholera tents...she was like 5 months pregnant...you see more retained placentas with premature births...so, we tried for a little while and then I went ahead and did the manual removal...for some reason I always get these...Marthonie always gets eclamptic ladies...
marthonie worked the other night because she had gone and it was so crazy that she stayed to help...they had alot of births, and 3 of these ladies had severe preeclampsia. Well, one of these ladies, she died. She maybe had a heart attack. It sounds like maybe she had a heart condition, because what happened was that she just suddenly laid down and died...she never had had seizures or anything...Marthonie told me the whole story...she was really bummed...she has seen alot of people die...so she had worked the night before class, and needed to sleep, so I taught class the next morning...it was good to do it by myself...I feel like my Creole isn't really good enought to really really do a good job teaching classes and explaining physiology...but I did a pretty good job, and felt proud of myself...usually we do the classes together and kind of share the teaching and add things to eachother's teaching...
Last week also, while we had a few births and one lady who had a retained placenta, at the same time, there was this other lady who was only 10 weeks pregnant and severely anemic...her hemoglobin was 4.6...she couldn't stand up...we did her admission and did a requisition for 2 units of blood from the red cross, and....they were out of blood. Maybe out of her type of blood. They had her family looking for someone to donate blood for her.
I feel like there were other stories from the hospital last week but maybe I've highlighted some of the main ones...
Each day is so interesting...I am really enjoying living here and learning more and more Creole...the hospital is super interesting but also super frusturating...because there is nothing, often not even charts to write on...it's crazy...MWH is trying to establish a formal relationship with Zanmi Lasante (Partners in Health)--for referring people to them and also to get meds and supplies...but apparantly, this action is offensive to some people...because they don't want everyone to know the truth about the hospital...they act like they care and want to help Maternity access materials and meds, but it's all a show and I know they're just cursing us under their breath...there was a lady last week who was there for 6 days and couldn't breath because her lungs were full of fluid...she had some kind of lunf infection probably but also had had severe preeclampsia...we had done her birth...her baby was premature (maybe 32 weeks?) and did after about 1 day...anyway, she wasn't on oxygen or anything...finally, we tried to transfer her to the PIH hospital in Cange...they came and got her...she would have died if we didn't do this...well apparantly this made some people really mad, that we took it upon ourselves to refer her...
Unbelievable stuff...
Ok I love you guys...hopefully will keep being able to write every week or two...
Reina
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